Medicare Program; Inpatient Rehabilitation Facility Prospective Payment System for FY 2006; Correction, 57166-57174 [05-19610]

Agencies

• Centers for Medicare & Medicaid Services
• DEPARTMENT OF HEALTH AND HUMAN SERVICES

[Federal Register Volume 70, Number 189 (Friday, September 30, 2005)]
[Rules and Regulations]
[Pages 57166-57174]
From the Federal Register Online via the Government Printing Office [www.gpo.gov]
[FR Doc No: 05-19610]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare & Medicaid Services

42 CFR Part 412

[CMS-1290-CN]
RIN 0938-AN43


Medicare Program; Inpatient Rehabilitation Facility Prospective 
Payment System for FY 2006; Correction

AGENCY: Centers for Medicare & Medicaid Services (CMS), HHS.

ACTION: Final rule; correction.

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SUMMARY: This document corrects technical errors that appeared in the 
FY 2006 Inpatient Rehabilitation Facility (IRF) Prospective Payment 
System (PPS) regulation entitled ``Inpatient Rehabilitation Facility 
Prospective Payment System for FY 2006'' (70 FR 47880).

DATES: Effective Date: October 1, 2005. This rule applies for 
discharges on or after October 1, 2005 and on or before September 30, 
2006 (FY 2006).

FOR FURTHER INFORMATION CONTACT: Pete Diaz, (410) 786-1235.

SUPPLEMENTARY INFORMATION:

I. Background

    In the FY 2006 IRF PPS final rule (70 FR 47880), there were a 
number of technical errors that are identified and corrected in the 
``Correction of Errors'' section below. The provisions in this 
correction notice are effective as if they had been included in the FY 
2006 IRF PPS final rule (70 FR 47880). Accordingly, the corrections are 
effective for the payments for discharges occurring on or after October 
1, 2005 and on or before September 30, 2006.
    Most of the technical errors identified and corrected in the 
``Correction of Errors'' section below originate from the same error, 
an inadvertent inclusion of incorrect data for four inpatient 
rehabilitation facilities (IRFs) in the analysis for the FY 2006 final 
rule (70 FR 47880). In the analysis for the FY 2006 final rule (70 FR 
47880), we inadvertently and incorrectly neglected to apply any rural 
adjustment amount to estimated payments for four IRFs in our analysis 
sample that should have received a portion of the rural adjustment 
under the IRF hold harmless policy (as described below). When we reran 
the data analysis with the correct portion of the rural adjustment 
applied to payments for these four facilities, it resulted in the 
technical changes to the

[[Page 57167]]

majority of the numbers described in the ``Correction of Errors'' 
section below.
    According to the hold harmless policy described in the FY 2006 
final rule (70 FR 47880, 47924), those existing IRFs that meet the 
definition in 42 CFR 412.602 as rural in FY 2005 and will become urban 
under the FY 2006 Core-Based Statistical Area (CBSA)-based designations 
will qualify, under the hold harmless policy, for an adjustment to 
their payments in FY 2006 equal to all or some portion of two-thirds of 
the 19.14 percent rural adjustment effective in FY 2005 (as described 
below).
    The hold harmless policy for the IRF PPS rural adjustment, as 
described in the FY 2006 final rule (70 FR 47880, 47924), results in 
two groups of IRFs that are within the scope of the policy. Both groups 
must meet the hold harmless criteria (that is, classified as rural in 
FY 2005 and redesignated as urban under the CBSA-based definitions in 
FY 2006). The first group of IRFs are those that meet the hold harmless 
criteria and that we estimate will experience lower payments in FY 2006 
(with the hold harmless policy) than they otherwise would have if 
instead they had been paid under their rural designation in FY 2006, 
including the FY 2005 rural adjustment of 19.14 percent (as described 
in step 2 below). This first group of IRFs will receive an adjustment 
to payments in FY 2006 equal to a full two-thirds of the FY 2005 rural 
adjustment of 19.14 percent. The second group of IRFs meets the hold 
harmless criteria (described above), and we estimate that they will 
experience higher payments (with the hold harmless policy) than they 
otherwise would have if instead they had been paid under their rural 
designation in FY 2006, including the FY 2005 rural adjustment of 19.14 
percent (as described in step 2 below). As discussed in the final rule 
(70 FR 47880, 47924), our intent of the hold harmless policy is to 
mitigate the negative payment effect upon an existing rural facility 
that is redesignated as an urban facility (effective FY 2006), but our 
intent is not for an IRF that comes under the hold harmless policy to 
realize greater payments as a result of the policy than the IRF would 
have if instead the IRF had been paid under its rural designation in FY 
2006, including the FY 2005 rural adjustment of 19.14 percent. 
Therefore, under the hold harmless policy as described in the final 
rule (70 FR 47880, 47924), the second group of IRFs will receive a 
portion of the two-thirds of the 19.14 percent rural adjustment (as 
described further below), rather than the full adjustment.
    The analysis for the FY 2006 final rule (70 FR 47880) and for this 
correction notice contained four IRFs in the second group (that is, 
facilities that would qualify for some portion less than the full two-
thirds of the 19.14 percent rural adjustment in FY 2006).
    In conducting the analysis for the FY 2006 final rule (70 FR 
47880), we applied the hold harmless policy to IRF PPS payments using 
the following steps:
    Step 1. We identified IRFs that qualify for the hold harmless 
policy (that is, those existing IRFs that are classified as rural in FY 
2005 under Sec.  412.602 and will be redesignated as urban under the 
CBSA-based definitions in FY 2006).
    Step 2. For the IRFs that qualify for the hold harmless policy 
(identified in step 1), we estimated what they would have been paid 
under their rural designation in FY 2006, including the FY 2005 rural 
adjustment of 19.14 percent, based on what we estimate they would have 
been paid if we had issued an update notice to update FY 2006 IRF PPS 
payment rates instead of a final rule implementing substantive policy 
changes. An update notice for FY 2006 would have updated FY 2005 IRF 
PPS payment rates by the following: the FY 2006 MSA-based wage index, 
the FY 2006 estimate of the FY 1997-based excluded hospital market 
basket with capital, and the FY 2006 labor-related share estimated 
based on the FY 1997-based excluded hospital market basket with 
capital. Because an update notice would not have changed any IRF PPS 
policies, the 19.14 percent rural adjustment would have remained 
unchanged. Thus, to estimate what the IRFs that qualify for the hold 
harmless policy would have been paid under their rural designation in 
FY 2006 for the final rule and for this correction notice, we updated 
FY 2005 IRF PPS payments by the FY 2006 MSA-based wage index, the FY 
2006 estimate of the FY 1997-based excluded hospital market basket with 
capital, and the FY 2006 labor related share estimated based on the FY 
1997-based excluded hospital market basket with capital. We also kept 
the rural adjustment the same as it was in FY 2005, at 19.14 percent.
    Step 3. We estimated what the IRFs that qualify for the hold 
harmless policy would have been paid in FY 2006 with the full two-
thirds of the 19.14 percent hold harmless adjustment applied to their 
FY 2006 payment rates.
    Step 4. We compared the estimated payment rates from step 2 and 
step 3 for each of the IRFs that qualify for the hold harmless policy.
    Step 5. If an IRF's FY 2006 estimated payment rate from step 3 was 
less than the IRF's estimated payment rate from step 2, we applied the 
full two-thirds of the 19.14 percent adjustment to that IRF's estimated 
payment rate for FY 2006. However, if an IRF's FY 2006 estimated 
payment rate from step 3 was greater than that IRF's estimated payment 
rate from step 2, our methodology for the FY 2006 final rule (70 FR 
47880), which is the same methodology we are using in this correction 
notice, requires that we apply only a portion of the two-thirds of the 
19.14 percent adjustment to that IRF's estimated payment rate for FY 
2006. The portion of the two-thirds of the 19.14 percent adjustment 
that we intended to apply in the final rule and in this correction 
notice to each of these facility's estimated payments was the amount 
that would make each IRF's estimated payment rate for FY 2006 equal to 
the estimated payment rate we computed in step 2 (that is, so that the 
IRF's estimated payment rate would equal, but not exceed, what we 
estimate the IRF would have been paid in FY 2006 if we had issued an 
update notice instead of a final rule implementing substantive policy 
changes for FY 2006 IRF PPS payments). However, in doing the analysis 
for the FY 2006 final rule, we inadvertently neglected to apply any 
portion of this adjustment to the estimated payments for these 
facilities.
    Although our methodology in the FY 2006 final rule (70 FR 47880) 
included the steps discussed above, we inadvertently and incorrectly 
assigned no hold harmless adjustment in step 5 to estimated payments 
for the four IRFs that should have received a portion of the hold 
harmless adjustment when doing the data computations (as described 
above). In light of the inadvertent inclusion of incorrect data in the 
analysis for the final rule published in the FY 2006 IRF PPS regulation 
(70 FR 47880), we are making the following conforming technical changes 
to some of the numbers and the corresponding text in the FY 2006 final 
rule (70 FR 47880).
     The budget neutrality factor for the rural adjustment is 
reduced, from 0.9961 to 0.9957, because the conforming change from 
initially applying no rural adjustment to estimated payments for the 
four IRFs described above to applying a portion of the rural adjustment 
to estimated payments for these four providers increases estimated 
total payments to IRFs for FY 2006. Since we are implementing the hold 
harmless policy (described in the FY 2006 final rule (70 FR 47880)) in 
a budget neutral manner, we need to reduce the budget neutrality factor 
for the rural adjustment in order to make estimated total IRF payments 
in

[[Page 57168]]

FY 2006 the same with and without the hold harmless policy. Decreasing 
the budget neutrality factor for the rural adjustment also decreases 
the standard payment amount obtained after applying the budget 
neutrality factor, from $13,105 to $13,100. In addition, because we now 
apply the same budget neutrality factor for the low-income patient 
(LIP) adjustment (0.9851) to $13,100 instead of to $13,105, the 
resulting standard payment amount obtained after applying the budget 
neutrality factor for the LIP also decreases, from $12,910 to $12,905 
(that is, now the calculation is $13,100 x 0.9851 = $12,905, whereas 
before the change to the budget neutrality factor for the rural 
adjustment the calculation was $13,105 x 0.9851 = $12,910).
     The combined budget neutrality factor (that is, the single 
budget neutrality factor we obtain from multiplying the budget 
neutrality factors for the wage index adjustment, the rural adjustment, 
the LIP adjustment, and the teaching status adjustment) decreases, from 
0.9699 to 0.9695, because one of the four factors that make up the 
combined budget neutrality factor decreases (as discussed above).
     The standard payment conversion factor decreases by $5, 
from $12,767 to $12,762, because the budget neutrality factor for the 
rural adjustment that is applied to the standard payment amount to 
calculate the standard payment conversion factor decreases, as 
described above.
     The outlier threshold amount is reduced by $3, from $5,132 
to $5,129, as a result of making the conforming changes to reduce the 
budget neutrality factor for the rural adjustment and, therefore, to 
reduce the standard payment conversion factor. This is because, when we 
lower the standard payment conversion factor by $5, we have to account 
for this change when we set the outlier threshold amount to ensure that 
estimated outlier payments will continue to equal 3 percent of 
estimated total payments in FY 2006.
     Table 11, the example of computing an IRF's Federal 
prospective payment rate, is revised because the reduction of the 
standard payment conversion factor, described above, changes all of the 
FY 2006 Federal prospective payment rates (in Table 12). A change in 
the rates necessitates a change in the example that is constructed 
using those payment rates. We have also made conforming changes to the 
numbers in the text that refer to Table 11.
     Table 12, which contains the final FY 2006 Federal 
prospective payment rates, is revised because we had to recalculate the 
prospective payment rates because we are correcting the standard 
payment conversion factor, described above in this correction notice. 
The Federal prospective payment rates are computed by multiplying the 
standard payment conversion factor by the relative weights for each 
case-mix group (CMG) and tier. Therefore, since the standard payment 
conversion factor changed, we had to multiply the corrected standard 
payment conversion factor by the relative weights for each CMG and 
tier.
     Table 13, which contains the projected impacts of the FY 
2006 refinements to the IRF PPS, is revised because the distribution of 
payments among providers changes slightly due to the budget neutral 
implementation of the policies. That is, estimated payments to the four 
IRFs described above increase by an average of 11 percent as a result 
of applying a portion of the two-thirds of the 19.14 percent rural 
adjustment to these facilities' payments under the hold harmless 
policy. Therefore, to implement this policy in a budget neutral manner 
(that is, such that estimated total IRF payments in FY 2006 are the 
same with or without the hold harmless policy), estimated payments to 
those IRFs that do not qualify for the hold harmless policy must be 
lowered slightly so that estimated total payments to IRFs do not 
increase because of the policy. This produces a slight redistribution 
of estimated payments among IRFs that is reflected in the impact 
analysis (Table 13). Because some of the numbers in Table 13 change, we 
also make conforming changes to the text that describes Table 13.
    In addition to the technical corrections (described above) that we 
are making because of the inadvertent inclusion of incorrect data for 
the hold harmless policy, we are also correcting some of the numbers in 
the FY 2006 final rule (70 FR 47880, 47948 through 47949) that were 
used to describe our rationale for the hold harmless policy. These 
numbers, which were intended to indicate the estimated dollar impacts 
of the hold harmless policy, were inadvertently computed using the 
incorrect standard payment conversion factor. That is, we inadvertently 
used the incorrect standard payment conversion factor to compare what 
estimated payments to the IRFs that would qualify for the hold harmless 
policy would have been with and without the hold harmless policy. In 
light of this error, we have corrected the standard payment conversion 
factor and are making conforming changes to the impact numbers used to 
describe our rationale for the hold harmless policy in the Correction 
of Errors section below.
    We are also deleting a bullet point summarizing our final hold 
harmless policy because it was inadvertently added to the section of 
the FY 2006 final rule (70 FR 47880, 47883) that was summarizing the 
proposed rule, even though we did not propose this policy in the 
proposed rule. In light of this, we are making the conforming change to 
delete the bullet point from the section of the final rule in which we 
summarized the proposed rule.
    We are also correcting some typographical errors and typesetting 
errors.

II. Correction of Errors

    In FR Doc. 05-15419 (70 FR 47880), we make the following 
corrections as described above in Section I of this correction notice:
    1. On page 47883, in the second column, second paragraph, 10th 
bullet, remove the bullet ``Implement a budget neutral 3 year hold 
harmless policy for FY 2005 rural IRFs redesignated as urban in FY 
2006.'' This bullet point was inadvertently added to the section of the 
final rule that was summarizing the FY 2006 proposed rule (70 FR 
30188). Since we did not propose this policy in the proposed rule, it 
is therefore incorrect to indicate that it was a proposed policy.
    2. On page 47890, in the second column, in the third full 
paragraph, line 7, ``250.1'' is corrected to read ``250.01''. 
Commenters requested that we add code 250.01 (insulin dependent 
diabetes without mention of complications, not stated as uncontrolled). 
When we were adopting the commenter's request, we inadvertently typed 
the incorrect code number and corresponding description for this 
comorbidity code. Therefore, we are correcting typographical errors in 
the code and corresponding description. Furthermore, we note that code 
250.1 is for diabetes with ketoacidosis, not diabetes mellitus without 
mention of complication not stated as uncontrolled. In addition, 250.1 
(diabetes with ketoacidosis) makes no mention of controlled or 
uncontrolled status. This correction is merely a typographical error, 
and we are amending the error to reflect the description standard set 
forth within the ICD-9-CM manual.
    3. On page 47890, as explained above, in the second column, in the 
third full paragraph, line 9, ``controlled'' is corrected to read 
``uncontrolled''.
    4. On page 47890, as explained above, in the second column, in the 
fourth full paragraph, line 12, ``250.1'' is corrected to read 
``250.01''.

[[Page 57169]]

    5. On page 47890, as explained above, in the second column, in the 
fourth full paragraph, line 14, ``controlled'' is corrected to read 
``uncontrolled''.
    6. On page 47890, as explained above, in the second column, in the 
fourth full paragraph, line 15, ``250.1'' is corrected to read 
``250.01''.
    7. On page 47890, as explained above, in the second column, in the 
fourth full paragraph, line 24, ``250.1'' is corrected to read 
``250.01''.
    8. On page 47891, as explained above, in the second column, in the 
paragraph labeled ``Final Decision'', line 12, ``250.1'' is corrected 
to read ``250.01''.
    9. On page 47891, as explained above, in the second column, in the 
paragraph labeled ``Final Decision'', line 15, ``controlled'' is 
corrected to read ``uncontrolled''.
    10. On page 47911, in the third column, in the paragraph labeled 
``Miscellaneous Products'', line 11, ``1.322'' is corrected to read 
``1.188''. This was a misprint and does not have any effect on the 
market basket cost structure or the FY 2006 update.
    11. On page 47933, in the third column, third paragraph, line 12, 
immediately before the formula, the following should be inserted: 
``where the DSH patient percentage =''. This was inadvertently deleted 
in the typesetting process.
    12. On page 47936, in the second column, line 19, ``$5,132'' is 
corrected to read ``$5,129''.
    13. On page 47936, in the third column, second full paragraph, line 
6, ``$5,132'' is corrected to read ``$5,129''.
    14. On page 47936, in the third column, second full paragraph, line 
14, ``$5,132'' is corrected to read ``$5,129''.
    15. On page 47937, in the second column, line 31, ``0.9961'' is 
corrected to read ``0.9957''.
    16. On page 47937, in the second column, line 37, ``0.9961'' is 
corrected to read ``0.9957''.
    17. On page 47937, in the second column, line 38, ``0.9699'' is 
corrected to read ``0.9695''.
    18. On page 47937, in the second column, line 42, ``$12,767'' is 
corrected to read ``$12,762''.
    19. On page 47938, in the first column, in ``Step 8'', line 3, 
``0.9961'' is corrected to read ``0.9957''.
    20. On page 47938, in the second column, in the seventh paragraph, 
line 16, ``0.9961'' is corrected to read ``0.9957''.
    21. On page 47938, in the second column, in the last paragraph, 
line 9, ``$13,105'' is corrected to read ``$13,100''.
    22. On page 47938, in the second column, in the last paragraph, 
line 12, ``$13,105'' is corrected to read ``$13,100''.
    23. On page 47938, in the second column, in the last paragraph, 
line 13, ``$12,910'' is corrected to read ``$12,905''.
    24. On page 47938, in the third column, line 1, ``$12,910'' is 
corrected to read ``$12,905''.
    25. On page 47938, in the third column, line 1, ``$12,767'' is 
corrected to read ``$12,762''.
    26. On page 47939, in the second column, line 21, ``0.9699'' is 
corrected to read ``0.9695''.
    27. On page 47939, in the second column, line 23, ``$12,767'' is 
corrected to read ``$12,762''.
    28. On pages 47939 through 47940, Table 11 is corrected with the 
following new Table 11.

                      Table 11.--Examples of Computing an IRF's Federal Prospective Payment
----------------------------------------------------------------------------------------------------------------
                                                         Facility A  Dukes      Facility B     Facility C  Kings
                                                             County, MA     Queens County, NY      County, CA
----------------------------------------------------------------------------------------------------------------
Federal Prospective Payment............................         $27,675.67         $27,675.67         $27,675.67
Labor Share............................................          x 0.75865          x 0.75865          x 0.75865
                                                        --------------------
Labor Portion of Federal Payment.......................       = $20,996.15       = $20,996.15       = $20,996.15
FY 2006 Transition Wage Index (shown in Tables 1 in the           x 1.0216           x 1.3449           x 0.9797
 addendum).............................................
                                                        --------------------
Wage-Adjusted Amount...................................       = $21,449.66       = $28,237.72       = $20,569.93
Nonlabor Amount........................................          $6,679.52          $6,679.52          $6,679.52
Wage-Adjusted Federal Payment..........................         $28,129.19         $34,917.24         $27,249.45
Rural Adjustment.......................................           x 1.2130           x 1.0000           x 1.1276
                                                        --------------------
    Subtotal...........................................       = $34,120.70       = $34,917.24       = $30,726.48
LIP Adjustment.........................................           x 1.0310           x 1.0612           x 1.1203
                                                        --------------------
FY 2006 Adjusted Rural and LIP Federal Prospective            = $35,178.45       = $37,054.18       = $34,422.87
 Payment Rate..........................................
Wage-Adjusted Federal Payment..........................         $28,129.19         $34,917.24         $27,249.45
Teaching status adjustment.............................           x 1.0000           x 1.0900           x 1.0000
                                                        --------------------
                                                              = $28,129.19       = $38,059.79       = $27,249.45
Teaching Status addition to FY 2006 Adjusted Rural and               $0.00          $3,142.55              $0.00
 LIP Federal Prospective Payment Rate..................
                                                        --------------------
    Total FY 2006 Adjusted Federal Prospective Payment.         $35,178.45         $40,196.73         $34,422.87
----------------------------------------------------------------------------------------------------------------

    29. On page 47940, in the first column, line 2, ``$35,192.24'' is 
corrected to read ``$35,178.45'', as a result of correcting Table 11.
    30. On page 47940, in the second column, line 1, ``$40,212.49'' is 
corrected to read ``$40,196.73'', as a result of correcting Table 11.
    31. On page 47940, in the second column, line 2, ``$34,436.37'' is 
corrected to read ``$34,422.87'', as a result of correcting Table 11.
    32. On pages 47940 through 47941, Table 12 is corrected with the 
following new Table 12.

[[Page 57170]]



                         Table 12.--FY 2006 Payment Rate Table Based on All Refinements
----------------------------------------------------------------------------------------------------------------
                                         Payment rate       Payment rate       Payment rate     Payment rate  no
                 CMG                        tier 1             tier 2             tier 3          comorbidity
----------------------------------------------------------------------------------------------------------------
0101................................          $9,815.25          $9,314.98          $8,274.88          $8,103.87
0102................................          12,086.89          11,471.76          10,190.46           9,979.88
0103................................          14,244.94          13,520.06          12,010.32          11,762.74
0104................................          15,134.46          14,363.63          12,760.72          12,496.55
0105................................          18,164.15          17,240.19          15,315.68          14,999.18
0106................................          21,142.81          20,066.97          17,827.24          17,458.42
0107................................          24,402.22          23,160.48          20,574.90          20,151.20
0108................................          28,211.68          26,775.95          23,787.09          23,295.75
0109................................          28,045.77          26,618.98          23,646.71          23,159.20
0110................................          33,515.56          31,810.56          28,258.90          27,675.67
0201................................          10,388.27           8,711.34           7,684.00           7,207.98
0202................................          13,319.70          11,170.58           9,852.26           9,240.96
0203................................          15,935.91          13,364.37          11,786.98          11,057.00
0204................................          17,044.93          14,294.72          12,607.58          11,826.55
0205................................          20,905.43          17,532.44          15,462.44          14,504.01
0206................................          27,283.88          22,882.27          20,181.83          18,929.87
0207................................          35,295.86          29,600.18          26,107.22          24,487.73
0301................................          14,412.13          12,169.84          10,771.13           9,908.42
0302................................          18,797.15          15,873.38          14,048.41          12,922.80
0303................................          22,429.22          18,940.08          16,764.16          15,420.32
0304................................          30,910.84          26,102.12          23,103.05          21,250.01
0401................................          12,622.89          10,869.40           9,770.59           8,725.38
0402................................          17,407.37          14,990.25          13,474.12          12,032.01
0403................................          30,300.82          26,093.19          23,455.28          20,944.99
0404................................          54,324.01          46,780.39          42,050.79          37,550.91
0405................................          41,447.15          35,691.49          32,082.39          28,649.41
0501................................           9,833.12           8,230.21           7,199.04           6,456.30
0502................................          13,165.28          11,018.71           9,639.14           8,644.98
0503................................          17,453.31          14,607.39          12,778.59          11,459.00
0504................................          21,848.54          18,285.39          15,995.89          14,344.49
0505................................          25,892.82          21,671.15          18,957.95          17,000.26
0506................................          35,232.05          29,487.88          25,794.55          23,132.40
0601................................          11,441.13           9,355.82           8,890.01           8,286.37
0602................................          15,218.69          12,445.50          11,826.55          11,021.26
0603................................          19,482.47          15,932.08          15,139.56          14,109.67
0604................................          24,935.67          20,392.40          19,376.54          18,059.51
0701................................          11,555.99           9,872.68           9,271.59           8,403.78
0702................................          15,004.28          12,818.15          12,037.12          10,910.23
0703................................          18,678.46          15,957.60          14,985.14          13,582.60
0704................................          22,923.10          19,583.29          18,390.04          16,669.72
0801................................           8,373.15           7,033.14           6,520.11           5,865.42
0802................................          10,937.03           9,186.09           8,516.08           7,662.30
0803................................          16,216.67          13,619.61          12,626.72          11,359.46
0804................................          14,126.26          11,863.56          10,998.29           9,895.65
0805................................          17,786.40          14,937.92          13,849.32          12,459.54
0806................................          21,345.72          17,926.78          16,619.95          14,951.96
0901................................          10,735.39           9,773.14           8,684.54           7,772.06
0902................................          14,107.11          12,842.40          11,411.78          10,212.15
0903................................          18,610.82          16,942.83          15,055.33          13,472.84
0904................................          23,330.21          21,239.80          18,872.45          16,889.23
1001................................          12,300.02          11,342.87          10,121.54           9,331.57
1002................................          16,219.23          14,955.79          13,345.22          12,303.84
1003................................          22,813.35          21,035.60          18,771.63          17,306.55
1101................................          16,008.65          13,395.00          11,727.00          10,799.20
1102................................          23,967.04          20,052.93          17,555.41          16,166.90
1201................................          12,996.82          11,222.90          10,344.88           9,337.96
1202................................          16,821.59          14,526.98          13,389.89          12,085.61
1203................................          20,722.94          17,894.88          16,494.89          14,888.15
1301................................          13,193.36          12,273.22          10,624.37           9,390.28
1302................................          18,280.29          17,005.37          14,719.69          13,010.86
1303................................          23,364.67          21,736.24          18,815.02          16,631.44
1401................................          10,429.11           9,382.62           8,162.58           7,409.62
1402................................          14,081.59          12,667.56          11,021.26          10,004.13
1403................................          17,528.61          15,768.73          13,719.15          12,454.44
1404................................          22,230.13          19,999.33          17,398.43          15,794.25
1501................................          11,769.12          11,479.42           9,810.15           9,440.05
1502................................          14,879.22          14,511.67          12,402.11          11,935.02
1503................................          18,210.10          17,760.88          15,179.12          14,606.11
1504................................          24,007.87          23,415.72          20,012.09          19,256.58
1601................................          12,844.95          10,903.85           9,866.30           8,810.88
1602................................          17,624.32          14,962.17          13,536.65          12,089.44

[[Page 57171]]

 
1603................................          21,680.09          18,404.08          16,651.86          14,871.56
1701................................          12,892.17          12,294.91          10,621.81           9,343.06
1702................................          16,979.84          16,192.43          13,989.70          12,306.40
1703................................          20,204.80          19,268.07          16,645.48          14,643.12
1704................................          25,278.97          24,106.14          20,826.31          18,319.85
1801................................          15,464.99          12,547.60          10,522.27           9,293.29
1802................................          24,739.14          20,072.07          16,833.08          14,866.45
1803................................          44,391.34          36,016.92          30,205.10          26,676.41
1901................................          15,776.38          14,013.95          13,625.99          11,931.19
1902................................          29,559.34          26,256.54          25,529.10          22,352.64
1903................................          42,674.85          37,906.97          36,857.93          32,271.27
2001................................          11,157.82           9,427.29           8,452.27           7,717.18
2002................................          14,609.94          12,343.41          11,065.93          10,103.68
2003................................          18,873.72          15,946.12          14,295.99          13,051.70
2004................................          25,212.61          21,302.33          19,097.06          17,436.72
2101................................          27,895.18          27,895.18          20,304.34          18,839.26
5001................................               0.00               0.00               0.00           2,808.92
5101................................               0.00               0.00               0.00           8,105.15
5102................................               0.00               0.00               0.00          20,421.75
5103................................               0.00               0.00               0.00           9,193.74
5104................................               0.00               0.00               0.00          23,955.55
----------------------------------------------------------------------------------------------------------------

    33. On page 47944, in the first column, in the last bullet, line 2, 
``D5,132'' is corrected to read ``D5,129''.
    34. On page 47944, in the second column, in the second bullet, line 
8, ``0.9961'' is corrected to read ``0.9957''.
    35. On page 47944, in the second column, in the fourth bullet, line 
3, ``D12,767'' is corrected to read ``D12,762''.
    36. On pages 47947, Table 13 is corrected with the following new 
Table 13.

[[Page 57172]]



                                                                Table 13.--Projected Impact of FY 2006 Refinements to the IRF PPS
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
                                                                                       FY06 wage                           New CMG,
                                                                                       index and                Market    new tiers,     Rural      New LIP     Teach.                   Total
                   Facility classification                     Number of   Number of    labor-      Outlier     basket     and motor    adjust.     adjust.     status        1.9       percent
                                                                 IRFs        cases       share     (percent)   (percent)     score     (percent)   (percent)    adjust.     reduct.     change
                                                                                       (percent)                           (percent)                           (percent)
(1)                                                                  (2)         (3)         (4)         (5)         (6)         (7)         (8)         (9)        (10)        (11)        (12)
-------------------------------------------------------------
Total.......................................................       1,188     461,738         0.0         1.8         3.6         0.0         0.0         0.0         0.0        -1.9         3.4
Urban unit..................................................         802     261,229         0.1         2.3         3.6         0.9        -0.2         0.1         0.5        -1.9         5.4
Rural unit..................................................         169      34,664        -1.3         3.1         3.6         1.7         1.2        -0.1        -0.9        -1.9         5.5
Urban hospital..............................................         196     158,968         0.2         0.5         3.6        -1.7        -0.1        -0.1        -0.5        -1.9         0.0
Rural hospital..............................................          21       6,877        -1.6         7.0         3.6        -0.7         1.3         0.0        -1.0        -1.9         6.5
Urban For-Profit............................................         295     154,526         0.4         0.7         3.6        -1.8         0.0         0.0        -0.8        -1.9         0.0
Rural For-Profit............................................          59      11,952        -1.9         3.8         3.6         0.2         1.3         0.2        -1.0        -1.9         4.2
Urban Non-Profit............................................         603     237,384         0.0         2.1         3.6         1.0        -0.2         0.0         0.5        -1.9         5.0
Rural Non-Profit............................................         105      23,793        -1.0         4.1         3.6         1.7         1.2        -0.3        -0.8        -1.9         6.7
Urban Government............................................         100      28,287        -0.2         2.5         3.6         0.5        -0.1         0.5         1.7        -1.9         6.7
Rural Government............................................          26       5,796        -1.5         2.6         3.6         1.4         1.2         0.3        -1.0        -1.9         4.8
Urban.......................................................         998     420,197         0.1         1.6         3.6        -0.1        -0.1         0.0         0.1        -1.9         3.2
Rural.......................................................         190      41,541        -1.4         3.8         3.6         1.2         1.3        -0.1        -0.9        -1.9         5.6
Urban by region:
    New England.............................................          35      20,612        -0.3         1.7         3.6        -0.7        -0.4        -0.3        -0.6        -1.9         1.1
    Middle Atlantic.........................................         156      76,962        -0.4         2.0         3.6         1.1        -0.3         0.0         1.6        -1.9         5.7
    South Atlantic..........................................         124      73,677         0.4         0.6         3.6        -0.5         0.2         0.0        -0.3        -1.9         2.0
    East North Central......................................         189      69,315         0.1         2.3         3.6         1.2        -0.3        -0.2         0.1        -1.9         4.9
    East South Central......................................          54      30,473         0.2         0.0         3.6        -1.4         0.4         0.1        -0.5        -1.9         0.5
    West North Central......................................          71      22,217        -0.1         2.1         3.6         0.6        -0.2        -0.1         0.1        -1.9         4.2
    West South Central......................................         184      76,088         0.5         1.8         3.6        -0.7        -0.2        -0.1        -0.5        -1.9         2.3
    Mountain................................................          69      24,287        -0.2         1.2         3.6        -2.2        -0.1        -0.1        -0.5        -1.9        -0.3
    Pacific.................................................         116      26,566         0.8         2.2         3.6        -0.8        -0.3         1.1         0.0        -1.9         4.7
Rural by region:
    New England.............................................           4         924         0.4         2.1         3.6         1.7         1.2        -0.4        -0.9        -1.9         5.9
    Middle Atlantic.........................................          19       5,377        -1.1         8.2         3.6         1.5         1.3        -0.4        -1.0        -1.9        10.3
    South Atlantic..........................................          22       5,440        -1.0         2.5         3.6         1.2         1.3         0.1        -1.0        -1.9         4.7
    East North Central......................................          28       5,618        -1.0         3.0         3.6         1.9         1.2        -0.4        -0.9        -1.9         5.4
    East South Central......................................          20       5,362        -1.9         2.2         3.6         1.1         1.3         0.3        -0.7        -1.9         3.8
    West North Central......................................          30       5,351        -1.3         2.3         3.6         2.7         1.2        -0.2        -0.6        -1.9         5.8
    West South Central......................................          54      12,016        -1.7         4.3         3.6         0.3         1.3         0.1        -1.0        -1.9         4.9
    Mountain................................................           9         902        -3.2         9.4         3.6         2.6         1.1        -0.4        -0.9        -1.9        10.2
    Pacific.................................................           4         551         0.9         2.8         3.6        -2.7         1.1        -0.8        -0.8        -1.9         2.0
Teaching Status:
    Non-teaching............................................       1,053     400,072         0.0         1.6         3.6        -0.1         0.1        -0.1        -0.9        -1.9         2.2
    Resident to ADC less than 10............................          71      39,888         0.3         2.5         3.6         0.3        -0.3         0.2         2.2        -1.9         7.0
    Resident to ADC 10-19...................................          42      17,793        -0.9         2.8         3.6         0.4        -0.3         1.1         9.1        -1.9        14.2
    Resident to ADC greater than 19.........................          22       3,985        -0.1         4.1         3.6         0.0        -0.3         1.1        19.5        -1.9        27.4
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------


[[Page 57173]]

    37. On page 47948, in the third column, second full paragraph, line 
12, ``$207'' is corrected to read ``$1,322''.
    38. On page 47948, in the third column, second full paragraph, line 
13, ``$3,070'' is corrected to read ``$2,887''.
    39. On page 47948, in the third column, second full paragraph, line 
14, ``$1,472'' is corrected to read ``$1,986''.
    40. On page 47948, in the third column, third full paragraph, line 
5, ``5'' is corrected to read ``4''. This was a typographical error.
    41. On page 47949, in the first column, in the first line of the 
column, ``$9'' is corrected to read ``$55''.
    42. On page 47949, in the first column, in the second line of the 
column, ``$380'' is corrected to read ``$324''.
    43. On page 47949, in the first column, line 8, ``$32'' is 
corrected to read ``$81''.
    44. On page 47949, in the first column, in the eighth line of the 
column, ``$1,167'' is corrected to read ``$1,207''.
    45. On page 47949, in the first column, in the ninth line of the 
column, ``$426'' is corrected to read ``$512''.
    46. On page 47949, in the first column, in the first paragraph 
under section heading number 7, line 5, ``$5,132'' is corrected to read 
``$5,129''.
    47. On page 47949, in the third column, in the last sentence of the 
first full paragraph, ``1.4 percent estimated increase among all rural 
IRFs in the Middle Atlantic region'' is corrected to read ``1.3 percent 
estimated increase among all rural IRFs.'' When we reran the data 
analysis with the correct portion of the rural adjustment applied to 
payments for the four IRFs described above, some of the numbers in 
Table 13 changed slightly. These changes to some of the numbers in 
Table 13 were technical changes, primarily due to rounding. However, 
one of the technical changes in column 8 of Table 13 for rural IRFs in 
the Middle Atlantic region (from 1.4 percent to 1.3 percent) requires a 
conforming technical change to the text that explains Table 13. 
Previously, when rural IRFs in the Middle Atlantic region were 
projected to experience a 1.4 percent increase in payments for FY 2006 
due to the rural adjustment policy for FY 2006, this group of IRFs was 
projected to receive the largest payment increase due to the rural 
adjustment policy for FY 2006. However, after we reran the numbers, 
rural IRFs in the Middle Atlantic region were projected to experience 
roughly the same estimated impact of the final rural policies as all 
other rural IRFs (1.3 percent). Thus, it is no longer accurate to 
describe rural IRFs in the Middle Atlantic region as having a larger 
projected increase in payments for FY 2006 than all other rural IRFs. 
At 1.3 percent, all rural IRFs (including rural IRFs in the Middle 
Atlantic region) now have the largest estimated increase in payments 
for FY 2006. Thus, we are making the conforming change to the text that 
describes Table 13.
    48. On page 47949, in the third column, in the last sentence of the 
first full paragraph, ``0.3 percent estimated decrease among urban 
facilities in the New England, West South Central, and Pacific regions, 
and among all categories of teaching facilities'' is corrected to read 
``0.4 percent estimated decrease among urban facilities in the New 
England region.'' When we reran the data analysis with the correct 
portion of the rural adjustment applied to payments for the four IRFs 
described above, some of the numbers in Table 13 changed slightly. 
These changes to some of the numbers in Table 13 were technical 
changes, primarily due to rounding. However, one of the technical 
changes in column 8 of Table 13 for urban IRFs in the New England 
region (from -0.3 percent to -0.4 percent) requires a conforming 
technical change to the text that describes Table 13. The change from -
0.3 percent to -0.4 percent means that urban IRFs in the New England 
region are now projected to experience a slightly greater decrease in 
payments than the other categories of urban IRFs listed previously 
whose estimated impacts in column 8 remained at -0.3 percent (that is, 
urban IRFs in the West South Central and Pacific regions and all 
categories of teaching IRFs). Thus, it is no longer accurate to 
describe urban IRFs in the West South Central and Pacific regions and 
all categories of teaching IRFs as experiencing the largest estimated 
decreases in payments due to the rural adjustment. At -0.4 percent, 
urban IRFs in the New England region now have a slightly larger 
estimated decrease in payments for FY 2006 than the other groups 
listed. Thus, we are making the conforming change to the text that 
describes Table 13.
    49. On page 47952, in the first column, in the first paragraph 
under section heading number 14, line 9, ``5.7'' is corrected to read 
``5.6''.
    50. On page 47952, in the first column, in the first paragraph 
under section heading number 14, line 11, ``5.3'' is corrected to read 
``5.4''.
    51. On page 47952, in the first column, in the second paragraph 
under section heading number 14, line 5, ``14.3'' is corrected to read 
``14.2''.
    52. On page 47952, in the second column, in the ninth line of the 
column, ``0.2'' is corrected to read ``0.3''.
    53. On page 47954, in the column titled ``2006 CBSA-based WI'' of 
SSA Code 01090, ``.7628'' is corrected to read ``0.7628''. This was a 
typesetting error.
    54. On page 47954, in the column titled ``MSA No.'' of SSA Code 
01390, ``21030'' is corrected to read ``2030''. This was a typesetting 
error.
    55. On page 47960, in the column titled ``CBSA No.'' of SSA Code 
11110, ``5260'' is corrected to read ``15260''. This was a typesetting 
error.
    56. On page 47961, in the column titled ``CBSA No.'' of SSA Code 
11703, ``5260'' is corrected to read ``15260''. This was a typesetting 
error.
    57. On page 47964, in the column titled ``MSA No.'' of SSA Code 
15140, ``11640'' is corrected to read ``1640''. This was a typesetting 
error.
    58. On page 47964, in the column titled ``CBSA No.'' of SSA Code 
15310, ``0126900'' is corrected to read ``26900''. This was a 
typesetting error.
    59. On page 47968, in the column titled ``MSA No.'' of SSA Code 
18090, ``13400'' is corrected to read ``3400''. This was a typesetting 
error.
    60. On page 47972, in the column titled ``CBSA No.'' of SSA Code 
23380, ``2820'' is corrected to read ``28020''. This was a typesetting 
error.
    61. On page 47982, in the column titled ``MSA No.'' of SSA Code 
34400, ``13120'' is corrected to read ``3120''. This was a typesetting 
error.
    62. On page 47992, in the column titled ``CBSA No.'' of SSA Code 
44740, ``4980'' is corrected to read ``34980''. This was a typesetting 
error.
    63. On page 47992, in the column titled ``CBSA No.'' of SSA Code 
45221, ``7780'' is corrected to read ``17780''. This was a typesetting 
error.
    64. On page 48000, in the column titled ``CBSA No.'' of SSA Code 
52460, ``133460'' is corrected to read ``33460''. This was a 
typesetting error.

III. Waiver of Proposed Rulemaking and Delayed Effective Date

    We ordinarily publish a notice of proposed rulemaking in the 
Federal Register to provide a period for public comment before the 
provisions of a notice take effect in accordance with section 553(b) of 
the Administrative Procedure Act (APA) (5 U.S.C. 553(b)). We also 
ordinarily provide a 30-day delay in the effective date of the 
provisions of a notice in accordance with section 553(d) of the APA (5 
U.S.C. 553(d)). However, we can waive both the notice and comment 
procedure and the 30-day delay in effective date if the Secretary 
finds, for good cause, that

[[Page 57174]]

notice and comment process is impracticable, unnecessary, or contrary 
to the public interest and incorporates a statement of the finding and 
the reasons for it into the notice issued.
    The policies and payment methodology expressed in the FY 2006 final 
rule (70 FR 47880) have previously been subjected to notice and comment 
procedures. This correction notice merely provides technical 
corrections to the FY 2006 final rule that was promulgated through 
notice and comment rulemaking, and does not make substantive changes to 
the policies or payment methodology that were expressed in the final 
rule. For example, this notice corrects typographical errors and 
typesetting errors, revises inaccurate tabular data due to 
inadvertently neglecting to apply any rural adjustment amount to 
estimated payments for four IRFs in conformance with the hold harmless 
policy, updates the narrative to reflect the correct tabular data, 
corrects some estimated dollar impacts due to inadvertently computing 
the estimates using the incorrect standard payment conversion factor, 
and makes clarifications to the preamble text. Therefore, we find it 
unnecessary to undertake further notice and comment procedures with 
respect to this correction notice. We also believe it is in the public 
interest to waive notice and comment procedures and the 30-day delay in 
effective date for this notice. This correction notice is intended to 
ensure that the FY 2006 final rule accurately reflects the policies 
expressed in the final rule, and that the correct information is made 
available to the public prior to October 1, 2005, the date on which the 
final rule becomes effective.
    For the reasons stated above, we find that both notice and comment 
and the 30-day delay in effective date for this correction notice are 
unnecessary and impracticable, and that it is in the public interest to 
make this notice effective in conjunction with the final rule to which 
the corrections apply (and would be contrary to the public interest to 
do otherwise). Therefore, we find good cause to waive notice and 
comment procedures and the 30-day delay in effective date for this 
correction notice.

(Catalog of Federal Domestic Assistance Program No. 93.773, 
Medicare--Hospital Insurance; and Program No. 93.774, Medicare--
Supplementary Medical Insurance Program)

    Dated: September 27, 2005.
Ann C. Agnew,
Executive Secretary to the Department.
[FR Doc. 05-19610 Filed 9-29-05; 8:45 am]
BILLING CODE 4120-01-P