Medicare Program; Proposed Changes to the Hospital Inpatient Prospective Payment Systems and Fiscal Year 2007 Rates, 23996-24472 [06-3629]

Download as PDF 23996 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Medicare & Medicaid Services 42 CFR Parts 409, 410, 412, 413, 424, 485, and 489 [CMS–1488–P] RIN 0938–AO12 Medicare Program; Proposed Changes to the Hospital Inpatient Prospective Payment Systems and Fiscal Year 2007 Rates Centers for Medicare & Medicaid Services (CMS), HHS. ACTION: Proposed rule. wwhite on PROD1PC61 with PROPOSALS2 AGENCY: SUMMARY: We are proposing to revise the Medicare hospital inpatient prospective payment systems (IPPS) for operating and capital-related costs to implement changes arising from our continuing experience with these systems, and to implement a number of changes made by the Deficit Reduction Act of 2005 (Pub. L. 109–171). In addition, in the Addendum to this proposed rule, we describe the proposed changes to the amounts and factors used to determine the rates for Medicare hospital inpatient services for operating costs and capitalrelated costs. We also are setting forth proposed rate-of-increase limits as well as proposed policy changes for hospitals and hospital units excluded from the IPPS that are paid in full or in part on a reasonable cost basis subject to these limits. These proposed changes would be applicable to discharges occurring on or after October 1, 2006. In this proposed rule, we discuss our proposals to refine the diagnosis-related group (DRG) system under the IPPS to better recognize severity of illness among patients—for FY 2007, we are proposing to use a hospital-specific relative value cost center weighting methodology to adjust DRG relative weights and in FY 2008 (if not earlier), to implement consolidated severityadjusted DRGs or alternative severity adjustment methods. Among the other policy changes that we are proposing to make are changes related to: limited revisions of the reclassification of cases to DRGs; the long-term care (LTC)–DRGs and relative weights; the wage data, including the occupational mix data, used to compute the wage index; applications for new technologies and medical services addon payments; payments to hospitals for the direct and indirect costs of graduate medical education; submission of hospital quality data; payments to sole VerDate Aug<31>2005 17:10 Apr 24, 2006 Jkt 208001 community hospitals and Medicaredependent, small rural hospitals; and provisions governing emergency services under the Emergency Medical Treatment and Labor Act of 1986 (EMTALA). We are also inviting comments on a number of issues including performance-based hospital payments for services and health information technology, as well as how to improve data transparency for consumers. DATES: To be assured consideration, comments must be received at one of the addresses provided below, no later than 5 p.m. on June 12, 2006. ADDRESSES: In commenting, please refer to file code CMS–1488–P. Because of staff and resource limitations, we cannot accept comments by facsimile (FAX) transmission. You may submit comments in one of three ways (no duplicates, please): 1. Electronically. You may submit electronic comments on specific issues in this regulation to https:// www.cms.hhs.gov/eRulemaking. Click on the link ‘‘Submit electronic comments on CMS regulations with an open comment period’’. (Attachments should be in Microsoft Word, WordPerfect, or Excel; however, we prefer Microsoft Word.) 2. By regular mail. You may mail written comments (one original and two copies) to the following address ONLY: Centers for Medicare & Medicaid Services, Department of Health and Human Services, Attention: CMS–1488– P, P.O. Box 8011, Baltimore, MD 21244– 1850. Please allow sufficient time for mailed comments to be received before the close of the comment period. 3. By express or overnight mail. You may send written comments (one original and two copies) to the following address ONLY: Centers for Medicare & Medicaid Services, Department of Health and Human Services, Attention: CMS–1488–P, Mail Stop C4–26–05, 7500 Security Boulevard, Baltimore, MD 21244–1850. 4. By hand or courier. If you prefer, you may deliver (by hand or courier) your written comments (one original and two copies) before the close of the comment period to one of the following addresses. If you intend to deliver your comments to the Baltimore address, please call telephone number (410) 786– 7195 in advance to schedule your arrival with one of our staff members. Room 445–G, Hubert H. Humphrey Building, 200 Independence Avenue, SW., Washington, DC 20201, or 7500 Security Boulevard, Baltimore, MD 21244–1850. PO 00000 Frm 00002 Fmt 4701 Sfmt 4702 (Because access to the interior of the Hubert H. Humphrey Building is not readily available to persons without Federal Government identification, commenters are encouraged to leave their comments in the CMS drop slots located in the main lobby of the building. A stamp-in clock is available for persons wishing to retain proof of filing by stamping in and retaining an extra copy of the comments being filed.) Comments mailed to the addresses indicated as appropriate for hand or courier delivery may be delayed and received after the comment period. Submission of comments on paperwork requirements. You may submit comments on this document’s paperwork requirements by mailing your comments to the addresses provided at the end of the ‘‘Collection of Information Requirements’’ section in this document. For information on viewing public comments, see the beginning of the SUPPLEMENTARY INFORMATION section. FOR FURTHER INFORMATION CONTACT: Marc Hartstein, (410) 786–4548, Operating Prospective Payment, Diagnosis-Related Groups (DRGs), Wage Index, New Medical Services and Technology Add-On Payments, Hospital Geographic Reclassifications, Sole Community Hospital, Disproportionate Share Hospital, and Medicare-Dependent, Small Rural Hospital Issues. Tzvi Hefter, (410) 786–4487, Capital Prospective Payment, Excluded Hospitals, Graduate Medical Education, Critical Access Hospitals, and Long-Term Care (LTC)–DRG Issues. Siddhartha Mazumdar, (410) 786–6673, Rural Community Hospital Demonstration Issues. Sheila Blackstock, (410) 786–3502, Quality Data for Annual Payment Update Issues. Thomas Valuck, (410) 786–7479, Hospital Value-Based Purchasing Issues. Frederick Grabau, (410) 786–0206, Services in Foreign Hospitals Issues. Brian Reitz, (410) 786–5001, Obsolete Paper Claims Forms Issues. SUPPLEMENTARY INFORMATION: Submitting Comments: We welcome comments from the public on all issues set forth in this rule to assist us in fully considering issues and developing policies. You can assist us by referencing the file code CMS–1488–P and the specific ‘‘issue identifier’’ that precedes the section on which you choose to comment. Inspection of Public Comments: All comments received before the close of E:\FR\FM\25APP2.SGM 25APP2 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules the comment period are available for viewing by the public, including any personally identifiable or confidential business information that is included in a comment. We post all comments received before the close of the comment period on the following Web site as soon as possible after they have been received: https://www.cms.hhs.gov/ eRulemaking. Click on the link ‘‘Electronic Comments on CMS Regulations’’ on that Web site to view public comments. Comments received timely will also be available for public inspection as they are received, generally beginning approximately 3 weeks after publication of a document, at the headquarters of the Centers for Medicare & Medicaid Services, 7500 Security Boulevard, Baltimore, Maryland 21244, Monday through Friday of each week from 8:30 a.m. to 4 p.m. To schedule an appointment to view public comments, phone 1–800–743–3951. wwhite on PROD1PC61 with PROPOSALS2 Electronic Access This Federal Register document is also available from the Federal Register online database through GPO Access, a service of the U.S. Government Printing Office. Free public access is available on a Wide Area Information Server (WAIS) through the Internet and via asynchronous dial-in. Internet users can access the database by using the World Wide Web; the Superintendent of Documents’ home page address is https://www.gpoaccess.gov/, by using local WAIS client software, or by telnet to swais.access.gpo.gov, then login as guest (no password required). Dial-in users should use communications software and modem to call (202) 512– 1661; type swais, then login as guest (no password required). Acronyms AHA American Hospital Association AHIMA American Health Information Management Association AHRO Agency for Health Care Research and Quality AMI Acute myocardial infarction AOA American Osteopathic Association APR DRG All Patient Refined Diagnosis Related Group System ASC Ambulatory surgical center ASP Average sales price AWP Average wholesale price BBA Balanced Budget Act of 1997, Public Law 105–33 BBRA Medicare, Medicaid, and SCHIP [State Children’s Health Insurance Program] Balanced Budget Refinement Act of 1999, Public Law 106–113 BIPA Medicare, Medicaid, and SCHIP [State Children’s Health Insurance VerDate Aug<31>2005 17:10 Apr 24, 2006 Jkt 208001 Program] Benefits Improvement and Protection Act of 2000, Public Law 106–554 BLS Bureau of Labor Statistics CAH Critical access hospital CART CMS Abstraction & Reporting Tool CBSAs Core-based statistical areas CC Complication or comorbidity CDAC Clinical Data Abstraction Center CIPI Capital input price index CPI Consumer price index CMI Case-mix index CMS Centers for Medicare & Medicaid Services CMSA Consolidated Metropolitan Statistical Area COBRA Consolidated Omnibus Reconciliation Act of 1985, Public Law 99–272 CPI Consumer price index CRNA Certified registered nurse anesthetist CY Calendar year DRA Deficit Reduction Act of 2005, Public Law 109–171 DRG Diagnosis-related group DSH Disproportionate share hospital ECI Employment cost index EMR Electronic medical record EMTALA Emergency Medical Treatment and Labor Act of 1986, Public Law 99–272 FDA Food and Drug Administration FFY Federal fiscal year FIPS Federal information processing standards FQHC Federally qualified health center FTE Full-time equivalent FY Fiscal year GAAP Generally Accepted Accounting Principles GAF Geographic Adjustment Factor GME Graduate medical education HCAHPS Hospital Consumer Assessment of Healthcare Providers and Systems HCFA Health Care Financing Administration HCRIS Hospital Cost Report Information System HHA Home health agency HHS Department of Health and Human Services HIC Health insurance card HIPAA Health Insurance Portability and Accountability Act of 1996, Public Law 104–191 HIPC Health Information Policy Council HIS Health information system HIT Health information technology HMO Health maintenance organization HSA Health savings account HSCRC Maryland Health Services Cost Review Commission HSRV Hospital-specific relative value PO 00000 Frm 00003 Fmt 4701 Sfmt 4702 23997 HSRVcc Hospital-specific relative value cost center HQA Hospital Quality Alliance HQI Hospital Quality Initiative HwH Hospital-within-a-hospital ICD–9–CM International Classification of Diseases, Ninth Revision, Clinical Modification ICD–10–PCS International Classification of Diseases, Tenth Edition, Procedure Coding System ICU Intensive care unit IHS Indian Health Service IME Indirect medical education IOM Institute of Medicine IPF Inpatient psychiatric facility IPPS Acute care hospital inpatient prospective payment system IRF Inpatient rehabilitation facility JCAHO Joint Commission on Accreditation of Healthcare Organizations LAMCs Large area metropolitan counties LTC–DRG Long-term care diagnosisrelated group LTCH Long-term care hospital MCE Medicare Code Editor MCO Managed care organization MCV Major cardiovascular condition MDC Major diagnostic category MDH Medicare-dependent, small rural hospital MedPAC Medicare Payment Advisory Commission MedPAR Medicare Provider Analysis and Review File MEI Medicare Economic Index MGCRB Medicare Geographic Classification Review Board MMA Medicare Prescription Drug, Improvement, and Modernization Act of 2003, Public Law 108–173 MRHFP Medicare Rural Hospital Flexibility Program MSA Metropolitan Statistical Area NAICS North American Industrial Classification System NCD National coverage determination NCHS National Center for Health Statistics NCQA National Committee for Quality Assurance NCVHS National Committee on Vital and Health Statistics NECMA New England County Metropolitan Areas NICU Neonatal intensive care unit NQF National Quality Forum NTIS National Technical Information Service NVHRI National Voluntary Hospital Reporting Initiative OES Occupational employment statistics OIG Office of the Inspector General OMB Executive Office of Management and Budget O.R. Operating room E:\FR\FM\25APP2.SGM 25APP2 23998 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules OSCAR Online Survey Certification and Reporting (System) PRM Provider Reimbursement Manual PPI Producer price index PMSAs Primary metropolitan statistical areas PPS Prospective payment system PRA Per resident amount ProPAC Prospective Payment Assessment Commission PRRB Provider Reimbursement Review Board PS&R Provider Statistical and Reimbursement (System) QIG Quality Improvement Group, CMS QIO Quality Improvement Organization RHC Rural health clinic RHQDAPU Reporting hospital quality data for annual payment update RNHCI Religious Nonmedical Health care Institution RRC Rural referral center RUCAs Rural-urban commuting area codes RY Rate year SAF Standard Analytic File SCH Sole community hospital SFY State fiscal year SIC Standard Industrial Classification SNF Skilled nursing facility SOCs Standard occupational classifications SOM State Operations Manual SSA Social Security Administration SSI Supplemental Security Income TAG Technical Advisory Group TEFRA Tax Equity and Fiscal Responsibility Act of 1982, Pub. L. 97–248 UHDDS Uniform hospital discharge data set wwhite on PROD1PC61 with PROPOSALS2 Table of Contents I. Background A. Summary 1. Acute Care Hospital Inpatient Prospective Payment System (IPPS) 2. Hospitals and Hospital Units Excluded From the IPPS a. Inpatient Rehabilitation Facilities (IRFs) b. Long-Term Care Hospitals (LTCHs) c. Inpatient Psychiatric Facilities (IPFs) 3. Critical Access Hospitals (CAHs) 4. Payments for Graduate Medical Education (GME) B. Provisions of the Deficit Reduction Act of 2005 (DRA) C. Major Contents of this Proposed Rule 1. Proposed DRG Reclassifications and Recalibrations of Relative Weights 2. Proposed Changes to the Hospital Wage Index 3. Other Decisions and Proposed Changes to the IPPS for Operating Costs and GME Costs 4. Proposed Changes to the PPS for CapitalRelated Costs 5. Proposed Changes for Hospitals and Hospital Units Excluded From the IPPS 6. Payment for Services Furnished Outside the United States VerDate Aug<31>2005 17:10 Apr 24, 2006 Jkt 208001 7. Payment for Blood Clotting Factor Administered to Inpatients With Hemophilia 8. Limitation on Payments to Skilled Nursing Facilities for Bad Debt 9. Determining Proposed Prospective Payment Operating and Capital Rates and Rate-of-Increase Limits 10. Impact Analysis 11. Recommendation of Update Factors for Operating Cost Rates of Payment for Inpatient Hospital Services 12. Discussion of Medicare Payment Advisory Commission Recommendations 13. Appendix C—Combinations of Consolidated Severity-Adjusted DRGs and Appendix D—Crosswalk of Consolidated Severity-Adjusted DRGs to Respective APR DRGs II. Proposed Changes to DRG Classifications and Relative Weights A. Background B. DRG Reclassifications 1. General 2. Yearly Review for Making DRG Changes 3. Refinement of DRGs Based on Severity of Illness C. Proposals for Revisions to the DRG System Used Under the IPPS 1. MedPAC Recommendations 2. Refinement of the Relative Weight Calculation 3. Refinement of DRGs Based on Severity of Illness a. Comparison of the CMS DRG System and the APR DRG System b. Consolidated Severity-Adjusted DRGs for Use in the IPPS c. Changes to Case-Mix Index (CMI) From a New DRG System 4. Effect of Consolidated Severity-Adjusted DRGs on the Outlier Threshold 5. Impact of Refinement of DRG System on Payments 6. Conclusions D. Proposed Changes to Specific DRG Classifications 1. Pre-MDCs: Pancreas Transplants 2. MDC 1 (Diseases and Disorders of the Nervous System) a. Implantation of Intracranial Neurostimulator System for Deep Brain Stimulation (DBS) b. Carotid Artery Stents 3. MDC 5 (Diseases and Disorders of the Circulatory System) a. Insertion of Epicardial Leads for Defibrillator Devices b. Application of Major Cardiovascular Diagnoses (MCVs) List to Defibrillator DRGs 4. MDC 8 (Diseases and Disorders of the Musculoskeletal System and Connective Tissue) a. Hip and Knee Replacements b. Spinal Fusion c. ChariteTM Spinal Disc Replacement Device 5. MDC 18 (Infectious and Parasitic Diseases (Systemic or Unspecified Sites)): Severe Sepsis 6. Medicare Code Editor (MCE) Changes a. Newborn Diagnoses Edit b. Diagnoses Allowed for Females Only Edit c. Diagnoses Allowed for Males Only Edit PO 00000 Frm 00004 Fmt 4701 Sfmt 4702 d. Manifestations Not Allowed as Principal Diagnosis Edit e. Nonspecific Principal Diagnosis Edit f. Unacceptable Principal Diagnosis Edit g. Nonspecific O.R. Procedures Edit h. Noncovered Procedures Edit i. Bilateral Procedure Edit 7. Surgical Hierarchies 8. Refinement of Complications and Comorbidities (CC) List a. Background b. Comprehensive Review of the CC List c. CC Exclusions List Proposed for FY 2007 9. Review of Procedure Codes in DRGs 468, 476, and 477 a. Moving Procedure Codes From DRG 468 or DRG 477 to MDCs b. Reassignment of Procedures Among DRGs 468, 476, and 477 c. Adding Diagnosis or Procedure Codes to MDCs 10. Changes to the ICD–9–CM Coding System E. Proposed Recalibration of DRG Weights F. Proposed LTC–DRG Reclassifications and Relative Weights for LTCHs for FY 2007 1. Background 2. Proposed Changes in the LTC–DRG Classifications a. Background b. Patient Classifications into DRGs 3. Development of the Proposed FY 2007 LTC–DRG Relative Weights a. General Overview of Development of the LTC–DRG Relative Weights b. Data c. Hospital-Specific Relative Value Methodology d. Proposed Low-Volume LTC–DRGs 4. Steps for Determining the Proposed FY 2007 LTC–DRG Relative Weights G. Proposed Add-On Payments for New Services and Technologies 1. Background 2. Public Input Before Publication of This Notice of Proposed Rulemaking on AddOn Payments 3. FY 2007 Status of Technologies Approved for FY 2006 Add-On Payments a. Kinetra Implantable Neurostimulator for Deep Brain Stimulation b. Endovascular Graft Repair of the Thoracic Aorta c. Restore Rechargeable Implantable Neurostimulator 4. FY 2007 Applicants for New Technology Add-On Payments a. C-Port Distal Anastomosis System b. NovoSeven for Intracerebral Hemorrhage c. X STOP Interspinous Process Decompression System III. Proposed Changes to the Hospital Wage Index A. Background B. Core-Based Statistical Areas for the Proposed Hospital Wage Index C. Proposed Occupational Mix Adjustment to the Proposed FY 2007 Index 1. Development of Data for the Proposed Occupational Mix Adjustment 2. Calculation of the Proposed FY 2007 Occupational Mix Adjustment Factor and the Proposed FY 2007 Occupational Mix Adjusted Wage Index E:\FR\FM\25APP2.SGM 25APP2 wwhite on PROD1PC61 with PROPOSALS2 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules D. Worksheet S–3 Wage Data for the Proposed FY 2007 Wage Index Update E. Verification of Worksheet S–3 Wage Data F. Computation of the Proposed FY 2007 Unadjusted Wage Index G. Computation of the Proposed FY 2007 Blended Wage Index H. Proposed Revisions to the Wage Index Based on Hospital Redesignations 1. General 2. Effects of Reclassification 3. FY 2007 MGCRB Reclassifications 4. Proposed FY 2007 Redesignations Under Section 1886(d)(8)(B) of the Act 5. Reclassifications Under Section 508 of Pub. L. 108–173 6. Proposed Wage Indices for Reclassified Hospitals and Proposed Reclassification Budget Neutrality Factor I. Proposed FY 2007 Wage Index Adjustment Based on Commuting Patterns of Hospital Employees J. Process for Requests for Wage Index Data Corrections K. Labor-Related Share for the Wage Index for FY 2007 L. Proxy for the Hospital Market Basket IV. Other Decisions and Proposed Changes to the IPPS for Operating Costs and GME Costs A. Reporting of Hospital Quality Data for Annual Hospital Payment Update 1. Background 2. New Procedures for Hospital Reporting of Quality Data 3. Electronic Medical Records B. Value-Based Purchasing 1. Introduction 2. Premier Hospital Quality Incentive Demonstration 3. RHQDAPU Program a. Section 501(b) of Pub. L. 108–173 (MMA) b. Section 5001(a) of Pub. L. 109–171 (DRA) 4. Plan for Implementing Hospital ValueBased Purchasing Beginning With FY 2009 a. Measure Development and Refinement b. Data Infrastructure c. Incentive Methodology d. Public Reporting 5. Considerations Related to Certain Conditions, Including Hospital-Acquired Infections 6. Promoting Effective Use of Health Information Technology C. Sole Community Hospitals (SCHs) and Medicare-Dependent, Small Rural Hospitals (MDHs) 1. Background 2. Volume Decrease Adjustment for SCHs and MDHs a. HAS/Monitrend Data b. HAS/Monitrend Data Book Replacement Alternative 3. Mandatory Reporting Requirements for Any Changes in the Circumstances Under Which a Hospital Was Designated as an SCH or MDH 4. Proposed Payment Changes for MDHs Under the DRA of 2005 a. Background b. Proposed Regulation Changes 5. Proposed Technical Change VerDate Aug<31>2005 17:10 Apr 24, 2006 Jkt 208001 D. Rural Referral Centers 1. Case-Mix Index 2. Discharges E. Indirect Medical Education (IME) Adjustment 1. Background 2. IME Adjustment Factor for FY 2007 3. Technical Change to Revise CrossReference F. Payment Adjustment for Disproportionate Share Hospitals (DSHs) 1. Background 2. Technical Corrections 3. Proposed Reinstatement of Inadvertently Deleted Provisions on DSH Payment Adjustment Factors 4. Enhanced DSH Adjustment for MDHs G. Geographic Reclassifications 1. Background 2. Reclassifications under Section 508 of Pub. L. 108–173 3. Multicampus Hospitals 4. Urban Group Hospital Reclassifications 5. Effect of Change of Ownership on Urban County Group Reclassifications 6. Requested Reclassification for Hospitals Located in a Single Hospital MSA Surrounded by Rural Counties H. Payment for Direct Graduate Medical Education 1. Background 2. Determination of Weighted Average Per Resident Amounts (PRAs) for Merged Teaching Hospitals 3. Determination of Per Resident Amounts (PRAs) for New Teaching Hospitals 4. Requirements for Counting and Appropriate Documentation of FTE Residents: Clarification 5. Resident Time Spent in Nonpatient Care Activities as Part of Approved Residency Programs 6. Medicare GME Affiliated Groups: Technical Changes to Regulations I. Payment for the Costs of Nursing and Allied Health Education Activities: Clarification J. Hospital Emergency Services Under EMTALA 1. Background 2. Role of the EMTALA Technical Advisory Group (TAG) 3. Definition of ‘‘Labor’’ 4. Application of EMTALA Requirements to Hospitals Without Dedicated Emergency Departments 5. Clarification of Reference to ‘‘Referral Centers’’ K. Other Proposed Technical Changes 1. Proposed Cross-Reference Correction in Regulations on Limitations on Beneficiary Charges 2. Proposed Cross-Reference Corrections in Regulations on Payment Denials Based on Admissions and Quality Reviews 3. Proposed Cross-Reference Correction in Regulations on Outlier Payments 4. Removing References to Two Paper Claims Forms L. Rural Community Hospital Demonstration Program M. Health Care Information Transparency Initiative V. Proposed Changes to the PPS for CapitalRelated Costs A. Background PO 00000 Frm 00005 Fmt 4701 Sfmt 4702 23999 B. Treatment of Certain Urban Hospitals Reclassified as Rural Hospitals Under § 412.103 C. Other Technical Corrections Relating to the Capital PPS Geographic Adjustment Factors VI. Proposed Changes for Hospitals and Hospital Units Excluded From the IPPS A. Payments to Existing Hospitals and Hospital Units 1. Payments to Existing Excluded Hospitals and Hospital Units 2. Separate PPS for IRFs 3. Separate PPS for LTCHs 4. Separate PPS for IPFs 5. Grandfathering of Hospitals-WithinHospitals (HwHs) and Satellite Facilities 6. Proposed Changes to the Methodology for Determining LTCH Cost-to-Charge Ratios (CCRs) and the Reconciliation of High-Cost and Short-Stay Outlier Payments Under the LTCH PPS a. Background b. High-Cost Outliers c. Short-Stay Outliers 7. Technical Corrections Relating to LTCHs 8. Proposed Cross-Reference Correction in Authority Citations for 42 CFR 412 and 413 B. Critical Access Hospitals (CAHs) 1. Background 2. Sunset of Designation of CAHs as Necessary Providers: Technical Correction VII. Payment for Services Furnished Outside the United States A. Background B. Proposed Clarification of Regulations VIII. Payment for Blood Clotting Factor Administered to Inpatients With Hemophilia IX. Limitation on Payments to Skilled Nursing Facilities for Bad Debt A. Background B. Changes Made by Section 5004 of the DRA C. Proposed Regulation Changes X. MedPAC Recommendations XI. Other Required Information A. Requests for Data From the Public B. Collection of Information Requirements C. Public Comments XII. Regulation Text Addendum—Proposed Schedule of Standardized Amounts Effective With Discharges Occurring On or After October 1, 2006 and Update Factors and Rate-of-Increase Percentages Effective With Cost Reporting Periods Beginning on or After October 1, 2006 I. Summary and Background II. Proposed Changes to Prospective Payment Rates for Hospital Inpatient Operating Costs for FY 2007 A. Calculation of the Adjusted Standardized Amount 1. Standardization of Base-Year Costs or Target Amounts 2. Computing the Average Standardized Amount 3. Updating the Average Standardized Amount 4. Other Adjustments to the Average Standardized Amount a. Recalibration of DRG Weights and Updated Wage Index—Budget Neutrality Adjustment E:\FR\FM\25APP2.SGM 25APP2 wwhite on PROD1PC61 with PROPOSALS2 24000 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules b. Reclassified Hospitals—Budget Neutrality Adjustment c. Outliers d. Rural Community Hospital Demonstration Program Adjustment (Section 410A of Pub. L. 108–173) 5. Proposed FY 2007 Standardized Amount B. Adjustments for Area Wage Levels and Cost-of-Living 1. Adjustment for Area Wage Levels 2. Adjustment for Cost-of-Living in Alaska and Hawaii C. DRG Relative Weights D. Calculation of the Proposed Prospective Payment Rates for FY 2007 1. Federal Rate 2. Hospital-Specific Rate (Applicable Only to SCHs and MDHs) a. Calculation of Hospital-Specific Rate b. Updating the FY 1982, FY 1987, FY 1996, and FY 2002 Hospital-Specific Rates for FY 2007 3. General Formula for Calculation of Proposed Prospective Payment Rates for Hospitals Located in Puerto Rico Beginning On or After October 1, 2006 and Before October 1, 2007 a. Puerto Rico Rate b. National Rate III. Proposed Changes to Payment Rates for Acute Care Hospital Inpatient CapitalRelated Costs for FY 2007 A. Determination of Proposed Federal Hospital Inpatient Capital-Related Prospective Payment Rate Update 1. Projected Capital Standard Federal Rate Update a. Description of the Update Framework b. Comparison of CMS and MedPAC Update Recommendation 2. Proposed Outlier Payment Adjustment Factor 3. Proposed Budget Neutrality Adjustment Factor for Changes in DRG Classifications and Weights and the GAF 4. Proposed Exceptions Payment Adjustment Factor 5. Proposed Capital Standard Federal Rate for FY 2007 6. Proposed Special Capital Rate for Puerto Rico Hospitals B. Calculation of the Proposed Inpatient Capital-Related Prospective Payments for FY 2007 C. Capital Input Price Index 1. Background 2. Forecast of the CIPI for FY 2007 IV. Payment Rates for Excluded Hospitals and Hospital Units: Proposed Rate-ofIncrease Percentages A. Payments to Existing Excluded Hospitals and Units B. New Excluded Hospitals and Units V. Proposed Payment for Blood Clotting Factor Administered to Inpatients With Hemophilia Tables Table 1A—National Adjusted Operating Standardized Amounts, Labor/Nonlabor (69.7 Percent Labor Share/30.3 Percent Nonlabor Share If Wage Index Is Greater Than 1) Table 1B—National Adjusted Operating Standardized Amounts, Labor/Nonlabor (62 Percent Labor Share/38 Percent Nonlabor Share If Wage Index Is Less Than or Equal to 1) VerDate Aug<31>2005 17:10 Apr 24, 2006 Jkt 208001 Table 1C—Adjusted Operating Standardized Amounts for Puerto Rico, Labor/Nonlabor Table 1D—Capital Standard Federal Payment Rate Table 2—Hospital Case-Mix Indexes for Discharges Occurring in Federal Fiscal Year 2005; Hospital Wage Indexes for Federal Fiscal Year 2007; Hospital Average Hourly Wage for Federal Fiscal Years 2005 (2001 Wage Data), 2006 (2002 Wage Data), and 2007 (2003 Wage Data); Wage Indexes and 3-Year Average of Hospital Average Hourly Wages Table 3A—FY 2007 and 3-Year Average Hourly Wage for Urban Areas by CBSA Table 3B—FY 2007 and 3-Year Average Hourly Wage for Rural Areas by CBSA Table 4A–1—Wage Index and Capital Geographic Adjustment Factor (GAF) for Urban Areas by CBSA—FY2007 Table 4A–2—Wage Index and Capital Geographic Adjustment Factor (GAF) for Certain Urban Areas by CBSA for the Period April 1 through September 30, 2007 Table 4B—Wage Index and Capital Geographic Adjustment Factor (GAF) for Rural Areas by CBSA—FY 2007 Table 4C–1—Wage Index and Capital Geographic Adjustment Factor (GAF) for Hospitals That Are Reclassified by CBSA—FY 2007 Table 4C–2—Wage Index and Capital Geographic Adjustment Factor (GAF) for Certain Hospitals That Are Reclassified by CBSA for the Period April 1 Through September 30, 2007 Table 4F—Puerto Rico Wage Index and Capital Geographic Adjustment Factor (GAF) by CBSA—FY 2007 Table 4J—Out-Migration Wage Adjustment—FY 2007 Table 5—List of Diagnosis-Related Groups (DRGs), Relative Weighting Factors, and Geometric and Arithmetic Mean Length of Stay (LOS) Table 6A—New Diagnosis Codes Table 6B—New Procedure Codes Table 6C—Invalid Diagnosis Codes Table 6D—Invalid Procedure Codes Table 6E—Revised Diagnosis Code Titles Table 6F—Revised Procedure Code Titles Table 6G—Additions to the CC Exclusions List Table 6H—Deletions from the CC Exclusions List Table 7A—Medicare Prospective Payment System Selected Percentile Lengths of Stay: FY 2005 MedPAR Update December 2005 GROUPER V23.0 Table 7B—Medicare Prospective Payment System Selected Percentile Lengths of Stay: FY 2005 MedPAR Update December 2005 GROUPER V24.0 Table 8A—Statewide Average Operating Cost-to-Charge Ratios—March 2006 Table 8B—Statewide Average Capital Costto-Charge Ratios—March 2006 Table 8C—Proposed Statewide Average Total Cost-to-Charge Ratios for LTCHs— March 2006 Table 9A—Hospital Reclassifications and Redesignations by Individual Hospital and CBSA—FY 2007 Table 9B—Hospital Reclassifications and Redesignation by Individual Hospital PO 00000 Frm 00006 Fmt 4701 Sfmt 4702 Under Section 508 of Pub. L. 108–173— FY 2007 Table 9C—Hospitals Redesignated as Rural Under Section 1886(d)(8)(E) of the Act— FY 2007 Table 10—Geometric Mean Plus the Lesser of .75 of the National Adjusted Operating Standardized Payment Amount (Increased to Reflect the Difference Between Costs and Charges) or .75 of One Standard Deviation of Mean Charges by Diagnosis-Related Groups (DRGs)— March 2006 Table 11—Proposed FY 2007 LTC–DRGs, Relative Weights, Geometric Average Length of Stay, and 5⁄6ths of the Geometric Average Length of Stay Appendix A—Regulatory Impact Analysis I. Overall Impact II. Objectives III. Limitations on Our Analysis IV. Hospitals Included In and Excluded From the IPPS V. Effects on Excluded Hospitals and Hospital Units VI. Quantitative Effects of the Proposed Policy Changes Under the IPPS for Operating Costs A. Basis and Methodology of Estimates B. Analysis of Table I C. Effects on the Hospitals that Failed the Quality Data Submission Process (Column 2) D. Effects of the DRA Provision Related to MDHs (Column 3) E. Effects of the Changes to the DRG Reclassifications and Relative Cost-Based Weights (Column 4) F. Effects of Proposed Wage Index Changes (Column 5) G. Combined Effects of Proposed DRG and Wage Index Changes, Including Budget Neutrality Adjustment (Column 6) H. Effects of the 3-Year Provision Allowing Urban Hospitals that Were Converted to Rural as a Result of the FY 2005 Labor Market Area Changes to Maintain the Wage Index of the Urban Labor Market Area in Which They Were Formerly Located (Column 7) I. Effects of MGCRB Reclassifications (Column 8) J. Effects of the Proposed Wage Index Adjustment for Out-Migration (Column 9) K. Effects of All Changes (Column 10) L. Effects of Policy on Payment Adjustments for Low-Volume Hospitals M. Impact Analysis of Table II VII. Effects of Other Proposed Policy Changes A. Effects of LTC–DRG Reclassifications and Relative Weights for LTCHs B. Effects of Proposed New Technology Add-On Payments C. Effects of Requirements for Hospital Reporting of Quality Data for Annual Hospital Payment Update D. Effects of Other Proposed Policy Changes Affecting Sole Community Hospitals (SCHs) and MedicareDependent, Small Rural Hospitals (MDHs) E. Effects of Proposed Policy on Payment for Direct Costs of Graduate Medical Education E:\FR\FM\25APP2.SGM 25APP2 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules 1. Determination of Weighted Average GME PRAs for Merged Teaching Hospitals 2. Determination of PRAs for New Teaching Hospitals 3. Requirements for Counting and Appropriate Documentation of FTE Residents 4. Resident Time Spent in Nonpatient Care Activities as Part of an Approved Residency Program F. Effects of Proposed Policy Changes Relating to Emergency Services Under EMTALA G. Effects of Policy on Rural Community Hospital Demonstration Program H. Effects of Proposed Policy on HospitalsWithin-Hospitals and Satellite Facilities I. Effects of Proposed Policy Changes to the Methodology for Determining LTCH CCRs and the Reconciliation LTCH PPS Outlier Payments J. Effects of Proposed Policy on Payment for Services Furnished Outside the United States K. Effects of Proposed Policy on Limitation on Payments to SNFs VIII. Effects of Proposed Changes in the Capital PPS A. General Considerations B. Results IX. Alternatives Considered X. Overall Conclusion XI. Accounting Statement XII. Executive Order 12866 Appendix B—Recommendation of Update Factors for Operating Cost Rates of Payment for Inpatient Hospital Services I. Background II. Inpatient Hospital Update for FY 2007 III. Secretary’s Recommendation IV. MedPAC Recommendation for Assessing Payment Adequacy and Updating Payments in Traditional Medicare Appendix C—Combinations of Proposed Consolidated Severity-Adjusted DRGs Appendix D—Crosswalk of Proposed Consolidated Severity-Adjusted DRGs to Respective APR DRGs I. Background wwhite on PROD1PC61 with PROPOSALS2 A. Summary 1. Acute Care Hospital Inpatient Prospective Payment System (IPPS) Section 1886(d) of the Social Security Act (the Act) sets forth a system of payment for the operating costs of acute care hospital inpatient stays under Medicare Part A (Hospital Insurance) based on prospectively set rates. Section 1886(g) of the Act requires the Secretary to pay for the capital-related costs of hospital inpatient stays under a prospective payment system (PPS). Under these PPSs, Medicare payment for hospital inpatient operating and capital-related costs is made at predetermined, specific rates for each hospital discharge. Discharges are classified according to a list of diagnosis-related groups (DRGs). The base payment rate is comprised of a standardized amount that is divided VerDate Aug<31>2005 17:10 Apr 24, 2006 Jkt 208001 into a labor-related share and a nonlabor-related share. The laborrelated share is adjusted by the wage index applicable to the area where the hospital is located; and if the hospital is located in Alaska or Hawaii, the nonlabor-related share is adjusted by a cost-of-living adjustment factor. This base payment rate is multiplied by the DRG relative weight. If the hospital treats a high percentage of low-income patients, it receives a percentage add-on payment applied to the DRG-adjusted base payment rate. This add-on payment, known as the disproportionate share hospital (DSH) adjustment, provides for a percentage increase in Medicare payments to hospitals that qualify under either of two statutory formulas designed to identify hospitals that serve a disproportionate share of low-income patients. For qualifying hospitals, the amount of this adjustment may vary based on the outcome of the statutory calculations. If the hospital is an approved teaching hospital, it receives a percentage add-on payment for each case paid under the IPPS, known as the indirect medical education (IME) adjustment. This percentage varies, depending on the ratio of residents to beds. Additional payments may be made for cases that involve new technologies or medical services that have been approved for special add-on payments. To qualify, a new technology or medical service must demonstrate that it is a substantial clinical improvement over technologies or services otherwise available, and that, absent an add-on payment, it would be inadequately paid under the regular DRG payment. The costs incurred by the hospital for a case are evaluated to determine whether the hospital is eligible for an additional payment as an outlier case. This additional payment is designed to protect the hospital from large financial losses due to unusually expensive cases. Any outlier payment due is added to the DRG-adjusted base payment rate, plus any DSH, IME, and new technology or medical service add-on adjustments. Although payments to most hospitals under the IPPS are made on the basis of the standardized amounts, some categories of hospitals are paid the higher of a hospital-specific rate based on their costs in a base year (the higher of FY 1982, FY 1987, FY 1996, or FY 2002) or the IPPS rate based on the standardized amount. For example, sole community hospitals (SCHs) are the sole source of care in their areas, and Medicare-dependent, small rural hospitals (MDHs) are a major source of care for Medicare beneficiaries in their PO 00000 Frm 00007 Fmt 4701 Sfmt 4702 24001 areas. Both of these categories of hospitals are afforded this special payment protection in order to maintain access to services for beneficiaries. (Until FY 2007, an MDH has received the IPPS rate plus 50 percent of the difference between the IPPS rate and its hospital-specific rate if the hospitalspecific rate is higher than the IPPS rate. In addition, an MDH does not have the option of using FY 1996 as the base year for its hospital-specific rate. As discussed below, for discharges occurring on or after October 1, 2007, but before October 1, 2011, an MDH will receive the IPPS rate plus 75 percent of the difference between the IPPS rate and its hospital-specific rate, if the hospitalspecific rate is higher than the IPPS rate.) Section 1886(g) of the Act requires the Secretary to pay for the capital-related costs of inpatient hospital services ‘‘in accordance with a prospective payment system established by the Secretary.’’ The basic methodology for determining capital prospective payments is set forth in our regulations at 42 CFR 412.308 and 412.312. Under the capital PPS, payments are adjusted by the same DRG for the case as they are under the operating IPPS. Capital PPS payments are also adjusted for IME and DSH, similar to the adjustments made under the operating IPPS. In addition, hospitals may receive outlier payments for those cases that have unusually high costs. The existing regulations governing payments to hospitals under the IPPS are located in 42 CFR Part 412, Subparts A through M. 2. Hospitals and Hospital Units Excluded From the IPPS Under section 1886(d)(1)(B) of the Act, as amended, certain specialty hospitals and hospital units are excluded from the IPPS. These hospitals and units are: rehabilitation hospitals and units; long-term care hospitals (LTCHs); psychiatric hospitals and units; children’s hospitals; and cancer hospitals. Religious nonmedical health care institutions (RNHCIs) are also excluded from the IPPS. Various sections of the Balanced Budget Act of 1997 (Pub. L. 105–33), the Medicare, Medicaid and SCHIP [State Children’s Health Insurance Program] Balanced Budget Refinement Act of 1999 (Pub. L. 106–113), and the Medicare, Medicaid, and SCHIP Benefits Improvement and Protection Act of 2000 (Pub. L. 106–554) provide for the implementation of PPSs for rehabilitation hospitals and units (referred to as inpatient rehabilitation facilities (IRFs)), LTCHs, and psychiatric hospitals and units (referred to as E:\FR\FM\25APP2.SGM 25APP2 24002 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules inpatient psychiatric facilities (IPFs)), as discussed below. Children’s hospitals, cancer hospitals, and RNHCIs continue to be paid solely under a reasonable cost-based system. The existing regulations governing payments to excluded hospitals and hospital units are located in 42 CFR Parts 412 and 413. a. Inpatient Rehabilitation Facilities (IRFs) Under section 1886(j) of the Act, as amended, rehabilitation hospitals and units (IRFs) have been transitioned from payment based on a blend of reasonable cost reimbursement subject to a hospital-specific annual limit under section 1886(b) of the Act and the adjusted facility Federal prospective payment rate for cost reporting periods beginning on or after January 1, 2002 through September 30, 2002, to payment at 100 percent of the Federal rate effective for cost reporting periods beginning on or after October 1, 2002. IRFs subject to the blend were also permitted to elect payment based on 100 percent of the Federal rate. The existing regulations governing payments under the IRF PPS are located in 42 CFR Part 412, Subpart P. wwhite on PROD1PC61 with PROPOSALS2 b. Long-Term Care Hospitals (LTCHs) Under the authority of sections 123(a) and (c) of Pub. L. 106–113 and section 307(b)(1) of Pub. L. 106–554, LTCHs that do not meet the definition of ‘‘new’’ under § 412.23(e)(4) are being transitioned from being paid for inpatient hospital services based on a blend of reasonable cost-based reimbursement under section 1886(b) of the Act to 100 percent of the Federal rate during a 5-year period, beginning with cost reporting periods that start on or after October 1, 2002. These LTCHs that do not meet the definition of ‘‘new’’ may elect to be paid based on 100 percent of the Federal prospective payment rate instead of a blended payment in any year during the 5-year transition. For cost reporting periods beginning on or after October 1, 2006, LTCHs will be paid 100 percent of the Federal rate. The existing regulations governing payment under the LTCH PPS are located in 42 CFR Part 412, Subpart O. c. Inpatient Psychiatric Facilities (IPFs) Under the authority of sections 124(a) and (c) of Pub. L. 106–113, inpatient psychiatric facilities (IPFs) (formerly psychiatric hospitals and psychiatric units of acute care hospitals) are paid under the IPF PPS. Under the IPF PPS, some IPFs are transitioning from being paid for inpatient hospital services VerDate Aug<31>2005 17:10 Apr 24, 2006 Jkt 208001 based on a blend of reasonable costbased payment and a Federal per diem payment rate, effective for cost reporting periods beginning on or after January 1, 2005 (November 15, 2004 IPF PPS final rule (69 FR 66922) and January 23, 2006 IPF PPS proposed rule (71 FR 3616)). For cost reporting periods beginning on or after January 1, 2008, all IPFs will be paid 100 percent of the Federal per diem payment amount. The existing regulations governing payment under the IPF PPS are located in 42 CFR 412, Subpart N. 3. Critical Access Hospitals (CAHs) Under sections 1814, 1820, and 1834(g) of the Act, payments are made to critical access hospitals (CAHs) (that is, rural hospitals or facilities that meet certain statutory requirements) for inpatient and outpatient services based on 101 percent of reasonable cost. Reasonable cost is determined under the provisions of section 1861(v)(1)(A) of the Act and existing regulations under 42 CFR Parts 413 and 415. 4. Payments for Graduate Medical Education (GME) Under section 1886(a)(4) of the Act, costs of approved educational activities are excluded from the operating costs of inpatient hospital services. Hospitals with approved graduate medical education (GME) programs are paid for the direct costs of GME in accordance with section 1886(h) of the Act; the amount of payment for direct GME costs for a cost reporting period is based on the hospital’s number of residents in that period and the hospital’s costs per resident in a base year. The existing regulations governing payments to the various types of hospitals are located in 42 CFR Part 413. B. Provisions of the Deficit Reduction Act of 2005 (DRA) On February 8, 2006, the Deficit Reduction Act of 2005 (DRA), Pub. L. 109–171, was enacted. Pub. L. 109–171 made a number of changes to the Act relating to prospective payments to hospitals and other providers for inpatient services. This proposed rule would implement amendments made by the following sections of Pub. L. 109– 171: • Section 5001(a), which, effective for FY 2007 and subsequent years, expands the requirements for hospital quality data reporting. • Section 5003, which makes various improvements to the MDH program. It extends special payment provisions, requires MDHs to use FY 2002 as their base year for determining whether use of their hospital-specific rate enhances PO 00000 Frm 00008 Fmt 4701 Sfmt 4702 payment (but permits them to continue to use either their 1982 or 1987 hospitalspecific rate if using either of those rates results in higher payments), and removes the application of the 12percent cap on the DSH payment adjustment factor for MDHs. • Section 5004, which reduces certain allowable SNF bad debt payments by 30 percent. Payments for the bad debts of full-benefit, dual eligible individuals are not reduced. In this proposed rule, we also discuss and invite comments on the requirements of section 5001(b) of Pub. L. 109–171, which require us to develop a plan to implement, beginning with FY 2009, a value-based purchasing plan for section 1886(d) hospitals. This discussion also includes the provisions of section 5001(c) of Pub. L. 109–171, which requires a quality adjustment in DRG payments for certain hospitalacquired conditions, effective for FY 2008. C. Major Contents of This Proposed Rule In this proposed rule, we are setting forth proposed changes to the Medicare IPPS for operating costs and for capitalrelated costs in FY 2007. We also are setting forth proposed changes relating to payments for GME costs, payments to certain hospitals and units that continue to be excluded from the IPPS and paid on a reasonable cost basis, and payments for SCHs and MDHs. The changes being proposed would be effective for discharges occurring on or after October 1, 2006, unless otherwise noted. The following is a summary of the major changes that we are proposing to make: 1. Proposed DRG Reclassifications and Recalibrations of Relative Weights In section II. of the preamble to this proposed rule, as required by section 1886(d)(4)(C) of the Act, we are proposing limited revisions to the DRG classifications structure. In this section, we respond to several recommendations made by MedPAC intended to improve the DRG system. We are also proposing to use, for FY 2007, hospital-specific relative values for 10 cost centers to compute DRG relative weights. In addition, we are proposing to use consolidated severity-adjusted DRGs or alternative severity adjustment methods in FY 2008 (if not earlier). We also are presenting our reevaluation of certain FY 2006 applicants for add-on payments for high-cost new medical services and technologies, and our analysis of FY 2007 applicants (including public input, E:\FR\FM\25APP2.SGM 25APP2 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules (PRAs) for merged hospitals and new teaching hospitals, counting and appropriate documentation of FTE residents, and counting of resident time spent in nonpatient care activities as part of approved residency programs. • Proposed changes relating to payment for costs of nursing and allied 2. Proposed Changes to the Hospital health education programs. Wage Index • Proposed changes relating to In section III. of the preamble to this requirements for emergency services for proposed rule, we are proposing hospitals under EMTALA. revisions to the wage index and the • Discussion of the third year of annual update of the wage data. Specific implementation of the Rural issues addressed include the following: Community Hospital Demonstration • The FY 2007 wage index update, Program. using wage data from cost reporting We also are inviting comments on periods that began during FY 2003. promoting hospitals’ effective use of • The proposed FY 2007 occupational health information technology. mix adjustment to the wage index. • The proposed revisions to the wage 4. Proposed Changes to the PPS for Capital-Related Costs index based on hospital redesignations and reclassifications. In section V. of the preamble to this • The proposed adjustment to the proposed rule, we discuss the payment wage index for FY 2007 based on policy requirements for capital-related commuting patterns of hospital costs and capital payments to hospitals employees who reside in a county and and propose several technical work in a different area with a higher corrections to the regulations. wage index. 5. Proposed Changes for Hospitals and • The timetable for reviewing and Hospital Units Excluded From the IPPS verifying the wage data that will be in In section VI. of the preamble to this effect for the proposed FY 2007 wage proposed rule, we discuss payments to index. • The labor-related share for the FY excluded hospitals and hospital units, 2007 wage index, including the laborproposed policy changes regarding related share for Puerto Rico. increases or decreases in square footage or decreases in the number of beds of 3. Other Decisions and Proposed the ‘‘grandfathering’’ HwHs and satellite Changes to the IPPS for Operating Costs, facilities, proposed changes to the GME Costs, and Promoting Hospitals’ methodology for determining LTCH Effective Use of Health Information CCRs and the reconciliation of high-cost Technology and short-stay outlier payments under In section IV. of the preamble to this the LTCH PPS, and a proposed technical proposed rule, we discuss a number of change relating to the designation of provisions of the regulations in 42 CFR CAHs as necessary providers. Parts 412 and 413 including the 6. Payments for Services Furnished following: Outside the United States • The reporting of hospital quality data as a condition for receiving the full In section VII. of the preamble to this annual payment update increase. proposed rule, we set forth proposed • Proposed changes in payments to changes to clarify what is considered SCHs and MDHs. ‘‘outside the United States’’ for • Proposed updated national and Medicare payment purposes. regional case-mix values and discharges 7. Payment for Blood Clotting Factor for purposes of determining rural Administered to Inpatients With referral center status. Hemophilia • The statutorily-required IME adjustment factor for FY 2007. In section VIII. of the preamble to this • Proposed changes relating to proposed rule, we discuss the proposed hospitals’ geographic classifications, changes in payment for blood clotting including reclassifications under section factor administered to Medicare 508 of Pub. L. 108–173, multicampus beneficiaries with hemophilia for FY hospitals, urban group hospital 2007. reclassification and the effect of change 8. Limitation on Payments to Skilled in ownership on urban county group Nursing Facilities for Bad Debt reclassifications. In section IX. of the preamble to this • Proposed changes and clarifications proposed rule, we propose to implement relating to GME that address section 5004 of Pub. L. 109–171 relating determining the per resident amounts wwhite on PROD1PC61 with PROPOSALS2 as directed by Pub. L. 108–173, obtained in a town hall meeting). We are proposing the annual update of the long-term care diagnosis-related group (LTC–DRG) classifications and relative weights for use under the LTCH PPS for FY 2007. VerDate Aug<31>2005 17:10 Apr 24, 2006 Jkt 208001 PO 00000 Frm 00009 Fmt 4701 Sfmt 4702 24003 to reduction in payments to SNFs for bad debt. 9. Determining Proposed Prospective Payment Operating and Capital Rates and Rate-of-Increase Limits In the Addendum to this proposed rule, we set forth proposed changes to the amounts and factors for determining the FY 2007 prospective payment rates for operating costs and capital-related costs. We also establish the proposed threshold amounts for outlier cases. In addition, we address the proposed update factors for determining the rateof-increase limits for cost reporting periods beginning in FY 2007 for hospitals and hospital units excluded from the PPS. 10. Impact Analysis In Appendix A of this proposed rule, we set forth an analysis of the impact that the proposed changes would have on affected hospitals. 11. Recommendation of Update Factors for Operating Cost Rates of Payment for Inpatient Hospital Services In Appendix B of this proposed rule, as required by sections 1886(e)(4) and (e)(5) of the Act, we provided our recommendations of the appropriate percentage changes for FY 2007 for the following: • A single average standardized amount for all areas for hospital inpatient services paid under the IPPS for operating costs (and hospital-specific rates applicable to SCHs and MDHs). • Target rate-of-increase limits to the allowable operating costs of hospital inpatient services furnished by hospitals and hospital units excluded from the IPPS. 12. Discussion of Medicare Payment Advisory Commission Recommendations Under section 1805(b) of the Act, MedPAC is required to submit a report to Congress, no later than March 1 of each year, in which MedPAC reviews and makes recommendations on Medicare payment policies. MedPAC’s March 2006 recommendation concerning hospital inpatient payment policies addressed the update factor for inpatient hospital operating costs and capital-related costs under the IPPS and for hospitals and distinct part hospital units excluded from the IPPS. This recommendation is addressed in Appendix B of this proposed rule. For further information relating specifically to the MedPAC March 2006 reports or to obtain a copy of the reports, contact MedPAC at (202) 220–3700 or visit E:\FR\FM\25APP2.SGM 25APP2 24004 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules MedPAC’s Web site at: www.medpac.gov. 13. Appendix C and Appendix D In Appendix C of this proposed rule, we list the combinations of the consolidated severity-adjusted DRGs that we are proposing to implement on FY 2008 (if not earlier), as discussed in section II.C. of the preamble of this proposed rule. In Appendix D of this proposed rule, we provide a crosswalk of the proposed consolidated severityadjusted DRG system to the respective All Patient Related Diagnosis-Related Group (APR DRG) system. II. Proposed Changes to DRG Classifications and Relative Weights (If you choose to comment on issues in this section, please include the caption ‘‘DRG Reclassifications’’ at the beginning of your comment.) A. Background Section 1886(d) of the Act specifies that the Secretary shall establish a classification system (referred to as DRGs) for inpatient discharges and adjust payments under the IPPS based on appropriate weighting factors assigned to each DRG. Therefore, under the IPPS, we pay for inpatient hospital services on a rate per discharge basis that varies according to the DRG to which a beneficiary’s stay is assigned. The formula used to calculate payment for a specific case multiplies an individual hospital’s payment rate per case by the weight of the DRG to which the case is assigned. Each DRG weight represents the average resources required to care for cases in that particular DRG, relative to the average resources used to treat cases in all DRGs. Congress recognized that it would be necessary to recalculate the DRG relative weights periodically to account for changes in resource consumption. Accordingly, section 1886(d)(4)(C) of the Act requires that the Secretary adjust the DRG classifications and relative weights at least annually. These adjustments are made to reflect changes in treatment patterns, technology, and any other factors that may change the relative use of hospital resources. B. DRG Reclassifications 1. General For FY 2007, we are proposing only limited changes to the current DRG classifications, as discussed in section II.D. of the preamble to this proposed rule, that would be applicable to discharges occurring on or after October 1, 2006. We are limiting our proposed changes because, as discussed in detail in section II.C. of the preamble to this proposed rule, we are focusing our efforts on addressing the recommendations made last year by MedPAC to refine the entire CMS DRG system by taking into account severity of illness (if not earlier) and applying hospital-specific relative value (HSRV) weights to DRGs. Currently, cases are classified into CMS DRGs for payment under the IPPS based on the principal diagnosis, up to eight additional diagnoses, and up to six procedures performed during the stay. In a small number of DRGs, classification is also based on the age, sex, and discharge status of the patient. The diagnosis and procedure information is reported by the hospital using codes from the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD–9– CM). The process of forming the DRGs was begun by dividing all possible principal diagnoses into mutually exclusive principal diagnosis areas, referred to as Major Diagnostic Categories (MDCs). The MDCs were formed by physician panels as the first step toward ensuring that the DRGs would be clinically coherent. The diagnoses in each MDC correspond to a single organ system or etiology and, in general, are associated with a particular medical specialty. Thus, in order to maintain the requirement of clinical coherence, no final DRG could contain patients in different MDCs. Most MDCs are based on a particular organ system of the body. For example, MDC 6 is Diseases and Disorders of the Digestive System. This approach is used because clinical care is generally organized in accordance with the organ system affected. However, some MDCs are not constructed on this basis because they involve multiple organ systems (for example, MDC 22 (Burns)). For FY 2006, cases are assigned to one of 526 DRGs in 25 MDCs. The table below lists the 25 MDCs. wwhite on PROD1PC61 with PROPOSALS2 MAJOR DIAGNOSTIC CATEGORIES (MDCS) 1 ................................... 2 ................................... 3 ................................... 4 ................................... 5 ................................... 6 ................................... 7 ................................... 8 ................................... 9 ................................... 10 ................................. 11 ................................. 12 ................................. 13 ................................. 14 ................................. 15 ................................. 16 ................................. 17 ................................. 18 ................................. 19 ................................. 20 ................................. 21 ................................. 22 ................................. 23 ................................. 24 ................................. 25 ................................. VerDate Aug<31>2005 Diseases and Disorders of the Nervous System. Diseases and Disorders of the Eye. Diseases and Disorders of the Ear, Nose, Mouth, and Throat. Diseases and Disorders of the Respiratory System. Diseases and Disorders of the Circulatory System. Diseases and Disorders of the Digestive System. Diseases and Disorders of the Hepatobiliary System and Pancreas. Diseases and Disorders of the Musculoskeletal System and Connective Tissue. Diseases and Disorders of the Skin, Subcutaneous Tissue and Breast. Endocrine, Nutritional and Metabolic Diseases and Disorders. Diseases and Disorders of the Kidney and Urinary Tract. Diseases and Disorders of the Male Reproductive System. Diseases and Disorders of the Female Reproductive System. Pregnancy, Childbirth, and the Puerperium. Newborns and Other Neonates with Conditions Originating in the Perinatal Period. Diseases and Disorders of the Blood and Blood Forming Organs and Immunological Disorders. Myeloproliferative Diseases and Disorders and Poorly Differentiated Neoplasms. Infectious and Parasitic Diseases (Systemic or Unspecified Sites). Mental Diseases and Disorders. Alcohol/Drug Use and Alcohol/Drug Induced Organic Mental Disorders. Injuries, Poisonings, and Toxic Effects of Drugs. Burns. Factors Influencing Health Status and Other Contacts with Health Services. Multiple Significant Trauma. Human Immunodeficiency Virus Infections. 17:10 Apr 24, 2006 Jkt 208001 PO 00000 Frm 00010 Fmt 4701 Sfmt 4702 E:\FR\FM\25APP2.SGM 25APP2 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules In general, cases are assigned to an MDC based on the patient’s principal diagnosis before assignment to a DRG. However, for FY 2006, there are nine DRGs to which cases are directly assigned on the basis of ICD–9–CM procedure codes. These DRGs are for heart transplant or implant of heart assist systems, liver and/or intestinal transplants, bone marrow transplants, lung transplants, simultaneous pancreas/kidney transplants, and 24005 pancreas transplants, and for tracheostomies. Cases are assigned to these DRGs before they are classified to an MDC. The table below lists the nine current pre-MDCs. PRE-MAJOR DIAGNOSTIC CATEGORIES (PRE-MDCS) DRG DRG DRG DRG DRG DRG DRG DRG 103 480 481 482 495 512 513 541 ...................... ...................... ...................... ...................... ...................... ...................... ...................... ...................... wwhite on PROD1PC61 with PROPOSALS2 DRG 542 ...................... Heart Transplant or Implant of Heart Assist System. Liver Transplant and/or Intestinal Transplant. Bone Marrow Transplant. Tracheostomy for Face, Mouth, and Neck Diagnoses. Lung Transplant. Simultaneous Pancreas/Kidney Transplant. Pancreas Transplant. ECMO or Tracheostomy with Mechanical Ventilation 96+ Hours or Principal Diagnosis Except for Face, Mouth, and Neck Diagnosis with Major O.R. Tracheostomy with Mechanical Ventilation 96+ Hours or Principal Diagnosis Except for Face, Mouth, and Neck Diagnosis without Major O.R. Once the MDCs were defined, each MDC was evaluated to identify those additional patient characteristics that would have a consistent effect on the consumption of hospital resources. Because the presence of a surgical procedure that required the use of the operating room would have a significant effect on the type of hospital resources used by a patient, most MDCs were initially divided into surgical DRGs and medical DRGs. Surgical DRGs are based on a hierarchy that orders operating room (O.R.) procedures or groups of O.R. procedures by resource intensity. Medical DRGs generally are differentiated on the basis of diagnosis and age (0 to 17 years of age or greater than 17 years of age). Some surgical and medical DRGs are further differentiated based on the presence or absence of a complication or a comorbidity (CC). Generally, nonsurgical procedures and minor surgical procedures that are not usually performed in an operating room are not treated as O.R. procedures. However, there are a few non-O.R. procedures that do affect DRG assignment for certain principal diagnoses, for example, extracorporeal shock wave lithotripsy for patients with a principal diagnosis of urinary stones. Once the medical and surgical classes for an MDC were formed, each class of diagnoses was evaluated to determine if complications, comorbidities, or the patient’s age would consistently affect the consumption of hospital resources. Physician panels classified each diagnosis code based on whether the diagnosis, when present as a secondary condition, would be considered a substantial CC. A substantial CC was defined as a condition which, because of its presence with a specific principal diagnosis, would cause an increase in the length of stay by at least one day in VerDate Aug<31>2005 17:10 Apr 24, 2006 Jkt 208001 at least 75 percent of the patients. Each medical and surgical class within an MDC was tested to determine if the presence of any substantial CC would consistently affect the consumption of hospital resources. A patient’s diagnosis, procedure, discharge status, and demographic information is fed into the Medicare claims processing systems and subjected to a series of automated screens called the Medicare Code Editor (MCE). The MCE screens are designed to identify cases that require further review before classification into a DRG. After patient information is screened through the MCE and any further development of the claim is conducted, the cases are classified into the appropriate DRG by the Medicare GROUPER software program. The GROUPER program was developed as a means of classifying each case into a DRG on the basis of the diagnosis and procedure codes and, for a limited number of DRGs, demographic information (that is, sex, age, and discharge status). After cases are screened through the MCE and assigned to a DRG by the GROUPER, the PRICER software calculates a base DRG payment. The PRICER calculates the payment for each case covered by the IPPS based on the DRG relative weight and additional factors associated with each hospital, such as IME and DSH adjustments. These additional factors increase the payment amount to hospitals above the base DRG payment. The records for all Medicare hospital inpatient discharges are maintained in the Medicare Provider Analysis and Review (MedPAR) file. The data in this file are used to evaluate possible DRG classification changes and to recalibrate the DRG weights. However, in the July PO 00000 Frm 00011 Fmt 4701 Sfmt 4702 30, 1999 IPPS final rule (64 FR 41500), we discussed a process for considering non-MedPAR data in the recalibration process. In order for us to consider using particular non-MedPAR data, we must have sufficient time to evaluate and test the data. The time necessary to do so depends upon the nature and quality of the non-MedPAR data submitted. Generally, however, a significant sample of the non-MedPAR data should be submitted by midOctober for consideration in conjunction with the next year’s proposed rule. This allows us time to test the data and make a preliminary assessment as to the feasibility of using the data. Subsequently, a complete database should be submitted by early December for consideration in conjunction with the next year’s proposed rule. The limited changes that we are proposing to the DRG classification system for FY 2007 for the FY 2007 GROUPER, version 24.0 and to the methodology used to recalibrate the DRG weights are set forth under section II.E. of this proposed rule. Unless otherwise noted in this proposed rule, our DRG analysis is based on data from the December 2005 update of the FY 2005 MedPAR file, which contains hospital bills received through December 31, 2005, for discharges occurring in FY 2005. 2. Yearly Review for Making DRG Changes Many of the changes to the DRG classifications are the result of specific issues brought to our attention by interested parties. We encourage individuals with concerns about DRG classifications to bring those concerns to our attention in a timely manner so they can be carefully considered for possible E:\FR\FM\25APP2.SGM 25APP2 24006 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules inclusion in the annual proposed rule and, if included, may be subjected to public review and comment. Therefore, similar to the timetable for interested parties to submit non-MedPAR data for consideration in the DRG recalibration process, concerns about DRG classification issues should be brought to our attention no later than early December in order to be considered and possibly included in the next annual proposed rule updating the IPPS. The actual process of forming the DRGs was, and continues to be, highly iterative, involving a combination of statistical results from test data combined with clinical judgment. For purposes of this proposed rule, in deciding whether to create a separate DRG, we consider whether the resource consumption and clinical characteristics of the patients with a given set of conditions are significantly different than the remaining patients in the existing DRG. We evaluate patient care costs using average charges and lengths of stay as proxies for costs and rely on the judgment of our medical officers to decide whether patients are clinically distinct or similar to other patients in the DRG. In evaluating resource costs, we consider both the absolute and percentage differences in average charges between the cases we are selecting for review and the remainder of cases in the DRG. We also consider variation in charges within these groups; that is, whether observed average differences are consistent across patients or attributable to cases that are extreme in terms of charges or length of stay, or both. Further, we also consider the number of patients who will have a given set of characteristics and generally prefer not to create a new DRG unless it will include a substantial number of cases. C. Proposals for Revisions to the DRG System Used Under the IPPS wwhite on PROD1PC61 with PROPOSALS2 1. MedPAC Recommendations In the FY 2006 IPPS final rule, we discussed a number of recommendations made by MedPAC regarding revisions to the DRG system used under the IPPS (70 FR 47473 through 47482). In Recommendation 1–3 in the 2005 Report to Congress on Physician-Owned Specialty Hospitals, MedPAC recommended that CMS: • Refine the current DRGs to more fully capture differences in severity of illness among patients, including— • Base the DRG relative weights on the estimated cost of providing care. • Base the weights on the national average of the hospital-specific relative VerDate Aug<31>2005 17:10 Apr 24, 2006 Jkt 208001 values (HSRVs) for each DRG (using hospital-specific costs to derive the HSRVs). • Adjust the DRG relative weights to account for differences in the prevalence of high-cost outlier cases. • Implement the case-mix measurement and outlier policies over a transitional period. As we noted in the FY 2006 IPPS final rule, we had insufficient time to complete a thorough evaluation of these recommendations for full implementation in FY 2006. However, we did adopt severity-weighted cardiac DRGs in FY 2006 to address public comments on this issue and the specific concerns of MedPAC regarding cardiac surgery DRGs. We also indicated that we planned to further consider all of MedPAC’s recommendations and thoroughly analyze options and their impacts on the various types of hospitals in the FY 2007 IPPS proposed rule. Following the publication of the FY 2006 IPPS final rule, we contracted with 3M Health Information Systems to assist us in performing this analysis. Beginning with MedPAC’s relative weight recommendations, we analyzed MedPAC’s recommendations to move to a cost-based HSRV weighting methodology. In performing this portion of the analysis, we studied hospital cost report data, departmental cost-to-charge ratios (CCRs), MedPAR claims data, and HSRV weighting methodology. Our intention in undertaking this portion of the analysis was to find an administratively feasible approach to improving the accuracy of the DRG weights. As we describe in detail below, we believe some changes can be made to MedPAC’s methodology for determining the relative weights that will make it more feasible to replicate on an annual basis but will result in similar impacts. In conjunction with analyzing MedPAC’s relative weight recommendations, we looked at refining the current DRG system to better recognize severity of illness. Starting with the APR DRG GROUPER used by MedPAC in its analysis, we studied Medicare claims data. Based on this analysis, we developed a consolidated severity-adjusted DRG GROUPER that we believe could be a better alternative for recognizing severity of illness among the Medicare population. We note that MedPAC’s recommendations with regard to revising the DRGs to better recognize severity of illness may have implications for the outlier threshold, the measurement of real case-mix versus apparent case-mix, and the IME and the DSH adjustments. We will discuss these PO 00000 Frm 00012 Fmt 4701 Sfmt 4702 implications in more detail in the following sections. As we present below, we believe that the recommendations made by MedPAC, or some variants of them, have significant promise to improve the accuracy of the payment rates in the IPPS. For instance, the percent of DRGs with payment-to-cost ratios between 0.95 and 1.05 will increase substantially from adoption of these recommendations.1 We agree with MedPAC about exploring possible refinements to our payment methodology even in the absence of concerns about the proliferation of specialty hospitals. In the FY 2006 final rule, we indicated that until we had completed further analysis of the options and their effects, we could not predict the extent to which changing to APR DRGs would provide payment equity between specialty and general hospitals. In fact, we cautioned that any system that groups cases will always present some opportunities for providers to specialize in cases they believe to have higher margins. We believe that improving payment accuracy should reduce these opportunities, and potentially reduce the incentives that Medicare payments may provide for the further development of specialty hospitals. We considered MedPAC’s recommendation to adjust the relative weights to account for differences in the prevalence of outlier cases. However, we placed most of our attention and resources on the recommendations related to refinement of the current DRGs to more fully capture differences in severity of illness among patients as we do not have the statutory authority to make the specific changes to our outlier policy that MedPAC recommended. While we have not made MedPAC’s recommendation regarding outliers a central focus of our analysis, we do intend to examine this issue in more detail in the future. In the following sections II.C.2. through C.6. of this proposed rule, we present our analysis and discuss a number of issues related to the MedPAC recommendations. We also present the estimated impacts of implementing the recommendations and conclude with a specific proposal for FY 2007 and some proposed intended actions for implementation for FY 2008. We also are soliciting comments on other possible proposals or actions in FY 2007, FY 2008, or a combination of both. 1 Medicare Payment Advisory Commission: Report to the Congress; Physician-Owned Specialty Hospitals, March 2005, p. 37. E:\FR\FM\25APP2.SGM 25APP2 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules wwhite on PROD1PC61 with PROPOSALS2 2. Refinement of the Relative Weight Calculation (If you choose to comment on issues in this section, please include the caption ‘‘HSRV Weights’’ at the beginning of your comment.) MedPAC made two recommendations with respect to the DRG relative weight calculation. First, MedPAC recommended that CMS base the DRG relative weights on the estimated cost of providing care. Second, MedPAC recommended that CMS base the weights on the national average of the HSRVs in each DRG (using hospitalspecific costs to derive the HSRVs). Because both of these recommendations address the relative weight calculation, we are addressing them together. The work we have done to address these recommendations is discussed below. MedPAC recommended that CMS replace its charge-based relative weight methodology with cost-based HSRV weights as it believed that the chargebased relative weight methodology that CMS has utilized since 1983 has introduced bias into the weights due to differential markups for ancillary services among the DRGs. In analyzing claims data, it is evident to us that some hospital types (for example, teaching hospitals) are systematically more expensive overall than the average hospital and certain case types are more commonly treated at these more expensive facilities. This fact results in an upward bias in the weights for these types of cases. The HSRV methodology recommended by MedPAC would help reduce the bias that may be present in the national relative weights due to differences in case-mix adjusted costs. Under the HSRV method recommended by MedPAC, charges are standardized for each provider by converting its charges for each case to hospital-specific relative charge values and then adjusting those values for the hospital’s case-mix. The first step in this process involves dividing the charge for each case at the hospital by the average charge for all cases at the hospital in which the case was treated. The hospital-specific relative charge value, by definition, averages 1.0 for each hospital. The resulting ratio is then multiplied by the hospital’s case-mix index (CMI). In this way, each hospital’s relative charge value is adjusted by its case-mix to an average that reflects the complexity of the cases it treats relative to the complexity of the cases treated by all other hospitals. Our analysis of departmental-level CCRs from the Medicare cost report data has shown that charges for routine days, intensive care days, and various VerDate Aug<31>2005 17:10 Apr 24, 2006 Jkt 208001 ancillary services are not marked up by a consistent amount. For example, the markup amounts for cardiology services are higher than average. Because charges are the current basis for the DRG relative weights, the practice of differential markups can lead to bias in the DRG weights because various DRGs use, on average, more or less of particular ancillary services. MedPAC believes that the bias in the national DRG relative weights that may arise as a result of differential markups across various cost centers can be removed by moving from charge-based to cost-based weights. Based on the analysis we have conducted, we agree that it may be appropriate to adjust the DRG relative weights to account for the differences in charge markups across cost centers and to adopt an HSRV methodology. However, we have several concerns about the methodology used by MedPAC. MedPAC’s methodology to reduce hospital charges to cost is administratively burdensome, not only to develop, but also to maintain. First, MedPAC developed CCRs for individual hospitals at the most detailed department level. Specifically, in calculating costs as the basis for the relative weights, MedPAC applied hospital-specific CCRs from each provider’s cost report to the line item charges on the claims that the hospital submitted during the same time period. This methodology required matching cost report data to claims data, and because cost report data take longer to compile and file, the method necessitates using older claims data to set relative weights. The most recent complete set of Medicare cost reports available to us is from FY 2003. Thus, if we were to model the exact approach used by MedPAC and use claims data for a matching year, we would be using claims data from FY 2003. If we set DRG weights for FY 2007 using our current charge-based method, we would use FY 2005 hospital claims to set the proposed relative weights. In addition, MedPAC’s hospital-specific approach required detailed cost center distinctions for each hospital that are difficult to define, map, and apply. This approach also required the use of the Standard Analytic File (SAF) because MedPAR data that we currently use to set DRG weights did not have the necessary level of detail. Using the SAF increases processing time and adds further complexity to the process of setting the relative weights. Second, because MedPAC applied these CCRs at the individual claim level, missing or invalid data resulted in MedPAC deleting a large number of claims (approximately 10 percent) from PO 00000 Frm 00013 Fmt 4701 Sfmt 4702 24007 the relative weight calculation. Lastly, MedPAC acknowledged that its method was too difficult to replicate on an annual basis and suggested that the weights be recalculated once every 5 years with other adjustments based on charges during the intervening years. We have developed an alternative to MedPAC’s approach that we believe would achieve similar results in a more administratively feasible manner. This method involves developing hospitalspecific charge relative weights at the cost center level to remove the bias introduced by hospital characteristics (that is, teaching, disproportionate share, location, and size, among others) and then scaling the weights to costs using the national cost center charge ratios developed from the cost report data. After studying Medicare cost report data, we established 10 cost center categories based upon broad hospital accounting definitions. In our cost center categories, there are 8 ancillary cost groups in addition to routine day costs and intensive care day costs, and each category represents at least 5 percent of the charges in the claims data. The specific cost report lines that contribute to each category and the corresponding charge lines from the MedPAR claims data are itemized in Table A below. We believe this alternative approach, which we are labeling as the HSRV cost center (HSRVcc) methodology, has several advantages. First, the use of national average rather than hospitalspecific CCRs avoids the complexity encountered with cost center CCRs at the hospital level and allows us to retain more data for use in the relative weight calculation. In addition, the methodology eliminates the need to match claims to the time period of the CCRs, resulting in the ability to use more timely claims data. Furthermore, the alternative approach makes it more feasible to update the relative weights annually using a single methodology. We do not have to replicate the methodology once every 5 years and make adjustments based on changes in charges in the intervening years. In developing an alternative method of calculating DRG weights, we utilized two data sources: claims data and cost report data. The claims data are taken from the FY 2004 MedPAR file. This file is based on fully coded diagnostic and procedure data for all Medicare inpatient hospital bills. The FY 2004 MedPAR data include discharges occurring between October 1, 2003, and September 30, 2004, based on bills received by CMS through March 30, 2005, from all hospitals subject to the IPPS. The full FY 2004 MedPAR file E:\FR\FM\25APP2.SGM 25APP2 24008 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules wwhite on PROD1PC61 with PROPOSALS2 includes data for approximately 13,673,607 Medicare discharges. We excluded discharges for Medicare beneficiaries enrolled in a Medicare+Choice managed care plan from the analysis. In addition, we excluded data for any hospital that was paid under the IPPS during FY 2004 but became a CAH at any time before February 28, 2005; data from IPFs, IRFs, and LTCHs; data from Maryland hospitals; data from Indian Health Service hospitals; and data from allinclusive rate providers. The Medicare cost report data used in the analysis were from FY 2003, the most recent full set of data available. Under our alternative methodology, we calculated DRG weights from MedPAR and cost report data as follows: a. Step One: Clean the Data (1) All of the claims were grouped using Version 23.0 of the CMS DRGs. • The transplant cases that were used to establish the alternative relative weights for heart and heart-lung, liver and/or intestinal, and lung transplants (DRGs 103, 480, and 495 under the current Version 23.0 GROUPER) were limited to those Medicare-approved transplant centers that have cases in the FY 2004 MedPAR file. (Medicare coverage for heart, heart and lung, liver and/or intestinal, and lung transplants is limited to those facilities that have received approval from CMS as transplant centers.) • Organ acquisition for kidney, heart, heart-lung, liver, lung, pancreas, and intestinal (or multivisceral organs) transplants continue to be paid on a reasonable cost basis. Because these acquisition costs are paid separately from the prospective payment rate, it is necessary to subtract the acquisition charges from the total charges on each transplant bill that showed acquisition charges before adjusting the charges under the HSRVcc methodology and before eliminating statistical outliers. (2) The FY 2004 MedPAR data were edited to exclude claims for hospitals with no cost report data. Claims with total charges or total length of stay less than or equal to zero were eliminated. Claims that had an amount in the total charge field that differed by more or less than $10 from the sum of charges for routine days, intensive care, pharmacy, special equipment, therapy, operating room, cardiology, laboratory, radiology, and other services were deleted. In addition, we deleted claims for providers that had charges only in the routine days and intensive care days cost centers and had no charges in any of the eight ancillary cost centers. These claims were deleted because we believe VerDate Aug<31>2005 17:10 Apr 24, 2006 Jkt 208001 the charges for the eight ancillary cost centers were included in the routine days and intensive care days cost centers. Had we included these claims, the charges for the routine days and intensive care days would have been inflated. After applying these edits, we identified 11,142,651 claims that we used in this analysis. (3) Statistical outliers were eliminated by removing all cases that were beyond 3.0 standard deviations from the mean of the log distribution of both the charges per case and the charges per day for each DRG. b. Step Two: Compute HSRVs for Each Cost Center for Each DRG Once the MedPAR data were edited, we sorted the data by provider so that charges could be standardized under the HSRVcc methodology. To do this, an average charge was computed for each provider for each of 10 proposed cost centers (see Table A). The average charge was computed by summing the charges for each cost center and dividing by the transfer-adjusted case count for each provider. A transfer case, identified by discharge code, DRG, and length of stay, was counted as a fraction of a case based on the ratio of its length of stay plus 1 day relative to the geometric mean length of stay for that DRG. That is, a transfer case with a length of stay of 2 days in a DRG with a geometric mean length of stay of 6 days would be counted as 3 (2 days plus 1 extra day) divided by 6 or 0.5 of a total case. This treatment of transfer cases is consistent with payment rules. After computing the average charge for each provider for each cost center, the cost center charges on each claim were divided by the provider’s average charge for the matching cost center across all services. For example, the routine day charges on each individual claim were divided by the average routine day charge for the provider across all services, the intensive care unit charges on the same claim were divided by the average intensive care unit charge for the provider across all services, and so on. By using a hospital’s relative charge structure, we found that the resulting weights did not reflect differences in charges among providers for factors such as location, size, wages, relative efficiency, average markup, IME adjustment, DSH adjustment, and the variety of cases treated. Therefore, once charge weights were computed at the hospital cost center level, they were multiplied by the provider’s CMI. We made this adjustment for the CMI to rescale the hospital-specific relative charge values which, by definition, PO 00000 Frm 00014 Fmt 4701 Sfmt 4702 averaged to 1.0 for each cost center. We believed that the CMI was a reasonable scale factor to use to further adjust the relative charges to reflect the complexity of cases treated by the provider. We assigned a starting CMI of 1 to the cost center for each provider. However, an alternative starting CMI could have been assigned because the algorithm is not sensitive to starting values of CMI. After the relative charges (cost center claim charge divided by the average cost center charge for the provider) were multiplied by the hospital’s matching cost center CMI, they were summed by DRG. The transfer adjusted case count for each DRG was also summed. Average charges by DRG were calculated for each cost center by taking the sum of the relative CMI-adjusted charges for that DRG and dividing by the transfer-adjusted case count for that DRG. A national average charge for each cost center was calculated summing all relative CMI-adjusted charges in the trimmed MedPAR data set and dividing by the total transfer-adjusted case count. We then created a set of cost center DRG weights by dividing the national average charge for each DRG for each cost center by the national average charge for that cost center. The result was a set of 10 weights for each DRG. These 10 weights are then assigned to each claim, and a new CMI is created for each provider. Then the relative charges for each cost center on the claim (total charge for cost center is divided by the provider’s average charge for that cost center) are multiplied by this new CMI and the weights are iterated until the national average CMI for each cost center stops changing between iterations. In preparing the proposed weights for their simulation, we used a transfer-adjusted CMI that was computed by taking the sum of the transfer-adjusted weights and dividing by a full case count, where the transfer-adjusted weight is computed by multiplying the transfer-adjusted case count (length of stay for the claim plus 1 day divided by geometric mean length of stay for the DRG) by the DRG weight. Table A below illustrates the charge line items from MedPAR that were included in each cost center charge group. In addition, it shows the corresponding line items from Worksheet C, Part 1, columns 5, 6, and 7 of the Medicare cost reports. The name of each cost report line item appears as it is listed in the Hospital Cost Report Information System (HCRIS) cost report database record layout which is available for download via the Web site: www.cms.hhs.gov. BILLING CODE 4120–01–P E:\FR\FM\25APP2.SGM 25APP2 VerDate Aug<31>2005 17:10 Apr 24, 2006 Jkt 208001 PO 00000 Frm 00015 Fmt 4701 Sfmt 4725 E:\FR\FM\25APP2.SGM 25APP2 24009 EP25AP06.000</GPH> wwhite on PROD1PC61 with PROPOSALS2 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules wwhite on PROD1PC61 with PROPOSALS2 c. Step Three: Compute CCRs From the Cost Reports for Each of the 10 Cost Center Groups Identified in Table A After the iteration process was completed, we removed the effects of differential markups within cost centers. The first step in this process was to develop national cost center CCRs. Taking FY 2003 cost report data, we edited the data to remove data for CAHs, IPFs, IRFs, LTCHs, Maryland hospitals, Indian Health Service hospitals, and all VerDate Aug<31>2005 17:10 Apr 24, 2006 Jkt 208001 inclusive rate hospitals, and cost reports that represented time periods of less than 1 year (365 days). We then created CCRs for each provider for each group of cost centers (see Table A for line items used in the calculations) while removing any cost center CCRs that were greater than 10 or less than .01, as we believe that these CCRs are outside of a reasonable range. We then took the logs of all of the cost center CCRs and removed any cost center CCRs where the log of the cost center CCR was PO 00000 Frm 00016 Fmt 4701 Sfmt 4702 greater or less than the mean log plus/ minus 1.96 standard deviations of the log of that cost center CCR. We used 1.96 standard deviations as a trim factor because the logs of the cost center CCRs are normally distributed and 1.96 standard deviations represent the 95th percentile of the T-Distribution for large sample size, for which 2,000 to 3,000 hospitals qualify. Once the cost report data were trimmed, we calculated the geometric mean CCR for each cost center. E:\FR\FM\25APP2.SGM 25APP2 EP25AP06.001</GPH> 24010 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules d. Step Four: Sum the Average Charge for Each Cost Center From the MedPAR Data and Apply the National CCRs From the MedPAR File Once the national average CCRs from Step Three were computed, they were multiplied by the total unadjusted charges for the matching cost centers in the MedPAR file. The estimated costs were then summed to derive a total cost for all cases across the Nation. The percentage that each cost center was contributing to the overall total costs is calculated by dividing the individual cost center cost by the total. For example, the total cost for routine days was divided by the total cost for all cases to arrive at 0.29, which indicated that routine costs were responsible for approximately 29 percent of total costs. The 10 scaling factors sum to 1.0. e. Step Five: Adjust Relative Weights From Step Two to Cost by Applying Scaling Factors From Step Four For each DRG, the cost center weights are multiplied by these scaling factors (that is, the routine day weight is multiplied by the routine day scaling factor, the intensive care unit weight is multiplied by the intensive care unit scaling factor, and so on). After the weights are adjusted by the scaling factor, they are summed by DRG to create one final weight for each DRG. wwhite on PROD1PC61 with PROPOSALS2 f. Step Six: Normalize the Weights In order to compare the weights calculated in Step Five to the chargebased weights that are in effect in FY 2006, the weights were normalized by the FY 2006 normalization factor of 1.47462 (70 FR 47332). This factor was applied to the charge-based weights from FY 2006 to ensure that recalibration by itself neither increases nor decreases total payments under the IPPS. We used the same normalization factor that we applied for purposes of calculating the DRG relative weights in the FY 2006 IPPS final rule because we used the same FY 2004 MedPAR data and FY 2003 cost report data that we used to set the FY 2006 DRG relative weights. We note that we likely will have more recent data available when we determine the DRG relative weights for the FY 2007 IPPS final rule. 3. Refinement of DRGs Based on Severity of Illness (If you choose to comment on issues in this section, please include the caption ‘‘DRGs: Severity of Illness’’ at the beginning of your comment.) For purposes of the following discussions, the term ‘‘CMS DRGs’’ means the DRG system we currently use under the IPPS; the term ‘‘APR DRGs’’ VerDate Aug<31>2005 17:10 Apr 24, 2006 Jkt 208001 means the severity DRG system designed by 3M Health Information Systems that currently is used by the State of Maryland; and the term ‘‘consolidated severity-adjusted DRGs’’ means the DRG system based on a consolidated version of the APR DRGs (as described in detail below). Although we discuss the consolidated severityadjusted DRGs in this proposed rule, we are interested in public comments on whether there are alternative DRG systems that could result in better recognition of severity than the consolidated severity-adjusted DRGs we are proposing. We refer to adopting consolidated severity-adjusted DRGs numerous times in this proposed rule. As we make clear in the detailed discussion below, there are still further changes that we believe may be important to make to this proposed system before it is ready for adoption. In the remainder of this proposed rule, ‘‘consolidated severity-adjusted DRGs’’ refers to the DRG system we have analyzed. However, it is possible that the public comment process will present compelling evidence that there are potential alternatives to the consolidated severity-adjusted DRG system for us to consider that could more effectively recognize severity of illness. In the FY 2006 IPPS final rule (70 FR 47474), we stated that we would consider making changes to the CMS DRGs to better reflect severity of illness among patients. We indicated that we would conduct a comprehensive review of the CC list as well as consider the possibility of using the APR DRGs for FY 2007. We did not adopt APR DRGs for FY 2006 because such an adoption would represent a significant undertaking that could have a substantial effect on all hospitals. There was insufficient time between the release of the MedPAC reports in March 2005 and the publication of the FY 2006 IPPS final rule for us to analyze fully a change of this magnitude. Instead, we adopted a more limited policy by implementing severity-adjusted cardiac DRGs. After publication of the FY 2006 IPPS final rule, CMS contracted with 3M Health Information Systems to further analyze the MedPAC recommendations in support of our consideration of possible changes to the IPPS for FY 2007. Under one task of this contract, 3M Health Information Systems analyzed the feasibility of using a revised DRG system under the IPPS that is modeled on the APR DRGs Version 23 to better recognize severity of illness. The APR DRGs have been used successfully as the basis of Belgium’s PO 00000 Frm 00017 Fmt 4701 Sfmt 4702 24011 hospital prospective global budgeting system since 2002. The State of Maryland began using APR DRGs as the basis of its all-payer hospital payment system in July 2005. More than a third of the hospitals in the United States are already using APR DRG software to analyze comparative hospital performance. Many major health information system vendors have integrated this system into their products. Several State agencies utilize the APR DRGs for the public dissemination of comparative hospital performance reports. APR DRGs have been widely applied in policy and health services research. In addition to being used in research by MedPAC, the APR DRGs also contain a separate measure of risk of mortality that is used in the Quality Indicators of the Agency for Healthcare Research and Quality, the Premier Hospital Quality Incentive Demonstration discussed in section IV.B. of this preamble, and the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) hospital accreditation survey process (Shared Visions-New Pathways). Below we present a comparison of the CMS DRG system and the APR DRG system. a. Comparison of the CMS DRG System and the APR DRG System The CMS DRG and APR DRG systems have a similar basic structure. There are 25 MDCs in both systems. The DRG assignments for both systems are based on the reporting of ICD–9–CM diagnosis and procedure codes. Both DRG systems are composed of a base DRG that describes the reason for hospital admission and a subdivision of the base DRG based on other patient attributes that affect the care of the patient. For surgical patients, the base DRG is defined based on the type of procedure performed. For medical patients, the base DRG is defined based on the principal diagnosis. In Version 23.0 of the CMS DRG system, there are 367 base DRGs and 526 total DRGs. In Version 23 of the APR DRG system, there are 314 base DRGs and 1,258 total APR DRGs. Some of the base DRGs in the two systems are virtually identical. For example, there is no significant difference between the base DRG under both systems for medical treatment of congestive heart failure. For other base DRGs, there are substantial differences. For example, in the CMS DRG system, there are two base DRGs for appendectomy (simple and complex); in the APR DRG system, there is only one base DRG for appendectomy (the relative complexity of the patient is addressed in the subsequent subdivision E:\FR\FM\25APP2.SGM 25APP2 24012 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules wwhite on PROD1PC61 with PROPOSALS2 of the base DRG into severity of illness subclasses). The focus of the CMS DRGs is on complexity. Complexity is defined as the relative volume and types of diagnostic, therapeutic, and bed services required for the treatment of a particular illness. Thus, the focus of payment in the CMS DRG system reflects the relative resource use needed by the patient in one DRG group compared to another. Resource use is generally correlated with severity of illness but an intensive resource use does not necessarily indicate a high level of severity in every case. It is possible that some patients will be resource-intensive and require high-cost services even though they are less severely ill than other patients. The CMS DRG system subdivides the base DRGs using age and the presence of a secondary diagnosis that represents a CC. The age subdivisions primarily relate to pediatric patients (those who are less than 18 years of age). Patients are assigned to the CC subgroup if they have at least one secondary diagnosis that is considered a CC. The diagnoses that are designated as CCs are the same across all base DRGs. The subdivisions of the base CMS DRGs are not uniform: some base DRGs have no subdivision; some base DRGs have a two-way subdivision based on the presence of a CC; and other base DRGs have a three-way subdivision VerDate Aug<31>2005 17:10 Apr 24, 2006 Jkt 208001 based on a pediatric subdivision followed by a CC subdivision of the adult patients. In addition, some base DRGs in MDC 5 (Diseases and Disorders of the Circulatory System) have a subdivision based on the presence of a major cardiovascular condition or complex diagnosis. The APR DRG system subdivides the base DRGs by adding four severity of illness subclasses to each DRG. Under the APR DRG system, severity of illness is defined as the extent of physiologic decompensation or organ system loss of function. The underlying clinical principle of APR DRGs is that the severity of illness of a patient is highly dependent on the patient’s underlying problem and that patients with high severity of illness are usually characterized by multiple serious diseases or illnesses. The assessment of the severity of illness of a patient is specific to the base APR DRG to which a patient is assigned. In other words, the determination of the severity of illness is disease-specific. High severity of illness is primarily determined by the interaction of multiple diseases. Patients with multiple comorbid conditions involving multiple organ systems are assigned to the higher severity of illness subclasses. The four severity of illness subclasses under the APR DRG system are numbered sequentially from 1 to 4, indicating minor (1), moderate (2), PO 00000 Frm 00018 Fmt 4701 Sfmt 4702 major (3), and extreme (4) severity of illness. The APR DRG system does not subdivide base DRGs based on the age of the patient. Instead, patient age is used in the determination of the severity of illness subclass. In the CMS DRG system, the CC list is generally the same across all base DRGs. However, there are CC list exclusions for secondary diagnoses that are related to the principal diagnosis. In the APR DRG system, the significance of a secondary diagnosis is dependent on the base DRG. For example, an infection is considered more significant for an immunesuppressed patient than for a patient with a broken arm. The logic of the CC subdivision in the CMS DRG system is a simple binary split for the presence or absence of a CC. In the APR DRG system, the determination of the severity subclass is based on an 18-step process that takes into account secondary diagnoses, principal diagnosis, age, and procedures. The 18 steps are divided into three phases. There are six steps in Phase I, three steps in Phase II, and nine steps in Phase III. The diagram below illustrates the three-phase process for determining patient severity of illness subclass. BILLING CODE 4120–01–P E:\FR\FM\25APP2.SGM 25APP2 24013 BILLING CODE 4120–01–C VerDate Aug<31>2005 17:10 Apr 24, 2006 Jkt 208001 PO 00000 Frm 00019 Fmt 4701 Sfmt 4702 E:\FR\FM\25APP2.SGM 25APP2 EP25AP06.002</GPH> wwhite on PROD1PC61 with PROPOSALS2 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules 24014 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules Under the CMS DRG system, a patient is assigned to the DRG with CC if there is at least one secondary diagnosis present that is a CC. There is no recognition of the impact of multiple CCs. Under the APR DRG system, high severity of illness is primarily determined by the interaction of multiple diseases. Under the CMS DRG system, patients are assigned to an MDC based on their principal diagnosis. While the principal diagnosis is generally used to assign the patient to an MDC in the APR DRG system, there is a rerouting step that assigns some patients to another MDC. For example, lower leg amputations can be performed for circulatory, endocrine, or musculoskeletal principal diagnoses. Instead of having three separate amputation base DRGs in different MDCs as is done in the CMS DRG system, the APR DRG system reroutes all of these amputation patients into a single base APR DRG in the musculoskeletal MDC. The CMS DRG system uses death as a variable in the DRG definitions but the APR DRG system does not. Both DRG systems are based on the information contained in the Medicare Uniform Bill. The APR DRG system requires the same information used by the current CMS DRG system. No changes to the claims form or the data reported would be necessary if CMS were to adopt APR DRGs or a variant of them. The CMS DRG structure makes some DRG modifications difficult to accommodate. For example, high severity diseases that occur in low volume are difficult to accommodate because the only choice is to form a separate base DRG with relatively few patients. Such an approach would lead to a proliferation of low-volume DRGs. Alternatively, these cases may be included in DRGs with other patients that are dissimilar clinically or in costs. Requests for new base DRGs formed on the use of a specific technology may also be difficult to accommodate. Base DRGs formed based on the use of a specific technology would result in the payment weight for the DRG being dominated by the price set by the manufacturer for the technology. The structure of the APR DRGs provides a means of addressing high severity cases that occur in low volume through assignment of the case to a severity of illness subclass. However, the APR DRG structure does not currently accommodate distinctions based on complexity. Technologies that represent increased complexity, but not necessarily greater severity of illness, are not explicitly recognized in the APR DRG system. For example, in the CMS DRGs, there are separate DRGs for coronary angioplasty with or without insertion of stents. The APR DRGs do not make such a differentiation. The insertion of the stent makes the patient’s case more complex but does not mean the patient is more severely ill. However, the inability to insert a stent may be indicative of a patient’s more advanced coronary artery disease. Although such conflicts are relatively few in number, they do represent an underlying difference between the two systems. If Medicare were to adopt a severity DRG system based on the APR DRG logic but assign cases based on complexity as well as severity as we do under the current Medicare DRG system, such a distinction would represent a departure from the exclusive focus on severity of illness that currently forms the basis of assigning cases in the APR DRG system. Section 1886(d)(4) of the Act specifies that the Secretary must adjust the classifications and weighting factors at least annually to reflect changes in treatment patterns, technology, and other factors that may change the relative use of hospital resources. Therefore, we believe a method of recognizing technologies that represent increased complexity, but not necessarily greater severity of illness, should be included in the system. We plan to develop criteria for determining when it is appropriate to recognize increased complexity in the structure of the DRG system and how these criteria interact with the existing statutory provisions for new technology add-on payments. We invite public comments on this particular issue. Another difference between the CMS DRG system and the APR DRG system is the assignment of diagnosis codes in category 996 (Complications peculiar to certain specified procedures). The CMS DRG system treats virtually all of these codes as CCs. With the exceptions of complications of organ transplant and limb reattachments, these complication codes do not contribute to the severity of illness subclass in the APR DRG system. While these codes could be added to the severity logic, the appropriateness of recognizing codes such as code 998.4 (Foreign body accidentally left during a procedure) as a factor in payment calculation could create the appearance of incentives for less than optimal quality. Although there is no direct recognition of the codes under the 996 category, the precise complication, in general, can be coded separately and could contribute to the severity of illness subclass assignment. Table B below summarizes the differences between the two DRG systems: TABLE B.—COMPARISON OF THE CMS DRG SYSTEM AND THE APR DRG SYSTEM CMS DRG system Number of base DRGs ..................................................... Total number of DRGs ..................................................... Number of CC (severity) subclasses ................................ Multiple CCs recognized ................................................... CC assignment specific to base DRG .............................. Logic of CC subdivision .................................................... Logic of MDC assignment ................................................ Death used in DRG definitions ......................................... Data requirements ............................................................ wwhite on PROD1PC61 with PROPOSALS2 Element 367 ............................................................ 526 ............................................................ 2 ................................................................ No ............................................................. No ............................................................. Presence or absence ................................ Principal diagnosis .................................... Yes ............................................................ Hospital claims .......................................... To illustrate the differences between the two DRG systems, we compare in Table C below four cases that have been assigned to CMS DRGs and APR DRGs. In all four cases, the patient is a 67-yearold who is admitted for diverticulitis of VerDate Aug<31>2005 17:10 Apr 24, 2006 Jkt 208001 the colon and who has a multiple segmental resection of the large intestine performed. ICD–9–CM diagnosis code 562.11 (Diverticulitis of colon (without mention of hemorrhage)) and ICD–9–CM procedure code 45.71 PO 00000 Frm 00020 Fmt 4701 Sfmt 4702 APR DRG system 314. 1,258. 4. Yes. Yes. 18-step process. Principal diagnosis with rerouting. No. Hospital claims. (Multiple segmental resection of large intestine) would be reported to capture this case. In both DRG systems, the patient would be assigned to the base DRG for major small and large bowel procedures. These four cases would fall E:\FR\FM\25APP2.SGM 25APP2 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules into two different CMS DRGs and four different APR DRGs. We include Medicare average charges in the table to illustrate the differences in hospital resource use. Case 1: The patient receives only a secondary diagnosis of an ulcer of anus and rectum (ICD–9–CM diagnosis code 569.41). Under the CMS DRG system, the patient is assigned to base DRG 149 (Major Small and Large Bowel Procedures Without CC). Under the APR DRG system, the patient is assigned to base DRG 221 (Major Small and Large Bowel Procedures) with a severity of illness subclass of 1 (minor). Case 2: The patient receives a secondary diagnosis of an ulcer of anus and rectum and an additional secondary diagnosis of unspecified intestinal obstruction (ICD–9–CM diagnosis code 560.9). Under the CMS DRG system, the patient is assigned to DRG 148 (Major Small and Large Bowel Procedures With CC). Under the APR DRG system, the patient is assigned to base DRG 221 and the severity of illness subclass increases to 2 (moderate). Case 3: The patient receives multiple secondary diagnoses of an ulcer of anus and rectum, unspecified intestinal obstruction, acute myocarditis (ICD–9– CM diagnosis code 422.99), and atrioventricular block, complete (ICD– 9–CM diagnosis code 426.0). Under the CMS DRG system, the patient is 24015 assigned to DRG 148. Under the APR DRG system, the patient is assigned to base DRG 221 and the severity of illness subclass increases to 3 (major). Case 4: The patient receives multiple secondary diagnoses of an ulcer of anus and rectum, unspecified intestinal obstruction, acute myocarditis, atrioventricular block, complete, and the additional diagnosis of acute renal failure, unspecified (ICD–9–CM diagnosis code 584.9). Under the CMS DRG system, the patient is assigned to DRG 148. Under the APR DRG system, the patient is assigned to base DRG 221 and the severity of illness subclass increases to 4 (extreme). TABLE C.—EXAMPLE OF SAMPLE CASES ASSIGNED UNDER THE CMS DRG SYSTEM AND UNDER THE APR DRG SYSTEM CMS DRG system Principal diagnosis code: 562.11 Procedure code: 45.71 DRG assigned APR DRG system Average charge Case 1—Secondary Diagnosis: 569.41 ............................ 149 without CC ................... $25,147 Case 2—Secondary Diagnoses: 569.41, 560.9 ............... 148 with CC ........................ 59,519 Case 3—Secondary Diagnoses: 569.41, 560.9, 422.99, 426.0. Case 4—Secondary Diagnoses: 569.41, 560.9, 422.99, 426.0, 584.9. 148 with CC ........................ 59,519 148 with CC ........................ 59,519 The largest significant difference in average charges is seen in case 4 where the average charge under the APR DRG assigned to the patient ($130,750) is more than double the average charge under the CMS DRG assigned to the patient ($59,519). wwhite on PROD1PC61 with PROPOSALS2 b. Consolidated Severity-Adjusted DRGs for Use in the IPPS APR DRGs were developed to encompass all-payer patient populations. As a result, we found that, for the Medicare population, some of the APR DRGs have very low volume. MedPAC noted that the larger number of DRGs under a severity-weighted system might mean that CMS would be faced with establishing weights in many categories that have few cases and, thus, potentially creating unstable estimates. While volume is an important consideration in evaluating any potential consolidation of APR DRGs for use under the IPPS, we believe that hospital resource use and clinical interpretability also need to be taken into consideration. For example, any VerDate Aug<31>2005 17:10 Apr 24, 2006 Jkt 208001 consolidation of severity of illness subclasses within a base DRG should be restricted to contiguous severity of illness subclasses. Thus, it would not be reasonable clinically to combine severity of illness subclasses 1 and 4 solely because both consist of lowvolume cases. We analyzed consolidating APR DRGs by either combining the base DRGs or the severity of illness subclasses within a base DRG. For consolidation across base APR DRGs, we considered patient volume, similarity of hospital charges across all four severity of illness subclasses and clinical similarity of the base APR DRGs. For consolidations of severity of illness subclasses within a base DRG, we considered patient volume and the similarity of hospital charges between severity of illness subclasses. In considering how to consolidate severity of illness subclasses, we believed it was important to use uniform criteria across all DRGs to avoid creating confusing and difficult to interpret results. That is, we were concerned about PO 00000 Frm 00021 Fmt 4701 Sfmt 4702 DRG assigned 221 with severity subclass 1. 221 with severity subclass 2. 221 with severity subclass 3. 221 with severity subclass 4. Average charge of illness $25,988 of illness 38,209 of illness 66,597 of illness 130,750 inconsistencies in the number of severity levels across different DRGs. The objective to simultaneously take into consideration patient volume and average charges often produced conflict. Table D below contains the overall patient volume and average charge by APR DRG severity of illness subclass. While severity of illness subclass 4 (extreme) has had the lowest patient volume of 5.80 percent, we found that the dramatically different average charges between severity of illness subclass 3 (major) and subclass 4 (extreme) patients of approximately $32,426 and $81,952, respectively, would make it difficult to consolidate severity of illness subclass 3 and 4 patients. Conversely, we found that, while the average charge difference between severity of illness subclass 1 (minor) and 2 (moderate) patients was much smaller, of approximately $17,649 and $20,021, respectively, the majority of patient volume (68.08 percent) is in these two subclasses. Thus, low patient volume and small average charge differences rarely coincided. E:\FR\FM\25APP2.SGM 25APP2 24016 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules TABLE D.—OVERALL AVERAGE CHARGES AND PATIENT VOLUME BY APR DRG SEVERITY OF ILLNESS SUBCLASS APR DRG severity of illness subclass 1 All cases Count .................................................................................... Average Charges ................................................................. There were also few opportunities to consolidate base DRGs. For base DRGs for which there was a clinical basis for considering a consolidation, there were usually significant differences in average charges for one or more of the severity of illness subclasses. APR DRGs already represented a considerable consolidation of base DRGs (314) compared to CMS DRGs (367). Thus, we expected that further base DRG consolidation would be difficult. We reviewed the patient volume and average charges across APR DRGs and found that medical cases assigned severity of illness subclass 4 within an MDC have similar average charges. We observed the same pattern in average charges across severity of illness subclass 4 surgical patients within an MDC. The data suggest that, in cases with a severity of illness of subclass 4, the severity of the cases had more 11,142,651 $26,342 21.47% $17,649 impact on hospital resource use than the reason for admission (that is, the base APR DRG within an MDC). Thus, we believe that, within each MDC, the severity of illness subclass 4 medical and surgical patients, respectively, could be consolidated into a single group. In some MDCs, it was not possible to consolidate into a single medical and a single surgical severity of illness subclass 4 group. In these MDCs, more than one group was necessary. For instance, Table E below contains the patient volume and average charges for severity of illness subclass 4 cases in MDC 11 (Diseases and Disorders of the Kidney and Urinary Tract). Taking into consideration volume and average charges, except for APR DRG 440 (Kidney Transplant), surgical cases assigned severity of illness subclass 4 in MDC 11 could be consolidated into a APR DRG severity of illness subclass 2 46.61% $20,021 APR DRG severity of illness subclass 3 26.12% $32,426 APR DRG severity of illness subclass 4 5.80% $81,952 single group having 5,492 patients and an average charge of $107,258. However, we decided not to include kidney transplant patients in this severity of illness 4 subclass due to their very high average charges (approximately $203,732 or more than $100,000 greater than other patients in MDC 11 having a severity of illness 4 subclass). Average charges within the consolidated severity of illness 4 surgical DRG in MDC 11 show some variation but are much higher than the corresponding average charges for the severity of illness subgroup 3 patients of $48,863. Thus, our analysis suggests that the data support maintaining three severity of illness levels for each base DRG in MDC 11; a separate severity of illness 4 subclass for all patients other than those having kidney transplant; and a separate DRG for kidney transplants. TABLE E.—SUMMARY STATISTICS FOR SURGICAL CASES WITH SEVERITY OF ILLNESS SUBCLASS 4 IN MDC 11 Number of cases APR DRG wwhite on PROD1PC61 with PROPOSALS2 440 441 442 443 444 445 446 447 (Kidney Transplant) .............................................................................................................. (Major Bladder Procedures) ................................................................................................. (Kidney & Urinary Tract Procedure for Malignancy) ............................................................ (Kidney & Urinary Tract Procedure for Non-Malignancy) .................................................... (Renal Dialysis Access Device Procedure Only Severity of Illness Subclass 4) .............. (Other Bladder Procedures) ................................................................................................. (Urethral & Transurethral Procedure—Severity of Illness Subclass 4) ............................... (Other Kidney, Urinary Tract & Related Procedures) .......................................................... The consolidation of severity of illness 4 subclass APR DRG into fewer groups was done for all MDCs except MDC 15 (Newborn and Other Neonates With Conditions Originating in the Perinatal Period), MDC 19 (Mental Diseases and Disorders), and MDC 20 (Alcohol/Drug Use and Alcohol/Drug Induced Organic Mental Disorders). In the 22 MDCs in which the severity of illness subclass 4 consolidation was applied, the number of separate severity of illness subclass 4 groups was reduced from 262 to 69. For MDC 14 (Pregnancy, Childbirth, and Puerperium), the base APR DRGs were consolidated from 12 to 6. Severity of illness subclass 1 through 3 were retained, and severity of illness subclass 4 was consolidated into a single APR VerDate Aug<31>2005 17:10 Apr 24, 2006 Jkt 208001 DRG, except for cesarean section and vaginal deliveries, which were maintained as separate APR DRGs. This consolidation reduced the total number of obstetric APR DRGs from 48 to 22. The Medicare patient volume in MDC 15 was very low, allowing for a more aggressive consolidation. For MDC 15, we consolidated 28 base APR DRGs into 7 base consolidated severity-adjusted DRGs. For each of the 7 consolidated base MDC 15 DRGs, we combined severity of illness subclasses 1 and 2 into one DRG and severity of illness subclass 3 and 4 into another one. This consolidation reduced the total number of MDC 15 DRGs from 112 in the APR DRG system to 14 consolidated severityadjusted DRGs. PO 00000 Frm 00022 Fmt 4701 Sfmt 4702 378 528 833 966 935 186 492 1,552 Average length of stay 18.0 21.5 16.6 18.4 18.3 15.2 13.4 19.3 Average total charges $203,732 128,729 101,501 103,905 104,249 80,197 73,110 121,011 In MDC 19, we consolidated 12 base DRGs into 4 base DRGs. We retained the 4 severity of illness subclasses in MDC 19 for each of the 4 base DRGs. In MDC 20, the base APR DRG for patients who left against medical advice has severity of illness subclass 1 and 2 consolidated and severity of illness subclass 3 and 4 consolidated. The remaining 4 base DRGs were consolidated into 1 base DRG and retained in 4 severity of illness subclasses. We did not consolidate any of the preMDC subclass 4 APR DRGs such as Heart Transplant. As explained earlier, pre-MDC DRGs are DRGs to which cases are directly assigned on the basis of ICD–9–CM procedure codes. These DRGs are for liver and/or intestinal transplants, heart and/or lung E:\FR\FM\25APP2.SGM 25APP2 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules wwhite on PROD1PC61 with PROPOSALS2 transplants, bone marrow transplants, pancreas transplants, and tracheotomies. For the pre-MDC DRGs, except for Bone Marrow Transplant, we consolidated severity of illness subclasses 1 and 2 into one DRG. In addition, the three base APR DRGs for Human Immunodeficiency Virus (HIV) VerDate Aug<31>2005 17:10 Apr 24, 2006 Jkt 208001 with multiple or major HIV-related conditions had severity of illness subclasses 1 and 2 consolidated. In total, we reduced 1,258 APR DRGs to 861 consolidated severity-adjusted DRGs. In Appendix C of this proposed rule, we present the 861 unique combinations of consolidated severityadjusted DRGs. PO 00000 Frm 00023 Fmt 4701 Sfmt 4702 24017 Table F below includes a description of the consolidations that we did within each individual MDC and includes information about the total number of DRGs that were eliminated from the APR DRGs to develop the consolidated severity-adjusted DRGs. BILLING CODE 4120–01–P E:\FR\FM\25APP2.SGM 25APP2 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules BILLING CODE 4120–01–C VerDate Aug<31>2005 17:10 Apr 24, 2006 Jkt 208001 PO 00000 Frm 00024 Fmt 4701 Sfmt 4702 E:\FR\FM\25APP2.SGM 25APP2 EP25AP06.003</GPH> wwhite on PROD1PC61 with PROPOSALS2 24018 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules Appendix D of this proposed rule shows the crosswalk of each consolidated severity-adjusted DRG to its respective APR DRG. We numbered the DRGs sequentially and incorporated the severity of illness subclass into the DRG description. However, within the range of sequential numbers used for an MDC, we retained some unused numbers to allow for future DRG expansion. By using a three-digit number for the consolidated severityadjusted DRGs, we also avoid the need for reprogramming of computer systems that would be necessary to accommodate a change from the current three-digit DRG number to separate fields for the base consolidated severityadjusted DRG number and the severity of illness subclass. Severity DRGs represent a significant change from our current DRG system. In addition to changing the way claims are grouped, severity DRGs introduce other issues requiring additional analysis, including possible increases in reported case-mix and changes to the outlier threshold. Our analysis of these issues is outlined below. wwhite on PROD1PC61 with PROPOSALS2 c. Changes to CMI From a New DRG System After the 1983 implementation of the IPPS DRG classification system, CMS observed unanticipated growth in inpatient hospital case-mix (the average relative weight of all inpatient hospital cases) that is used as proxy measurement for severity of illness. There are three factors that determine changes in a hospital’s CMI: (1) Admitting and treating a more resource intensive patient-mix (due, for example, to technical changes that allow treatment of previously untreatable conditions and/or an aging population); (2) Providing services (such as higher cost surgical treatments, medical devices, and imaging services) on an inpatient basis that previously were more commonly furnished in an outpatient setting; and (3) Changes in documentation (more complete medical records) and coding practice (more accurate and complete coding of the information contained in the medical record). Changes in CMI as a result of improved documentation and coding do not represent real increases in underlying resource demands. For the implementation of the IPPS in 1983, improved documentation and coding were found to be the primary cause in the underprojection of CMI increases, accounting for as much as 2 percent in VerDate Aug<31>2005 17:10 Apr 24, 2006 Jkt 208001 the annual rate of CMI growth observed post-PPS.2 We believe that adoption of consolidated severity-adjusted DRGs would create a risk of increased aggregate levels of payment as a result of increased documentation and coding. MedPAC notes that ‘‘refinements in DRG definitions have sometimes led to substantial unwarranted increase in payments to hospitals, reflecting more complete reporting of patients’ diagnoses and procedures.’’ MedPAC further notes that ‘‘refinements to the DRG definitions and weights would substantially strengthen providers’ incentives to accurately report patients’ comorbidities and complications.’’ To address this issue, MedPAC recommended that the Secretary ‘‘project the likely effect of reporting improvements on total payments and make an offsetting adjustment to the national average base payment amounts.’’ 3 The Secretary has broad discretion under section 1886(d)(3)(A)(vi) of the Act to adjust the standardized amount so as to eliminate the effect of changes in coding or classification of discharges that do not reflect real changes in casemix. While we modeled the changes to the DRG system and relative weights to ensure budget neutrality, we are concerned that the large increase in the number of DRGs will provide opportunities for hospitals to do more accurate documentation and coding of information contained in the medical record. Coding that has no effect on payment under the current DRG system may result in a case being assigned to a higher paid DRG under the consolidated severity-adjusted system. Thus, more accurate and complete documentation and coding may occur under the consolidated severityadjusted system because it will result in higher payments under the more sophisticated DRG system. We are soliciting comments on this issue. 4. Effect of Consolidated SeverityAdjusted DRGs on the Outlier Threshold (If you choose to comment on issues in this section, please include the caption ‘‘Cost-Based Weights: Outlier Threshold’’ at the beginning of your comment.) In its March 2005 Report to Congress on Physician-Owned Specialty Hospitals, MedPAC recommended that 2 Carter, Grace M. and Ginsburg, Paul: The Medicare Case Mix Index Increase, Medical Practice Changes, Aging and DRG Creep, Rand, 1985. 3 Medicare Payment Advisory Commission: Report to Congress on Physician-Owned Specialty Hospitals, March 2005, p. 42. PO 00000 Frm 00025 Fmt 4701 Sfmt 4702 24019 Congress amend the law to give the Secretary authority to adjust the DRG relative weights to account for the differences in the prevalence of highcost outlier cases. MedPAC recommended DRG-specific outlier thresholds that are financed by each DRG rather than through an across-theboard adjustment to the standardized amounts. Furthermore, in comments that MedPAC submitted during the comment period for the FY 2006 IPPS proposed rule, MedPAC stated its belief that the current policy makes DRGs with a high prevalence of outliers profitable for two reasons: (1) These DRGs receive more in outlier payments than the 5.1 percent that is removed from the national standardized amount; and (2) the relative weight calculation results in these DRGs being overvalued because of the high standardized charges of outlier cases. MedPAC also noted that, under its recommendations, outlier thresholds in each DRG would reduce the distortion in the relative weights that comes from including the outlier cases in the calculation of the weight and would correct the differences in profitability that stem from using a uniform outlier offset for all cases. MedPAC added that its recommendation would help make relative profitability more uniform across all DRGs. In the FY 2006 IPPS final rule (70 FR 47481), we responded to MedPAC’s recommendation on outliers by noting that a change in policy to replace the 5.1 percent offset to the standardized amount would require a change in law. However, because the Secretary has broad discretion to consider all factors that change the relative use of hospital resources in the calculation of the DRG relative weights, we stated we would consider changes that would reduce or eliminate the effect of high-cost outliers on the DRG relative weights. At this time, we have not completed a detailed analysis of MedPAC’s outlier recommendation because we do not have the authority to adopt such a change under current law. Instead, we have focused our resources on analyzing MedPAC’s recommendations with respect to adopting severity DRGs and calculating cost-based HSRV weights that can be adopted without a change in law. While we intend to study MedPAC’s recommendation in more detail at a future date, we note that the changes described above with respect to adopting a consolidated severityadjusted DRG system would have important implications for the outlier threshold. As noted above, we have completed a detailed analysis that would increase E:\FR\FM\25APP2.SGM 25APP2 24020 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules the number of DRGs from 526 under the current CMS DRG system to 861 under a consolidated severity-adjusted DRG system. Using FY 2004 Medicare charge data, 3M Health Information Systems simulated the effect of adopting consolidated severity-adjusted DRGs in conjunction with cost-based HSRV weights (described below) on the FY 2006 outlier threshold using the same estimation parameters used by CMS in the FY 2006 final rule (that is, the charge inflation factor of 14.94 percent) (70 FR 47494). Under these assumptions, 3M Health Information Systems estimated that the outlier threshold would be reduced from $23,600 under the current system to $18,758 under a consolidated severityadjusted DRG system. By increasing the number of DRGs to better recognize severity, the DRG system itself would provide better recognition for cases that are currently paid as outliers. That is, many cases that are high-cost outlier cases under the current DRG system would be paid using a severity of illness subclass 3 or 4 under the consolidated severity-adjusted DRGs and could potentially be paid as nonoutlier cases. 5. Impact of Refinement of DRG System on Payments Using the FY 2004 MedPAR claims data, we simulated the payment impacts of moving to the consolidated severityadjusted DRG GROUPER and the alternative HSRVcc method for developing HSRV weights. These payment simulations do not make any adjustments for changes in coding or case-mix. For purposes of this analysis, estimated payments were held budget neutral to the estimated FY 2006 payments because we have a statutory requirement to make any changes to the weights or GROUPER budget neutral. Based on the results of this impact analysis, we are proposing to adopt both the HSRVcc weighting methodology and the consolidated severity-adjusted DRGs. However, for reasons described in more detail below, we are proposing to implement the HSRVcc weighting methodology we described above for FY 2007 and future fiscal years and the consolidated severity-adjusted DRG GROUPER for implementation in FY 2008 (if not earlier). Although we are proposing to adopt each of these changes to the IPPS sequentially, the changes should be viewed as part of a unified effort to improve Medicare’s inpatient hospital payment system. Our findings in support of these proposals are discussed below. In examining the effects of moving to consolidated severity-adjusted DRGs with HSRVcc relative weights, the primary impact of the changes generally results from a redistribution of the relative weights from the surgical DRGs to the medical DRGs. In Table G below, we show an analysis of the total casemix change for the medical and surgical DRGs. We are comparing the percent change in case-mix between the FY 2006 DRGs with HSRVcc relative weights and the FY 2006 GROUPER with the FY 2006 charge-based relative weights. We also show the percent change in case-mix between the consolidated severity-adjusted DRGs with HSRVcc relative weights and the FY 2006 GROUPER with the FY 2006 charge-based relative weights and the percent change between the consolidated severity-adjusted DRGs with HSRVcc relative weights and the FY 2006 DRGs with HSRVcc relative weights. TABLE G.—PERCENT CHANGE IN CASE-MIX AMONG MEDICAL AND SURGICAL DRGS BY MDC MDC description Percent change in case-mix due to consolidated severityadjusted DRGs 6.0 ¥5.7 Cases Medical ............................................................................................................. Surgical ............................................................................................................ Surgical DRGs experience a decline of 5.7 percent in weights, while medical DRGs overall increase by approximately 6 percent when we apply the HSRVcc method to the FY6 DRGs. Adoption of the consolidated severity-adjusted DRGs also shows a redistribution of payment from the surgical to the medical DRGs, Percent change in case-mix due to HSRVcc 1.3 ¥1.3 7,832,185 3,301,570 but to a much lesser extent. The redistribution of payments from adopting the HSRVcc weighting methodology can be explained by the much lower CCRs for ancillary cost centers that account for a higher proportion of total charges in the surgical DRGs than the medical DRGs. Total impact all changes (percent) 7.3 ¥6.9 Table H below shows department charges as a percent of total charges and the CCRs for the two routine cost centers (routine days and intensive care unit) and eight ancillary cost centers that we used to develop the cost-based weights. TABLE H.—DEPARTMENTAL CHARGES AS PERCENT OF TOTAL CHARGES FOR MEDICAL AND SURGICAL DRGS AND DEPARTMENTAL COST-TO-CHARGE RATIOS (CCRS) [In percent] wwhite on PROD1PC61 with PROPOSALS2 Routine days Cost-to-Charge Ratio ............... Medical ............... Surgical .............. 85 24 10 Intensive care unit Supplies & equipment 72 12 10 As the above Table H shows, the routine cost centers account for 36 percent (24 percent for routine days and VerDate Aug<31>2005 17:10 Apr 24, 2006 Jkt 208001 Therapy 34 5 23 35 7 4 Lab Radiology 25 14 8 24 10 5 12 percent for intensive care unit) and 20 percent (10 percent for routine days and 10 percent for intensive care unit) PO 00000 Frm 00026 Fmt 4701 Sfmt 4702 Other 51 7 4 O.R. Pharmacy 37 1 17 26 16 13 Cardiac 20 5 6 of total charges in the medical and surgical DRGs, respectively. These departments have CCRs that range from E:\FR\FM\25APP2.SGM 25APP2 24021 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules 85 (routine days) to 72 percent (intensive care unit). However, the markup over costs is much higher in the ancillary than in the routine cost centers. The CCRs in the ancillary departments range from 20 percent (cardiac) to 51 percent (other). Ancillary cost centers account for 64 percent of total charges in the medical and 80 percent of total charges in the surgical DRGs. Thus, because ancillary departments have higher markups and account for a larger proportion of total charges in the medical than the surgical DRGs, adopting HSRVcc redistributes payments to the more routine-intensive medical DRGs. Table H supports the hypothesis that the charge-based relative weight methodology results in high payments to surgical DRGs that use more ancillary services relative to medical DRGs that use more routine services. By changing the relative weight methodology from the chargebased to the HSRVcc method, the weights will more closely reflect actual relative costs. In addition to examining the change in weights by MDC for the medical and surgical DRGs, we also looked at the percent change to the relative weights for several DRGs that account for the high Medicare spending. Again, the payment impacts illustrate that a change from the charge-based relative weights to the HSRVcc weighting methodology will result in significant payment redistribution for selected DRGs. Table I below also shows payment reductions from adopting HSRVcc for several DRGs where ancillary charges represent a high proportion of total charges and the ancillary department has a low CCR. For instance, Table I shows a 30-percent reduction in payment for DRG 558 from adopting HSRVcc weights. For this DRG, charges for the medical supplies and the cardiac care represent over 60 percent of average total hospital charges. These cost centers have low CCRs (34 and 20 percent for medical supplies and cardiology respectively). For this DRG, routine cost center charges account for only 7 percent of total hospital charges. Thus, similar to the MDC analysis presented above, payment for this DRG can be expected to decline because ancillary departments with higher markups account for a larger proportion of total charges. The data are similar for many of the other DRGs presented in Table I that are showing large reductions in the relative weights from adopting the HSRVcc weighting methodology. Conversely, Table I shows payment increases from adopting HSRVcc for DRGs where routine charges represent a high proportion of total charges. These departments have high CCRs. Below we illustrate the charges by cost center as a percent of total charges for DRGs 558 and 089. ILLUSTRATION Routine days (percent) ICU (percent) Supplies and equipment (percent) Therapy (percent) Laboratory (percent) Radiology (percent) Other (percent) O.R. (percent) Pharmacy (percent) Cardiac (percent) 85 2 25 72 5 9 34 39 7 35 0 9 25 3 14 24 2 8 51 1 6 37 2 1 26 8 19 20 29 3 CCRs ........................ DRG 558 .................. DRG 089 .................. wwhite on PROD1PC61 with PROPOSALS2 Table I below shows a 30-percent reduction in payment for DRG 558 from adopting HSRVcc weights. For this DRG, charges for the medical supplies and the cardiac care represent nearly 80 percent of average total hospital charges. These cost centers have low CCRs (34 percent and 20 percent for medical supplies and cardiology, respectively). For this DRG, routine cost center charges account for only 7 percent of total hospital charges. Thus, similar to VerDate Aug<31>2005 17:10 Apr 24, 2006 Jkt 208001 the MDC analysis presented above, payment for this DRG can be expected to decline because ancillary departments with higher markups account for a larger proportion of total charges. The data are similar for many of the other DRGs presented in Table I that are showing large reductions in the relative weights from adopting HSRVcc. Conversely, routine charges account for a higher proportion of total charges for the DRGs that are showing large PO 00000 Frm 00027 Fmt 4701 Sfmt 4702 increases in payments. For instance, payment for DRG 089 is increasing nearly 10 percent from adoption of HSRVcc weights. Routine day charges account for 34 percent of total charges for DRG 089. Thus, because routine charges represent a high proportion of total charges and these cost centers have relatively low markups, the HSRVcc methodology will lead to higher payments for this DRG. BILLING CODE 4120–01–P E:\FR\FM\25APP2.SGM 25APP2 VerDate Aug<31>2005 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules 17:10 Apr 24, 2006 Jkt 208001 PO 00000 Frm 00028 Fmt 4701 Sfmt 4725 E:\FR\FM\25APP2.SGM 25APP2 EP25AP06.004</GPH> wwhite on PROD1PC61 with PROPOSALS2 24022 24023 BILLING CODE 4120–01–C VerDate Aug<31>2005 17:10 Apr 24, 2006 Jkt 208001 PO 00000 Frm 00029 Fmt 4701 Sfmt 4702 E:\FR\FM\25APP2.SGM 25APP2 EP25AP06.005</GPH> wwhite on PROD1PC61 with PROPOSALS2 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules 24024 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules Our payment impacts were similar to MedPAC’s in both magnitude and direction. Table J below compares our impact estimates to those simulated by MedPAC 4 using our alternative HSRVcc weighting methodology and the consolidated severity-adjusted DRG GROUPER. TABLE J.—COMPARISON OF MEDPAC’S TABLE OF COMBINED PAYMENT IMPACT OF SEVERITY-ADJUSTED DRGS AND COST-BASED, HOSPITAL-SPECIFIC RELATIVE VALUES (HSRVS) TO THE CMS/3M ANALYSIS [The percent changes estimated by CMS/3M are shown in parenthesis.] Decrease greater than ¥5% Type of hospital Specialty: Heart ............................................................................. Orthopedic .................................................................... Surgical ......................................................................... All Other IPPS: Urban ............................................................................ Rural ............................................................................. High IME/DSH .............................................................. Decrease between ¥5% and ¥1% Decrease/increase between ¥1% and 1% Increase between +1% and +5% Increase greater than +5% 87% (95%) 76% (91%) N/A (67%) 13% (5%) 24% (2%) N/A (17%) 0% (0%) 0% (2%) N/A (0%) 0% (0%) 0% (2%) N/A (17%) 0% (0%) 0% (2%) N/A (0%) 7% (8%) 8% (11%) 8% (10%) 22% (25%) 25% (35%) 28% (25%) 16% (19%) 17% (20%) 14% (15%) 33% (31%) 33% (26%) 25% (28%) 22% (17%) 16% (9%) 24% (23%) **Numbers may not add to 100 percent due to rounding. As shown in Table J above, the shifts in payment from MedPAC’s method compared to the alternative approach that we developed are fairly similar. Both methods introduce refinements to the DRG GROUPER and relative weight methods that expand the DRG groups and create greater homogeneity among the cases within each DRG. These changes will significantly reduce payments to hospitals that specialize in certain DRGs experiencing a reduction in payment. There are also payment impacts across all other hospitals. Although some urban (17 percent) and rural (9 percent) providers are estimated to receive increases of greater than 5 percent from these combined changes, 8 percent of urban hospitals and 11 percent of rural hospitals are expected to experience decreases of greater than 5 percent in payment and an additional 25 percent of urban providers and 35 percent of rural providers are expected to experience a decrease of between 1 and 5 percent. Table K below shows the impact on specific categories of hospitals of adopting HSRVcc weights and the consolidated severity-adjusted DRGs. As illustrated in Table K, cardiac specialty hospitals and orthopedic specialty hospitals may experience an 11.2 and 4.4 percent decline in payments, respectively, from the move to the HSRVcc weighting method alone. Urban hospitals experience a small decline of 0.3 but rural hospitals experience a gain of 2.7 percent. While urban hospitals as a group are not expected to experience a change in overall payments with the combined introduction of the consolidated severity-adjusted DRGs and the HSRVcc weighting methodology, rural hospitals would likely experience a 0.4 percent decline in payments. TABLE K.—PAYMENT IMPACT OF HOSPITAL-SPECIFIC COST WEIGHTS AND CONSOLIDATED SEVERITY-ADJUSTED DRGS BY HOSPITAL TYPE Number of hospitals wwhite on PROD1PC61 with PROPOSALS2 Specialty Hospital Type: Cardiac .......................................................................... Orthopedic .................................................................... Surgery ......................................................................... All Other IPPS: Urban ............................................................................ Rural ............................................................................. High IME/DSH .............................................................. In Table L, we provide a more detailed impact analysis by hospital type. Column 1 shows the estimated impact of moving from the current charge-based relative weight methodology to the HSRVcc method. Cases Percent change in case-mix due to HSRVcc Percent change in case-mix due to consolidated severityadjusted DRGs 19 43 12 44,203 11,097 1,840 ¥11.2 ¥4.4 0.3 ¥0.5 ¥5.2 ¥7.4 ¥11.7 ¥9.4 ¥7.2 1,959 880 734 7,148,362 1,444,664 2,492,485 ¥0.3 2.7 0 0.3 ¥3.1 0.4 0 ¥0.4 0.4 Hospitals with more than 60 percent of Medicare patients are projected to receive the greatest benefit in payments with a 7.6 percent increase. Hospitals with less than 50 beds are estimated to experience an additional 4.1 percent increase, and hospitals with 50 to 100 beds are also projected to benefit with a 2.54 percent increase. Payments to major and other teaching hospitals are estimated to decrease by 1.1 percent and 1 percent, respectively, 4 Medicare Payment Advisory Commission: Report to Congress on Physician-Owned Specialty Hospitals, March 2005, p. 39. VerDate Aug<31>2005 17:10 Apr 24, 2006 Jkt 208001 PO 00000 Frm 00030 Total impact all changes Fmt 4701 Sfmt 4702 E:\FR\FM\25APP2.SGM 25APP2 24025 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules while payments to nonteaching hospitals are estimated to increase by 1.3 percent. Hospitals with less than 20 percent DSH payments will experience declines in payment from 0.48 to 1.45 percent, while hospitals with DSH payments greater than 50 percent will experience a 2.3 percent increase. Because we are proposing to implement the HSRVcc weighting methodology for FY 2007, we are also showing the impact of this proposal on FY 2007 payments in the impact section in the Addendum to this proposed rule. We note that the impact section models adopting the HSRVcc in isolation using FY 2005 Medicare charge data. The impacts shown here were simulated with FY 2004 Medicare charge data. Thus, the payment changes shown in this section from adopting HSRVcc may differ from those shown in the impact section in the Addendum to this proposed rule. Column 2 shows the estimated incremental impacts of transitioning from the FY 2006 GROUPER with HSRVcc relative weights to the consolidated severity-adjusted DRG GROUPER with HSRVcc relative weights. Hospitals with high Medicare patient percentages experience the largest payment increases of 1.1 percent, followed by hospitals in the East North Central Region where increases are estimated at 0.9 percent. Hospitals with less than 50 beds, rural hospitals, and hospitals with 50 to 100 beds experience the greatest estimated decreases in payment of 5.2, 3.1, and 2.8 percent, respectively. Column 3 shows the estimated total impact of moving from the FY 2006 GROUPER with the current chargebased relative weights to the consolidated severity-adjusted DRG GROUPER with HSRVcc relative weights. While large urban hospitals are expected to gain 0.7 percent from the combined changes, other urban hospitals and rural hospitals are projected to experience declines of 0.7 percent and 0.4 percent, respectively. Hospitals with high percentages of Medicare patients would see the greatest increase in payments, while hospitals with low DSH percentages, hospitals with under 50 beds, and hospitals in the West North Central Region are projected to experience the greatest decreases. TABLE L.—PAYMENT IMPACT OF HOSPITAL-SPECIFIC COST WEIGHTS AND CONSOLIDATED SEVERITY-ADJUSTED DRGS BY HOSPITAL CATEGORY wwhite on PROD1PC61 with PROPOSALS2 Number of hospitals Geographic Location: Large Urban .................................................................. Other Urban .................................................................. Rural ............................................................................. Census: New England ................................................................ Middle Atlantic .............................................................. South Atlantic ................................................................ East North Central ........................................................ East South Central ....................................................... West North Central ....................................................... West South Central ...................................................... Mountain ....................................................................... Pacific ........................................................................... Bed Size: Less than 50 beds ........................................................ 50–100 beds ................................................................. 100–200 beds ............................................................... 200–300 beds ............................................................... 300–400 beds ............................................................... 400–500 beds ............................................................... Greater than 500 beds ................................................. Teaching Status: Major Teaching ............................................................. Other Teaching ............................................................. Non Teaching ............................................................... Disproportionate Share: %DSH Less than 5% .................................................... %DSH 5–10% ............................................................... %DSH 10–15% ............................................................. %DSH 15–20% ............................................................. %DSH 20–25% ............................................................. %DSH 25–30% ............................................................. %DSH 30–40% ............................................................. %DSH 40–50% ............................................................. %DSH Greater than 50% ............................................. Percent Medicare Discharges: Less than 10% Medicare Cases .................................. 10%–20% Medicare Cases .......................................... 20%–30% Medicare Cases .......................................... 30%–40% Medicare Cases .......................................... 40%–50% Medicare Cases .......................................... VerDate Aug<31>2005 17:10 Apr 24, 2006 Jkt 208001 PO 00000 Frm 00031 Cases Percent change in case mix due to HSRVcc (1) Percent change in case-mix due to consolidated severityadjusted DRGs (2) Total impact all changes (3) 1,454 1,158 1,035 5,159,405 4,313,598 1,669,648 ¥0.1 ¥0.7 2.8 0.7 0.0 ¥3.1 0.7 ¥0.7 ¥0.4 150 473 556 541 368 314 572 234 439 550,391 1,750,452 2,191,787 1,973,092 973,664 846,046 1,332,819 502,128 1,022,272 0.3 0.1 ¥0.2 ¥0.1 0.3 ¥0.5 ¥0.1 ¥0.6 0.6 ¥0.5 ¥0.5 0.4 0.9 ¥1.3 ¥0.8 ¥0.1 0.6 0.3 ¥0.2 ¥0.4 0.2 0.8 ¥1.0 ¥1.3 ¥0.2 ¥0.1 0.9 761 717 1,096 509 269 138 157 423,096 1,028,840 2,895,808 2,396,739 1,666,872 1,017,724 1,713,572 4.1 2.5 1.8 0.0 ¥0.9 ¥1.5 ¥1.8 ¥5.2 ¥2.8 ¥0.6 0.5 0.7 0.7 0.8 ¥1.3 ¥0.3 1.2 0.5 ¥0.2 ¥0.8 ¥1.0 268 760 2,619 1,552,985 3,856,302 5,733,364 ¥1.1 ¥0.9 1.3 0.5 0.6 ¥0.8 ¥0.5 ¥0.3 0.5 202 335 460 582 528 455 516 262 307 339,171 1,048,420 1,429,319 2,061,387 1,812,743 1,497,940 1,586,376 693,815 673,480 ¥1.4 ¥0.6 ¥0.6 ¥0.5 0.1 0.0 0.0 0.6 2.3 ¥0.8 ¥0.1 0.1 ¥0.1 ¥0.1 0.2 0.0 ¥0.1 0.5 ¥2.2 ¥0.7 ¥0.4 ¥0.6 0.0 0.2 ¥0.1 0.4 2.9 1,194 1,471 617 226 86 3,210,704 5,109,042 1,934,947 617,518 197,882 ¥0.7 0.1 ¥0.1 0.9 2.0 ¥0.1 0.0 0.1 0.1 0.8 ¥0.8 0.0 ¥0.1 1.0 2.8 Fmt 4701 Sfmt 4702 E:\FR\FM\25APP2.SGM 25APP2 24026 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules TABLE L.—PAYMENT IMPACT OF HOSPITAL-SPECIFIC COST WEIGHTS AND CONSOLIDATED SEVERITY-ADJUSTED DRGS BY HOSPITAL CATEGORY—Continued Number of hospitals 50%–60% Medicare Cases .......................................... Greater than 60% Medicare Cases .............................. wwhite on PROD1PC61 with PROPOSALS2 6. Conclusions As we describe in more detail below, we believe that adopting HSRVcc weights and the consolidated severityadjusted DRGs as recommended by MedPAC has the potential to result in significant improvements to Medicare’s IPPS payments. This rule proposes the HSRVcc methodology effective for FY 2007. Because we believe that accounting more appropriately for severity of illness may significantly improve the effectiveness of the IPPS, we are also proposing implementation of the consolidated severity-adjusted DRGs or alternative severity adjustment methods in FY 2008 (if not earlier). In developing this proposal, we considered a range of alternatives outlined below, and we are soliciting comments on both the proposal and the alternatives. We ask commenters to consider both the consolidated severity-adjusted DRGs and alternative severity adjustment methods for accounting for severity more comprehensively in the DRG payment system. For example, under one alternative, we would implement the consolidated severity-adjusted DRGs in FY 2007 along with the HSRVcc weighting methodology. In this event, as discussed above, to maintain budget neutrality, we would also implement in FY 2007 an adjustment to the standardized amounts to eliminate the effect of changes in coding or classification of discharges that do not reflect real changes in case-mix. Under another alternative, as proposed, we would adopt and implement consolidated severity-adjusted DRGs in FY 2008. Under yet another alternative, we would consider partially implementing the consolidated severityadjusted DRGs in FY 2007 and complete implementation in FY 2008. However, there are practical difficulties associated with partial implementation of consolidated severity-adjusted DRGs because cases in a single DRG under the current CMS DRG system may group to multiple DRGs and MDCs under a consolidated severity-adjusted DRG VerDate Aug<31>2005 17:10 Apr 24, 2006 Jkt 208001 Cases 39 14 Percent change in case mix due to HSRVcc (1) Percent change in case-mix due to consolidated severityadjusted DRGs (2) Total impact all changes (3) 5.2 7.6 1.1 ¥0.2 6.4 7.4 55,346 17,212 system. Conversely, cases that group to multiple MDCs and DRGs under the current system may group to a single MDC and DRG under the current system. We welcome public comments on this issue. One potential alternative to partially adopting consolidated severity-adjusted DRGs would involve applying a clinical severity concept to an expanded set of DRGs in FY 2007. For example, we have received correspondence that raised the concern that hospitals may have incentives under the current DRG system to avoid severely ill, resourceintensive back and spine surgical cases (as discussed in section II.D.3.b. of this proposed rule; the correspondence specifically requested that we apply a clinical severity concept to DRG 546). Other surgical DRGs may not accurately recognize case severity. Because of the frequency of DRG use and the potential for risk selection, certain DRGs may be particularly important in creating a financial incentive for hospitals to select a less severely ill patient whose case would be assigned to the same DRG as a more severely ill patient. Therefore, while we are proposing to adopt the consolidated severity-adjusted DRGs in FY 2008, we are considering whether to make more limited changes to the current DRG system to better recognize severity of illness in FY 2007. In the FY 2006 IPPS final rule (70 FR 47474 through 47478), we took steps to better recognize severity of illness among cardiovascular patients. For all DRGs except cardiac DRGs, we currently distinguish between more complex and less complex cases based on the presence or absence of a CC. However, the diagnoses that we designate as CCs are the same across all base DRGs. Because the CC list is not dependent on the patient’s underlying condition, CCs may not accurately recognize severity in a given case. The changes we made in FY 2006 to the cardiac DRGs significantly improved recognition of severity between patients by distinguishing between more and less severe cases based on the presence or absence of a major cardiovascular PO 00000 Frm 00032 Fmt 4701 Sfmt 4702 condition (MCV). We are considering whether a similar approach applied to other DRGs would improve payment. Much like the approach we took last year to identify MCV conditions that represented higher severity in cardiovascular patients, we plan to examine which conditions identify more severely ill cases in selected MDCs and DRGs. We are soliciting comments as to whether it would be appropriate to adopt these types of limited changes in FY 2007 as an intermediate step to adopting consolidated severity-adjusted DRGs in FY 2008. We also encourage commenters to send suggestions regarding this method for modifying the DRGs. Under the final alternative, we would implement the consolidated severity-adjusted DRGs in FY 2007 and the HSRVcc methodology in FY 2008. As the impacts presented in this proposed rule are based on the latest and best available data, we believe the estimated yearly impacts due to implementing the HSRVcc methodology in FY 2007 described in the regulatory impact section of Appendix A of this proposed rule would be similar to the annual impact of adopting the HSRVcc methodology in FY 2008. With respect to the relative weight calculations, we believe that adopting HSRVcc weights has the potential to significantly improve payment equity between DRGs. As MedPAC notes, ‘‘a survey of hospitals’ charging practices suggest that hospitals use diverse strategies for setting service charges and raising them over time.’’ MedPAC found that data from the Medicare cost reports indicate that hospital markups for ancillary services (for example, operating room, radiology, and laboratory) are generally higher than for routine services (for example, intensive care unit and room and board).5 Thus, MedPAC has concluded that the relative weights for DRGs that use more ancillary services may be too high compared to other DRGs where the routine costs account for a higher proportion of hospital costs. We agree. 5 Ibid., E:\FR\FM\25APP2.SGM p. 26. 25APP2 wwhite on PROD1PC61 with PROPOSALS2 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules The CCRs that we are using to develop the HSRVccs support MedPAC’s conclusion. As indicated above, we summarized hospital-level cost and charge information to 2 routine and 8 ancillary departmental cost centers and found that national average routine cost center CCRs ranged from 72 percent (intensive care unit days) to 85 percent (routine days), while ancillary cost center CCRs ranged from 20 percent (cardiology) to 37 percent (operating room). MedPAC also found that relative profitability ratios were higher among cardiovascular surgical DRGs than the medical DRGs.6 We believe the relative profitability of the surgical cardiovascular DRGs has been an important factor in the development of specialty heart hospitals. Our payment impact analysis indicates that this issue will be addressed by adopting HSRVccs. Moving from the current system of charge-based weights to HSRVcc weights increases payment in the medical DRGs relative to the surgical DRGs. We expected this result, given that routine costs will generally account for a higher proportion of total costs in the medical DRGs than in the surgical DRGs. Adopting HSRVcc weights would result in the most significant improvement in hospital payment-tocost ratios among the changes to the IPPS recommended by MedPAC.7 For these reasons described above, we are proposing to adopt HSRVccs for FY 2007. Based on our analysis, we concur with MedPAC that the modified version of the APR DRGs would account more completely for differences in severity of illness and associated costs among hospitals. MedPAC observed some modest improvements in hospitals’ payment-to-cost ratios from adopting APR DRGs.8 We modeled the consolidated severity-adjusted DRGs discussed above and observed a 12percent increase in the explanatory power (or R-square statistic) of the DRG system to explain total hospital charges. That is, we found more uniformity among hospital total charges within the consolidated severity-adjusted DRG system than we did with Medicare’s current DRG system. While we believe the consolidated severity-adjusted DRG system that we described above has the potential to improve the IPPS, we have the following concerns about adopting these changes for FY 2007, which is why we have proposed not adopting the changes in FY 2007. However, we 6 Ibid., p. 29. p. 37. 8 Ibid., p. 37. 7 Ibid., VerDate Aug<31>2005 17:10 Apr 24, 2006 Jkt 208001 recognize that there may be countervailing views, and we specifically seek comment on the wisdom of adopting consolidated severity-adjusted DRGs in FY 2007. Below are our concerns with immediate implementation of consolidated severity-adjusted DRGs: • These changes would represent a major change to how hospitals are paid for Medicare inpatient services. Given the number of new DRGs and logic for assigning cases in a consolidated severity-adjusted DRG system, we believe it may be appropriate to provide hospitals with additional time to plan for these changes. We also are considering whether hospitals should have more than the 60-day public comment period and the additional 60day delay between the publication of the final rule and implementation on October 1, 2006, to fully understand and plan for the changes that we are proposing. Further, we welcome public comment on the changes we are proposing; • If, based on analysis of data and public comments received, we were to make significant revisions in the final rule to the consolidated severityadjusted DRGs we describe above, hospitals would have only 60 total days between the publication of the final rule and the October 1, 2006 effective date of the IPPS rule to understand and plan for the new DRG system. • While we modeled the changes to the DRG system and relative weights to reflect budget neutrality, we believe the large increase in the number of DRGs would provide opportunities for hospitals to more accurately and completely code the information contained in the medical record. Coding that has no effect on payment under the current DRG system may result in a case being assigned to a higher paid DRG under the consolidated severityadjusted DRG system. Thus, more accurate and complete coding may occur under the new system because the more sophisticated DRG system would mean that more comprehensive coding could result in higher payments. Section 1886(d)(3)(A)(vi) of the Act provides the Secretary with the authority to adjust the standardized amounts to account for the effect of coding or classification changes that do not reflect real changes in case-mix. We are interested in public comments on this issue. • As described above, adoption of a consolidated severity-adjusted DRG system could have implications for the outlier threshold. • As we indicated in the introduction to this section, adoption of a consolidated severity-adjusted DRG PO 00000 Frm 00033 Fmt 4701 Sfmt 4702 24027 system also raises issues regarding the IME and DSH adjustments. It is possible that a consolidated severity-adjusted DRG system would have important implications for these payment adjustments. We believe further study of this issue is warranted. • To this point, we have only considered one alternative DRG system to better recognize severity of illness. It is possible that the public comment process will present compelling evidence that there are potential alternatives to the consolidated severityadjusted DRG system that could also better recognize severity of illness. Therefore, for the reasons indicated above, we are seeking comment on the most effective approach to address severity of illness in the IPPS. However, we reserve the option to adopt consolidated severity-adjusted DRGs in FY 2007, based upon the comments that we receive. Between now and the eventual implementation, we will carefully study the additional impact of these DRGs on payment accuracy after our proposed refinements in relative weights are implemented, as well as their impact on hospitals before reaching a final decision. Given the changes we are proposing, we believe that hospitals would be interested in understanding how a given case would be assigned to a consolidated severity-adjusted DRG under the new system. In order to facilitate understanding of the underlying severity DRG concepts and logic, we are providing a link below to 3M’s Web site for the duration of the comment period where users can access information related to the proposed consolidated severity-adjusted DRGs. Users will have access to a tool that allows them to build case examples using this proposed DRG classification system. The report produced by the tool will provide a detailed explanation of how the severity of illness was assigned and the diagnostic and demographic factors affecting that assignment. In addition, users will be able to view the APR DRG Definitions Manual, a report showing the mapping from the standard APR DRGs to the consolidated severityadjusted DRGs, a report showing basic APR DRG statistics, and other APR DRG background and educational materials. This site can be accessed at https:// www.aprdrgassign.com. In addition to the above information, CMS makes available for purchase the Expanded Modified MedPAR data that were used in simulating the policies proposed in the IPPS rule. If readers have already ordered the proposed rule data, we are in the process of filling the orders and will be providing the FY E:\FR\FM\25APP2.SGM 25APP2 24028 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules 2005 MedPAR data that were used to model the proposed changes to the DRGs and relative weights for FY 2007 as well as the FY 2004 MedPAR data that we used to model the consolidated severity-adjusted DRGs that we are proposing to implement in FY 2008 (if not earlier). If readers have not ordered the proposed rule MedPAR data but are interested in receiving them, we encourage them to order the data as soon as possible by following the directions provided below. We will process orders in the order they are received. For information on how to order the Expanded Modified MedPAR, go to the following Web site: https:// www.cms.hhs.gov/LimitedDataSets/ and click on MedPAR Limited Data Set (LDS)—Hospital (National). This Web page will describe the file and provide directions to further detailed instructions for how to order. Persons placing orders must send the following: Letter of Request, LDS Data Use Agreement and Research Protocol (see Web site for further instructions), LDS Form, and a check for $3,655 to: Centers for Medicare & Medicaid Services, Public Use Files, Accounting Division, P.O. Box 7520, Baltimore, MD 21207– 0520. We are seeking public comments on both of these proposals and whether we should provide a transition to the HSRVcc weights. The proposed changes to the relative weights, in some cases, could result in significant changes to hospital payments. Using FY 2005 MedPAR data, we computed an estimated FY 2006 CMI (based on FY 2006 relative weights) and an estimated FY 2007 CMI (based on the FY 2007 weights that we are proposing in this proposed rule) and looked at the percent change from FY 2006 to FY 2007. Table M shows the number of hospitals in each category that can expect to experience increases or decreases in CMI of more than 5 percent and also shows the number of providers expected to experience smaller changes in casemix. Overall, we estimate that 134 providers may experience decreases in payment of greater than 5 percent, while 1,003 providers may expect increases of greater than 5 percent. Approximately 54 percent of rural hospitals may receive increases in their CMI of greater than 5 percent. However, as discussed in the previous section, the eventual implementation of a consolidated severity-adjusted DRG system in FY 2008 (if not earlier) would offset these increases for some types of cases or categories of hospitals. For this reason, we are considering whether to provide a transition to the HSRVcc weights. Under such a transition, we would blend the HSRVcc weights with the charge-based weights over a period of 2, 3, or 4 years. For instance, if we were to implement the HSRVcc methodology over 2 years, we would blend 1/2 of the HSRVcc weights with 1/2 of the chargebased weights. Such a transition would result in an impact of 50 percent of moving directly to the HSRVcc weights. If we were to establish a longer transition to the HSRVcc weights, we would blend charge-based with hospital-specific cost weights calculated under the consolidated severityadjusted DRGs. As discussed in the previous sentences, we are presenting an example of a 2-year transition because the payment impact of consolidated severity-adjusted DRGs and the HSRVcc weights go in different directions for some types of cases or categories of hospitals. Thus, a 2-year transition provides the shortest time period for achieving the improvements to the IPPS we have analyzed. However, we welcome public comments on this issue. TABLE M.—PERCENT CHANGE IN CASE-MIX INDEX BETWEEN FY 2006 AND FY 2007 BASED ON FY 2005 MEDPAR DATA Number of providers with more than 5% loss Number of providers with loss between 1 and 5% Number of providers with 1% loss to 1% gain Number of providers with gain between 1 and 5% Number of providers with greater than 5% gain (1) wwhite on PROD1PC61 with PROPOSALS2 Number of hospitals (2) (3) (4) (5) (6) All Hospitals ..................................................................... By Geographic Location: Urban hospitals ......................................................... Large urban areas (populations over 1 million) ....... Other urban areas (populations of 1 million or fewer) .................................................................... Rural hospitals .......................................................... Bed Size (Urban): 0–99 beds ................................................................. 100–199 beds ........................................................... 200–299 beds ........................................................... 300–499 beds ........................................................... 500 or more beds ..................................................... Bed Size (Rural): 0–49 beds ................................................................. 50–99 beds ............................................................... 100–149 beds ........................................................... 150–199 beds ........................................................... 200 or more beds ..................................................... Urban by Region: New England ............................................................ Middle Atlantic .......................................................... South Atlantic ............................................................ East North Central .................................................... East South Central ................................................... West North Central ................................................... West South Central .................................................. Mountain ................................................................... VerDate Aug<31>2005 17:10 Apr 24, 2006 Jkt 208001 PO 00000 Frm 00034 3,522 134 581 394 1,410 1,003 2,517 1,391 127 63 540 238 356 191 1,030 639 464 260 1,126 1,005 64 7 302 41 165 38 391 380 204 539 590 865 482 414 166 46 22 20 28 11 58 103 133 164 82 26 87 102 93 48 191 490 205 120 24 269 163 22 9 1 349 366 179 64 47 2 1 1 2 1 5 4 14 6 12 3 5 10 14 6 67 155 92 40 26 272 201 62 2 2 127 353 381 388 163 156 350 143 2 15 19 14 8 15 27 12 22 50 86 100 36 49 85 42 6 39 39 68 19 28 68 36 75 194 179 145 51 39 99 42 22 55 58 61 49 25 71 11 Fmt 4701 Sfmt 4702 E:\FR\FM\25APP2.SGM 25APP2 24029 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules TABLE M.—PERCENT CHANGE IN CASE-MIX INDEX BETWEEN FY 2006 AND FY 2007 BASED ON FY 2005 MEDPAR DATA—Continued Number of providers with more than 5% loss Number of providers with loss between 1 and 5% Number of providers with 1% loss to 1% gain Number of providers with gain between 1 and 5% Number of providers with greater than 5% gain (1) wwhite on PROD1PC61 with PROPOSALS2 Number of hospitals (2) (3) (4) (5) (6) Pacific ....................................................................... Puerto Rico ............................................................... Rural by Region: New England ............................................................ Middle Atlantic .......................................................... South Atlantic ............................................................ East North Central .................................................... East South Central ................................................... West North Central ................................................... West South Central .................................................. Mountain ................................................................... Pacific ....................................................................... By Payment Classification: Urban hospitals ......................................................... Large urban areas (populations over 1 million) ....... Other urban areas (populations of 1 million or fewer) .................................................................... Rural areas ............................................................... Teaching Status: Nonteaching .............................................................. Fewer than 100 residents ......................................... 100 or more residents .............................................. Urban DSH: Non-DSH ................................................................... 100 or more beds ..................................................... Less than 100 beds .................................................. Rural DSH: SCH .......................................................................... RRC .......................................................................... Other Rural: 100 or more beds ..................................................... Less than 100 beds .................................................. Urban teaching and DSH: Both teaching and DSH ............................................ Teaching and no DSH .............................................. No teaching and DSH ............................................... No teaching and no DSH ......................................... Rural Hospital Types: Non special status hospitals ..................................... RRC .......................................................................... SCH .......................................................................... MDH .......................................................................... SCH and RRC .......................................................... MDH and RRC .......................................................... Type of Ownership: Voluntary ................................................................... Proprietary ................................................................ Government .............................................................. Medicare Utilization as a Percent of Inpatient Days: 0–25 .......................................................................... 25–50 ........................................................................ 50–65 ........................................................................ Over 65 ..................................................................... Unknown ................................................................... Urban Hospitals Reclassified by the Medicare Geographic Classification Review Board: First Half FY 2007 Reclassifications ........................ Urban Nonreclassified, First Half FY 2007 ............... All Urban Hospitals Reclassified Second Half FY 2007 ...................................................................... Urban Nonreclassified Hospitals Second Half FY 2007 ...................................................................... All Rural Hospitals Reclassified Full Year FY 2007 Rural Nonreclassified Hospitals Full Year FY 2007 All Section 401 Reclassified Hospitals ..................... VerDate Aug<31>2005 17:10 Apr 24, 2006 Jkt 208001 PO 00000 Frm 00035 404 52 13 2 69 1 51 2 188 18 83 29 19 72 175 125 181 118 191 80 44 0 1 0 3 1 0 1 1 0 1 2 2 5 5 15 6 5 0 0 2 4 3 9 5 9 4 2 15 34 67 69 37 57 40 35 26 3 33 102 45 129 41 135 35 16 2,539 1,400 128 63 538 238 353 191 1,042 644 478 264 1,139 983 65 6 300 43 162 41 398 368 214 525 2,449 836 237 80 42 12 262 237 82 194 147 53 1,008 318 84 905 92 6 854 1,513 333 71 52 8 165 374 12 95 256 12 364 645 98 159 186 203 383 196 0 3 6 23 5 24 106 124 266 22 55 188 0 0 0 1 2 0 26 47 27 140 809 198 1,037 495 38 13 22 55 248 57 138 95 156 37 112 48 290 81 453 218 77 10 312 79 288 140 341 126 80 8 1 3 0 0 2 0 6 20 6 0 10 1 5 18 7 1 10 0 88 86 113 29 47 5 188 13 215 96 11 2 2,087 831 604 65 61 8 406 139 36 248 96 50 895 292 223 473 243 287 252 1,302 1,490 459 19 8 54 45 25 2 26 312 210 33 0 23 200 147 24 0 130 475 669 129 7 65 261 419 248 10 319 2,119 17 109 72 444 37 312 146 846 47 408 339 17 75 37 160 50 2,099 385 604 38 109 5 2 0 441 30 11 2 312 34 4 3 832 210 163 11 405 106 424 22 Fmt 4701 Sfmt 4702 E:\FR\FM\25APP2.SGM 25APP2 24030 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules TABLE M.—PERCENT CHANGE IN CASE-MIX INDEX BETWEEN FY 2006 AND FY 2007 BASED ON FY 2005 MEDPAR DATA—Continued Number of hospitals Number of providers with more than 5% loss Number of providers with loss between 1 and 5% Number of providers with 1% loss to 1% gain Number of providers with gain between 1 and 5% Number of providers with greater than 5% gain (1) (2) (3) (4) (5) (6) Other Reclassified Hospitals (Section 1886(d)(8)(B)) ........................................................ Section 508 Hospitals ............................................... wwhite on PROD1PC61 with PROPOSALS2 We also recognize the change from the current Medicare DRGs to a consolidated severity-adjusted DRG system would represent significant changes for hospitals. While we have considered the possibility of blending the two DRG systems, we do not believe there is a practical and simple mechanism to transition from the CMS DRGs to a consolidated severityadjusted DRG system. Our payments would be a blend of two different relative weights that would have to be determined using two different DRG systems. The systems and legal implications of such a transition could be significant. First, we believe that the use of two DRG systems would involve significant administrative complexity and expense for the Nation’s hospitals, fiscal intermediaries, and CMS. Second, we would likely have to establish two sets of Medicare rates with one set specific to each DRG system. In addition to complicating the ratesetting process and making it unclear to hospitals how Medicare’s IPPS rates for a year were determined, we are uncertain how we would: • Apply the budget neutrality requirement under section 1886(d)(4)(C)(iii) of the Act for changes to DRG classifications and weighting factors. • Determine the outlier threshold under section 1886(d)(5)(A)(iv) and the amounts removed for outliers from the IPPS standardized amounts under section 1886(d)(3)(B) of the Act. While we believe there are significant administrative, technical, and legal difficulties associated with making a blended transition from one DRG system to another, we welcome public comments on this issue as well. D. Proposed Changes to Specific DRG Classifications 1. Pre-MDCs: Pancreas Transplants (If you choose to comment on issues in this section, please include the caption ‘‘Pancreas Transplants’’ at the beginning of your comment.) VerDate Aug<31>2005 17:10 Apr 24, 2006 Jkt 208001 54 95 1 1 On July 1, 1999, we issued coverage policy which specified that pancreas transplants were only covered when performed simultaneously with or after a Medicare covered kidney transplant. A noncoverage policy for pancreas transplant remained in effect for patients who had not experienced end stage renal failure secondary to diabetes. On July 29, 2005, we opened a national coverage determination (NCD) to determine whether pancreas transplant alone, that is, without a kidney transplant, is a reasonable and necessary service for Medicare beneficiaries. On January 26, 2006, we published the proposed decision memorandum for pancreas transplants on our Web site at https://www.cms.hhs.gov.mcd/ viewdraftdecisionmemo.asp?id=166, stating that the evidence is adequate to conclude that pancreas transplant alone is reasonable and necessary for Medicare beneficiaries under limited circumstances. Medicare coverage of pancreas transplants alone is proposed to be limited to transplants in those facilities that are Medicare-approved for kidney transplantation. A listing of approved transplant centers can be found at https://www.cms.hhs.gov/ AprovedTransplantCenters/. In addition to other criteria listed in the draft decision memorandum, patients must have a diagnosis of Type I diabetes. Because we have issued a proposed NCD and a final NCD is not expected to be completed until late April 2006, which is after the publication date of this proposed rule, we are using this proposed rule to indicate the coding changes that we would make to DRG 513 (Pancreas Transplant) in FY 2007 if limited coverage of pancreas transplants alone is established. If the final NCD indicates that a pancreas transplant alone is not a reasonable and necessary service, in the IPPS final rule, we will not adopt the changes we are currently proposing to make to DRG 513 to implement the NCD. In addition, we are also indicating the conforming changes PO 00000 Frm 00036 Fmt 4701 Sfmt 4702 0 24 0 7 24 45 29 18 that we would make to the MCE ‘‘NonCovered Procedure’’ edit if Medicare coverage is established for pancreas transplants alone. That discussion can be found in the section II.D.6. of this preamble, which describes proposed changes to the MCE. Because of the potential decision to cover pancreas transplants alone, the logic for the determination of patient case assignment to DRG 513 would have to be modified to remove the requirement that patients also have kidney disease. Therefore, if the NDC is finalized, DRG 513 would consist of the following logic: List A (the diabetes codes) of the required principal or secondary diagnosis codes would remain the same, as would the required operating room procedures (codes 52.80 (Pancreatic transplant NOS), and 52.82, (Homotransplant of pancreas)). List B would be removed from the logic; the following codes would no longer be required as a principal or secondary diagnosis: • 403.01, Hypertensive kidney disease, malignant, with chronic kidney disease. • 403.11, Hypertensive kidney disease, benign, with chronic kidney disease. • 403.91, Hypertensive kidney disease, unspecified, with chronic kidney disease. • 404.02, Hypertensive heart and kidney disease, malignant, with chronic kidney disease. • 404.03, Hypertensive heart and kidney disease, malignant, with heart failure and chronic kidney disease. • 404.12, Hypertensive heart and kidney disease, benign, with chronic kidney disease. • 404.13, Hypertensive heart and kidney disease, benign, with heart failure and chronic kidney disease. • 404.92, Hypertensive heart and kidney disease, unspecified, with chronic kidney disease. • 404.93, Hypertensive heart and kidney disease, unspecified, with heart failure and chronic kidney disease. E:\FR\FM\25APP2.SGM 25APP2 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules • 585.1, Chronic kidney disease, Stage I. • 585.2, Chronic kidney disease, Stage II (mild). • 585.3, Chronic kidney disease, Stage III (moderate). • 585.4, Chronic kidney disease, Stage IV (severe). • 585.5, Chronic kidney disease, Stage V. • 585.6, End stage renal disease. • 585.9, Chronic kidney disease, unspecified. • V42.0, Organ or tissue replaced by transplant, kidney. • V43.89, Organ or tissue replaced by other means, other organ or tissue, other. We note that DRG 513 would remain in the Pre-MDC hierarchy. 2. MDC 1 (Diseases and Disorders of the Nervous System) a. Implantation of Intracranial Neurostimulator System for Deep Brain Stimulation (DBS) wwhite on PROD1PC61 with PROPOSALS2 (If you choose to comment on issues in this section, please include the caption ‘‘DRGs: Neurostimulators’’ at the beginning of your comment.) Deep-brain stimulation (DBS) is designed to deliver electrical stimulation to the subthalamic nucleus or internal globus pallidus to ameliorate symptoms caused by abnormal neurotransmitter levels that lead to abnormal cell-to-cell electrical impulses in Parkinson’s disease and essential tremor. DBS implants for essential tremor are unilateral, with neurostimulation leads on one side of the brain. DBS implants for Parkinson’s disease are bilateral, requiring implantation of neurostimulation leads in both the left and right sides of the brain. The implantation of a full DBS system requires two types of procedures. First, surgeons implant leads containing electrodes into the targeted sections of the brain where neurostimulation therapy is to be delivered. Second, a neurostimulator pulse generator is implanted in the pectoral region and extensions from the neurostimulator pulse generator are then tunneled under the skin along the neck and connected with the proximal ends of the leads implanted in the brain. Hospitals stage the two procedures required for a fullsystem DBS implant. In FY 2005, to better account for these two types of procedures, we revised procedure code 02.93 (Implantation or replacement of intracranial neurostimulator lead(s)) for the lead placement and created three new procedures codes for the pulse generator: 86.94 (Insertion or replacement of single array neurostimulator pulse generator); 86.95 (Insertion or replacement of dual array neurostimulator pulse generator); and 86.96 (Insertion or replacement of other neurostimulator pulse generator). We published the new procedure codes and revised procedure code titles in Tables 6B and 6F of the FY 2005 IPPS final rule (69 FR 49627 and 49641). In FY 2006, we made further refinements to the pulse generator codes to identify rechargeable pulse generators. We published the new procedure codes and revised procedure code titles in Tables 6B and 6F of the FY 2006 IPPS final rule (70 FR 47637 and 47639). The current list of pulse generators codes are: • 86.94 (Insertion or replacement of single array neurostimulator pulse generator, not specified as rechargeable); • 86.95 (Insertion or replacement of dual array neurostimulator pulse generator, not specified as rechargeable); • 86.96 (Insertion or replacement of other neurostimulator pulse generator); • 86.97 (Insertion or replacement of single array neurostimulator rechargeable generator); and • 86.98 (Insertion or replacement of dual array neurostimulator rechargeable generator). Kinetra is an implantable dual array neurostimulator pulse generator that is approved for a new technology add-on payment through FY 2006. For more information about the new technology add-on payment, please refer to section II.G.3.a. of this preamble. Medtronic, the manufacturer of Kinetra, argues that the new technology add-on payment provision is designed to recognize the higher costs of new medical innovations for the initial period the technology is available on the market, and until the associated costs and charges related to the technology are available in the MedPAR database and can be used to recalibrate the DRG weights. Medtronic also argues that, once a technology is no longer eligible for new technology add-on payments, DRG DRG DRG DRG 1—All Cases ................................................................................................................. 1—Cases with 02.93 and 86.95 (Kinetra) .................................................................. 1—Cases with 02.93 and 86.96 (Unspecified) ............................................................ 2—All Cases ................................................................................................................. VerDate Aug<31>2005 17:10 Apr 24, 2006 Jkt 208001 PO 00000 the new technology add-on payment provision is designed to support the reclassification of the technology to other clinically coherent DRGs with comparable resource costs. With the conclusion of the new technology add-on payment, Medtronic is concerned that Kinetra will be inadequately paid in DRG 1 (Craniotomy Age >17 With CC) or DRG 2 (Craniotomy Age >17 Without CC) under MDC 1. Medtronic recommended that CMS reassign the full-system Kinetra implants to DRG 543 (Craniotomy with Implant of Chemo Agent or Acute Complex CNS Principal Diagnosis) under MDC 1. To accommodate this recommendation, procedure codes 02.93 and 86.95 would have to be reassigned to DRG 543 and the title for DRG 543 would have to be revised to ‘‘Craniotomy with Implantation of Major Device or Acute Complex CNS Principal Diagnosis.’’ Medtronic argued that DRG 543 would be a ‘‘clinically-consistent DRG that more appropriately reflects the resource utilization associated with full-system [deep brain stimulation] procedures.’’ Medtronic also emphasized that its proposal would only apply to fullsystem Kinetra implants when both the leads and generators are implanted during a single inpatient stay or procedure codes 02.93 and 86.95 both appear on the claim. Medtronic believes the current DRG assignment is appropriate for partial system implants. Medtronic provided an analysis of FY 2004 MedPAR data. Procedure code 86.95 was not created until FY 2005 so Medtronic used procedure codes 02.93 and 86.09 (Other incision of skin and subcutaneous tissue) to identify the full system. It identified 193 cases assigned to DRG 1 with average charges of approximately $69,155, and 532 cases assigned to DRG 2 with average charges of approximately $56,113. We have reviewed the latest data for the full-system DBS implants assigned to DRG 1 or DRG 2 in the FY 2005 MedPAR file. We identified cases with procedure codes 02.93 and 86.95 for full-system dual array cases. We also identified cases with reported codes 02.93 and 86.96 for those full-system cases where the type of pulse generator was not specified. The following table displays our results: Number of cases DRG Frm 00037 Fmt 4701 Sfmt 4702 24031 Average length of stay 23,037 51 101 9,707 E:\FR\FM\25APP2.SGM 25APP2 9.61 5.18 4.86 4.41 Average charges $55,494 73,020 53,356 32,791 24032 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules Number of cases DRG wwhite on PROD1PC61 with PROPOSALS2 DRG 2—Cases with 02.93 and 86.95 (Kinetra) .................................................................. DRG 2—Cases with 02.93 and 86.96 (Unspecified) ............................................................ DRG 543—All cases .............................................................................................................. The data show that approximately one-quarter of the full-system dual array neurostimulator pulse generator cases are assigned to DRG 1 and approximately three-quarters of these cases are assigned to DRG 2. In both DRGs, the average length of stay was shorter for the full-system array neurostimulator pulse generator cases than for all other cases. However, the average charges for the full-system dual array neurostimulator pulse generator cases are approximately $18,000 and $27,000 higher than the average charges for DRGs 1 and 2, respectively. The average charges for these cases in DRG 1 are comparable to those for DRG 543. However, the more commonly occurring cases in DRG 2 have average charges that are less than those in DRG 543 by nearly $12,000. We reviewed all of the procedures that will result in a case being assigned to DRGs 1 and 2. Unlike the full-system DBS implants, we believe for most of the cases assigned to these DRGs, there will be no device cost to the hospital. For this reason, we believe the higher average charges and lower length of stay for cases involving full-system dual array neurostimulator pulse generators are likely accounted for by the cost of the device. While it is possible that the cost of the device itself will make the full-system DBS implants more expensive than other cases in the DRG, the hospital’s charge markup may also explain the higher charges but lower average length of stay. As indicated in section II.G.3.a.of this proposed rule, the national average CCR for medical equipment and supplies is approximately 34 percent. Thus, the actual cost to the hospital of the case including the full-system dual array neurostimulator pulse generator may be much lower than the charges would suggest. With respect to whether the cost of the technology itself, absent a charge markup, makes the case more expensive, we intend to address this issue as we make further refinements to the severity DRG system we are proposing to implement in FY 2008 (if not earlier), as discussed in section II.C. of this preamble. As we indicate in section II.C. of this proposed rule, the consolidated severity-adjusted DRG system that we are proposing does not currently assign a case to a higher weighted DRG based on use of a VerDate Aug<31>2005 17:10 Apr 24, 2006 Jkt 208001 technology that represents increased complexity but not necessarily greater severity of illness. The data above indicate that approximately threequarters of the patients who receive a full-system dual array neurostimulator pulse generator do not have a CC. Thus, it appears that these patients would be more likely to be assigned to a lower severity of illness class based solely on diagnosis. However, the implant of a full-system dual array neurostimulator pulse generator may increase complexity and resource use even though the patient is not more severely ill. As we also explain in section II.C. of this proposed rule, we believe that the consolidated severity-adjusted DRG system we are proposing would need to be further refined to assign cases based on complexity as well as severity to account for technologies like the fullsystem dual array neurostimulator pulse generator implants that increase costs. We plan to further develop the consolidated severity-adjusted DRGs between now and its implementation to address this issue. b. Carotid Artery Stents (If you choose to comment on issues in this section, please include the caption ‘‘DRGs: Carotid Artery Stents’’ at the beginning of your comment.) Stroke is the third leading cause of death in the United States and the leading cause of serious, long-term disability. Approximately 70 percent of all strokes occur in people age 65 and older. The carotid artery, located in the neck, is the principal artery supplying the head and neck with blood. Accumulation of plaque in the carotid artery can lead to stroke either by decreasing the blood flow to the brain or by having plaque break free and lodge in the brain or in other arteries to the head. The percutaneous transluminal angioplasty (PTA) procedure involves inflating a balloon-like device in the narrowed section of the carotid artery to reopen the vessel. A carotid stent is then deployed in the artery to prevent the vessel from closing or restenosing. A distal filter device (embolic protection device) may also be present, which is intended to prevent pieces of plaque from entering the bloodstream. Effective July 1, 2001, Medicare covers PTA of the carotid artery concurrent with carotid stent placement PO 00000 Frm 00038 Fmt 4701 Sfmt 4702 Average length of stay 146 249 5,192 2.40 2.12 11.71 Average charges 59,414 47,047 71,138 when furnished in accordance with the FDA-approved protocols governing Category B Investigational Device Exemption (IDE) clinical trials. PTA of the carotid artery, when provided solely for the purpose of carotid artery dilation concurrent with carotid stent placement, is considered to be a reasonable and necessary service only when provided in the context of such clinical trials and, therefore, is considered a covered service for the purposes of these trials. Performance of PTA in the carotid artery when used to treat obstructive lesions outside of approved protocols governing Category B IDE clinical trials remained noncovered until the release of the October 12, 2004 NCD for PTA of the carotid artery in post-approval studies. This decision extended coverage of PTA in the carotid artery concurrent with placement of an FDA-approved carotid stent for an FDA-approved indication when furnished in accordance with the FDA-approved protocols governing post-approval studies. On March 17, 2005, CMS released the NCD extending coverage to patients at high risk for carotid endarterectomy (CEA) who also have symptomatic carotid artery stenosis ≥ 70 percent. Procedures must be performed in CMS-approved facilities and with FDA-approved carotid artery stenting with distal embolic protection. (Section 20.7 of the NCD manual, which may be viewed at the Web site: https://www.cms.hhs.gov/ manuals/downloads/ ncd103c1_Part1.pdf.) We established codes for carotid artery stenting procedures for use with discharges occurring on or after October 1, 2004, for inpatients who are enrolled in an FDA-approved clinical trial and are using on-label FDAapproved stents and embolic protection devices. These codes are as follows: • 00.61 (Percutaneous angioplasty or atherectomy of precerebral (extracranial vessel(s)); and • 00.63 (Percutaneous insertion of carotid artery stent(s)). We assigned procedure code 00.61 to four MDCs and seven DRGs. The most likely scenario is that in which cases are assigned to MDC 1 (Diseases and Disorders of the Nervous System) in DRGs 533 (Extracranial Procedures with CC) and 534 (Extracranial Procedures without CC). Other DRG assignments E:\FR\FM\25APP2.SGM 25APP2 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules can be found in Table 6B of the Addendum to the FY 2005 IPPS final rule (69 FR 49624). As part of our annual DRG review, for the FY 2006 final rule (70 FR 47300), we used proxy codes to evaluate the costs and DRG assignments for carotid artery stenting because codes 00.61 and 00.63 were only approved for use beginning October 1, 2004, and MedPAR data for this period were not yet available. We used procedure code 39.50 (Angioplasty or atherectomy of other noncoronary vessel(s)) in combination with procedure code 39.90 (Insertion of nondrug-eluting peripheral vessel stent(s)) in DRGs 533 and 534 as the proxy codes for carotid artery stenting. For this evaluation, we used principal diagnosis code 433.10 (Occlusion and stenosis of carotid artery, without mention of cerebral infarction) to reflect the clinical trial criteria. Based on the results of our review, for FY 2006, we wwhite on PROD1PC61 with PROPOSALS2 DRG DRG DRG DRG DRG DRG 533—All 533 with 533 with 534—All 534 with 534 with cases .............................................................................................................. codes 00.61 and 00.63 reported ................................................................... code 00.61 and without 00.63 ....................................................................... cases .............................................................................................................. codes 00.61 and 00.63 reported ................................................................... code 00.61 and without 00.63 ....................................................................... We found that 5.5 and 5.1 percent of the cases in DRGs 533 and 534, respectively, involved placement of a carotid artery stent. In both DRGs, the average length of stay was shorter for the carotid stenting cases than for all other cases. However, the average charges for the carotid stent cases were higher by $6,968 in DRG 533 and $7,804 in DRG 534. We reviewed all of the procedures that would result in a case being assigned to DRGs 533 and 534. Unlike the carotid artery stent placements, we believe that, for most of the cases assigned to these DRGs, there will be no device cost to the hospital. For this reason, we believe the higher average charges and lower length of stay for the cases involving carotid artery stents are likely accounted for by the cost of the device. While it is possible that the cost of the device itself will make the stent cases more expensive than other cases in the DRG, the hospital’s charge markup may also explain the higher charges but lower average length of stay. As indicated elsewhere in this proposed rule, the national average CCR for medical equipment and supplies is approximately 34 percent. Thus, the actual cost to the hospital of the case including the carotid stent may be much lower than the charges would suggest. With respect to whether the cost of the technology itself, absent a charge markup, makes the case more expensive, we intend to address this issue as we make further refinements to the severity-adjusted DRG system we describe above. As we indicate in section II.C. of the preamble of this proposed rule, the consolidated severity-adjusted DRG system that we are proposing does not currently assign VerDate Aug<31>2005 17:10 Apr 24, 2006 Jkt 208001 did not find sufficient evidence to warrant a DRG change at that time. Manufacturer representatives have suggested that we assign all carotid stenting cases to DRG 533 only, bypassing DRG 534. We have reviewed the FY 2005 MedPAR data on all cases in DRGs 533 and 534 and on those cases containing code 00.61 in combination with 00.63. The following table displays our results: Number of cases DRG a case to a higher weighted DRG based on use of a technology that represents increased complexity but not necessarily greater severity of illness. The use of a carotid stent or stents may increase complexity and resource use even though the patient is not more severely ill. We believe that the consolidated severity-adjusted DRG system we are proposing would need to be further refined to assign cases based on complexity as well as severity to account for technologies such as carotid stents that increase costs. For this reason, we believe that this issue of assignment of carotid stent cases may be better addressed in the consolidated severity-adjusted DRG system that we are proposing in FY 2008 (if not earlier) than through a change to the current DRG assignment for these cases. 3. MDC 5 (Diseases and Disorders of the Circulatory System) a. Insertion of Epicardial Leads for Defibrillator Devices (If you choose to comment on issues in this section, please include the caption ‘‘DRGs: Epicardial Leads’’ at the beginning of your comment.) We received a comment indicating that a change in coding advice for the insertion of epicardial leads for CRT–D defibrillator devices affects DRG assignment. The commenter noted that the Third Quarter 2005 issue of the American Hospital Association’s publication Coding Clinic for ICD–9–CM instructs coders to assign code 37.74 (Insertion or replacement of epicardial lead [electrode] into atrium) for pacemaker or defibrillator leads inserted through use of a thoracotomy into the epicardium. While the use of code 37.74 is standard coding practice for PO 00000 Frm 00039 Fmt 4701 Sfmt 4702 24033 Average length of stay (days) 44,031 2,400 99 40,381 2,056 55 3.65 2.94 5.95 1.72 1.52 2.31 Average charges $26,376 33,344 46,591 17,196 25,000 27,895 pacemakers, the advice is new for defibrillators. This coding advice was discussed at the ICD–9–CM Coordination and Maintenance Committee meeting held on September 29 and 30, 2005. Participants at the Committee meeting proposed modifications for the code category 37.7 (insertion, revision, replacement, and removal of pacemaker leads; insertion of temporary pacemaker system; and revision of cardiac device pocket). These modifications involved expanding the category so that the codes for leads would no longer be restricted to pacemakers. This change would guide coders to use code 37.74 for the insertion of epicardial leads for both defibrillators and pacemakers. This change was adopted for the ICD–9–CM and will become effective on October 1, 2006. The commenter pointed out that this coding advice would restrict some defibrillator cases from being assigned to the defibrillator DRGs. Specifically, the commenter expressed concerns about the DRG logic for the following DRGs: • DRG 515 (Cardiac Defibrillator Implant without Cardiac Catheter. • DRG 535 (Cardiac Defibrillator Implant with Cardiac Catheter with AMI/Heart Failure/Shock). • DRG 536 (Cardiac Defibrillator Implant with Cardiac Catheter without AMI/Heart Failure/Shock). Cases are assigned to one of these three DRGs when a total defibrillator system, including both the device and one or more leads, is implanted. The implant could be represented by the ICD–9-CM codes for the total system, that is, code 00.51 (Implantation of cardiac resynchronization defibrillator, E:\FR\FM\25APP2.SGM 25APP2 wwhite on PROD1PC61 with PROPOSALS2 24034 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules total system [CRT–D]) or code 37.94 (Implantation or replacement of automatic cardioverter/defibrillator, total system [AICD]). Cases can also be assigned to DRGs 515, 535, and 536 when a combination of a device and a lead code is reported. The following combinations of defibrillator device and lead codes are present in the current DRG logic: • 00.52 (Implantation or replacement of transvenous lead [electrode] into left ventricular coronary venous system) and 00.54 (Implantation or replacement of cardiac resynchronization defibrillator, pulse generator device only [CRT–D]). • 37.95 (Implantation of automatic cardioverter/defibrillator lead(s) only) and 00.54 (Implantation or replacement of cardiac resynchronization defibrillator, pulse generator device only [CRT–D]). • 37.95 (Implantation of automatic cardioverter/defibrillator lead(s) only) and 37.96 (Implantation of automatic cardioverter/defibrillator pulse generator only). • 37.97 (Replacement of automatic cardioverter/defibrillator lead(s) only) and 00.54 (Implantation or replacement of cardiac resynchronization defibrillator, pulse generator device only [CRT–D]). • 37.97 (Replacement of automatic cardioverter/defibrillator lead(s) only) and 37.98 (Replacement of automatic cardioverter/defibrillator pulse generator only). A DRG logic issue has arisen concerning the instruction to use code 37.74 to capture epicardial leads inserted with CRT–D defibrillators. The new combination of a defibrillator device with an epicardial lead (code 37.74) is not included in DRGs 515, 535, and 536. The commenter recommended that the following combinations be added to DRGs 515, 535, and 536 so that all types of defibrillator device and lead combinations would be included: code 37.74 and code 00.54; code 37.74 and code 37.96; and code 37.74 and code 37.98. We agree that these three combinations should be added to the list of combination codes included in DRGs 515, 535, and 536. This would result in all combinations of defibrillator devices and leads being assigned to one of the defibrillator DRGs. Therefore, we are proposing to add these three combinations to the list of procedure combinations under DRGs 515, 535, and 536. VerDate Aug<31>2005 17:10 Apr 24, 2006 Jkt 208001 b. Application of Major Cardiovascular Diagnoses (MCVs) List to Defibrillator DRGs (If you choose to comment on issues in this section, please include the caption ‘‘DRGs: MCVs and Defibrillators’’ at the beginning of your comment.) In the FY 2006 IPPS final rule (70 FR 47289 and 47474 through 47479), we addressed a comment we had received in response to the FY 2006 proposed rule which noted that section 507(c) of Pub. L. 108–173 required MedPAC to conduct a study to determine how the DRG system should be updated to better reflect the cost of delivering care in a hospital setting. The commenter noted that MedPAC reported that the ‘‘cardiac surgery DRGs have high relative profitability ratios.’’ While the commenter acknowledged that it may take time to conduct and complete a thorough evaluation of the MedPAC payment recommendations for all DRGs, the commenter strongly encouraged CMS to revise the cardiac DRGs through patient severity refinement as part of the IPPS final rule effective for FY 2006. In response to this comment, we performed an extensive review of the cardiovascular DRGs in MDC 5, particularly those DRGs that were commonly billed by specialty hospitals. We observed that there was some overlap between the lists of cardiovascular complications and complex diagnoses and that these lists were already used to segregate patients into DRGs that use greater resources. Because the hospital industry already was familiar with the major complication and complex diagnosis lists used within the cardiovascular DRGs, we began our analysis with these two overlapping lists. The two lists were originally developed for the current DRG system because they contained conditions that could have an impact on the resources needed to treat a patient with cardiovascular complications. Many of the conditions were cardiovascular diagnoses and, therefore, would be classified to MDC 5. However, we determined that some of the diagnoses were not cardiovascular, but would still have an impact on a patient with cardiovascular complications. The conditions that were not cardiovascular diagnoses were not assigned to MDC 5 if they were the principal diagnosis. We reviewed the conditions on the two overlapping lists and identified conditions that we believed would lead to a more complicated patient stay requiring greater resource use. We referred to these conditions as ‘‘major PO 00000 Frm 00040 Fmt 4701 Sfmt 4702 cardiovascular conditions (MCVs).’’ The MCVs could be present as either a principal diagnosis or a secondary diagnosis and lead to greater resource consumption. The complete list of MCVs was published in the FY 2006 IPPS final rule (70 FR 47477 and 47478). In the FY 2006 IPPS final rule, we also adopted new DRGs 547 through 558, effective October 1, 2006 (70 FR 47475 and 47476). However, we emphasized that the refinements to the DRGs were being taken as an interim step to better recognize severity in the DRG system for FY 2006 until we could complete a more comprehensive analysis of the APR DRG system and the CC list as part of a complete analysis of the MedPAC recommendations that we planned to perform for FY 2007 (and which is addressed in section II.C. of the preamble of this proposed rule). Since publication of the FY 2006 IPPS final rule, we have received a question from a commenter as to why we did not apply the MCV list to the following defibrillator DRGs: 515, 535, and 536. The commenter noted that the pacemaker DRGs were revised using the MCV list, but the defibrillator DRGs were not. As noted above, for FY 2006, we created new DRGs 546 through 558 to identify cases with more costly and severely ill patients as an interim step to evaluating severity DRGs. We analyzed for the first time past year data on cases within MDC 5 and presented data that showed significant difference for patients in certain DRGs based on the presence of absence of an MCV. This split did not work for the defibrillator DRGs, as we could not identify groups with significantly different resource use. For instance, splitting DRG 515 based on the presence of an MCV would lead to two groups with differences in charges of only $3,430 ($89,341 for those with an MCV and $85,911 for those without an MCV). In the data we displayed in the FY 2006 IPPS final rule, the differences for DRGs selected for an MCV split ranged from $10,319 to $21,035. Splitting DRG 515 based on an MCV would produce a difference in charges of only 10.1 percent as compared to differences of 28.7 to 47.7 percent for DRGs 547 through 558. Therefore, the data did not support including DRG 515 among those split based on the presence or absence of an MCV. Similar results were found when DRG 536 was split by an MCV. There was only an 8.1 percent difference in charges between the two groups. We also identified other problems with splitting DRG 535 based on the presence or absence of an MCV. Some of the codes a claim must include for the case E:\FR\FM\25APP2.SGM 25APP2 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules to be grouped to DRG 535 under our current system are also codes on the MCV list. Therefore, applying the MCV list to DRG 535 would result in all cases being assigned to the DRG with an MCV and none to the DRG without an MCV. For these reasons, we did not subdivide DRGs 515, 535, and 536 based on the presence or absence of an MCV. We have decided not to propose additional refinements of the DRGs based on MCVs for FY 2007 because of our efforts to propose a broader refinement of the DRG system that would focus on consolidated severityadjusted DRGs, as discussed in detail in section II.C. of this proposed rule. However, as discussed further in section II.C. of this preamble, we are soliciting comments on whether it would be appropriate in FY 2007 to apply a clinical severity concept to an expanded set of DRGs, similar to the approach we used in FY 2006 to refine cardiac DRGs based on the presence or absence of an MCV. 4. MDC 8 (Diseases and Disorders of the Musculoskeletal System and Connective Tissue) wwhite on PROD1PC61 with PROPOSALS2 a. Hip and Knee Replacements (If you choose to comment on issues in this section, please include the caption ‘‘DRGs: Hip and Knee Replacements’’ at the beginning of your comment.) In the FY 2006 final rule (70 FR 47303), we deleted DRG 209 (Major Joint and Limb Reattachment Procedures of Lower Extremity) and created new DRGs 544 (Major Joint Replacement or Reattachment of Lower Extremity) and 545 (Revision of Hip or Knee Replacement) to help resolve payment issues for hospitals that perform revisions of joint replacements because we found revisions of joint replacements to be significantly more resource intensive than original hip and knee replacements. DRG 544 includes the following code assignments: • 81.51, Total hip replacement. • 81.52, Partial hip replacement. • 81.54, Total knee replacement. • 81.56, Total ankle replacement. • 84.26, Foot reattachment. • 84.27, Lower leg or ankle reattachment. • 84.28, Thigh reattachment. DRG 545 includes the following procedure code assignments: • 00.70, Revision of hip replacement, both acetabular and femoral components. • 00.71, Revision of hip replacement, acetabular component. • 00.72, Revision of hip replacement, femoral component. VerDate Aug<31>2005 17:10 Apr 24, 2006 Jkt 208001 • 00.73, Revision of hip replacement, acetabular liner and/or femoral head only. • 00.80, Revision of knee replacement, total (all components). • 00.81, Revision of knee replacement, tibial component. • 00.82, Revision of knee replacement, femoral component. • 00.83, Revision of knee replacement, patellar component. • 00.84, Revision of knee replacement, tibial insert (liner). • 81.53, Revision of hip replacement, not otherwise specified. • 81.55, Revision of knee replacement, not otherwise specified. In the FY 2006 IPPS final rule (70 FR 47305), we indicated that the American Association of Orthopaedic Surgeons had requested that, once we receive claims data using the two DRG procedure code assignments, we closely examine data from the use of the codes under the two DRGs to determine if future additional DRG modifications are needed. After publication of the FY 2006 IPPS final rule, a number of hospitals and coding personnel advised us that the DRG logic for DRG 471 (Bilateral or Multiple Major Joint Procedures of Lower Extremity), which utilizes the new and revised hip and knee procedure codes under DRGs 544 and 545, also includes codes that describe procedures that are not bilateral or that do not involve multiple major joints. DRG 471 was developed to include cases where major joint procedures such as revisions or replacements were performed either bilaterally or on two joints of one lower extremity. We changed the logic for DRG 471 last year for the first time when we added the new and revised codes. The commenters indicated that, by adding the more detailed codes that do not include total revisions or replacements to the list of major joint procedures to DRG 471, we are assigning cases to DRG 471 that do not have bilateral or multiple joint procedures. For example, when a hospital reports a code for revision of the tibial component (code 00.81) and patellar component of the right knee (code 00.83), the current DRG logic assigns the case to DRG 471. The commenters indicated that this code assignment is incorrect because only one joint has undergone surgery, but two components were used. One commenter indicated that ICD–9–CM does not identify left/right laterality. Therefore, it is difficult to use the current coding structure to determine if procedures are performed on the same leg or on both legs. The commenters raised concern about whether CMS PO 00000 Frm 00041 Fmt 4701 Sfmt 4702 24035 intended to pay hospitals using DRG 471 for procedures performed on one joint. The commenters indicated that the DRG assignments for these codes would also make future data analysis misleading. The commenters recommended removing codes from DRG 471 that do not specifically identify bilateral or multiple joint procedures so that DRG 471 will only include cases involving the more resource intensive cases of bilateral or multiple total joint replacements and revisions. We agree that the new and revised joint procedure codes should not be assigned to DRG 471 unless they include bilateral and multiple joints. Therefore, we are proposing to remove the following codes from DRG 471 that do not capture bilateral and multiple joint revisions or replacements: • 00.71, Revision of hip replacement, acetabular component. • 00.72, Revision of hip replacement, femoral component. • 00.73, Revision of hip replacement, acetabular liner and/or femoral head only. • 00.81, Revision of knee replacement, tibial component. • 00.82, Revision of knee replacement, femoral component. • 00.83, Revision of knee replacement, patellar component. • 00.84, Revision of total knee replacement, tibial insert (liner). • 81.53, Revision of hip replacement, not otherwise specified. • 81.55, Revision of knee replacement, not otherwise specified. The proposed revised DRG 471 would then contain only the following codes: • 00.70, Revision of hip replacement, both acetabular and femoral components. • 00.80, Revision of knee replacement, total (all components). • 81.51, Total hip replacement. • 81.52, Partial hip replacement. • 81.54, Total knee replacement. • 81.56, Total ankle replacement. As a result of the proposed removal of the identified codes from DRG 471, we are proposing that one or more of the following hip or knee revision codes would be assigned to DRG 545: 00.71, 00.72, 00.73, 00.81, 00.82, 00.83, 00.84, 81.53, and 81.55. This list includes partial revisions of the knee and hip as well as unspecified joint procedures such as code 81.55 where it is not clear if the revision is total or partial. We plan to perform extensive data analysis on the new and revised joint procedure codes as we receive billing data to determine if future refinements of these DRGs are needed. In addition, as indicated in section II.C. of this E:\FR\FM\25APP2.SGM 25APP2 24036 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules preamble, we are proposing to adopt a consolidated severity-adjusted DRG system for the IPPS. We encourage commenters to evaluate how the new and revised joint procedures are addressed in the consolidated severityadjusted DRG system. If changes to these procedures are warranted based on public comments and our continuing analysis, we will evaluate them as we further develop our plans for adopting the consolidated severity-adjusted DRGs. wwhite on PROD1PC61 with PROPOSALS2 b. Spinal Fusion (If you choose to comment on issues in this section, please include the caption ‘‘DRGs: Spinal Fusion’’ at the beginning of your comment.) In the FY 2006 IPPS final rule (70 FR 47307), we created new DRG 546 (Spinal Fusions Except Cervical with Curvature of the Spine or Malignancy). DRG 546 is composed of all noncervical spinal fusions previously assigned to DRGs 497 (Spinal Fusion Except Cervical with CC) and 498 (Spinal Fusion Except Cervical without CC) that have a principal or secondary diagnosis of curvature of the spine or a principal diagnosis of a malignancy. The principal diagnosis codes that lead to DRG 546 assignment are the following: • 170.2, Malignant neoplasm of vertebral column, excluding sacrum and coccyx. • 198.5, Secondary malignant neoplasm of bone and bone marrow. • 213.2, Benign neoplasm of bone and articular cartilage; vertebral column, excluding sacrum and coccyx. • 238.0, Neoplasm of uncertain behavior of other and unspecified sites and tissues; Bone and articular cartilage. • 239.2, Neoplasms of unspecified nature; bone, soft tissue, and skin. • 732.0, Juvenile osteochondrosis of spine. • 733.13, Pathologic fracture of vertebrae. • 737.0, Adolescent postural kyphosis. • 737.10, Kyphosis (acquired) (postural). • 737.11, Kyphosis due to radiation. • 737.12, Kyphosis, postlaminectomy. • 737.19, Kyphosis (acquired), other. • 737.20, Lordosis (acquired) (postural). • 737.21, Lordosis, postlaminectomy. • 737.22, Other postsurgical lordosis. • 737.29, Lordosis (acquired), other. • 737.30, Scoliosis [and kyphoscoliosis], idiopathic. • 737.31, Resolving infantile idiopathic scoliosis. • 737.32, Progressive infantile idiopathic scoliosis. VerDate Aug<31>2005 17:10 Apr 24, 2006 Jkt 208001 • 737.33, Scoliosis due to radiation. • 737.34, Thoracogenic scoliosis. • 737.39, Other kyphoscoliosis and scoliosis. • 737.8, Other curvatures of spine. • 737.9, Unspecified curvature of spine. • 754.2, Congenital scoliosis. • 756.51, Osteogenesis imperfecta. The secondary diagnoses that will lead to DRG 546 assignment are: • 737.40, Curvature of spine, unspecified. • 737.41, Curvature of spine associated with other conditions, kyphosis. • 737.42, Curvature of spine associated with other conditions, lordosis. • 737.43, Curvature of spine associated with other conditions, scoliosis. After publication of the FY 2006 IPPS final rule, we received a comment stating that creating new DRG 546 was insufficient to address clinical severity and resource differences among spinal fusion cases that involve fusing multiple levels of the spine. Specifically, the commenter suggested that the spinal fusion DRGs be further modified to incorporate Bone Morphogenic Protein (BMP), code 84.52 (Insertion of recombinant bone morphogenetic protein). The commenter also suggested that CMS apply a clinical severity concept to all back and spine surgical cases similar to the approach that we used for the MCVs to refine the cardiac DRGs in the final rule for FY 2006. The commenter recommended recognizing additional conditions that reflect higher resource needs, regardless of whether they are principal or secondary diagnoses. The commenter also suggested that the spine DRGs be further subdivided based on the use of specific spinal devices such as artificial discs. These changes would entail the creation of 10 new spine DRGs in addition to other changes requested. We agree that it is important to recognize severity when classifying patients into specific DRGs. In response to recommendations made by MedPAC last year that are discussed in section II.C. of this proposed rule, we are conducting a comprehensive analysis of the entire DRG system to determine whether to undertake significant reform to better recognize severity of illness. At this time, we believe it is premature to develop a severity adjustment for spine surgeries while we are considering a more systematic approach to capturing severity of illness across all DRGs. We also believe it would be premature to propose revisions to DRG 546 because this DRG was created on October 1, PO 00000 Frm 00042 Fmt 4701 Sfmt 4702 2005, and we do not yet have data to analyze its impact. Given the number of innovations occurring in spinal surgery over the last several years (for example, artificial spinal disc prostheses, kyphoplasty, and vertebroplasty), we agree that additional analysis of the spine DRGs would be warranted if we were to continue with the current DRG system and not adopt consolidated severity-adjusted DRGs. However, as discussed above, we are proposing to develop a severity-adjusted DRG system. For this reason, we are not further researching this issue for FY 2007. However, we encourage commenters to examine the proposed consolidated severity-adjusted DRG system described in section II.C. of the preamble of this proposed rule to determine whether there is a better recognition of severity of illness and resource use in that system. c. ChariteTM Spinal Disc Replacement Device (If you choose to comment on issues in this section, please include the caption ‘‘DRGs: CHARITETM’’ at the beginning of your comment.) CHARITETM is a prosthetic intervertebral disc. On October 26, 2004, the FDA approved the CHARITETM Artificial Disc for single level spinal arthroplasty in skeletally mature patients with degenerative disc disease between L4 and S1. On October 1, 2004, we created new procedure codes for the insertion of spinal disc prostheses (codes 84.60 through 84.69). We provided the DRG assignments for these new codes in Table 6B of the FY 2005 IPPS proposed rule (69 FR 28673). We received a number of comments on the proposed rule recommending that we change the assignments for these codes from DRG 499 (Back and Neck Procedures Except Spinal Fusion With CC) and DRG 500 (Back and Neck Procedures Except Spinal Fusion Without CC) to the DRGs for spinal fusion, DRG 497 (Spinal Fusion Except Cervical With CC) and DRG 498 (Spinal Fusion Except Cervical Without CC) for procedures on the lumbar spine and to DRGs 519 and 520 for procedures on the cervical spine. In the FY 2005 IPPS final rule (69 FR 48938), we indicated that DRGs 497 and 498 are limited to spinal fusion procedures. Because the surgery involving the CHARITETM is not a spinal fusion, we decided not to include this procedure in these DRGs. However, we stated that we would continue to analyze this issue and solicited further public comments on the DRG assignment for spinal disc prostheses. In the FY 2006 final rule (70 FR 47353), we noted that, if a product E:\FR\FM\25APP2.SGM 25APP2 wwhite on PROD1PC61 with PROPOSALS2 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules meets all of the criteria for Medicare to pay for the product as a new technology under section 1886(d)(5)(K) of the Act, there is a clear preference expressed in the statute for us to assign the technology to a DRG based on similar clinical or anatomical characteristics or costs. However, for FY 2006, we did not find that CHARITETM met the substantial clinical improvement criterion and, thus, did not qualify as a new technology. Consequently, we did not address the DRG classification request made under the authority of this provision of the Act. However, we did evaluate whether to reassign CHARITETM to different DRGs using the Secretary’s authority under section 1886(d)(4) of the Act (70 FR 47308). We indicated that we did not have Medicare charge information to evaluate DRG changes for cases involving an implant of a prosthetic intervertebral disc like CHARITETM and did not make a change in its DRG assignments. We stated that we would consider whether changes to the DRG assignments for CHARITETM were warranted for FY 2007, once we had information from Medicare’s data system that would assist us in evaluating the costs of these patients. For the FY 2007 IPPS update, we received a comment regarding the DRG assignments for the CHARITETM Artificial Disc, code 84.65 (Insertion of total spinal disc prosthesis, lumbosacral). The commenter had previously submitted an application for the CHARITETM Artificial Disc for new technology add-on payments for FY 2006 and had requested a reassignment of cases involving CHARITETM implantation to DRGs 497 and 498. The commenter asked that we examine claims data for FY 2005 and reassign procedure code 84.65 from DRGs 499 and 500 into DRGs 497 and 498. The commenter again stated the view that cases with the CHARITETM Artificial Disc reflect comparable resource use and similar clinical indications as do those in DRGs 497 and 498. If CMS were to reject reassignment of the CHARITETM Artificial Disc to DRGs 497 and 498, the commenter suggested creating two separate DRGs for lumbar disc replacements. On February 16, 2006, we posted a proposed NCD memorandum regarding lumber artificial disc replacement with a focus of the CHARITETM Lumber Artificial Disc for public comment on the CMS Web site. This is part of the process for issuing an NCD. In this memorandum, we proposed to issue an NCD. We are seeking public comment on our proposed determination that the evidence is not adequate to conclude VerDate Aug<31>2005 17:10 Apr 24, 2006 Jkt 208001 that lumbar artificial disc replacement with the CHARITETM Lumber Artificial Disc is reasonable and necessary. This proposed decision memorandum can be found at: https://www.cms.hhs.gov/mcd/ viewnca.asp?where=index& nca_id=170&basket=nca:00292N:170: Lumbar+Artificial+Disc+Replacement: Open:New:5. After considering the public comments and any additional evidence, we will make a final determination and issue a final NCD. The proposed NCD states that lumber artificial disc replacement with the CHARITETM Lumber Artificial Disc is generally not indicated in patients over 65 years old. Further, it states that there is insufficient evidence among either the aged or disabled Medicare population to make a reasonable and necessary determination for coverage. With an NCD pending to make spinal arthroplasty with CHARITETM noncovered, we do not believe it is appropriate at this time to reassign procedure code 84.65 from DRGs 499 and 500 to DRGs 497 and 498. 5. MDC 18 (Infectious and Parasitic Diseases (Systemic or Unspecified Sites)): Severe Sepsis (If you choose to comment on issues in this section, please include the caption ‘‘DRGs: Severe Sepsis’’ at the beginning of your comment.) In FYs 2005 and 2006, we considered requests for the creation of a separate DRG for the diagnosis of severe sepsis. Severe sepsis is described by ICD–9–CM code 995.92 (Systemic inflammatory response syndrome due to infection with organ dysfunction). Patients admitted with sepsis as a principal diagnosis currently are assigned to DRG 416 (Septicemia Age > 17) and DRG 417 (Septicemia Age 0–17) in MDC 18 (Infectious and Parasitic Diseases (Systemic or Unspecified Sites)). The commenter requested that all cases in which severe sepsis is present on admission, as well as those cases in which it develops after admission (which are currently classified elsewhere), be included in this new DRG. In both FY 2005 and FY 2006 (69 FR 48975 and 70 FR 47309), we did not believe the current clinical definition of severe sepsis was specific enough to identify a meaningful cohort of patients in terms of clinical coherence and resource utilization to warrant a separate DRG. Sepsis is found across hundreds of medical and surgical DRGs, and the term ‘‘organ dysfunction’’ implicates numerous currently existing diagnosis codes. While we recognize that Medicare beneficiaries with severe sepsis are quite ill and require extensive hospital resources, in the past we have PO 00000 Frm 00043 Fmt 4701 Sfmt 4702 24037 not found that they can be identified adequately to justify removing them from all of the other DRGs in which they appear. For this reason, we did not create a new DRG for severe sepsis for FY 2005 or FY 2006. We indicated that we would continue to work with National Center for Health Statistics (NCHS) to improve the codes so that our data on these patients improve. We also indicated that we would continue to examine data on these patients as we consider future modifications. For this FY 2007 proposed rule, we again received a request to consider creating a separate DRG for patients diagnosed with severe sepsis. The information and data available to us from hospital bills with respect to identifying patients with severe sepsis have not changed since last year. However, the NCHS discussed modifications to the current ICD–9–CM diagnosis codes for systemic inflammatory response syndrome (SIRS), codes 995.91 through 995.94 (which include severe sepsis) at the September 29–30, 2005 ICD–9–CM Coordination and Maintenance Committee meeting. During the meeting, it became clear that there is still confusion surrounding the use of these codes. As a result of the meeting and the comments received, the Committee made modifications to the set of SIRS codes. These modifications are reflected in Table 6E, Revised Diagnosis Code Titles, of the Addendum to this proposed rule. We believe that implementation of the modified SIRS diagnosis codes and the updated coding guidelines over the next year could begin the process of improving data for this group of patients. The desired outcome is to be able to better evaluate Medicare beneficiaries with severe sepsis with regard to their clinical coherence, resource utilization, and charges. Therefore, at this time, we are not proposing to create a new DRG for severe sepsis for FY 2007. We also note that we are proposing to adopt a consolidated severity-adjusted DRG system, as discussed in section II.C. of this preamble. The underlying clinical principle of the proposed consolidated severity-adjusted DRG system is that the severity of illness of a patient is highly dependent on the patient’s underlying problem and that patients with high severity of illness are usually characterized by multiple serious diseases or illnesses. The assessment of the severity of illness of a patient is specific to the base DRG to which a patient is assigned. In other words, the determination of the severity of illness is disease-specific. High severity of E:\FR\FM\25APP2.SGM 25APP2 24038 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules illness is primarily determined by the interaction of multiple diseases. Patients with multiple comorbid conditions involving multiple organ systems are assigned to the higher severity of illness subclasses. Thus, patients with severe sepsis and organ dysfunction are likely to be classified as severity of illness subclass 3 or 4 under the proposed DRG system, depending on the other comorbid conditions or underlying problems the patient may have at that time. It is possible that the consolidated severity-adjusted DRG system that we are planning to adopt would better recognize the extensive resources that hospitals use to treat patients with severe sepsis. We encourage commenters to examine the consolidated severity-adjusted DRGs described in section II.C. of this proposed rule to determine whether there is a better recognition of severity of illness and resource use in that proposed system. 6. Medicare Code Editor (MCE) Changes (If you choose to comment on issues in this section, please include the caption ‘‘Medicare Code Editor’’ at the beginning of your comment.) As explained under section II.B.1. of this preamble, the Medicare Code Editor (MCE) is a software program that detects and reports errors in the coding of Medicare claims data. Patient diagnoses, procedure(s), discharge status, and demographic information go into the Medicare claims processing systems and are subjected to a series of automated screens. The MCE screens are designed to identify cases that require further review before classification into a DRG. For FY 2007, we are proposing to make the following changes to the MCE edits: wwhite on PROD1PC61 with PROPOSALS2 a. Newborn Diagnoses Edit We are proposing to add code 780.92 (Excessive crying of infant (baby)) to the ‘‘Newborn Diagnoses’’ edit in the MCE. This edit is structured for patients with an age of ‘‘0’’. In the Tabular portion of the ICD–9–CM diagnosis codes, the ‘‘excludes’’ note at code 780.92 states that this code ‘‘excludes excessive crying of child, adolescent or adult’’ and sends the coder to code 780.95 (Other excessive crying. (The new title of this code, shown on Table 6E of the Addendum to this proposed rule is ‘‘Excessive crying of child, adolescent, or adult).) To make a conforming change, we also are proposing that code 780.92 be removed from the ‘‘Pediatric Diagnoses—Age 0 Through 17’’ edit. VerDate Aug<31>2005 17:10 Apr 24, 2006 Jkt 208001 b. Diagnoses Allowed for Females Only Edit • V26.39, Other genetic testing of male. The following codes are now invalid codes, as shown in Table 6C of the Addendum to this proposed rule. Therefore, we are proposing to remove them from the ‘‘Diagnosis Allowed for Females Only’’ edit in the MCE. • 616.8, Other specified inflammatory diseases of cervix, vagina, and vulva. • 629.8, Other specified disorders of female genital organs. Codes 616.8 and 629.8 have been expanded to the fifth-digit level. Therefore, we are proposing to place the following expanded codes in the ‘‘Diagnoses Allowed for Females Only’’ edit. • 616.81, Mucositis (ulcerative) of cervix, vagina, and vulva. • 616.89, Other inflammatory disease of cervix, vagina, and vulva. • 629.81, Habitual aborter without current pregnancy. • 629.89, Other specified disorders of female genital organs. The following two codes have revised descriptions (as shown in Table 6E of the Addendum to this proposed rule) which specify gender. Therefore, we are proposing to add them to ‘‘Diagnoses Allowed for Females Only’’ edit. • V26.31, Testing of female for genetic disease carrier status. • V26.32, Other genetic testing of female. d. Manifestations Not Allowed as Principal Diagnosis Edit c. Diagnoses Allowed for Males Only Edit Code 608.2 (Torsion of testis) is now an invalid code (as shown in Table 6C of the Addendum to this proposed rule). Therefore, we are proposing to remove it from the ‘‘Diagnoses Allowed for Males Only’’ edit. This code has been expanded to the fifth-digit level. Therefore, we are proposing to place the following expanded codes in the ‘‘Diagnoses Allowed for Males Only’’ edit: • 608.20, Torsion of testis, unspecified. • 608.21, Extravaginal torsion of spermatic cord. • 608.22 Intravaginal torsion of spermatic cord. • 608.23, Torsion of appendix testis. • 608.24, Torsion of appendix epididymis. The following codes have been created effective for FY 2007 and are gender specific. Therefore, we are proposing to add them to the ‘‘Diagnosis Allowed for Males Only’’ edit. • V26.34, Testing of male for genetic disease carrier status. • V26.35, Encounter for testing of male partner of habitual aborter. PO 00000 Frm 00044 Fmt 4701 Sfmt 4702 We are proposing to add the following codes to the ‘‘Manifestations Not Allowed as Principal Diagnosis’’ edit in the MCE: • 362.03, Nonproliferative diabetic retinopathy, NOS. • 362.04, Mild nonproliferative diabetic retinopathy. • 362.05, Moderate nonproliferative diabetic retinopathy. • 362.06, Severe nonproliferative diabetic retinopathy. • 362.07, Diabetic macular edema. In addition, we are proposing to remove code 525.10 (Acquired absence of teeth, unspecified) from this edit in the MCE. e. Nonspecific Principal Diagnosis Edit We are proposing to add the following codes to the ‘‘Nonspecific Principal Diagnosis’’ edit in the MCE: • 255.10, Hyperaldosteronism, unspecified. • 323.9, Unspecified causes of encephalitis, myelitis, and encephalomyelitis. • 770.10, Fetal and newborn aspiration, unspecified. • 780.31, Febrile convulsions (simple), unspecified. Codes 255.10, 323.9, and 780.31 appear on Table 6E, Revised Diagnosis Codes, and are being included in this edit because of their revised descriptions. Code 770.10 was inadvertently left off this list for FY 2006 when the code was created. f. Unacceptable Principal Diagnosis Edit Most V-codes describe an individual’s health status, but these codes are not usually a current illness or injury. Therefore, most V-codes are included in the ‘‘Unacceptable Principal Diagnosis’’ edit. The following codes became invalid (as shown in Table 6C of the Addendum to this proposed rule) for FY 2007, and we are proposing to remove them from this edit: • V18.5, Family history, digestive disorders. • V58.3, Attention to surgical dressings and sutures. • V72.1, Examination of ears and hearing. The following V-codes represent either fifth-digit extensions of the above codes, or new codes that were created effective October 1, 2006 (Table 6A of the Addendum to this proposed rule). Therefore, we are proposing to add the following codes to the ‘‘Unacceptable Principal Diagnosis’’ edit: E:\FR\FM\25APP2.SGM 25APP2 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules • V18.51, Family history, colonic polyps. • V18.59, Family history, other digestive disorders. • V26.34, Testing of male for genetic disease carrier status. • V26.35, Encounter for testing of male partner of habitual aborter. • V26.39, Other genetic testing of male. • V45.86, Bariatric surgery status. • V58.30, Encounter for change or removal of nonsurgical wound dressing. • V58.31, Encounter for change or removal of surgical wound dressing. • V58.32, Encounter for removal of sutures. • V72.11, Encounter for hearing examination following failed hearing screening. • V72.19, Other examination of ears and hearing. • V82.71, Screening for genetic disease carrier status. • V82.79, Other genetic screening. • V85.51, Body mass index, pediatric, less than 5th percentile for age. • V85.52, Body mass index, pediatric, 5th percentile to less than 85th percentile for age. • V85.53, Body mass index, pediatric, 85th percentile to less than 95th percentile for age. • V85.54, Body mass index, pediatric, greater than or equal to 95th percentile for age. • V86.0, Estrogen receptor positive status [ER+]. • V86.1, Estrogen receptor negative status [ER¥]. wwhite on PROD1PC61 with PROPOSALS2 g. Nonspecific O.R. Procedures Edit We are proposing to remove code 00.29 (Intravascular imaging unspecified vessel(s)) from the ‘‘Nonspecific O.R. Procedure’’ edit in the MCE. This code was erroneously placed in this edit; it is not considered an O.R. procedure. h. Noncovered Procedures Edit Under the proposed changes to DRG 513 (Pancreas Transplant) under the Pre-MDCs described in section II.D.1. of this preamble, a patient must have a history of medically uncontrollable, insulin-dependent diabetes mellitus, that is, Type I diabetes mellitus. Therefore, to conform the ‘‘Noncovered Procedures’’ Edit in the MCE to these proposed changes, we are proposing to revise Diagnosis List 1 in this edit to include only the following codes: • 250.01, Diabetes mellitus without mention of complication, type I [juvenile type], not stated as uncontrolled. • 250.03, Diabetes mellitus without mention of complication, type I [juvenile type], uncontrolled. VerDate Aug<31>2005 17:10 Apr 24, 2006 Jkt 208001 • 250.11, Diabetes with ketoacidosis, type I [juvenile type], not stated as uncontrolled. • 250.13, Diabetes with ketoacidosis, type I [juvenile type], uncontrolled. • 250.21, Diabetes with hyperosmolarity, type I [juvenile type], not stated as uncontrolled. • 250.23, Diabetes with hyperosmolarity, type I [juvenile type], uncontrolled. • 250.31, Diabetes with other coma, type I [juvenile type], not stated as uncontrolled. • 250.33, Diabetes with other coma, type I [juvenile type], uncontrolled. • 250.41, Diabetes with renal manifestations, type I [juvenile type], not stated as uncontrolled. • 250.43, Diabetes with renal manifestations, type I [juvenile type], uncontrolled. • 250.51, Diabetes with ophthalmic manifestations, type I [juvenile type], not stated as uncontrolled. • 250.53, Diabetes with ophthalmic manifestations, type I [juvenile type], uncontrolled. • 250.61, Diabetes with neurological manifestations, type I [juvenile type], not stated as uncontrolled. • 250.63, Diabetes with neurological manifestations, type I [juvenile type], uncontrolled. • 250.71, Diabetes with peripheral circulatory disorders, type I [juvenile type], not stated as uncontrolled. • 250.73, Diabetes with peripheral circulatory disorders, type I [juvenile type], uncontrolled. • 250.81, Diabetes with other specified manifestations, type I [juvenile type], not stated as uncontrolled. • 250.83, Diabetes with other specified manifestations, type I [juvenile type], uncontrolled. • 250.91, Diabetes with unspecified complication, type I [juvenile type], not stated as uncontrolled. • 250.93, Diabetes with unspecified complication, type I [juvenile type], uncontrolled. In addition, we are proposing to remove Diagnosis List 2 from the ‘‘Noncovered Procedures’’ edit, which is comprised of the following codes: • 403.01, Hypertensive kidney disease, malignant, with chronic kidney disease. • 403.11, Hypertensive kidney disease, benign, with chronic kidney disease. • 403.91, Hypertensive kidney disease, unspecified, with chronic kidney disease. • 404.02, Hypertensive heart and kidney disease, malignant, with chronic kidney disease. PO 00000 Frm 00045 Fmt 4701 Sfmt 4702 24039 • 404.03, Hypertensive heart and kidney disease, malignant, with heart failure and chronic kidney disease. • 404.12, Hypertensive heart and kidney disease, benign, with chronic kidney disease. • 404.13, Hypertensive heart and kidney disease, benign, with heart failure and chronic kidney disease. • 404.92, Hypertensive heart and kidney disease, unspecified, with chronic kidney disease. • 404.93, Hypertensive heart and kidney disease, unspecified, with heart failure and chronic kidney disease. • 585.1, Chronic kidney disease, Stage I. • 585.2, Chronic kidney disease, Stage II (mild). • 585.3, Chronic kidney disease, Stage III (moderate). • 585.4, Chronic kidney disease, Stage IV (severe). • 585.5, Chronic kidney disease, Stage V. • 585.6, End stage renal disease. • 585.9, Chronic kidney disease, unspecified. • V42.0, Organ or tissue replaced by transplant, kidney. • V43.89, Organ or tissue replaced by other means, other organ or tissue, other. i. Bilateral Procedure Edit We are proposing to remove the following codes from the ‘‘Bilateral Procedure’’ edit, as these are adjunct codes. They are not O.R. codes recognized by the GROUPER as procedures, and the edit was created in error last year. • 00.74, Hip replacement bearing surface, metal on polyethylene. • 00.75, Hip replacement bearing surface, metal-on-metal. • 00.76, Hip replacement bearing surface, ceramic-on-ceramic. 7. Surgical Hierarchies (If you choose to comment on issues in this section, please include the caption ‘‘DRGs: Surgical Hierarchies’’ at the beginning of your comments.) Some inpatient stays entail multiple surgical procedures, each one of which, occurring by itself, could result in assignment of the case to a different DRG within the MDC to which the principal diagnosis is assigned. Therefore, it is necessary to have a decision rule within the GROUPER by which these cases are assigned to a single DRG. The surgical hierarchy, an ordering of surgical classes from most resource-intensive to least resourceintensive, performs that function. Application of this hierarchy ensures that cases involving multiple surgical E:\FR\FM\25APP2.SGM 25APP2 wwhite on PROD1PC61 with PROPOSALS2 24040 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules procedures are assigned to the DRG associated with the most resourceintensive surgical class. Because the relative resource intensity of surgical classes can shift as a function of DRG reclassification and recalibrations, we reviewed the surgical hierarchy of each MDC, as we have for previous reclassifications and recalibrations, to determine if the ordering of classes coincides with the intensity of resource utilization. A surgical class can be composed of one or more DRGs. For example, in MDC 11, the surgical class ‘‘kidney transplant’’ consists of a single DRG (DRG 302) and the class ‘‘kidney, ureter and major bladder procedures’’ consists of three DRGs (DRGs 303, 304, and 305). Consequently, in many cases, the surgical hierarchy has an impact on more than one DRG. The methodology for determining the most resourceintensive surgical class involves weighting the average resources for each DRG by frequency to determine the weighted average resources for each surgical class. For example, assume surgical class A includes DRGs 1 and 2 and surgical class B includes DRGs 3, 4, and 5. Assume also that the average charge of DRG 1 is higher than that of DRG 3, but the average charges of DRGs 4 and 5 are higher than the average charge of DRG 2. To determine whether surgical class A should be higher or lower than surgical class B in the surgical hierarchy, we would weight the average charge of each DRG in the class by frequency (that is, by the number of cases in the DRG) to determine average resource consumption for the surgical class. The surgical classes would then be ordered from the class with the highest average resource utilization to that with the lowest, with the exception of ‘‘other O.R. procedures’’ as discussed below. This methodology may occasionally result in assignment of a case involving multiple procedures to the lowerweighted DRG (in the highest, most resource-intensive surgical class) of the available alternatives. However, given that the logic underlying the surgical hierarchy provides that the GROUPER search for the procedure in the most resource-intensive surgical class, in cases involving multiple procedures, this result is sometimes unavoidable. We note that, notwithstanding the foregoing discussion, there are a few instances when a surgical class with a lower average charge is ordered above a surgical class with a higher average charge. For example, the ‘‘other O.R. procedures’’ surgical class is uniformly ordered last in the surgical hierarchy of each MDC in which it occurs, regardless VerDate Aug<31>2005 17:10 Apr 24, 2006 Jkt 208001 of the fact that the average charge for the DRG or DRGs in that surgical class may be higher than that for other surgical classes in the MDC. The ‘‘other O.R. procedures’’ class is a group of procedures that are only infrequently related to the diagnoses in the MDC, but are still occasionally performed on patients in the MDC with these diagnoses. Therefore, assignment to these surgical classes should only occur if no other surgical class more closely related to the diagnoses in the MDC is appropriate. A second example occurs when the difference between the average charges for two surgical classes is very small. We have found that small differences generally do not warrant reordering of the hierarchy because, as a result of reassigning cases on the basis of the hierarchy change, the average charges are likely to shift such that the higherordered surgical class has a lower average charge than the class ordered below it. Based on the changes under the HSVRcc weighting methodology that we are proposing for FY 2007, as discussed in section II.C.2. of this preamble, we are proposing to revise the surgical hierarchy for Pre-MDCs, MDC 1 (Diseases and Disorders of the Nervous System), MDC 2 (Diseases and Disorders of the Eye), MDC 3 (Diseases and Disorders of the Ear, Nose, Mouth and Throat), MDC 8 (Diseases and Disorders of the Musculoskeletal System and Connective Tissue), MDC 10 (Endocrine, Nutritional and Metabolic Diseases and Disorders), and MDC 13 (Diseases and Disorders of the Female Reproductive System) as follows. In our analysis, we looked at the number of cases and the arithmetic mean. In Pre-MDCs, we are proposing to reorder DRG 481 (Bone Marrow Transplant) above DRG 513 (Pancreas Transplant). In MDC 1, we are proposing to reorder DRGs 531–532 (Spinal Procedures, with CC and without CC, respectively) above DRGs 529–530 (Ventricular Shunt Procedures, with CC and without CC, respectively). In MDC 2, we are proposing to reorder DRG 42 (Intraocular Procedures Except Retina, Iris and Lens) above DRG 36 (Retinal Procedures). In MDC 3, we are proposing to reorder DRGs 168–169 (Mouth Procedures, with CC and without CC, respectively) above DRG 57 (T&A Procedures, Except Tonsillectomy and/or Adenoidectomy Only, Age > 17) and DRG 58 (T&A Procedures, Except Tonsillectomy and/ or Adenoidectomy Only, Age 0–17). In MDC 8, we are proposing to reorder DRG 213 (Amputation for PO 00000 Frm 00046 Fmt 4701 Sfmt 4702 Musculoskeletal System and Connective Tissue Disorders) above DRG 216 (Biopsies of Musculoskeletal System and Connective Tissue). In MDC 10, we are proposing to reorder DRG 285 (Amputation of Lower Limb for Endocrine, Nutritional and Metabolic Diseases and Disorders) above DRG 288 (O.R. Procedures for Obesity). In MDC 13, we are proposing to reorder DRG 363 (D&C, Conization and Radio-Implant, for Malignancy) and DRG 364 (D&C, Conization and RadioImplant, Except for Malignancy) above DRG 360 (Vagina, Cervix, and Vulva Procedures). 8. Refinement of Complications and Comorbidities (CC) List (If you choose to comment on issues in this section, please include the caption ‘‘CC List’’ at the beginning of your comment.) a. Background As indicated earlier in this preamble, under the IPPS DRG classification system, we have developed a standard list of diagnoses that are considered complications or comorbidities (CCs). Historically, we developed this list using physician panels that classified each diagnosis code based on whether the diagnosis, when present as a secondary condition, would be considered a substantial complication or comorbidity. A substantial complication or comorbidity was defined as a condition that, because of its presence with a specific principal diagnosis, would cause an increase in the length of stay by at least 1 day in at least 75 percent of the patients. b. Comprehensive Review of the CC List In previous years, we have made changes to the standard list of CCs, either by adding new CCs or deleting CCs already on the list, but we have never conducted a comprehensive review of the list. Given the long period of time that had elapsed since the original CC list was developed, the incremental nature of changes to it, and changes in the way inpatient care is delivered, and in partial response to recommendations in MedPAC’s March 2005 Report to Congress on PhysicianOwned Specialty Hospitals, for the FY 2006 IPPS final rule, we reviewed the 121-paired DRGs that were split on the presence or absence of a CC among the 3,285 diagnosis codes on the CC list. We presented the results of that review and summarized public comments that we received in the FY 2006 proposed rule on the review results in the FY 2006 IPPS final rule (70 FR 47313 through 47315). Further analysis of the CC list E:\FR\FM\25APP2.SGM 25APP2 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules wwhite on PROD1PC61 with PROPOSALS2 and refinement to recognize the effects of differences in severity of illness among patients is discussed in section II.C. of this preamble as part of our efforts to develop a consolidated severity-adjusted DRG system for use in the IPPS. However, as further discussed in section II.C. of the preamble to this proposed rule, we are soliciting comments on whether it would be appropriate in FY 2007 to apply to an expanded set of DRGs a clinical severity concept similar to the approach we used in FY 2006 to refine cardiac DRGs based on the presence or absence of an MCV. c. CC Exclusions List Proposed for FY 2007 In the September 1, 1987 final notice (52 FR 33143) concerning changes to the DRG classification system, we modified the GROUPER logic so that certain diagnoses included on the standard list of CCs would not be considered valid CCs in combination with a particular principal diagnosis. We created the CC Exclusions List for the following reasons: (1) To preclude coding of CCs for closely related conditions; (2) to preclude duplicative or inconsistent coding from being treated as CCs; and (3) to ensure that cases are appropriately classified between the complicated and uncomplicated DRGs in a pair. As we indicated above, we developed a list of diagnoses, using physician panels, to include those diagnoses that, when present as a secondary condition, would be considered a substantial complication or comorbidity. In previous years, we have made changes to the list of CCs, either by adding new CCs or deleting CCs already on the list. At this time, we are not proposing to delete any of the diagnosis codes on the CC list for FY 2007. In the May 19, 1987 proposed notice (52 FR 18877) and the September 1, 1987 final notice (52 FR 33154), we explained that the excluded secondary diagnoses were established using the following five principles: • Chronic and acute manifestations of the same condition should not be considered CCs for one another. • Specific and nonspecific (that is, not otherwise specified (NOS)) diagnosis codes for the same condition should not be considered CCs for one another. • Codes for the same condition that cannot coexist, such as partial/total, unilateral/bilateral, obstructed/ unobstructed, and benign/malignant, should not be considered CCs for one another. • Codes for the same condition in anatomically proximal sites should not be considered CCs for one another. VerDate Aug<31>2005 17:10 Apr 24, 2006 Jkt 208001 • Closely related conditions should not be considered CCs for one another. The creation of the CC Exclusions List was a major project involving hundreds of codes. We have continued to review the remaining CCs to identify additional exclusions and to remove diagnoses from the master list that have been shown not to meet the definition of a CC.9 We are proposing to make limited revisions to the CC Exclusions List to take into account the changes that will be made in the ICD–9–CM diagnosis coding system effective October 1, 2006. (See section II.D.10. of this preamble for a discussion of ICD–9–CM changes.) We are proposing these changes in accordance with the principles established when we created the CC Exclusions List in 1987. Tables 6G and 6H in the Addendum to this proposed rule contain the revisions to the CC Exclusions List that would be effective for discharges occurring on or after October 1, 2006. Each table shows the principal diagnoses with changes to the excluded CCs. Each of these principal diagnoses is shown with an asterisk, and the additions or deletions to the CC Exclusions List are provided in an indented column immediately following the affected principal diagnosis. CCs that are added to the list are in Table 6G—Additions to the CC Exclusions List. Beginning with discharges on or after October 1, 2006, the indented diagnoses will not be recognized by the GROUPER as valid CCs for the asterisked principal diagnosis. 9 See the FY 1989 final rule (53 FR 38485, September 30, 1988), for the revision made for the discharges occurring in FY 1989; the FY 1990 final rule (54 FR 36552, September 1, 1989), for the FY 1990 revision; the FY 1991 final rule (55 FR 36126, September 4, 1990), for the FY 1991 revision; the FY 1992 final rule (56 FR 43209, August 30, 1991) for the FY 1992 revision; the FY 1993 final rule (57 FR 39753),September 1, 1992), for the FY 1993 revision; the FY 1994 final rule (58 FR 46278, September 1, 1993), for the FY 1994 revisions; the FY 1995 final rule (59 FR 45334, September 1, 1994), for the FY 1995 revisions; the FY 1996 final rule (60 FR 45782, September 1, 1995), for the FY 1996 revisions; the FY 1997 final rule (61 FR 46171, August 30, 1996), for the FY 1997 revisions; the FY 1998 final rule (62 FR 45966, August 29, 1997) for the FY 1998 revisions; the FY 1999 final rule (63 FR 40954, July 31, 1998), for the FY 1999 revisions; the FY 2001 final rule (65 FR 47064, August 1, 2000), for the FY 2001 revisions; the FY 2002 final rule (66 FR 39851, August 1, 2001), for the FY 2002 revisions; the FY 2003 final rule (67 FR 49998, August 1, 2002), for the FY 2003 revisions; the FY 2004 final rule (68 FR 45364, August 1, 2003), for the FY 2004 revisions; the FY 2005 final rule (69 FR 49848, August 11, 2004), for the FY 2005 revisions; and the FY 2006 final rule (70 FR 47640, August 12, 2005), for the FY 2006 revisions. In the FY 2000 final rule (64 FR 41490, July 30, 1999, we did not modify the CC Exclusions List because we did not make any changes to the ICD–9–CM codes for FY 2000. PO 00000 Frm 00047 Fmt 4701 Sfmt 4702 24041 CCs that are deleted from the list are in Table 6H—Deletions from the CC Exclusions List. Beginning with discharges on or after October 1, 2006, the indented diagnoses will be recognized by the GROUPER as valid CCs for the asterisked principal diagnosis. Copies of the original CC Exclusions List applicable to FY 1988 can be obtained from the National Technical Information Service (NTIS) of the Department of Commerce. It is available in hard copy for $152.50 plus shipping and handling. A request for the FY 1988 CC Exclusions List (which should include the identification accession number (PB) 88–133970) should be made to the following address: National Technical Information Service, United States Department of Commerce, 5285 Port Royal Road, Springfield, VA 22161; or by calling (800) 553–6847. Users should be aware of the fact that all revisions to the CC Exclusions List (FYs 1989, 1990, 1991, 1992, 1993, 1994, 1995, 1996, 1997, 1998, 1999, 2001, 2002, 2003, 2004, 2005, and 2006) and those in Tables 6G and 6H of this proposed rule for FY 2007 must be incorporated into the list purchased from NTIS in order to obtain the CC Exclusions List applicable for discharges occurring on or after October 1, 2006. (Note: There was no CC Exclusions List in FY 2000 because we did not make changes to the ICD–9–CM codes for FY 2000.) Alternatively, the complete documentation of the GROUPER logic, including the current CC Exclusions List, is available from 3M/Health Information Systems (HIS), which, under contract with CMS, is responsible for updating and maintaining the GROUPER program. The current DRG Definitions Manual, Version 23.0, is available for $225.00, which includes $15.00 for shipping and handling. Version 24.0 of this manual, which will include the final FY 2007 DRG changes, will be available in hard copy for $250.00. Version 24.0 of the manual is also available on a CD for $200.00; a combination hard copy and CD is available for $400.00. These manuals may be obtained by writing 3M/HIS at the following address: 100 Barnes Road, Wallingford, CT 06492; or by calling (203) 949–0303. Please specify the revision or revisions requested. 9. Review of Procedure Codes in DRGs 468, 476, and 477 Each year, we review cases assigned to DRG 468 (Extensive O.R. Procedure Unrelated to Principal Diagnosis), DRG 476 (Prostatic O.R. Procedure Unrelated E:\FR\FM\25APP2.SGM 25APP2 24042 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules wwhite on PROD1PC61 with PROPOSALS2 to Principal Diagnosis), and DRG 477 (Nonextensive O.R. Procedure Unrelated to Principal Diagnosis) to determine whether it would be appropriate to change the procedures assigned among these DRGs. DRGs 468, 476, and 477 are reserved for those cases in which none of the O.R. procedures performed are related to the principal diagnosis. These DRGs are intended to capture atypical cases, that is, those cases not occurring with sufficient frequency to represent a distinct, recognizable clinical group. DRG 476 is assigned to those discharges in which one or more of the following prostatic procedures are performed and are unrelated to the principal diagnosis: • 60.0, Incision of prostate. • 60.12, Open biopsy of prostate. • 60.15, Biopsy of periprostatic tissue. • 60.18, Other diagnostic procedures on prostate and periprostatic tissue. • 60.21, Transurethral prostatectomy. • 60.29, Other transurethral prostatectomy. • 60.61, Local excision of lesion of prostate. • 60.69, Prostatectomy, not elsewhere classified. • 60.81, Incision of periprostatic tissue. • 60.82, Excision of periprostatic tissue. • 60.93, Repair of prostate. • 60.94, Control of (postoperative) hemorrhage of prostate. • 60.95, Transurethral balloon dilation of the prostatic urethra. • 60.96, Transurethral destruction of prostate tissue by microwave thermotherapy. • 60.97, Other transurethral destruction of prostate tissue by other thermotherapy. • 60.99, Other operations on prostate. All remaining O.R. procedures are assigned to DRGs 468 and 477, with DRG 477 assigned to those discharges in which the only procedures performed are nonextensive procedures that are unrelated to the principal diagnosis.10 10 The original list of the ICD–9–CM procedure codes for the procedures we consider nonextensive procedures, if performed with an unrelated principal diagnosis, was published in Table 6C in section IV. of the Addendum to the FY 1989 final rule (53 FR 38591). As part of the FY 1991 final rule (55 FR 36135), the FY 1992 final rule (56 FR 43212), the FY 1993 final rule (57 FR 23625), the FY 1994 final rule (58 FR 46279), the FY 1995 final rule (59 FR 45336), the FY 1996 final rule (60 FR 45783), the FY 1997 final rule (61 FR 46173), and the FY 1998 final rule (62 FR 45981), we moved several other procedures from DRG 468 to DRG 477, and some procedures from DRG 477 to DRG 468. No procedures were moved in FY 1999, as noted in the final rule (63 FR 40962); in FY 2000 (64 FR 41496); in FY 2001 (65 FR 47064); or in FY 2002 (66 FR 39852). In the FY 2003 final rule (67 FR 49999) we VerDate Aug<31>2005 17:10 Apr 24, 2006 Jkt 208001 For FY 2007, we are not proposing to change the procedures assigned among these DRGs. a. Moving Procedure Codes From DRG 468 or DRG 477 to MDCs We annually conduct a review of procedures producing assignment to DRG 468 or DRG 477 on the basis of volume, by procedure, to see if it would be appropriate to move procedure codes out of these DRGs into one of the surgical DRGs for the MDC into which the principal diagnosis falls. The data are arrayed two ways for comparison purposes. We look at a frequency count of each major operative procedure code. We also compare procedures across MDCs by volume of procedure codes within each MDC. We identify those procedures occurring in conjunction with certain principal diagnoses with sufficient frequency to justify adding them to one of the surgical DRGs for the MDC in which the diagnosis falls. Based on this year’s review, we are not proposing to remove any procedures in DRGs 468 or 477 to one of the surgical DRGs for FY 2007. b. Reassignment of Procedures Among DRGs 468, 476, and 477 We also annually review the list of ICD–9–CM procedures that, when in combination with their principal diagnosis code, result in assignment to DRGs 468, 476, and 477, to ascertain if any of those procedures should be reassigned from one of these three DRGs to another of the three DRGs based on average charges and the length of stay. We look at the data for trends such as shifts in treatment practice or reporting practice that would make the resulting DRG assignment illogical. If we find these shifts, we would propose to move cases to keep the DRGs clinically similar or to provide payment for the cases in a similar manner. Generally, we move only those procedures for which we have an adequate number of discharges to analyze the data. We are not proposing to move any procedure codes from DRG 476 to DRGs 468 or 477, or from DRG 477 to DRGs 468 or 476 for FY 2007. did not move any procedures from DRG 477. However, we did move procedure codes from DRG 468 and placed them in more clinically coherent DRGs. In the FY 2004 final rule (68 FR 45365), we moved several procedures from DRG 468 to DRGs 476 and 477 because the procedures are nonextensive. In the FY 2005 final rule (69 FR 48950), we moved one procedure from DRG 468 to 477. In addition, we added several existing procedures to DRGs 476 and 477. In the FY 2006 (70 FR 47317), we moved one procedure from DRG 468 and assigned it to DRG 477. PO 00000 Frm 00048 Fmt 4701 Sfmt 4702 c. Adding Diagnosis or Procedure Codes to MDCs Based on our review this year, we are not proposing to add any diagnosis codes to MDCs for FY 2007. 10. Changes to the ICD–9–CM Coding System As described in section II.B.1. of this preamble, the ICD–9–CM is a coding system used for the reporting of diagnoses and procedures performed on a patient. In September 1985, the ICD– 9–CM Coordination and Maintenance Committee was formed. This is a Federal interdepartmental committee, co-chaired by the National Center for Health Statistics (NCHS), the Centers for Disease Control and Prevention, and CMS, charged with maintaining and updating the ICD–9–CM system. The Committee is jointly responsible for approving coding changes, and developing errata, addenda, and other modifications to the ICD–9–CM to reflect newly developed procedures and technologies and newly identified diseases. The Committee is also responsible for promoting the use of Federal and non-Federal educational programs and other communication techniques with a view toward standardizing coding applications and upgrading the quality of the classification system. The Official Version of the ICD–9–CM contains the list of valid diagnosis and procedure codes. (The Official Version of the ICD–9–CM is available from the Government Printing Office on CD– ROM for $25.00 by calling (202) 512– 1800.) The Official Version of the ICD– 9–CM is no longer available in printed manual form from the Federal Government; it is only available on CD– ROM. Users who need a paper version are referred to one of the many products available from publishing houses. The NCHS has lead responsibility for the ICD–9–CM diagnosis codes included in the Tabular List and Alphabetic Index for Diseases, while CMS has lead responsibility for the ICD–9–CM procedure codes included in the Tabular List and Alphabetic Index for Procedures. The Committee encourages participation in the above process by health-related organizations. In this regard, the Committee holds public meetings for discussion of educational issues and proposed coding changes. These meetings provide an opportunity for representatives of recognized organizations in the coding field, such as the American Health Information Management Association (AHIMA), the American Hospital Association (AHA), E:\FR\FM\25APP2.SGM 25APP2 wwhite on PROD1PC61 with PROPOSALS2 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules and various physician specialty groups, as well as individual physicians, health information management professionals, and other members of the public, to contribute ideas on coding matters. After considering the opinions expressed at the public meetings and in writing, the Committee formulates recommendations, which then must be approved by the agencies. The Committee presented proposals for coding changes for implementation in FY 2007 at a public meeting held on September 29–30, 2005, and finalized the coding changes after consideration of comments received at the meetings and in writing by December 2, 2005. Those coding changes are announced in Tables 6A through 6F in the Addendum to this proposed rule. The Committee held its 2006 meeting on March 23–24, 2006. Proposed new codes for which there was a consensus of public support and for which complete tabular and indexing changes can be made by May 2006 will be included in the October 1, 2006 update to ICD–9–CM. Code revisions that were discussed at the March 23–24, 2006 Committee meeting could not be finalized in time to include them in this FY 2007 IPPS proposed rule. These additional codes will be included in Tables 6A through 6F of the final rule and will be marked with an asterisk (*). Copies of the minutes of the procedure codes discussions at the Committee’s September 29–30, 2005 meeting can be obtained from the CMS Web site: https://new.cms.hhs.gov/ ICD9ProviderDiagnosticCodes/ 03_meetings.asp. The minutes of the diagnosis codes discussions at the September 29–30, 2005 meeting are found at: https://www.cdc.gov/nchs/ icd9.htm. Paper copies of these minutes are no longer available and the mailing list has been discontinued. These Web sites also provide detailed information about the Committee, including information on requesting a new code, attending a Committee meeting, and timeline requirements and meeting dates. We encourage commenters to address suggestions on coding issues involving diagnosis codes to: Donna Pickett, CoChairperson, ICD–9–CM Coordination and Maintenance Committee, NCHS, Room 2402, 3311 Toledo Road, Hyattsville, MD 20782. Comments may be sent by E-mail to: dfp4@cdc.gov. Questions and comments concerning the procedure codes should be addressed to: Patricia E. Brooks, CoChairperson, ICD–9–CM Coordination and Maintenance Committee, CMS, Center for Medicare Management, Hospital and Ambulatory Policy Group, VerDate Aug<31>2005 17:10 Apr 24, 2006 Jkt 208001 Division of Acute Care, C4–08–06, 7500 Security Boulevard, Baltimore, MD 21244–1850. Comments may be sent by E-mail to: Patricia.Brooks1@cms.hhs.gov. The ICD–9–CM code changes that have been approved will become effective October 1, 2006. The new ICD– 9–CM codes are listed, along with their DRG classifications, in Tables 6A and 6B (New Diagnosis Codes and New Procedure Codes, respectively) in the Addendum to this proposed rule. As we stated above, the code numbers and their titles were presented for public comment at the ICD–9–CM Coordination and Maintenance Committee meetings. Both oral and written comments were considered before the codes were approved. In this proposed rule, we are only soliciting comments on the proposed classification of these new codes. For codes that have been replaced by new or expanded codes, the corresponding new or expanded diagnosis codes are included in Table 6A. New procedure codes are shown in Table 6B. Diagnosis codes that have been replaced by expanded codes or other codes or have been deleted are in Table 6C (Invalid Diagnosis Codes). These invalid diagnosis codes will not be recognized by the GROUPER beginning with discharges occurring on or after October 1, 2006. Table 6D contains invalid procedure codes. These invalid procedure codes will not be recognized by the GROUPER beginning with discharges occurring on or after October 1, 2006. Revisions to diagnosis code titles are in Table 6E (Revised Diagnosis Code Titles), which also includes the DRG assignments for these revised codes. Table 6F includes revised procedure code titles for FY 2007. In the September 7, 2001 final rule implementing the IPPS new technology add-on payments (66 FR 46906), we indicated we would attempt to include proposals for procedure codes that would describe new technology discussed and approved at the April meeting as part of the code revisions effective the following October. As stated previously, ICD–9–CM codes discussed at the March 23–24, 2006 Committee meeting that received consensus and that can be finalized by May 2006, will be included in Tables 6A through 6F of the Addendum to the final rule. Section 503(a) of Pub. L. 108–173 included a requirement for updating ICD–9–CM codes twice a year instead of a single update on October 1 of each year. This requirement was included as part of the amendments to the Act relating to recognition of new PO 00000 Frm 00049 Fmt 4701 Sfmt 4702 24043 technology under the IPPS. Section 503(a) amended section 1886(d)(5)(K) of the Act by adding a clause (vii) which states that the ‘‘Secretary shall provide for the addition of new diagnosis and procedure codes in April 1 of each year, but the addition of such codes shall not require the Secretary to adjust the payment (or diagnosis-related group classification) * * * until the fiscal year that begins after such date.’’ This requirement improves the recognition of new technologies under the IPPS system by providing information on these new technologies at an earlier date. Data will be available 6 months earlier than would be possible with updates occurring only once a year on October 1. While section 1886(d)(5)(K)(vii) of the Act states that the addition of new diagnosis and procedure codes on April 1 of each year shall not require the Secretary to adjust the payment, or DRG classification under section 1886(d) of the Act until the fiscal year that begins after such date, we have to update the DRG software and other systems in order to recognize and accept the new codes. We also publicize the code changes and the need for a mid-year systems update by providers to capture the new codes. Hospitals also have to obtain the new code books and encoder updates, and make other system changes in order to capture and report the new codes. The ICD–9–CM Coordination and Maintenance Committee holds its meetings in the Spring and Fall in order to update the codes and the applicable payment and reporting systems by October 1 of each year. Items are placed on the agenda for the ICD–9–CM Coordination and Maintenance Committee meeting if the request is received at least 2 months prior to the meeting. This requirement allows time for staff to review and research the coding issues and prepare material for discussion at the meeting. It also allows time for the topic to be publicized in meeting announcements in the Federal Register as well as on the CMS Web site. The public decides whether or not to attend the meeting based on the topics listed on the agenda. Final decisions on code title revisions are currently made by March 1 so that these titles can be included in the IPPS proposed rule. A complete addendum describing details of all changes to ICD–9–CM, both tabular and index, are publicized on CMS and NCHS Web pages in May of each year. Publishers of coding books and software use this information to modify their products that are used by health care providers. This 5-month time period has proved to be necessary E:\FR\FM\25APP2.SGM 25APP2 wwhite on PROD1PC61 with PROPOSALS2 24044 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules for hospitals and other providers to update their systems. A discussion of this timeline and the need for changes are included in the December 4–5, 2005 ICD–9–CM Coordination and Maintenance Committee minutes. The public agreed that there was a need to hold the fall meetings earlier, in September or October, in order to meet the new implementation dates. The public provided comment that additional time would be needed to update hospital systems and obtain new code books and coding software. There was considerable concern expressed about the impact this new April update would have on providers. In the FY 2005 IPPS final rule, we implemented section 1886(d)(5)(K)(vii) of the Act, as added by section 503(a) of Public Law 108–173, by developing a mechanism for approving, in time for the April update, diagnosis and procedure code revisions needed to describe new technologies and medical services for purposes of the new technology add-on payment process. We also established the following process for making these determinations. Topics considered during the Fall ICD–9–CM Coordination and Maintenance Committee meeting are considered for an April 1 update if a strong and convincing case is made by the requester at the Committee’s public meeting. The request must identify the reason why a new code is needed in April for purposes of the new technology process. The participants at the meeting and those reviewing the Committee meeting summary report are provided the opportunity to comment on this expedited request. All other topics are considered for the October 1 update. Participants at the Committee meeting are encouraged to comment on all such requests. There were no requests for an expedited April l, 2006 implementation of an ICD–9–CM code at the September 29–30, 2005 Committee meeting. Therefore, there were no new ICD–9–CM codes implemented on April 1, 2006. We believe that this process captures the intent of section 1886(d)(5)(K)(vii) of the Act. This requirement was included in the provision revising the standards and process for recognizing new technology under the IPPS. In addition, the need for approval of new codes outside the existing cycle (October 1) arises most frequently and most acutely where the new codes will capture new technologies that are (or will be) under consideration for new technology addon payments. Thus, we believe this provision was intended to expedite data collection through the assignment of VerDate Aug<31>2005 17:10 Apr 24, 2006 Jkt 208001 new ICD–9–CM codes for new technologies seeking higher payments. Current addendum and code title information is published on the CMS Web page at: https://www.cms.hhs.gov/ icd9ProviderDiagnosticCodes. Information on ICD–9–CM diagnosis codes, along with the Official ICD–9– CM Coding Guidelines, can be found on the Web page at: https://www.cdc.gov/ nchs/icd9.htm. Information on new, revised, and deleted ICD–9–CM codes is also provided to the AHA for publication in the Coding Clinic for ICD–9–CM. AHA also distributes information to publishers and software vendors. CMS also sends copies of all ICD–9– CM coding changes to its contractors for use in updating their systems and providing education to providers. These same means of disseminating information on new, revised, and deleted ICD–9–CM codes will be used to notify providers, publishers, software vendors, contractors, and others of any changes to the ICD–9–CM codes that are implemented in April. The code titles are adopted as part of the ICD–9–CM Coordination and Maintenance Committee process. Thus, although we publish the code titles in the IPPS proposed and final rules, they are not subject to comment in the proposed or final rules. We will continue to publish the October code updates in this manner within the IPPS proposed and final rules. For codes that are implemented in April, we will assign the new procedure code to the same DRG in which its predecessor code was assigned so there will be no DRG impact as far as DRG assignment. This mapping was specified by section 1886(d)(5)(K)(vii) of the Act as added by section 503(a) of Pub. L. 108–173. Any midyear coding updates will be available through the websites indicated above and through the Coding Clinic for ICD–9–CM. Publishers and software vendors currently obtain code changes through these sources in order to update their code books and software systems. We will strive to have the April 1 updates available through these Web sites 5 months prior to implementation (that is, early November of the previous year), as is the case for the October 1 updates. Codebook publishers are evaluating how they will provide any code updates to their subscribers. Some publishers may decide to publish midyear book updates. Others may decide to sell an addendum that lists the changes to the October 1 code book. Coding personnel should contact publishers to determine how they will update their books. CMS and its contractors will also consider developing provider education articles concerning this change to the PO 00000 Frm 00050 Fmt 4701 Sfmt 4702 effective date of certain ICD–9–CM codes. E. Proposed Recalibration of DRG Weights (If you choose to comment on issues in this section, please include the caption ‘‘DRG Weights’’ at the beginning of your comment.) We are proposing to change the DRG recalibration process methodology for FY 2007 to move to an HSRV weighting method as discussed in section II.C.2. of the preamble to this proposed rule. For FY 2006 and years prior, we have recalibrated the DRG weights based on charge data for Medicare discharges using the most current charge information available (for example, the FY 2005 MedPAR file would have been used for FY 2007). Our thorough analysis of the March 2005 MedPAC recommendations regarding refinement of the DRG system used for the IPPS (see discussion of the MedPAC recommendations in section II.C.2. of this preamble) has shown that using gross charges as a basis for setting the DRG weights has introduced bias into the weighting process. Specifically, hospitals that are systematically more expensive than others (that is, teaching hospitals and specialty hospitals) tend to treat certain cases more commonly than others, causing the weights for these cases to be artificially high. In addition, hospitals may mark up their charges for routine days, intensive care days, and various ancillary services by different percentages. This practice of differential markups among hospital cost centers may also introduce bias into the weights. For instance, we have observed that ancillary service cost centers generally have higher charge markups than routine services. Thus, the charge-based relative weight methodology may result in high weights for DRGs that use more ancillary services relative to DRGs that use more routine services than would occur under a system where the weights are based on costs. As discussed in section II.C.2. of this preamble, based on our study of the MedPAC recommendations, we have developed an alternative methodology for recalibrating the DRG weights. This method involves applying the HSRV methodology at the cost center level (HSRVcc) to remove the bias introduced by hospital characteristics (that is, teaching, disproportionate share, location, and size, among others) and then scaling the weights to costs using national cost center CCRs derived from cost report data. In developing this proposed system of weights, we used two data sources: E:\FR\FM\25APP2.SGM 25APP2 wwhite on PROD1PC61 with PROPOSALS2 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules Claims data and cost report data. As in previous years, the claims data source is the MedPAR file. This file is based on fully coded diagnostic and procedure data for all Medicare inpatient hospital bills. The FY 2005 MedPAR data used in this proposed rule include discharges occurring between October 1, 2004 and September 30, 2005, based on bills received by CMS through December 31, 2005, from all hospitals subject to the IPPS and short-term acute care hospitals in Maryland (which are under a waiver from the IPPS under section 1814(b)(3) of the Act). The FY 2005 MedPAR file used in calculating the relative weights includes data for approximately 12,137,358 Medicare discharges. Discharges for Medicare beneficiaries enrolled in a Medicare+Choice managed care plan are excluded from this analysis. The data exclude CAHs, including hospitals that subsequently became CAHs after the period from which the data were taken. The second data source used in the new HSRVcc weight methodology are the FY 2003 Medicare cost report data files from HCRIS, which represents the most recent full set of cost report data available. We used the December 31, 2005 update of the HCRIS cost report files for FY 2003 in setting the proposed relative weights. Previously, the charge-based methodology used to calculate the DRG relative weights from the MedPAR data was as follows: • To the extent possible, all the claims were regrouped using the DRG classification revisions that we would have proposed. • The transplant cases that were used to establish the proposed relative weight for heart and heart-lung, liver and/or intestinal, and lung transplants (DRGs 103, 480, and 495) were limited to those Medicare-approved transplant centers that have cases in the FY 2005 MedPAR file. (Medicare coverage for heart, heartlung, liver and/or intestinal, and lung transplants is limited to those facilities that have received approval from CMS as transplant centers.) • Organ acquisition costs for kidney, heart, heart-lung, liver, lung, pancreas, and intestinal (or multivisceral organs) transplants continue to be paid on a reasonable cost basis. Because these acquisition costs are paid separately from the prospective payment rate, it would have been necessary to subtract the acquisition charges from the total charges on each transplant bill that showed acquisition charges before computing the average charge for the DRG and before eliminating statistical outliers. VerDate Aug<31>2005 17:10 Apr 24, 2006 Jkt 208001 • Charges would have been standardized to remove the effects of differences in area wage levels, indirect medical education and disproportionate share payments, and, for hospitals in Alaska and Hawaii, the applicable costof-living adjustment. • The average standardized charge per DRG was calculated by summing the standardized charges for all cases in the DRG and dividing that amount by the number of cases classified in the DRG. A transfer case would have been counted as a fraction of a case based on the ratio of its transfer payment under the per diem payment methodology to the full DRG payment for non-transfer cases. That is, a transfer case receiving payment under the transfer methodology equal to half of what the case would receive as a non-transfer would be counted as 0.5 of a total case. • Statistical outliers were eliminated by removing all cases that were beyond 3.0 standard deviations from the mean of the log distribution of both the charges per case and the charges per day for each DRG. • The average charge for each DRG was then recomputed (excluding the statistical outliers) and divided by the national average standardized charge per case to determine the relative weight. These charge-based weights were then normalized by an adjustment factor so that the average case weight after recalibration is equal to the average case weight before recalibration. We will continue to apply this normalization adjustment as it is intended to ensure that recalibration by itself neither increases nor decreases total payments under the IPPS as required by section 1886(d)(4)(C)(iii) of the Act. The methodology we are proposing to calculate the DRG weights from the FY 2005 MedPAR and FY 2003 cost report data is as follows: • To the extent possible, all the claims were regrouped using the proposed DRG classification revisions discussed in section II.D. of this preamble. • The transplant cases that were used to establish the proposed relative weight for heart and heart-lung, liver and/or intestinal, and lung transplants (DRGs 103, 480, and 495) were limited to those Medicare-approved transplant centers that have cases in the FY 2005 MedPAR file. (Medicare coverage for heart, heartlung, liver and/or intestinal, and lung transplants is limited to those facilities that have received approval from CMS as transplant centers.) • Organ acquisition costs for kidney, heart, heart-lung, liver, lung, pancreas, and intestinal (or multivisceral organs) PO 00000 Frm 00051 Fmt 4701 Sfmt 4702 24045 transplants continue to be paid on a reasonable cost basis. Because these acquisition costs are paid separately from the prospective payment rate, it is necessary to subtract the acquisition charges from the total charges on each transplant bill that showed acquisition charges before adjusting the charges under the HSRVcc methodology and before eliminating statistical outliers. • Claims for IPPS hospitals were used in this analysis (claims for IPFs, IRFs, LTCHs, cancer and children’s hospitals, and RNHCIs were dropped). Claims with total charges or total length of stay less than or equal to zero were dropped. Claims that had an amount in the total charge field that differed by more than $10.00 from the sum of the routine day charges, intensive care charges, pharmacy charges, special equipment charges, therapy services charges, operating room charges, cardiology charges, laboratory charges, radiology charges, and other service charges were also dropped. At least 96 percent of the providers in the MedPAR file had charges for 8 of the 10 cost centers. Claims for providers that did not have charges greater than zero for at least 8 of the 10 cost centers were dropped. • Statistical outliers were eliminated by removing all cases that were beyond 3.0 standard deviations from the mean of the log distribution of both the charges per case and the charges per day for each DRG. Once the MedPAR data were trimmed, the data were sorted by provider so that charges could be standardized under the HSRVcc methodology (discussed in section II.C.2. of this preamble). To do this, an average charge was computed for each provider for each of 10 proposed cost centers. The average charge was computed by summing the charges for each cost center and dividing by the transfer adjusted case count for each provider. A transfer case, identified by discharge code, DRG, and length of stay, was counted as a fraction of a case based on the ratio of its length of stay plus 1 day relative to the geometric mean length of stay for that DRG. That is, a transfer case with a length of stay of 2 days in a DRG with a geometric mean length of stay of 6 days would be counted as 3 (2 days plus 1 extra day) divided by 6 or 0.5 of a total case as this reflects current payment policy. The 10 cost centers that we are proposing to use in the HSRV weight calculation are shown in the following table. In addition, the table shows the lines on the cost report that we are proposing to use to create the national cost center CCRs that will be discussed later in this section: E:\FR\FM\25APP2.SGM 25APP2 VerDate Aug<31>2005 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules 17:10 Apr 24, 2006 Jkt 208001 PO 00000 Frm 00052 Fmt 4701 Sfmt 4725 E:\FR\FM\25APP2.SGM 25APP2 EP25AP06.006</GPH> wwhite on PROD1PC61 with PROPOSALS2 24046 wwhite on PROD1PC61 with PROPOSALS2 BILLING CODE 4120–01–C After computing the average charge for each provider for each cost center, the cost center charges on each claim are divided by the provider’s average charge for the matching cost center. For example, the routine day charges on the claim are divided by the average routine day charge for the provider, the intensive care unit charges on the claim are divided by the average intensive care unit charge for the provider, and so on. By using a hospital’s relative charge structure, the resulting weights from this step do not reflect differences in charges among providers for factors such as location, size, wages, relative efficiency, average markup, IME, DSH and the variety of cases treated. Once these charges are adjusted by the average charge for the cost center, they VerDate Aug<31>2005 17:10 Apr 24, 2006 Jkt 208001 are then multiplied by the provider’s CMI. This adjustment for CMI is needed to rescale the hospital-specific relative charge values which, by definition, will average to 1.0 for each cost center. Because the average relative weight for a provider is that provider’s CMI, we believe CMI is a reasonable scale factor to use to further adjust the relative charges to reflect the complexity of cases treated by the provider. A starting CMI of one was assigned to each cost center for each provider. After the relative charges (cost center claim charge divided by the average cost center charge for the provider) are multiplied by the hospital’s matching cost center CMI, they are summed by DRG. The transfer adjusted case count for each DRG is also summed. Average PO 00000 Frm 00053 Fmt 4701 Sfmt 4702 24047 charges by DRG are calculated for each cost center by taking the sum of the relative, CMI adjusted charges for that DRG and dividing by the transfer adjusted case count for that DRG. A national average charge is calculated for each cost center by summing all relative CMI adjusted charges in the trimmed MedPAR data set and dividing by the total transferadjusted case count. The first set of DRG weights is created by dividing the average charge for each DRG for each cost center by the national average charge for that cost center. The result is a set of 10 weights for each DRG. These 10 weights are then assigned to each claim, a new CMI is created for each provider, the relative charges for each cost center on the claim (total charge for cost center is divided by the provider’s E:\FR\FM\25APP2.SGM 25APP2 EP25AP06.007</GPH> Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules 24048 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules average charge for that cost center) are multiplied by the new CMI and the weights are iterated until the national average CMI for each cost center stops changing between iterations. In preparing the proposed weights for this proposed rule, we used a straight CMI calculation where each case was given a full weight and counted as a full case regardless of transfer status. Alternatively, we could use the method we applied in our study of the MedPAC recommendations (see section II.C. of this preamble) where we used a CMI that was computed by taking the sum of the transfer-adjusted weights and dividing by a full case count, where the transfer-adjusted weight is computed by multiplying the transfer-adjusted case count (length of stay for claim plus one day divided by geometric mean length of stay for the DRG) by the DRG weight. We are soliciting public comment on which CMI calculation would be the most appropriate to use in this weighting methodology. After the iteration process is completed, we remove the effects of differential markups within cost centers. To do this, we are proposing to use national average departmental CCRs in conjunction with the total charges from the trimmed MedPAR file to create scaling factors for each cost center. The first step in this process is to develop national cost center CCRs. Taking the FY 2003 cost report data, we removed CAHs, Maryland hospitals, Indian Health Service hospitals, allinclusive rate hospitals, and cost reports that represented time periods of less than 1 year (365 days). We then created CCRs for each provider for each cost center (see prior table for line items used in the calculations) and removed any cost CCRs that were greater than 10 or less than .01. We then took the logs of all of the cost center CCRs and removed any cost center CCRs where the log of the cost center CCR was greater or less than the mean log plus/ minus 1.96 times the standard deviation for the log of that cost center CCR. We are proposing to use 1.96 times the standard deviation as a trim factor because the logs of the cost center CCRs are normally distributed and 1.96 times the standard deviation represents the 95 percentile of the T-Distribution for large sample size, for which 2,000 to 3,000 hospitals should qualify. Once the cost report data was trimmed, we calculated the geometric mean CCR for each cost center. We are proposing to use these geometric mean CCRs to create cost scaling factors to apply to the DRG weights. Once the national average CCRs are computed, they are multiplied by the total unadjusted charges for the matching group of cost centers in MedPAR. The resulting costs for each group of cost centers are then summed to derive a total cost for all cases across the Nation. The percentage that each cost center is contributing to the overall total costs is calculated by dividing the individual cost center cost by the total amount. For example, the total cost for routine days is divided by the total cost for all cases to arrive at 0.29, which indicates that routine costs are responsible for approximately 29 percent of total cost. We are proposing to use these percentages as scaling factors to apply to the relative weights. For each DRG, the cost center weights are multiplied by these scaling factors (that is, routine day weight is multiplied by the routine day scaling factor, intensive care unit weight is multiplied by the intensive care unit scaling factor, and so on). After the weights are adjusted by the scaling factor, they are summed by DRG to create one final weight for each DRG. Following that, they are normalized by a factor of 1.49216 so that the weights so that the average case weight after recalibration is equal to the average case weight before recalibration. This normalization adjustment was intended to ensure that recalibration by itself neither increases nor decreases total payments under the IPPS. When we recalibrated the DRG weights for previous years, we set a threshold of 10 cases as the minimum number of cases required to compute a reasonable weight. We are proposing to use that same case threshold in recalibrating the DRG weights for FY 2007. Using the FY 2005 MedPAR data set, there are 40 DRGs that contain fewer than 10 cases. Because we believe that we do not have sufficient MedPAR data to set accurate and stable HSRVcc weights for these low-volume DRGs, we are proposing to assign them the weights of similar DRGs for which we have more complete data. The crosswalk we are proposing to use is shown below. We are soliciting comment on this crosswalk. DRG title Crosswalk to DRG 3 ............................... 30 ............................. Craniotomy Age 0–17 ............................................................ Traumatic Stupor & Coma, Coma <1 HR Age 0–17 ............ 33 41 48 54 58 ............................. ............................. ............................. ............................. ............................. 60 62 74 81 ............................. ............................. ............................. ............................. Concussion Age 0–17 ........................................................... Extraocular Procedures Except Orbit Age 0–17 ................... Other Disorders Of The Eye Age 0–17 ................................. Sinus and Mastoid Procedures Age 0–17 ............................ T&A Proc, Except Tonsillectomy &/or Adenoidectomy Only, Age 0–17. Tonsillectomy and/or Adenoidectomy Only, Age 0–17 ......... Myringotomy W Tube Insertion Age 0–17 ............................ Other Ear, Nose, Mouth & Throat Diagnoses Age 0–17 ...... Respiratory Infections & Inflammations Age 0–17 ................ 137 ........................... Cardiac Congental & Valvular Disorders Age 0–17 .............. 156 ........................... wwhite on PROD1PC61 with PROPOSALS2 Low volume DRG Stomach, Esophageal & Duodenal Procedures Age 0–17 ... 163 ........................... Hernia Procedures Age 0–17 ................................................ 186 ........................... Dental & Oral Disease Except Extractions & Restorations Age 0–17. Lower Extrem & Humer Proc Except Hip, Foot, Femur Age 0–17. Fx, Sprn, Strn & Disl Of Foreman, Hand, Foot Age 0–17 .... 2 (Craniotomy Age >17 Without CC). 29 (Traumatic Stupor & Coma, Coma <1 HR Age >17 Without CC). 32 (Concussion Age >17 Without CC). 40 (Extraocular Procedures Except Orbit Age >17). 47 (Other Disorders of The Eye Age >17 Without CC). 53 (Sinus and Mastoid Procedures Age >17). 57 (T&A Proc, Except Tonsillectomy &/or Adenoidectomy Only, Age >17). 59 (Tonsillectomy and/or Adenoidectomy Only, Age >17). 61 (Myringotomy With Tube Insertion Age >17). 73 (Other Ear, Nose, Mouth & Throat Diagnoses Age >17). 79 (Respiratory Infections & Inflammations Age >17 With CC). 135 (Cardiac Congental & Valvular Disorders Age >17 With CC). 155 (Stomach, Esophageal & Duodenal Procedures Age >17 Without CC). 162 (Inguinal & Femoral Hernia Procedures Age >17 Without CC). 185 (Dental & Oral Disease Except Extractions & Restorations, Age >17). 219 (Lower Extrem & Humer Proc Except Hip, Foot, Femur Age >17 Without CC). 251 (Fx, Sprn, Strn & Disl of Foreman, Hand, Foot Age >17 Without CC). 220 ........................... 252 ........................... VerDate Aug<31>2005 17:10 Apr 24, 2006 Jkt 208001 PO 00000 Frm 00054 Fmt 4701 Sfmt 4702 E:\FR\FM\25APP2.SGM 25APP2 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules 24049 Low volume DRG DRG title Crosswalk to DRG 255 ........................... Fx, Sprn, Strn & Disl Of Uparm, Lowleg Ex Foot Age 0–17 279 ........................... 282 ........................... Cellulitis Age 0–17 ................................................................. Trauma To The Skin, Subcut Tiss & Breast Age 0–17 ........ 314 330 340 343 351 362 385 387 ........................... Urethral Procedures, Age 0–17 ............................................. Urethral Stricture Age 0–17 ................................................... Testes Procedures, Non-Malignancy Age 0–17 ................... Circumcism Age 0–17 ........................................................... Sterilization, Male .................................................................. Endoscopic Tubal Interruption ............................................... Neonates, Died Or Transferred To Another Acute Care Facility. Extreme Immaturity Or Respiratory Distress Syndrome, Neonate. Prematurity With Major Problems ......................................... 388 ........................... Prematurity Without Major Problems .................................... 389 ........................... Full Term Neonate With Major Problems .............................. 390 ........................... Neonate With Other Significant Problems ............................ 391 ........................... Normal Newborn .................................................................... 393 ........................... 405 ........................... Splenectomy Age 0–17 ......................................................... Acute Leukemia Without Major O.R. Procedure Age 0–17 .. 411 ........................... History Of Malignancy Without Endoscopy ........................... 412 ........................... History Of Malignancy With Endoscopy ................................ 446 ........................... 448 ........................... 451 ........................... Traumatic Injury Age 0–17 .................................................... Allergic Reactions Age 0–17 ................................................. Poisoning and Toxic Effects Of Drugs Age 0–17 ................. 254 Fx, Sprn, Strn & Disl of Uparm, Lowleg Ex Foot Age >17 Without CC). 278 (Cellulitis Age >17 Without CC). 281 (Trauma To The Skin, Subcut Tiss & Breast Age >17 Without CC). 313 (Urethral Procedures, Age >17 Without CC). 329 (Urethral Stricture Age >17 Without CC). 339 (Testes Procedures, Non-Malignancy Age >17). 342 (Circumcism Age >17). 352 (Other Male Reproductive System Diagnoses). 361 (Laparoscopy & Incisional Tubal Interruption). FY 2006 FR weight (adjusted by percent change in average weight of the cases in other DRGs). FY 2006 FR weight (adjusted by percent change in average weight of the cases in other DRGs). FY 2006 FR weight (adjusted by percent change in average weight of the cases in other DRGs). FY 2006 FR weight (adjusted by percent change in average weight of the cases in other DRGs). FY 2006 FR weight (adjusted by percent change in average weight of the cases in other DRGs). FY 2006 FR weight (adjusted by percent change in average weight of the cases in other DRGs). FY 2006 FR weight (adjusted by percent change in average weight of the cases in other DRGs). 392 (Splenectomy Age >17). 473 (Acute Leukemia Without Major O.R. Procedure Age >17). 465 (Aftercare With History of Malignancy As Secondary Diagnosis). 465 (Aftercare With History of Malignancy As Secondary Diagnosis). 445 (Traumatic Injury Age >17 Without CC). 447 (Allergic Reactions Age >17). 450 (Poisoning and Toxic Effects of Drugs Age >17 Without CC). ........................... ........................... ........................... ........................... ........................... ........................... ........................... 386 ........................... wwhite on PROD1PC61 with PROPOSALS2 Section 1886(d)(4)(C)(iii) of the Act requires that, beginning with FY 1991, reclassification and recalibration changes be made in a manner that assures that the aggregate payments are neither greater than nor less than the aggregate payments that would have been made without the changes. Although normalization is intended to achieve this effect, equating the average case weight after recalibration to the average case weight before recalibration does not necessarily achieve budget neutrality with respect to aggregate payments to hospitals because payments to hospitals are affected by factors other than average case weight. Therefore, as we have done in past years, and as discussed in section II.A.4.a. of the Addendum to this proposed rule, we are making a budget neutrality adjustment to ensure that the requirement of section 1886(d)(4)(C)(iii) of the Act is met. F. Proposed LTC–DRG Reclassifications and Relative Weights for LTCHs for FY 2007 (If you choose to comment on issues in this section, please include the caption ‘‘LTC–DRGs’’ at the beginning of your comment.) VerDate Aug<31>2005 17:10 Apr 24, 2006 Jkt 208001 1. Background In the June 6, 2003 LTCH PPS final rule (68 FR 34122), we changed the LTCH PPS annual payment rate update cycle to be effective July 1 through June 30 instead of October 1 through September 30. In addition, because the patient classification system utilized under the LTCH PPS uses the same DRGs as those currently used under the IPPS for acute care hospitals, in that same final rule, we explained that the annual update of the long-term care diagnosis-related group (LTC–DRG) classifications and relative weights will continue to remain linked to the annual reclassification and recalibration of the DRGs used under the IPPS. In that same final rule, we specified that we will continue to update the LTC–DRG classifications and relative weights to be effective for discharges occurring on or after October 1 through September 30 each year. Furthermore, we stated that we will publish the annual update of the LTC–DRGs in the proposed and final rules for the IPPS. In the past, the annual update to the IPPS DRGs has been based on the annual revisions to the ICD–9–CM codes and was effective each October 1. As PO 00000 Frm 00055 Fmt 4701 Sfmt 4702 discussed in the FY 2006 IPPS final rule (70 FR 47323 through 47341) and in the Rate Year (RY) 2007 LTCH PPS proposed rule (71 FR 4652 through 4658), with the implementation of section 503(a) of Pub. L. 108–173, there is the possibility that one feature of the GROUPER software program may be updated twice during a Federal fiscal year (October 1 and April 1) as required by the statute for the IPPS. Specifically, ICD–9–CM diagnosis and procedure codes for new medical technology may be created and added to existing DRGs in the middle of the Federal fiscal year on April 1. However, this policy change will have no effect on the LTC–DRG relative weights, which will continue to be updated only once a year (October 1), nor will there be any impact on Medicare payments under the LTCH PPS. The use of the ICD–9–CM code set is also compliant with the current requirements of the Transactions and Code Sets Standards regulations at 45 CFR Parts 160 and 162, promulgated in accordance with the Health Insurance Portability and Accountability Act of 1996 (HIPAA), Pub. L. 104–191. As we explained in the RY 2007 LTCH PPS proposed rule (71 FR 4654 E:\FR\FM\25APP2.SGM 25APP2 wwhite on PROD1PC61 with PROPOSALS2 24050 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules through 4658), in the health care industry, historically annual changes to the ICD–9–CM codes were effective for discharges occurring on or after October 1 each year. Thus, the manual and electronic versions of the GROUPER software, which are based on the ICD– 9–CM codes, were also revised annually and effective for discharges occurring on or after October 1 each year. As noted above, the patient classification system used under the LTCH PPS (LTC–DRGs) is based on the patient classification system used under the IPPS (CMS DRGs), which historically had been updated annually and effective for discharges occurring on or after October 1 through September 30 each year. As also mentioned above, the ICD–9–CM coding update process was revised as a result of implementing section 503(a) of Pub. L. 108–173, which includes a requirement for updating ICD–9–CM codes as often as twice a year instead of the current process of annual updates on October 1 of each year (as discussed in greater detail in section II.D.10. of the preamble of this proposed rule). This requirement is included as part of the amendments to the Act relating to recognition of new medical technology under the IPPS. Section 503(a) of Pub. L. 108–173 amended section 1886(d)(5)(K) of the Act by adding a new clause (vii) which states that ‘‘the Secretary shall provide for the addition of new diagnosis and procedure codes in [sic] April 1 of each year, but the addition of such codes shall not require the Secretary to adjust the payment (or diagnosis-related group classification) * * * until the fiscal year that begins after such date.’’ This requirement improves the recognition of new technologies under the IPPS by accounting for those ICD–9–CM codes in the MedPAR claims data at an earlier date. Despite the fact that aspects of the GROUPER software may be updated to recognize any new technology ICD–9– CM codes, as discussed most recently in the RY 2007 LTCH PPS proposed rule (71 FR 4654 through 4655), there will be no impact on either LTC–DRG assignments or payments under the LTCH PPS at that time. That is, changes to the LTC–DRGs (such as the creation or deletion of LTC–DRGs) and the relative weights will continue to be updated in the manner and timing (October 1) as they are now. As noted above and as described in the RY 2007 LTCH PPS proposed rule (71 FR 4655), updates to the GROUPER for both the IPPS and the LTCH PPS (with respect to relative weights and the creation or deletion of DRGs) are made in the VerDate Aug<31>2005 17:10 Apr 24, 2006 Jkt 208001 annual IPPS proposed and final rules and are effective each October 1. We also explained that because we do not publish a midyear IPPS rule, any April 1 code updates will not be published in a midyear IPPS rule. Rather, we will assign any new diagnosis or procedure codes to the same DRG in which its predecessor code was assigned, so that there will be no impact on the DRG assignments (as also discussed in section II.D.10. of this preamble). Any coding updates will be available through the Web sites provided in section II.D.10. of this preamble and through the Coding Clinic for ICD–9– CM. Publishers and software vendors currently obtain code changes through these sources in order to update their code books and software system. If new codes are implemented on April 1, revised code books and software systems, including the GROUPER software program, will be necessary because we must use current ICD–9–CM codes. Therefore, for purposes of the LTCH PPS, because each ICD–9–CM code must be included in the GROUPER algorithm to classify each case into a LTC–DRG, the GROUPER software program used under the LTCH PPS would need to be revised to accommodate any new codes. In implementing section 503(a) of Pub. L. 108–173, there will only be an April 1 update if new technology codes are requested and approved. We note that any new codes created for April 1 implementation will be limited to those diagnosis and procedure code revisions primarily needed to describe new technologies and medical services. However, we reiterate that the process of discussing updates to the ICD–9–CM has been an open process through the ICD–9–CM Coordination and Maintenance Committee since 1995. Requestors will be given the opportunity to present the merits for a new code and make a clear and convincing case for the need to update ICD–9–CM codes for purposes of the IPPS new technology add-on payment process through an April 1 update (as also discussed in section II.D.10. of this preamble). However, as we discussed in the RY 2007 LTCH PPS proposed rule (71 FR 4655), at the September 29–30, 2005 ICD–9–CM Coordination and Maintenance Committee meeting, there were no requests for an April 1, 2006 implementation of ICD–9–CM codes, and, therefore, the next update to the ICD–9–CM coding system would not occur until October 1, 2006 (FY 2007). Presently, as there were no coding changes suggested for an April 1, 2006 update, the ICD–9–CM coding set PO 00000 Frm 00056 Fmt 4701 Sfmt 4702 implemented on October 1, 2005, will continue through September 30, 2006 (FY 2006). The proposed update to the ICD–9–CM coding system for FY 2007 is discussed above in section II.D.10. of this preamble. Accordingly, in this proposed rule, as discussed in greater detail below, we are proposing revisions to the LTC–DRG classifications and relative weights, and to the extent that they are finalized, we will publish them in the corresponding IPPS final rule, to be effective October 1, 2006 through September 30, 2007 (FY 2007). Furthermore, we would notify LTCHs of any revisions to the GROUPER software used under the IPPS and the LTCH PPS that would be implemented April 1, 2007. The proposed LTC–DRGs and relative weights for FY 2007 in this proposed rule are based on the proposed IPPS DRGs (GROUPER Version 24.0) discussed in section II.B. of the preamble to this proposed rule. 2. Proposed Changes in the LTC–DRG Classifications a. Background Section 123 of Pub. L. 106–113 specifically requires that the agency implement a PPS for LTCHs be a per discharge system with a DRG-based patient classification system reflecting the differences in patient resources and costs in LTCHs while maintaining budget neutrality. Section 307(b)(1) of Pub. L. 106–554 modified the requirements of section 123 of Pub. L. 106–113 by specifically requiring that the Secretary examine ‘‘the feasibility and the impact of basing payment under such a system [the LTCH PPS] on the use of existing (or refined) hospital diagnosis-related groups (DRGs) that have been modified to account for different resource use of long-term care hospital patients as well as the use of the most recently available hospital discharge data.’’ In accordance with section 307(b)(1) of Pub. L. 106–554 and § 412.515 of our existing regulations, the LTCH PPS uses information from LTCH patient records to classify patient cases into distinct LTC–DRGs based on clinical characteristics and expected resource needs. The LTC–DRGs used as the patient classification component of the LTCH PPS correspond to the DRGs under the IPPS for acute care hospitals. Thus, in this proposed rule, we are proposing to use the IPPS GROUPER Version 24.0 for FY 2007 to process LTCH PPS claims for LTCH discharges occurring from October 1, 2006 through September 30, 2007. The proposed changes to the CMS–DRG classification system used under the IPPS for FY 2007 E:\FR\FM\25APP2.SGM 25APP2 wwhite on PROD1PC61 with PROPOSALS2 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules (GROUPER Version 24.0) are discussed in section II.D. of the preamble to this proposed rule. We note that, as we discuss in section II.C.6. of the preamble to this proposed rule, MedPAC, in its 2005 Report to Congress on Physician-Owned Specialty Hospitals, recommended that CMS, among other things, refine the current DRGs under the IPPS to more fully capture differences in severity of illness among patients. As we also discuss in that same section, in evaluating the MedPAC recommendation for the IPPS, we are evaluating the APR DRG GROUPER used by MedPAC in its analysis. Based on this analysis, we concur with MedPAC that the modified version of the APR DRGs would account more completely for differences in severity of illness and associated costs among hospitals. Therefore, as discussed in greater detail in section II.C.6. of the preamble of this proposed rule, we are proposing to adopt the consolidated severity adjusted DRGs for implementation in the IPPS in FY 2008 (if not earlier). As discussed above in this section, the LTCH PPS uses the same patient classification system (DRGs). In response to MedPAC’s recommendation that severity adjusted DRGs, such as the APR DRGs or a modified version of the APR DRGs, be adopted under the IPPS (as discussed in greater detail in section II.C. of this preamble), we are proposing to adopt consolidated severity-adjusted DRGs under the IPPS in FY 2008 (if not earlier). At that time, we would need to consider whether to propose revisions to the patient classification system under the LTCH PPS. Any proposed changes to the patient classification system would be done through notice and comment rulemaking. Under the LTCH PPS, we determine relative weights for each of the DRGs to account for the difference in resource use by patients exhibiting the case complexity and multiple medical problems characteristic of LTCH patients. In a departure from the IPPS, as we discussed in the August 30, 2002 LTCH PPS final rule (67 FR 55985), which implemented the LTCH PPS, and the FY 2006 IPPS final rule (70 FR 47324), we use low-volume quintiles in determining the LTC–DRG relative weights for LTC–DRGs with less than 25 LTCH cases, because LTCHs do not typically treat the full range of diagnoses as do acute care hospitals. Specifically, we group those lowvolume LTC–DRGs (that is, LTC–DRGs with fewer than 25 cases) into 5 quintiles based on average charge per discharge. (A listing of the composition of low-volume quintiles for the FY 2006 VerDate Aug<31>2005 17:10 Apr 24, 2006 Jkt 208001 LTC–DRGs (based on FY 2004 MedPAR data) appears in section II.G.3. of the FY 2006 IPPS final rule (70 FR 47325 through 47332).) We also adjust for cases in which the stay at the LTCH is less than or equal to five-sixths of the geometric average length of stay; that is, short-stay outlier cases (§ 412.529), as discussed below in section II.F.4. of this preamble. b. Patient Classifications Into DRGs Generally, under the LTCH PPS, Medicare payment is made at a predetermined specific rate for each discharge; that is, payment varies by the LTC–DRG to which a beneficiary’s stay is assigned. Just as cases are classified into DRGs for acute care hospitals under the IPPS (see section II.B. of this preamble), cases are classified into LTC–DRGs for payment under the LTCH PPS based on the principal diagnosis, up to eight additional diagnoses, and up to six procedures performed during the stay, as well as age, sex, and discharge status of the patient. The diagnosis and procedure information is reported by the hospital using the ICD–9–CM codes. As discussed in section II.B. of this preamble, the CMS–DRGs are organized into 25 major diagnostic categories (MDCs), most of which are based on a particular organ system of the body; the remainder involve multiple organ systems (such as MDC 22, Burns). Accordingly, the principal diagnosis determines MDC assignment. Within most MDCs, cases are then divided into surgical DRGs and medical DRGs. Some surgical and medical DRGs are further differentiated based on the presence or absence of CCs. (See section II.B. of this preamble for further discussion of surgical DRGs and medical DRGs.) Because the assignment of a case to a particular LTC–DRG will determine the amount that is paid for the case, it is important that the coding is accurate. As used under the IPPS, classifications and terminology used under the LTCH PPS are consistent with the ICD–9–CM and the Uniform Hospital Discharge Data Set (UHDDS), as recommended to the Secretary by the National Committee on Vital and Health Statistics (‘‘Uniform Hospital Discharge Data: Minimum Data Set, National Center for Health Statistics, April 1980’’) and as revised in 1984 by the Health Information Policy Council (HIPC) of the U.S. Department of Health and Human Services. We point out again that the ICD–9–CM coding terminology and the definitions of principal and other diagnoses of the UHDDS are consistent with the requirements of the Transactions and Code Sets Standards under HIPAA (45 CFR Parts 160 and 162). PO 00000 Frm 00057 Fmt 4701 Sfmt 4702 24051 The emphasis on the need for proper coding cannot be overstated. Inappropriate coding of cases can adversely affect the uniformity of cases in each LTC–DRG and produce inappropriate weighting factors at recalibration and result in inappropriate payments under the LTCH PPS. LTCHs are to follow the same coding guidelines used by acute care hospitals to ensure accuracy and consistency in coding practices. There will be only one LTC– DRG assigned per long-term care hospitalization; it will be assigned at the time of discharge of the patient. Therefore, it is mandatory that the coders continue to report the same principal diagnosis on all claims and include all diagnosis codes for conditions that coexist at the time of admission, for conditions that are subsequently developed, or for conditions that affect the treatment received. Similarly, all procedures performed in a LTCH, or paid for under arrangements by a LTCH, during that stay are to be reported on each claim. Upon the discharge of the patient from a LTCH, the LTCH must assign appropriate diagnosis and procedure codes from the ICD–9–CM. Completed claim forms are to be submitted electronically to the LTCH’s Medicare fiscal intermediary. Medicare fiscal intermediaries enter the clinical and demographic information into their claims processing systems and subject this information to a series of automated screening processes called the Medicare Code Editor (MCE). These screens are designed to identify cases that require further review before assignment into an LTC–DRG can be made. After screening through the MCE, each LTCH claim will be classified into the appropriate LTC–DRG by the Medicare LTCH GROUPER. The LTCH GROUPER is specialized computer software and is the same GROUPER used under the IPPS. After the LTC– DRG is assigned, the Medicare fiscal intermediary determines the prospective payment by using the Medicare LTCH PPS PRICER program, which accounts for LTCH hospital-specific adjustments and payment rates. As provided for under the IPPS, we provide an opportunity for the LTCH to review the LTC–DRG assignments made by the fiscal intermediary and to submit additional information within a specified timeframe (§ 412.513(c)). The LTCH GROUPER is used both to classify past cases in order to measure relative hospital resource consumption to establish the LTC–DRG weights and to classify current cases for purposes of determining payment. The records for all Medicare hospital inpatient E:\FR\FM\25APP2.SGM 25APP2 24052 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules discharges are maintained in the MedPAR file. The data in this file are used to evaluate possible DRG classification changes and to recalibrate the DRG weights during our annual update (as discussed in section II.E. of this preamble). The LTC–DRG relative weights are based on data for the population of LTCH discharges, reflecting the fact that LTCH patients represent a different patient-mix than patients in short-term acute care hospitals. 3. Development of the Proposed FY 2007 LTC–DRG Relative Weights a. General Overview of Development of the LTC–DRG Relative Weights As we stated in the August 30, 2002 LTCH PPS final rule (67 FR 55981), one of the primary goals for the implementation of the LTCH PPS is to pay each LTCH an appropriate amount for the efficient delivery of care to Medicare patients. The system must be able to account adequately for each LTCH’s case-mix in order to ensure both fair distribution of Medicare payments and access to adequate care for those Medicare patients whose care is more costly. To accomplish these goals, we adjust the LTCH PPS standard Federal prospective payment system rate by the applicable LTC–DRG relative weight in determining payment to LTCHs for each case. Under the LTCH PPS, relative weights for each LTC–DRG are a primary element used to account for the variations in cost per discharge and resource utilization among the payment groups (§ 412.515). To ensure that Medicare patients classified to each LTC–DRG have access to an appropriate level of services and to encourage efficiency, we calculate a relative weight for each LTC–DRG that represents the resources needed by an average inpatient LTCH case in that LTC–DRG. For example, cases in an LTC–DRG with a relative weight of 2 will, on average, cost twice as much as cases in an LTC– DRG with a weight of 1. wwhite on PROD1PC61 with PROPOSALS2 b. Data To calculate the proposed LTC–DRG relative weights for FY 2007 in this proposed rule, we obtained total Medicare allowable charges from FY 2005 Medicare LTCH bill data from the December 2005 update of the MedPAR file, which are the best available data at this time, and we used the proposed Version 24.0 of the CMS GROUPER used under the IPPS (as discussed in section II.B. of this preamble) to classify cases. To calculate the final LTC–DRG relative weights for FY 2007, we are proposing that, if more recent data are VerDate Aug<31>2005 17:10 Apr 24, 2006 Jkt 208001 available (that is, data from the March 2006 update of the MedPAR file, for example), we would use that data and use the finalized Version 24.0 of the CMS GROUPER used under the IPPS. As we discussed in the FY 2006 IPPS final rule (70 FR 47325), we have excluded the data from LTCHs that are all-inclusive rate providers and LTCHs that are reimbursed in accordance with demonstration projects authorized under section 402(a) of Pub. L. 90–248 (42 U.S.C. 1395b–1) or section 222(a) of Pub. L. 92–603 (42 U.S.C. 1395b–1). Therefore, in the development of the proposed FY 2007 LTC–DRG relative weights, we have excluded the data of the 19 all-inclusive rate providers and the 3 LTCHs that are paid in accordance with demonstration projects that had claims in the FY 2005 MedPAR file. c. Hospital-Specific Relative Value Methodology By nature, LTCHs often specialize in certain areas, such as ventilatordependent patients and rehabilitation and wound care. Some case types (DRGs) may be treated, to a large extent, in hospitals that have, from a perspective of charges, relatively high (or low) charges. This nonarbitrary distribution of cases with relatively high (or low) charges in specific LTC–DRGs has the potential to inappropriately distort the measure of average charges. To account for the fact that cases may not be randomly distributed across LTCHs, we use a hospital-specific relative value method to calculate the LTC–DRG relative weights instead of the methodology used to determine the DRG relative weights under the IPPS described in section II.E. of this preamble. We believe this method will remove this hospital-specific source of bias in measuring LTCH average charges. Specifically, we reduce the impact of the variation in charges across providers on any particular LTC–DRG relative weight by converting each LTCH’s charge for a case to a relative value based on that LTCH’s average charge. Under the hospital-specific relative value method, we standardize charges for each LTCH by converting its charges for each case to hospital-specific relative charge values and then adjusting those values for the LTCH’s case-mix. The adjustment for case-mix is needed to rescale the hospital-specific relative charge values (which, by definition, averages 1.0 for each LTCH). The average relative weight for a LTCH is its case-mix, so it is reasonable to scale each LTCH’s average relative charge value by its case-mix. In this way, each LTCH’s relative charge value is adjusted PO 00000 Frm 00058 Fmt 4701 Sfmt 4702 by its case-mix to an average that reflects the complexity of the cases it treats relative to the complexity of the cases treated by all other LTCHs (the average case-mix of all LTCHs). In accordance with the methodology established under § 412.523, as implemented in the August 30, 2002 LTCH PPS final rule (67 FR 55989 through 55991), we standardize charges for each case by first dividing the adjusted charge for the case (adjusted for short-stay outliers under § 412.529 as described in section II.F.4. (step 3) of this preamble) by the average adjusted charge for all cases at the LTCH in which the case was treated. Short-stay outliers under § 412.529 are cases with a length of stay that is less than or equal to five-sixths the average length of stay of the LTC–DRG. The average adjusted charge reflects the average intensity of the health care services delivered by a particular LTCH and the average cost level of that LTCH. The resulting ratio is multiplied by that LTCH’s case-mix index to determine the standardized charge for the case. Multiplying by the LTCH’s case-mix index accounts for the fact that the same relative charges are given greater weight at a LTCH with higher average costs than they would at a LTCH with low average costs, which is needed to adjust each LTCH’s relative charge value to reflect its case-mix relative to the average case-mix for all LTCHs. Because we standardize charges in this manner, we count charges for a Medicare patient at a LTCH with high average charges as less resource intensive than they would be at a LTCH with low average charges. For example, a $10,000 charge for a case at a LTCH with an average adjusted charge of $17,500 reflects a higher level of relative resource use than a $10,000 charge for a case at a LTCH with the same case-mix, but an average adjusted charge of $35,000. We believe that the adjusted charge of an individual case more accurately reflects actual resource use for an individual LTCH because the variation in charges due to systematic differences in the markup of charges among LTCHs is taken into account. d. Proposed Low-Volume LTC–DRGs In order to account for LTC–DRGs with low-volume (that is, with fewer than 25 LTCH cases), in accordance with the methodology established in the August 30, 2002 LTCH PPS final rule (67 FR 55984), we group those ‘‘lowvolume LTC–DRGs’’ (that is, DRGs that contained between 1 and 24 cases annually) into one of five categories (quintiles) based on average charges, for the purposes of determining relative weights. For this FY 2007 IPPS E:\FR\FM\25APP2.SGM 25APP2 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules wwhite on PROD1PC61 with PROPOSALS2 proposed rule, we are proposing to continue to employ this treatment of low-volume LTC–DRGs in determining the FY 2007 LTC–DRG relative weights using the best available LTCH data. In this proposed rule, using LTCH cases from the December 2005 update of the FY 2005 MedPAR file, we identified 173 LTC–DRGs that contained between 1 and 24 cases. This list of LTC–DRGs was then divided into one of the 5 lowvolume quintiles, each containing a minimum of 34 LTC–DRGs (173/5 = 34 with 3 LTC–DRGs as the remainder). In accordance with our established methodology, we are proposing to make an assignment to a specific low-volume quintile by sorting the low-volume LTC–DRGs in ascending order by average charge. For this proposed rule, this results in an assignment to a specific low-volume quintile of the sorted 173 low-volume LTC–DRGs by ascending order by average charge. Because the number of LTC–DRGs with less than 25 LTCH cases is not evenly divisible by five, the average charge of the low-volume LTC–DRG was used to VerDate Aug<31>2005 17:10 Apr 24, 2006 Jkt 208001 determine which low-volume quintile received the additional LTC–DRG. After sorting the 173 low-volume LTC–DRGs in ascending order, we are proposing to group the first fifth of low-volume LTC– DRGs with the lowest average charge into Quintile 1. The highest average charge cases would be grouped into Quintile 5. Because the average charge of the 35th LTC–DRG in the sorted list is closer to the 34th proposed LTC– DRG’s average charge (assigned to Quintile 1) than to the average charge of the proposed 36th LTC–DRG in the sorted list (to be assigned to Quintile 2), we are proposing to place it into Quintile 1. This process was repeated through the remaining proposed lowvolume LTC–DRGs so that 3 proposed low-volume quintile contain 35 proposed LTC–DRGs and 2 proposed low-volume quintiles contain 34 proposed LTC–DRGs. In order to determine the proposed relative weights for the proposed LTC– DRGs with low volume for FY 2007, in accordance with the methodology established in the August 30, 2002 LTCH PPS final rule (67 FR 55984), we PO 00000 Frm 00059 Fmt 4701 Sfmt 4702 24053 are proposing to use the five lowvolume quintiles described above. The composition of each of the proposed five low-volume quintiles shown in the chart below was used in determining the proposed LTC–DRG relative weights for FY 2007. We would determine a proposed relative weight and (geometric) average length of stay for each of the five proposed low-volume quintiles using the formula that we apply to the regular proposed LTC– DRGs (25 or more cases), as described below in section II.F.4. of this preamble. We are proposing to assign the same relative weight and average length of stay to each of the proposed LTC–DRGs that make up that proposed low-volume quintile. We note that, as this system is dynamic, it is possible that the number and specific type of LTC–DRGs with a low volume of LTCH cases will vary in the future. We use the best available claims data in the MedPAR file to identify low-volume LTC–DRGs and to calculate the relative weights based on our methodology. BILLING CODE 4120–01–P E:\FR\FM\25APP2.SGM 25APP2 VerDate Aug<31>2005 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules 17:10 Apr 24, 2006 Jkt 208001 PO 00000 Frm 00060 Fmt 4701 Sfmt 4725 E:\FR\FM\25APP2.SGM 25APP2 EP25AP06.008</GPH> wwhite on PROD1PC61 with PROPOSALS2 24054 VerDate Aug<31>2005 17:10 Apr 24, 2006 Jkt 208001 PO 00000 Frm 00061 Fmt 4701 Sfmt 4725 E:\FR\FM\25APP2.SGM 25APP2 24055 EP25AP06.009</GPH> wwhite on PROD1PC61 with PROPOSALS2 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules VerDate Aug<31>2005 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules 17:10 Apr 24, 2006 Jkt 208001 PO 00000 Frm 00062 Fmt 4701 Sfmt 4725 E:\FR\FM\25APP2.SGM 25APP2 EP25AP06.010</GPH> wwhite on PROD1PC61 with PROPOSALS2 24056 VerDate Aug<31>2005 17:10 Apr 24, 2006 Jkt 208001 PO 00000 Frm 00063 Fmt 4701 Sfmt 4725 E:\FR\FM\25APP2.SGM 25APP2 24057 EP25AP06.011</GPH> wwhite on PROD1PC61 with PROPOSALS2 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules 24058 BILLING CODE 4120–01–C wwhite on PROD1PC61 with PROPOSALS2 We note that we will continue to monitor the volume (that is, the number of LTCH cases) in these low-volume quintiles to ensure that our proposed quintile assignment results in appropriate payment for such cases and does not result in an unintended financial incentive for LTCHs to inappropriately admit these types of cases. 4. Steps for Determining the Proposed FY 2007 LTC–DRG Relative Weights As we noted previously, the proposed FY 2007 LTC–DRG relative weights are determined in accordance with the methodology established in the August 30, 2002 LTCH PPS final rule (67 FR VerDate Aug<31>2005 17:10 Apr 24, 2006 Jkt 208001 55989 through 55991). In summary, LTCH cases must be grouped in the appropriate LTD–DRG, while taking into account the proposed low-volume LTD– DRGs as described above, before the proposed FY 2007 LTD–DRG relative weights can be determined. After grouping the cases in the appropriate proposed LTD–DRG, we are proposing to calculate the relative weights for FY 2007 in this proposed rule by first removing statistical outliers and cases with a length of stay of 7 days or less, as discussed in greater detail below. Next, we are proposing to adjust the number of cases in each proposed LTD– DRG for the effect of short-stay outlier cases under § 412.529, as also discussed PO 00000 Frm 00064 Fmt 4701 Sfmt 4702 in greater detail below. The short-stay adjusted discharges and corresponding charges are used to calculate ‘‘relative adjusted weights’’ in each proposed LTD–DRG using the hospital-specific relative value method described above. Below we discuss in detail the steps for calculating the proposed FY 2007 LTD–DRG relative weights. We note that, as we stated above in section II.F.3.b. of this preamble, we have excluded the data of all-inclusive rate LTCHs and LTCHs that are paid in accordance with demonstration projects that had claims in the FY 2005 MedPAR file. Step 1—Remove statistical outliers. E:\FR\FM\25APP2.SGM 25APP2 EP25AP06.012</GPH> Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules wwhite on PROD1PC61 with PROPOSALS2 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules The first step in the calculation of the proposed FY 2007 LTD–DRG relative weights is to remove statistical outlier cases. We define statistical outliers as cases that are outside of 3.0 standard deviations from the mean of the log distribution of both charges per case and the charges per day for each proposed LTD–DRG. These statistical outliers are removed prior to calculating the proposed relative weights. As noted above, we believe that they may represent aberrations in the data that distort the measure of average resource use. Including those LTCH cases in the calculation of the proposed relative weights could result in an inaccurate proposed relative weight that does not truly reflect relative resource use among the proposed LTD–DRGs. Step 2—Remove cases with a length of stay of 7 days or less. The proposed FY 2007 LTD–DRG relative weights reflect the average of resources used on representative cases of a specific type. Generally, cases with a length of stay 7 days or less do not belong in a LTCH because these stays do not fully receive or benefit from treatment that is typical in a LTCH stay, and full resources are often not used in the earlier stages of admission to a LTCH. As explained above, if we were to include stays of 7 days or less in the computation of the proposed FY 2007 LTD–DRG relative weights, the value of many proposed relative weights would decrease and, therefore, payments would decrease to a level that may no longer be appropriate. We do not believe that it would be appropriate to compromise the integrity of the payment determination for those LTCH cases that actually benefit from and receive a full course of treatment at a LTCH, in order to include data from these very short-stays. Thus, as explained above, in determining the proposed FY 2007 LTD–DRG relative weights, we remove LTCH cases with a length of stay of 7 days or less. Step 3—Adjust charges for the effects of short-stay outliers. After removing cases with a length of stay of 7 days or less, we are left with cases that have a length of stay of greater than or equal to 8 days. The next step in the calculation of the proposed FY 2007 LTD–DRG relative weights is to adjust each LTCH’s charges per discharge for those remaining cases for the effects of short-stay outliers as defined in § 412.529(a). (However, we note that even if a case was removed in Step 2 (that is, cases with a length of stay of 7 days or less), it was paid as a short-stay outlier if its length of stay was less than or equal to five-sixths of the VerDate Aug<31>2005 17:10 Apr 24, 2006 Jkt 208001 average length of stay of the LTD–DRG, in accordance with § 412.529.) We make this adjustment by counting a short-stay outlier as a fraction of a discharge based on the ratio of the length of stay of the case to the average length of stay for the proposed LTD– DRG for nonshort-stay outlier cases. This has the effect of proportionately reducing the impact of the lower charges for the short-stay outlier cases in calculating the average charge for the proposed LTD–DRG. This process produces the same result as if the actual charges per discharge of a short-stay outlier case were adjusted to what they would have been had the patient’s length of stay been equal to the average length of stay of the proposed LTD– DRG. As we explained in the FY 2006 IPPS final rule (70 FR 47336), counting shortstay outlier cases as full discharges with no adjustment in determining the proposed LTC–DRG relative weights would lower the proposed LTC–DRG relative weight for affected proposed LTC–DRGs because the relatively lower charges of the short-stay outlier cases would bring down the average charge for all cases within a proposed LTC– DRG. This would result in an ‘‘underpayment’’ for nonshort-stay outlier cases and an ‘‘overpayment’’ for short-stay outlier cases. Therefore, in this proposed rule, we adjust for shortstay outlier cases under § 412.529 in this manner because it results in more appropriate payments for all LTCH cases. Step 4—Calculate the proposed FY 2007 LTC–DRG relative weights on an iterative basis. The process of calculating the proposed LTC–DRG relative weights using the hospital-specific relative value methodology is iterative. First, for each LTCH case, we calculate a hospitalspecific relative charge value by dividing the short-stay outlier adjusted charge per discharge (see step 3) of the LTCH case (after removing the statistical outliers (see step 1)) and LTCH cases with a length of stay of 7 days or less (see step 2) by the average charge per discharge for the LTCH in which the case occurred. The resulting ratio is then multiplied by the LTCH’s case-mix index to produce an adjusted hospitalspecific relative charge value for the case. An initial case-mix index value of 1.0 is used for each LTCH. For each proposed LTC–DRG, the proposed FY 2007 LTC–DRG relative weight is calculated by dividing the average of the adjusted hospital-specific relative charge values (from above) for the proposed LTC–DRG by the overall average hospital-specific relative charge PO 00000 Frm 00065 Fmt 4701 Sfmt 4702 24059 value across all cases for all LTCHs. Using these recalculated proposed LTC– DRG relative weights, each LTCH’s average relative weight for all of its cases (case-mix) is calculated by dividing the sum of all the LTCH’s proposed LTC–DRG relative weights by its total number of cases. The LTCHs’ hospital-specific relative charge values above are multiplied by these hospitalspecific case-mix indexes. These hospital-specific case-mix adjusted relative charge values are then used to calculate a new set of proposed LTC– DRG relative weights across all LTCHs. In this proposed rule, this iterative process is continued until there is convergence between the weights produced at adjacent steps, for example, when the maximum difference is less than 0.0001. Step 5—Adjust the proposed FY 2007 LTC–DRG relative weights to account for nonmonotonically increasing relative weights. As explained in section II.B. of this preamble, the proposed FY 2007 CMS DRGs, on which the proposed FY 2007 LTC–DRGs are based, contain ‘‘pairs’’ that are differentiated based on the presence or absence of CCs. The proposed LTC–DRGs with CCs are defined by certain secondary diagnoses not related to or inherently a part of the disease process identified by the principal diagnosis, but the presence of additional diagnoses does not automatically generate a CC. As we discussed in the FY 2006 IPPS final rule (70 FR 47336), the value of monotonically increasing relative weights rises as the resource use increases (for example, from uncomplicated to more complicated). The presence of CCs in a proposed LTC– DRG means that cases classified into a ‘‘without CC’’ proposed LTC–DRG are expected to have lower resource use (and lower costs). In other words, resource use (and costs) are expected to decrease across ‘‘with CC/without CC’’ pairs of proposed LTC–DRGs. For a case to be assigned to a proposed LTC–DRG with CCs, more coded information is called for (that is, at least one relevant secondary diagnosis), than for a case to be assigned to a proposed LTC–DRG ‘‘without CCs’’ (which is based on only one principal diagnosis and no relevant secondary diagnoses). Currently, the LTCH claims data include both accurately coded cases without complications and cases that have complications (and cost more), but were not coded completely. Both types of cases are grouped to a proposed LTC–DRG ‘‘without CCs’’ when only the principal diagnosis was coded. Since the LTCH PPS was only implemented E:\FR\FM\25APP2.SGM 25APP2 wwhite on PROD1PC61 with PROPOSALS2 24060 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules for cost reporting periods beginning on or after October 1, 2002 (FY 2003), and LTCHs were previously paid under costbased reimbursement, which is not based on patient diagnoses, coding by LTCHs for these cases may not have been as detailed as possible. Thus, in developing the FY 2003 LTC–DRG relative weights for the LTCH PPS based on FY 2001 claims data, as we discussed in the August 30, 2002 LTCH PPS final rule (67 FR 55990), we found on occasion that the data suggested that cases classified to the LTC–DRG ‘‘with CCs’’ of a ‘‘with CC’’/ ‘‘without CC’’ pair had a lower average charge than the corresponding LTC– DRG ‘‘without CCs.’’ Similarly, as discussed in the FY 2006 IPPS final rule (70 FR 47336 through 47337), based on FY 2004 claims data, we also found on occasion that the data suggested that cases classified to the LTC–DRG ‘‘with CCs’’ of a ‘‘with CC’’/‘‘without CC’’ pair have a lower average charge than the corresponding LTC–DRG ‘‘without CCs’’ for the FY 2006 LTC–DRG relative weights. We believe this anomaly may be due to coding that may not have fully reflected all comorbidities that were present. Specifically, LTCHs may have failed to code relevant secondary diagnoses, which resulted in cases that actually had CCs being classified into a ‘‘without CC’’ LTC–DRG. It would not be appropriate to pay a lower amount for the ‘‘with CC’’ LTC–DRG because, in general, cases classified into a ‘‘with CC’’ LTC–DRG are expected to have higher resource use (and higher cost) as discussed above. Therefore, previously when we determined the LTC–DRG relative weights in accordance with the methodology established in the August 30, 2002 LTCH PPS final rule (67 FR 55990), we grouped both the cases ‘‘with CCs’’ and ‘‘without CCs’’ together for the purpose of calculating the LTC– DRG relative weights since the implementation of the LTCH PPS in FY 2003. As we stated in that same final rule, we will continue to employ this methodology to account for nonmonotonically increasing relative weights until we have adequate data to calculate appropriate separate weights for these anomalous LTC–DRG pairs. We expect that, as was the case when we first implemented the IPPS, this problem will be self-correcting, as LTCHs submit more completely coded data in the future. There are three types of ‘‘with CC’’ and ‘‘without CC’’ pairs that could be nonmonotonic; that is, where the ‘‘without CC’’ LTC–DRG would have a higher average charge than the ‘‘with CC’’ proposed LTC–DRG. For this VerDate Aug<31>2005 17:10 Apr 24, 2006 Jkt 208001 proposed rule, using the LTCH cases in the December 2005 update of the FY 2005 MedPAR file (the most recent and complete data available at this time), we identified one of the three types of nonmonotonic LTC–DRG pairs. As we stated in the August 30, 2002 LTCH PPS final rule (67 FR 55990), we believe this anomaly may be due to coding inaccuracies and expect that, as was the case when we first implemented the acute care hospital IPPS, this problem will be self-correcting, as LTCHs submit more completely coded data in the future. The first category of nonmonotonically increasing relative weights for LTC–DRG pairs ‘‘with and without CCs’’ contains one pair of LTC– DRGs in which both the proposed LTC– DRG ‘‘with CCs’’ and the proposed LTC–DRG ‘‘without CCs’’ had 25 or more LTCH cases and, therefore, did not fall into one of the 5 low-volume quintiles. For those nonmonotonic LTC– DRG pairs, based on our established methodology (67 FR 55983 through 55990), we would combine the LTCH cases and compute a new relative weight based on the case-weighted average of the combined LTCH cases of the LTC–DRGs. The case-weighted average charge is determined by dividing the total charges for all LTCH cases by the total number of LTCH cases for the combined LTC–DRG. This new relative weight would then be assigned to both of the LTC–DRGs in the pair. In this proposed rule, for FY 2007, there were no LTC–DRGs that fell into this category. The second category of nonmonotonically increasing relative weights for LTC–DRG pairs ‘‘with and without CCs’’ consists of one pair of LTC–DRGs that has fewer than 25 cases, and each LTC–DRG would be grouped to different low-volume quintiles in which the ‘‘without CC’’ LTC–DRG is in a higher-weighted low-volume quintile than the ‘‘with CC’’ LTC–DRG. For those pairs, based on our established methodology, we would combine the LTCH cases and determine the caseweighted average charge for all LTCH cases. The case-weighted average charge is determined by dividing the total charges for all LTCH cases by the total number of LTCH cases for the combined proposed LTC–DRG. Based on the caseweighted average LTCH charge, we determine within which low-volume quintile the ‘‘combined LTC–DRG’’ is grouped. Both LTC–DRGs in the pair are then grouped into the same low-volume quintile, thus have the same relative weight. In this proposed rule, for FY 2007, there are no LTC–DRGs that fell into this category. PO 00000 Frm 00066 Fmt 4701 Sfmt 4702 The third category of nonmonotonically increasing proposed relative weights for proposed LTC–DRG pairs ‘‘with and without CCs’’ consists of one pair of proposed LTC–DRGs where one of the proposed LTC–DRGs has fewer than 25 LTCH cases and is grouped to a low-volume quintile and the other proposed LTC–DRG has 25 or more LTCH cases and has its own proposed LTC–DRG relative weight, and the proposed LTC–DRG ‘‘without CCs’’ has the proposed higher relative weight. Based on our established methodology, we removed the proposed low-volume LTC–DRG from the proposed lowvolume quintile and combined it with the other proposed LTC–DRG for the computation of a proposed new relative weight for each of these proposed LTC– DRGs. This proposed new relative weight is assigned to both proposed LTC–DRGs, so they each have the same proposed relative weight. In this proposed rule, for FY 2007, 4 ‘‘pairs’’ of proposed LTC–DRGs fall into this category: LTC–DRGs 94 and 95; LTC– DRGs 96 and 97; LTC–DRGs 141 and 142; and LTC–DRGs 292 and 293. Step 6—Determine a proposed FY 2007 LTC–DRG relative weight for proposed LTC–DRGs with no LTCH cases. As we stated above, we determine the proposed relative weight for each proposed LTC–DRG using charges reported in the December 2005 update of the FY 2005 MedPAR file. Of the 526 proposed LTC–DRGs for FY 2007, we identified 191 proposed LTC–DRGs for which there were no LTCH cases in the database. That is, based on data from the FY 2005 MedPAR file used in this proposed rule, no patients who would have been classified to those proposed LTC–DRGs were treated in LTCHs during FY 2005 and, therefore, no charge data were reported for those proposed LTC–DRGs. Thus, in the process of determining the proposed LTC–DRG relative weights, we are unable to determine weights for these 191 proposed LTC–DRGs using the methodology described in Steps 1 through 5 above. However, because patients with a number of the diagnoses under these proposed LTC–DRGs may be treated at LTCHs beginning in FY 2007, we are proposing to assign proposed relative weights to each of the 191 proposed ‘‘no volume’’ LTC–DRGs based on clinical similarity and relative costliness to one of the remaining 335 (526¥191 = 335) proposed LTC–DRGs for which we are able to determine proposed relative weights, based on FY 2005 LTCH claims data. As there are currently no LTCH cases in these proposed ‘‘no volume’’ LTC– E:\FR\FM\25APP2.SGM 25APP2 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules wwhite on PROD1PC61 with PROPOSALS2 DRGs, we determined proposed relative weights for the 191 proposed LTC–DRGs with no LTCH cases in the FY 2005 MedPAR file used in this proposed rule by grouping them to the appropriate proposed low-volume quintile. This methodology is consistent with our methodology used in determining proposed relative weights to account for the proposed low-volume LTC–DRGs described above. Our methodology for determining the proposed relative weights for the proposed ‘‘no volume’’ LTC–DRGs is as follows: We crosswalk the proposed no volume LTC–DRGs by matching them to other similar proposed LTC–DRGs for which there were LTCH cases in the FY 2005 MedPAR file based on clinical VerDate Aug<31>2005 17:10 Apr 24, 2006 Jkt 208001 similarity and intensity of use of resources as determined by care provided during the period of time surrounding surgery, surgical approach (if applicable), length of time of surgical procedure, post-operative care, and length of stay. We assign the proposed relative weight for the applicable proposed low-volume quintile to the proposed no volume LTC–DRG if the proposed LTC–DRG to which it is crosswalked is grouped to one of the proposed low-volume quintiles. If the proposed LTC–DRG to which the proposed no volume LTC–DRG is crosswalked is not one of the proposed LTC–DRGs to be grouped to one of the proposed low-volume quintiles, we PO 00000 Frm 00067 Fmt 4701 Sfmt 4702 24061 compare the proposed relative weight of the proposed LTC–DRG to which the proposed no volume LTC–DRG is crosswalked to the proposed relative weights of each of the proposed five quintiles and we assign the proposed no volume LTC–DRG the relative weight of the proposed low-volume quintile with the closest weight. For this proposed rule, a list of the proposed no volume FY 2007 LTC–DRGs and the proposed FY 2007 LTC–DRG to which it is crosswalked in order to determine the appropriate proposed low-volume quintile for the assignment of a proposed relative weight for FY 2007 is shown in the chart below. BILLING CODE 4120–01–P E:\FR\FM\25APP2.SGM 25APP2 VerDate Aug<31>2005 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules 17:10 Apr 24, 2006 Jkt 208001 PO 00000 Frm 00068 Fmt 4701 Sfmt 4725 E:\FR\FM\25APP2.SGM 25APP2 EP25AP06.013</GPH> wwhite on PROD1PC61 with PROPOSALS2 24062 VerDate Aug<31>2005 17:10 Apr 24, 2006 Jkt 208001 PO 00000 Frm 00069 Fmt 4701 Sfmt 4725 E:\FR\FM\25APP2.SGM 25APP2 24063 EP25AP06.014</GPH> wwhite on PROD1PC61 with PROPOSALS2 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules VerDate Aug<31>2005 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules 17:10 Apr 24, 2006 Jkt 208001 PO 00000 Frm 00070 Fmt 4701 Sfmt 4725 E:\FR\FM\25APP2.SGM 25APP2 EP25AP06.015</GPH> wwhite on PROD1PC61 with PROPOSALS2 24064 VerDate Aug<31>2005 17:10 Apr 24, 2006 Jkt 208001 PO 00000 Frm 00071 Fmt 4701 Sfmt 4725 E:\FR\FM\25APP2.SGM 25APP2 24065 EP25AP06.016</GPH> wwhite on PROD1PC61 with PROPOSALS2 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules VerDate Aug<31>2005 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules 17:10 Apr 24, 2006 Jkt 208001 PO 00000 Frm 00072 Fmt 4701 Sfmt 4725 E:\FR\FM\25APP2.SGM 25APP2 EP25AP06.017</GPH> wwhite on PROD1PC61 with PROPOSALS2 24066 wwhite on PROD1PC61 with PROPOSALS2 BILLING CODE 4120–01–C To illustrate this methodology for determining the proposed relative weights for the proposed 191 LTC–DRGs with no LTCH cases, we are providing the following examples, which refer to the proposed no volume LTC–DRGs crosswalk information for FY 2007 provided in the chart above. Example 1: There were no cases in the FY 2005 MedPAR file used for this proposed rule for proposed LTC–DRG 3 (Craniotomy Age 0–17). Since the procedure is similar in resource use and the length and complexity of the procedures and the length of stay are similar, we determined that proposed LTC–DRG 1 (Craniotomy Age >17 with CC), which is assigned to proposed lowvolume Quintile 1 for the purpose of determining the proposed FY 2007 relative weights, would display similar clinical and resource use. Therefore, we assign the same proposed relative weight of proposed LTC–DRG 1 of 1.6479 (Quintile 5) for FY 2007 (Table 11 in the Addendum to this proposed rule) to LTC–DRG 3. Example 2: There were no LTCH cases in the FY 2005 MedPAR file used in this proposed rule for LTC–DRG 91 (Simple Pneumonia and Pleurisy Age 0– 17). Since the severity of illness in patients with bronchitis and asthma is similar in patients regardless of age, we determined that proposed LTC–DRG 90 (Simple Pneumonia and Pleurisy Age >17 Without CC) would display similar clinical and resource use characteristics and have a similar length of stay to VerDate Aug<31>2005 17:10 Apr 24, 2006 Jkt 208001 proposed LTC–DRG 91. There were over 25 cases in proposed LTC–DRG 90. Therefore, it would not be assigned to a proposed low-volume quintile for the purpose of determining the proposed LTC–DRG relative weights. However, under our established methodology, proposed LTC–DRG 91, with no LTCH cases, would need to be grouped to a proposed low-volume quintile. We determined that the proposed lowvolume quintile with the closest weight to proposed LTC–DRG 90 (0.4981) (refer to Table 11 in the Addendum to this proposed rule) would be proposed lowvolume Quintile 2 (0.5655) (refer to Table 11 in the Addendum to this proposed rule). Therefore, we assign proposed LTC–DRG 91 a proposed relative weight of 0.5655 for FY 2007. We note that we will continue to monitor the volume (that is, the number of LTCH cases) that have few or no LTCH cases to ensure that our proposed no volume LTC–DRG crosswalking and relative weight assignment results in appropriate payments for such cases and does not result in an unintended financial incentive for LTCHs to inappropriately admit these types of cases. Furthermore, we are proposing to establish proposed LTC–DRG relative weights of 0.0000 for heart, kidney, liver, lung, pancreas, and simultaneous pancreas/kidney transplants (LTC–DRGs 103, 302, 480, 495, 512, and 513, respectively) for FY 2007 because Medicare will only cover these procedures if they are performed at a PO 00000 Frm 00073 Fmt 4701 Sfmt 4702 24067 hospital that has been certified for the specific procedures by Medicare and presently no LTCH has been so certified. Based on our research, we found that most LTCHs only perform minor surgeries, such as minor small and large bowel procedures, to the extent any surgeries are performed at all. Given the extensive criteria that must be met to become certified as a transplant center for Medicare, we believe it is unlikely that any LTCHs would become certified as a transplant center. In fact, in the nearly 20 years since the implementation of the IPPS, there has never been a LTCH that even expressed an interest in becoming a transplant center. However, if in the future a LTCH applies for certification as a Medicareapproved transplant center, we believe that the application and approval procedure would allow sufficient time for us to determine appropriate weights for the LTC–DRGs affected. At the present time, we would only include these six transplant LTC–DRGs in the GROUPER program for administrative purposes. Because we use the same GROUPER program for LTCHs as is used under the IPPS, removing these LTC– DRGs would be administratively burdensome. Again, we note that as this system is dynamic, it is entirely possible that the number of proposed LTC–DRGs with a zero volume of LTCH cases based on the system will vary in the future. We used the best most recent available claims data in the MedPAR file to identify zero E:\FR\FM\25APP2.SGM 25APP2 EP25AP06.018</GPH> Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules 24068 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules volume LTC–DRGs and to determine the proposed relative weights in this proposed rule. Table 11 in the Addendum to this proposed rule lists the proposed LTC– DRGs and their respective proposed relative weights, geometric mean length of stay, and five-sixths of the geometric mean length of stay (to assist in the determination of short-stay outlier payments under § 412.529) for FY 2007. We also wish to point out that in section VI.A.5. of the preamble of this proposed rule, we discuss our proposal to revise the regulations for grandfathered HwHs, grandfathered hospital satellite facilities, and grandfathered satellite units at §§ 412.22(f), 412.22(h)(3); and 412.25(e)(3), respectively. In addition, in section VI.A.6. of the preamble of this proposed rule, we discuss our proposal to revise and clarify the existing policies governing the determination of LTCHs’ CCRs and the reconciliation of high-cost and short-stay outlier payments under the LTCH PPS. (We note that these proposed changes concerning the determination of LTCHs’ CCRs and the reconciliation of LTCH PPS high-cost and short-stay outlier payments are the same as the changes proposed in the RY 2007 LTCH PPS proposed rule (71 FR 674 through 4676 and 4690 through 4692). As discussed in greater detail in that section, in response to comments and requests, in this IPPS proposed rule, we are presenting the same proposed changes to the policies governing the determination of LTCHs’ CCRs and the reconciliation of high-cost and shortstay outlier payments, and providing additional information on the values of the proposed LTCH CCR ceiling and the proposed statewide average LTCH CCRs that would be effective October 1, 2006, rather than responding to comments or finalizing any policy changes in the RY 2007 LTCH PPS final rule.) wwhite on PROD1PC61 with PROPOSALS2 G. Proposed Add-On Payments for New Services and Technologies (If you choose to comment on issues in this section, please include the caption ‘‘New Technology’’ at the beginning of your comment.) 1. Background Sections 1886(d)(5)(K) and (L) of the Act establish a process of identifying and ensuring adequate payment for new medical services and technologies (sometimes collectively referred to in this section as ‘‘new technologies’’) under the IPPS. Section 1886(d)(5)(K)(vi) of the Act specifies that a medical service or technology will be considered new if it meets criteria established by the Secretary after notice VerDate Aug<31>2005 17:10 Apr 24, 2006 Jkt 208001 and opportunity for public comment. Section 1886(d)(5)(K)(ii)(I) of the Act specifies that the process must apply to a new medical service or technology if, ‘‘based on the estimated costs incurred with respect to discharges involving such service or technology, the DRG prospective payment rate otherwise applicable to such discharges under this subsection is inadequate.’’ The regulations implementing this provision establish three criteria for new medical services and technologies to receive an additional payment. First, § 412.87(b)(2) defines when a specific medical service or technology will be considered new for purposes of new medical service or technology add-on payments. The statutory provision contemplated the special payment treatment for new medical services or technologies until such time as data are available to reflect the cost of the technology in the DRG weights through recalibration. There is a lag of 2 to 3 years from the point a new medical service or technology is first introduced on the market and when data reflecting the use of the medical service or technology are used to calculate the DRG weights. For example, data from discharges occurring during FY 2005 are used to calculate the proposed FY 2007 DRG weights in this proposed rule. Section 412.87(b)(2) provides that a ‘‘medical service or technology may be considered new within 2 or 3 years after the point at which data begin to become available reflecting the ICD–9–CM code assigned to the new medical service or technology (depending on when a new code is assigned and data on the new medical service or technology become available for DRG recalibration). After CMS has recalibrated the DRGs, based on available data, to reflect the costs of an otherwise new medical service or technology, the medical service or technology will no longer be considered ‘new’ under the criterion for this section.’’ The 2-year to 3-year period during which a medical service or technology can be considered new would ordinarily begin with FDA approval, unless there was some documented delay in bringing the product onto the market after that approval (for instance, component production or drug production had been postponed until FDA approval due to shelf life concerns or manufacturing issues). After the DRGs have been recalibrated to reflect the costs of an otherwise new medical service or technology, the special add-on payment for new medical services or technology ceases (§ 412.87(b)(2)). For example, an approved new technology that received FDA approval PO 00000 Frm 00074 Fmt 4701 Sfmt 4702 in October 2005 and entered the market at that time may be eligible to receive add-on payments as a new technology until FY 2008 (discharges occurring before October 1, 2007), when data reflecting the costs of the technology would be used to recalibrate the DRG weights. Because the FY 2008 DRG weights will be calculated using FY 2006 MedPAR data, the costs of such a new technology would likely be reflected in the FY 2008 DRG weights. Section 412.87(b)(3) further provides that, to receive special payment treatment, new medical services or technologies must be inadequately paid otherwise under the DRG system. To assess whether technologies would be inadequately paid under the DRGs, we establish thresholds to evaluate applicants for new technology add-on payments. In the FY 2004 IPPS final rule (68 FR 45385, August 1, 2003), we established the threshold at the geometric mean standardized charge for all cases in the DRG plus 75 percent of 1 standard deviation above the geometric mean standardized charge (based on the logarithmic values of the charges and transformed back to charges) for all cases in the DRG to which the new medical service or technology is assigned (or the caseweighted average of all relevant DRGs, if the new medical service or technology occurs in many different DRGs). Table 10 in the Addendum to the FY 2004 IPPS final rule (68 FR 45648) listed the qualifying threshold by DRG, based on the discharge data that we used to calculate the FY 2004 DRG weights. However, section 503(b)(1) of Pub. L. 108–173 amended section 1886(d)(5)(K)(ii)(I) of the Act to provide for ‘‘applying a threshold * * * that is the lesser of 75 percent of the standardized amount (increased to reflect the difference between cost and charges) or 75 percent of 1 standard deviation for the diagnosis-related group involved.’’ The provisions of section 503(b)(1) apply to classification for fiscal years beginning with FY 2005. We updated Table 10 from the Federal Register document that corrected the FY 2004 final rule (68 FR 57753, October 6, 2003), which contained the thresholds that we used to evaluate applications for new service or technology add-on payments for FY 2005, using the section 503(b)(1) measures stated above, and posted these new thresholds on our Web site at: https://www.cms.hhs.gov/ AcuteInpatientPPS/08_newtech.asp. In the FY 2005 IPPS final rule (in Table 10 of the Addendum), we included the final thresholds that were being used to evaluate applicants for new technology add-on payments for FY 2006. (Refer to E:\FR\FM\25APP2.SGM 25APP2 wwhite on PROD1PC61 with PROPOSALS2 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules section IV.D. of the preamble to the FY 2005 IPPS final rule (69 FR 49084, August 11, 2004) for a discussion of a revision of the regulations to incorporate the change made by section 503(b)(1) of Pub. L. 108–173.) Table 10 of the Addendum to the FY 2006 final rule (70 FR 47680) contained the final thresholds that are being used to evaluate applications for new technology add-on payments for FY 2007. Section 412.87(b)(1) of our existing regulations provides that a new technology is an appropriate candidate for an additional payment when it represents ‘‘an advance that substantially improves, relative to technologies previously available, the diagnosis or treatment of Medicare beneficiaries.’’ For example, a new technology represents a substantial clinical improvement when it reduces mortality, decreases the number of hospitalizations or physician visits, or reduces recovery time compared to the technologies previously available. (Refer to the September 7, 2001 final rule (66 FR 46902) for a complete discussion of this criterion.) The new medical service or technology add-on payment policy provides additional payments for cases with high costs involving eligible new medical services or technologies while preserving some of the incentives under the average-based payment system. The payment mechanism is based on the cost to hospitals for the new medical service or technology. Under § 412.88, Medicare pays a marginal cost factor of 50 percent for the costs of a new medical service or technology in excess of the full DRG payment. If the actual costs of a new medical service or technology case exceed the DRG payment by more than the 50-percent marginal cost factor of the newmedical service or technology, Medicare payment is limited to the DRG payment plus 50 percent of the estimated costs of the new technology. The report language accompanying section 533 of Pub. L. 106–554 indicated Congressional intent that the Secretary implement the new mechanism on a budget neutral basis (H.R. Conf. Rep. No. 106–1033, 106th Cong., 2nd Sess. at 897 (2000)). Section 1886(d)(4)(C)(iii) of the Act requires that the adjustments to annual DRG classifications and relative weights must be made in a manner that ensures that aggregate payments to hospitals are not affected. Therefore, in the past, we accounted for projected payments under the new medical service and technology provision during the upcoming fiscal year at the same time we estimated the payment effect of VerDate Aug<31>2005 17:10 Apr 24, 2006 Jkt 208001 changes to the DRG classifications and recalibration. The impact of additional payments under this provision was then included in the budget neutrality factor, which was applied to the standardized amounts and the hospital-specific amounts. Section 1886(d)(5)(K)(ii)(III) of the Act, as amended by section 503(d)(2) of Pub. L. 108–173, provides that there shall be no reduction or adjustment in aggregate payments under the IPPS due to add-on payments for new medical services and technologies. Therefore, add-on payments for new medical services or technologies for FY 2005 and later years are not budget neutral. Applicants for add-on payments for new medical services or technologies for FY 2008 must submit a formal request, including a full description of the clinical applications of the medical service or technology and the results of any clinical evaluations demonstrating that the new medical service or technology represents a substantial clinical improvement, along with a significant sample of data to demonstrate the medical service or technology meets the high-cost threshold, no later than October 15, 2006. Applicants must submit a complete database no later than December 30, 2006. Complete application information, along with final deadlines for submitting a full application, will be available at our Web site: https://www.cms.hhs.gov/ AcuteInpatientPPS/08_newtech.asp. To allow interested parties to identify the new medical services or technologies under review before the publication of the proposed rule for FY 2008, the Web site will also list the tracking forms completed by each applicant. 2. Public Input Before Publication of This Notice of Proposed Rulemaking on Add-On Payments Section 1886(d)(5)(K)(viii) of the Act, as amended by section 503(b)(2) of Pub. L. 108–173, provides for a mechanism for public input before publication of a notice of proposed rulemaking regarding whether a medical service or technology represents a substantial clinical improvement or advancement. The process for evaluating new medical service and technology applications requires the Secretary to— • Provide, before publication of a proposed rule, for public input regarding whether a new service or technology represents an advance in medical technology that substantially improves the diagnosis or treatment of Medicare beneficiaries. • Make public and periodically update a list of the services and PO 00000 Frm 00075 Fmt 4701 Sfmt 4702 24069 technologies for which applications for add-on payments are pending. • Accept comments, recommendations, and data from the public regarding whether a service or technology represents a substantial clinical improvement. • Provide, before publication of a proposed rule, for a meeting at which organizations representing hospitals, physicians, manufacturers, and any other interested party may present comments, recommendations, and data regarding whether a new service or technology represents a substantial clinical improvement to the clinical staff of CMS. In order to provide an opportunity for public input regarding add-on payments for new medical services and technologies for FY 2007 before publication of this FY 2007 IPPS proposed rule, we published a notice in the Federal Register on December 23, 2005 (70 FR 76315) and held a town hall meeting at the CMS Headquarters Office in Baltimore, MD, on February 16, 2006. In the announcement notice for the meeting, we stated that the opinions and alternatives provided during the meeting would assist us in our evaluations of applications by allowing public discussions of the substantial clinical improvement criterion for each of the FY 2007 new medical service and technology add-on payment applications before the publication of this FY 2007 IPPS proposed rule. Approximately 35 participants registered and attended the town hall meeting in person, while additional participants listened over an open telephone line. The participants focused on presenting data on the substantial clinical improvement aspect of their products, as well as the need for additional payments to ensure access to Medicare beneficiaries. In addition, we received written comments regarding the substantial clinical improvement criterion for the applicants. We considered these comments in our evaluation of each new application for FY 2007 in this proposed rule. We have summarized these comments or, if applicable, indicated that no comments were received, at the end of the discussion of the individual applications. We received two general comments about application of the newness and substantial clinical improvement criteria. Comment: AdvaMed encouraged CMS to amend the definition of substantial clinical improvement for the IPPS new technology provision to conform with the outpatient definition of substantial clinical improvement used in 2001. Specifically, AdvaMed requests that E:\FR\FM\25APP2.SGM 25APP2 wwhite on PROD1PC61 with PROPOSALS2 24070 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules after ‘‘decreased pain, bleeding, or other quantifiable symptom,’’ CMS should insert, the following language: ‘‘such as convenience, durability, ease of operation or make other improvements in quality of life.’’ Response: We believe we addressed this concern in the FY 2006 IPPS final rule (70 FR 47360). We use similar standards to evaluate substantial clinical improvement in the IPPS and OPPS and, in both systems, we employ identical language to explain and elaborate on the kinds of considerations that are taken into account in determining whether a new technology represents a substantial clinical improvement. We do not believe a change to the regulations text is necessary. Comment: AdvaMed commented that CMS should not use ‘‘substantial similarity’’ to evaluate newness without also determining whether the product is a substantial clinical improvement. AdvaMed argues that CMS is applying a concept that is not defined in regulations. If CMS applies the concept as part of determining whether a product is new without evaluating substantial clinical improvement, AdvaMed commented that we should define substantial similarity through notice and comment rulemaking. Response: We addressed this comment in the FY 2006 IPPS final rule (70 FR 47350 through 47351). We refer readers to that final rule for a detailed response to this comment. Section 1886(d)(5)(K)(ix) of the Act, as added by section 503(c) of Pub. L. 108– 173, requires that, before establishing any add-on payment for a new medical service or technology, the Secretary shall seek to identify one or more DRGs associated with the new technology, based on similar clinical or anatomical characteristics and the costs of the technology and assign the new technology into a DRG where the average costs of care most closely approximate the costs of care using the new technology. No add-on payment shall be made if the new technology is assigned to a DRG that most closely approximates its costs. At the time an application for new technology add-on payments is submitted, the DRGs associated with the new technology are identified. We only determine that a new DRG assignment is necessary or a new technology add-on payment is appropriate when the payment under these currently assigned DRGs is not adequate and the technology otherwise meets the newness, cost, and substantial clinical improvement criteria. VerDate Aug<31>2005 17:10 Apr 24, 2006 Jkt 208001 In this proposed rule, we evaluate whether new technology add-on payments will continue in FY 2007 for the three technologies that currently receive such payments. In addition, we present our evaluations of three applications for add-on payments in FY 2007. 3. FY 2007 Status of Technologies Approved for FY 2006 Add-On Payments a. Kinetra Implantable Neurostimulator for Deep Brain Stimulation Medtronic, Inc. submitted an application for approval of the Kinetra implantable neurostimulator device for new technology add-on payments for FY 2005. In the IPPS final rule for FY 2005 (69 FR 49019, August 11, 2004), we approved Kinetra for new technology add-on payments. As noted above, the period for which technologies are eligible to receive new technology add-on payments is 2 to 3 years after the product becomes available on the market and data reflecting the cost of the technology are reflected in the DRG weights. This technology received FDA approval on December 16, 2003. Therefore, the technology will be beyond the 2- to 3year period during which it can be considered new during FY 2007. Therefore, we are proposing to discontinue add-on payments for the Kinetra rechargeable, implantable neurostimulator device for FY 2007. The manufacturer has submitted a request that we consider a higher paying DRG assignment for dual array neurostimulator pulse generator cases. We have taken this request into consideration and have reviewed the FY 2005 Medicare charge data for cases that use implantable neurostimulator for deep brain stimulation. Our findings and a full discussion of this issue can be found in Section II.D.2.a. of the preamble of this proposed rule. b. Endovascular Graft Repair of the Thoracic Aorta W. L. Gore & Associates, Inc. submitted an application for consideration of its Endovascular Graft Repair of the Thoracic Aorta (GORE TAG) for new technology add-on payments for FY 2006. The manufacturer argued that endovascular stent-grafting of the descending thoracic aorta provides a less invasive alternative to the traditional open surgical approach required for the management of descending thoracic aortic aneurysms. The GORE TAG device is a tubular stent-graft mounted on a catheter-based delivery system, and it PO 00000 Frm 00076 Fmt 4701 Sfmt 4702 replaces the synthetic graft normally sutured in place during open surgery. The device was initially identified using ICD–9–CM procedure code 39.79 (Other endovascular repair (of aneurysm) of other vessels). The applicant also requested a unique ICD–9–CM procedure code. As noted in Table 6B of the FY 2006 IPPS final rule (70 FR 47637), new procedure code 39.73 (Endovascular implantation of graft in thoracic aorta) was assigned to this technology. In the FY 2006 IPPS final rule (70 FR 47356), we approved the GORE TAG device for new technology add-on payment for FY 2006. We noted that any substantially similar device that is FDAapproved before or during FY 2006 that uses the same ICD–9–CM procedure code as GORE TAG and falls into the same DRGs as those approved for new technology add-on payments may also receive the new technology add-on payment associated with this technology in FY 2006. FDA approved GORE TAG on March 23, 2005. The technology remains within the 2-to 3-year period during which it can be considered new. Therefore, we are proposing to continue add-on payments for the endovascular graft repair of the thoracic aorta for FY 2007. c. Restore Rechargeable Implantable Neurostimulator Medtronic Neurological submitted an application for new technology add-on payments for its Restore Rechargeable Implantable Neurostimulator for FY 2006. The Restore Rechargeable Implantable Neurostimulator is designed to deliver electrical stimulation to the spinal cord to block the sensation of pain. The technology standard for neurostimulators uses internal sealed batteries as the power source to generate the electrical current. These internal batteries have finite lives, and require replacement when their power has been completely discharged. According to the manufacturer, the Restore Rechargeable Implantable Neurostimulator ‘‘represents the next generation of neurostimulator technology, allowing the physician to set the voltage parameters in such a way that fully meets the patient’s requirements to achieve adequate pain relief without fear of premature depletion of the battery.’’ The applicant stated that the expected life of the Restore rechargeable battery is 9 years, compared to an average life of 3 years for conventional neurostimulator batteries. We approved new technology add-on payments for all rechargeable, implantable neurostimulators for FY E:\FR\FM\25APP2.SGM 25APP2 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules 2006. Cases involving these devices, made by any manufacturer, are identified by the presence of newly created ICD–9–CM code 86.98 (Insertion or replacement of dual array rechargeable neurostimulator pulse generator). As noted above, the period for which technologies are eligible to receive new technology add-on payments is 2 to 3 years after the product becomes available on the market and data reflecting the cost of the technology are reflected in the DRG weights. The FDA approved the Restore Rechargeable Implantable Neurostimulator in 2005. However, as noted above and in the FY 2006 IPPS final rule (70 FR 47357), at least one similar product was approved by the FDA as early as April 2004. Nevertheless, consistent with current policy (70 FR 47362) and decisions for prior products (that is, bone morphogenetic products and CRT–D devices), we are proposing to continue new technology add-on payments for rechargeable, implantable neurostimulators in FY 2007 because the product will be beyond the 3-year period only in the latter 6 months of the fiscal year. 4. FY 2007 Applications for New Technology Add-On Payments wwhite on PROD1PC61 with PROPOSALS2 a. C–Port Distal Anastomosis System Cardica, Inc. submitted an application for new technology add-on payments for FY 2007 for its Cardica C–Port Distal Anastomosis System. The manufacturer states that the C–Port System is indicated for all patients requiring a vein as a conduit during a coronary bypass operation for bypassing a coronary artery stenosis or occlusion. The manufacturer contends that the C– Port System is specifically designed to create a reliable and consistent end-toside anastomosis between a conduit, such as a venous graft, and a small arterial vessel during the bypass surgery. The device consists of eight stainless steel clips and a delivery system. Once the vein graft has been loaded into the device and the device positioned against the target vessel, the anastomosis is created by pushing a single button. Cardica, Inc. states the main purpose of the device is to replace a conventional hand-sewn, distal anastomosis with an automated, compliant, mechanical anastomosis. The C–Port System was granted section 510(K) approval from the FDA on November 10, 2005. While the device appears to meet the criteria for being considered new based on its FDA approval date, we are concerned that various forms of surgical staples and VerDate Aug<31>2005 17:10 Apr 24, 2006 Jkt 208001 clips have been used for more than a decade in a wide range of surgical procedures. In fact, the FDA found that the C–Port System ‘‘is substantially equivalent to the predicate devices with regard to indications, device characteristics, method of use, labeling and materials.’’ Thus, given its similarity to other devices currently on the market, we are concerned that the C–Port System may not qualify as new. We welcome comments on whether this device is new and how it can be distinguished from predicate devices that perform the same or a similar function. We also note that there is currently no ICD–9–CM code used to identify how the anastomosis is performed. The surgical technique used to graft the bypass to the arterial vessel is part of the surgical procedure itself and is not separately identified in our current coding structure. Thus, if a new code is created, we would be creating a code that is a subset of the surgical procedure that identifies whether the graft was performed by hand-sewing or using a device like the C–Port System, a distinction that has been unnecessary to date for inpatient hospital payments. Furthermore, we note that such a coding distinction would only be necessary for the new technology add-on payment period if the device met all of the criteria. Once the new technology addon payments are completed, the surgical technique used for the anasotomosis would not need to be identified because the code that describes the grafting procedure would be the same whether or not this technology is used. The applicant made several arguments in support of the device meeting the cost criterion. Cardica, Inc. estimates that the cost of each device will be approximately $1,200. The applicant assumes a hospital markup of 100 percent, with an average use of 2.5 C–Port devices per case. Therefore it estimates that the total average charge per patient will be $6,000. The C–Port System would be used when a coronary artery bypass graft is performed. Thus, we are assessing whether it meets the cost criterion in relation to the threshold for DRGs 106 (Coronary Bypass with Percutaneous Transluminal Coronary Angioplasty), 547 (Coronary Bypass with Cardiac Catheter with Major CV Diagnosis), 548 (Coronary Bypass with Cardiac Catheter without Major CV Diagnosis), 549 (Coronary Bypass without Cardiac Catheter with Major CV Diagnosis), and 550 (Coronary Bypass without Cardiac Catheter without Major CV Diagnosis). We note that the data analysis for this technology is slightly unusual, as the DRGs to which the PO 00000 Frm 00077 Fmt 4701 Sfmt 4702 24071 technology would have been assigned in FY 2005 (the MedPAR data we are currently using) are DRGs 107 and 109. These DRGs were terminated in FY 2006, and 4 new coronary bypass DRGs were created for these cases (DRGs 547, 548, 549, and 550). The manufacturer provided estimates showing a caseweighted threshold for DRGs 106, 547, 548, 549 and 550 of $75,373. The applicant projects a 20-percent market penetration for the device in FY 2007 or its use in approximately 23,000 cases across the 5 DRGs. The applicant submitted data showing average standardized charges for cases using the C–Port System of $80,887. Therefore, the applicant argued that the device meets the cost threshold for a new technology add-on payment. Our internal data analysis of the technology, using the FY 2005 MedPAR data and Table 10 thresholds for FY 2005, shows a case-weighted threshold of $68,416. We identified cases using coronary bypass procedure codes 36.10, 36.11, 36.12, 36.13 and 36.14, and concluded that the case-weighted average standardized charge for these bypass cases was $79,394. Thus, our internal data also suggest that the device may meet the cost threshold. The applicant made several arguments in support of the device meeting the substantial clinical improvement criterion. The manufacturer argues that the C–Port creates a reliable and fully compliant end-to-side anastomosis between a vein graft and a coronary artery, in less time than is required to create a hand-sewn distal anastomosis. The applicant also states that the C–Port System integrates deployment of the anastomotic clips and creation of the arteriotomy, thus enabling deployment to occur without occlusion of blood flow through the target vessel. However, we note that the applicant submitted evidence suggesting that the device does not always produce reliable anastomoses; specifically, a study of 130 patients receiving 132 devices reported 13 incomplete anastomoses in 12 patients, and the study also noted that additional manual stitches were required in the majority of the patients studied. Therefore, we are concerned that these studies suggest that the C–Port System may not represent a substantial clinical improvement over the traditional handsewn technique. At the town hall meeting, the applicant noted that these results were associated with inexperience preparing the target vessel, vein thickness assessment, proper device alignment and anastomosis site selection rather than problems with the E:\FR\FM\25APP2.SGM 25APP2 24072 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules wwhite on PROD1PC61 with PROPOSALS2 device itself. The applicant believes that these problems will become infrequent as surgeons have more experience with the device. We welcome further information from commenters that would suggest how the product meets the substantial clinical improvement criterion. We received the following public comments at the new technology town hall meeting regarding whether this technology meets the substantial clinical improvement criteria: Comment: The manufacturer argued that this technology meets the substantial clinical improvement criterion because: • It achieves higher patency rates at 6 months compared to conventional handsown anastomoses. • Use of the device will result in less surgeon-to-surgeon variability in the quality of the anastomosis compared to hand sewing. • The device leads to reduced operative time. • The product allows for the creation of an anastomosis during minimally invasive surgery. In addition, we received written comments expressing support for approval of new technology add-on payments for the C–Port System. These commenters noted that: • The device allows the anastomosis to be completed quickly, reducing patient complications during surgery from ischemia. • The device will allow for smaller incisions during heart surgery and physicians will not have to position their hands in the chest cavity in order to hand-sew the anastomosis. • The rapidly deployed anastomosis clamp provides patients with a surgical alternative where one would otherwise not be available due to the comorbidities associated with the more invasive CABG procedures. Response: We appreciate the time and effort the applicant took to present at the town hall meeting. We will consider the information presented in the written comments and at the town hall meeting, and welcome objective data that will support the assertions presented above by the commenters. b. NovoSeven for Intracerebral Hemorrhage The Pinnacle Health Group in conjunction with Novo Nordisk Inc. (the manufacturer) submitted an application for new technology add-on payments for FY 2007 for NovoSeven for Intracerebral Hemorrhage. The technology is a drug that promotes hemostasis by activating clotting factors. The applicant is seeking new VerDate Aug<31>2005 17:10 Apr 24, 2006 Jkt 208001 technology add-on payments for the use of its product in the treatment of intracerebral hemorrhage (ICH) using ICD–9–CM diagnosis code 431 (Intracerebral hemorrhage). On March 25, 1999, the FDA approved NovoSeven for the treatment of bleeding episodes in patients with hemophilia A or B with inhibitors to Factor VIII or Factor IX. The applicant is now seeking FDA approval for the additional indication of ICH in patients without hemophilia or other clotting abnormalities. The applicant noted that it expects FDA approval sometime in the first quarter of 2007. Because the technology is not currently FDA approved, we are not presenting our full analysis on whether the technology meets the criteria for the new technology add-on payment in this proposed rule. However, we note that the applicant did submit the information below on the cost and substantial clinical improvement criteria. Cases using the NovoSeven are assigned to DRG 14 (Intracranial Hemorrhage or Cerebral Infraction). The applicant expects NovoSeven to be used in 20 to 35 percent of patients with ICH diagnosis code 431 in FY 2007. The applicant searched the FY 2004 MedPAR and found a total of 31,407 cases with a principal diagnosis code of ICH. The condition was present as a secondary diagnosis in 32,730 cases. The average standardized charge per case was $18,752.12 when ICH was the principal diagnosis and $19,045.58 when ICH was the secondary diagnosis. The applicant submitted data demonstrating that the technology costs a total of $7,265, including the costs for the drug, sterile water, IV supplies, nursing services, pharmaceuticals, and followup CT scan. However, some of these costs (for example, nursing and pharmacy) are not part of the drug or technology itself and are normal operating costs included in the Medicare DRG payment for the inpatient stay and cannot be considered ‘‘new.’’ Therefore, based on data from the applicant, the total cost for this technology is $5,997. We then added the revised cost of the technology to determine a total average standardized charge per case of $24,749.12 when ICH was the principal diagnosis and $25,455.58 when it was the secondary diagnosis. The threshold for DRG 14 is $23,807. Based on the analysis above, the applicant maintains that NovoSeven meets the cost criterion because the average standardized charge per case exceeds the threshold for DRG 14. PO 00000 Frm 00078 Fmt 4701 Sfmt 4702 The applicant also maintained that the technology meets the substantial clinical improvement criterion. The applicant explained that several studies have shown a correlation between the size of the intracranial hematoma and the mortality rate of patients with ICH within 30 days. As a result, Recombinant Coagulation Factors VIIa (rFVIIa), such as NovoSeven, are being explored as a treatment option for ICH. The applicant further explained that NovoSeven activates prothrombin to thrombin by binding factor VIIa to exposed tissue factor, which then activates Factor IX into IXa and Factor X into Xa. The applicant noted that use of rFVIIa for hemophilia patients showed an 84-percent efficacy rate, with only one fatality and no major adverse events or evidence of disseminated intravascular coagulation. The applicant stated that the use of rFVIIa in a nonhemophilia population was safe across a wide range of doses. In addition, a recent randomized trial published in the New England Journal of Medicine 11 researched 399 patients with ICH diagnosed by CT within 3 hours after onset who received either placebo or one of three doses of NovoSeven (40µg, 80µg, or 160µg). Some of the outcomes reported from the study for those patients treated with NovoSeven compared to placebo include: Mortality was reduced by 38 percent; the odds of improving by one level on the modified Rankin Scale at 90 days doubled; and the proportion of patients who died or were severely disabled declined from 69 percent in the placebo group to 53 percent in the treatment group (combined for all three levels of doses). The applicant noted that the study concluded that ultra early hemostatic therapy within 4 hours after the onset of ICH with rFVIIa significantly reduced the growth of the hemorrhage, reduced mortality, and improved the functional outcomes at 3 months, thus demonstrating substantial clinical improvement. We received no public comments regarding this application for new technology add-on payments at the town hall meeting. c. X STOP Interspinous Process Decompression System St. Francis Medical Technologies submitted an application for new technology add-on payments for the X STOP Interspinous Process Decompression System for FY 2007. 11 Mayer, S.A., et al. ‘‘Recombinant Activated Factor VII for Acute Intracerebral Hemorrhage.’’ New England Journal of Medicine, Vol. 352, No. 8, pp. 777–785, 2005. E:\FR\FM\25APP2.SGM 25APP2 wwhite on PROD1PC61 with PROPOSALS2 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules Lumbar spinal stenosis describes a condition that occurs when the spaces between bones in the spine become narrowed due to arthritis and other agerelated conditions. This narrowing, or stenosis, causes nerves coming from the spinal cord to be compressed, thereby causing symptoms including pain, numbness, and weakness. It particularly causes symptoms when the spine is in extension, as occurs when a patient stands fully upright or leans back. The X STOP device is inserted between the spinous processes of adjacent vertebrae in order to provide a minimally invasive alternative to conservative treatment (exercise and physical therapy) and invasive surgery (spinal fusion). It works by limiting the spine extension that compresses the nerve roots while still preserving as much motion as possible. The device is inserted in a relatively simple, primarily outpatient procedure using local anesthesia. However, in some circumstances, the physician may prefer to admit the patient for an inpatient stay. The manufacturer has described the device as providing ‘‘a new minimally invasive, stand-alone alternative treatment for lumbar spinal stenosis.’’ The X STOP Interspinous Process Decompression system received premarket approval from the FDA on November 21, 2005. The device is currently described by ICD–9–CM code 84.58 (Implantation of Interspinous process decompression device) (excluding: fusion of spine (codes 81.00 through 81.08, and 81.30 through 81.39)). This ICD–9–CM code went into effect on October 1, 2005. The manufacturer provided data in support of the device meeting the cost threshold criterion. The applicant stated that there would be an average of 1.6 units used per case. Each unit costs $5,500; therefore, the technology is expected to cost $8,800 per case. The device is currently assigned to DRGs 499 (Back and Neck Procedures Except Spinal Fusion with CC) and 500 (Back and Neck Procedures Except Spinal Fusion without CC). The manufacturer projected that there would be approximately 424 patients eligible to receive the device in DRG 499 in FY 2007, while there may be approximately 1,700 patients who receive the device in DRG 500. The manufacturer also provided data for cases involved in the clinical trials. The average standardized charge for the cases in FY 2004 was $24,065. The weighted threshold for DRGs 499 and 500 is $20,096. However, the manufacturer argued that because significantly less than 20 percent of patients receiving the X STOP experienced complications or had VerDate Aug<31>2005 17:10 Apr 24, 2006 Jkt 208001 comorbidities, the threshold should be calculated by estimating that 20 percent of patients would be assigned to DRG 499 and 80 percent would to DRG 500. The manufacturer stated in its application that, using this methodology, the applicable threshold should be $19,796. Using either calculation, it appears that the technology meets the cost threshold for new technology add-on payments. The applicant also submitted information in support of its claim of substantial clinical improvement. The manufacturer stated that the X STOP device is placed between the spinous processes to limit extension of the symptomatic level(s), yet allowing flexion, axial rotation, and lateral bending (that is, the device limits pressure on the spinal nerves and the resulting pain symptoms when the patient is in an upright position or leans backward while also preserving the patient’s ability to turn side-to-side, bend forward, and to turn to either side). The applicant contends that this technology provides an alternative with improved clinical outcomes to conservative and surgical treatments. The manufacturer further stated that the device may offer a new alternative to lumbar spinal decompression procedures such as laminectomy and laminotomy. Additional information included in the application suggests that the device preserves spinal motion and is superior to a spinal decompression procedure that requires concomitant fusion (with or without instrumentation). The applicant argued that the advantages over spinal decompression include reduced risk, shorter hospital stay, and earlier improvement in pain and function. The manufacturer further contends that disease progression at adjacent levels is minimal following X STOP implantation compared to the known risk associated with surgical decompression and concomitant fusion. The applicant stated that the X STOP is comparable to traditional surgical decompression of lumbar spinal stenosis with respect to improved quality of life postoperatively. According to the applicant, the device provides advantages over nonoperative care, including better symptom relief, improved function, and increased patient satisfaction. We believe that the device satisfies the newness and cost threshold criteria for new technology add-on payments. However, we are concerned that the information included with the application may raise issues about substantial clinical improvement. During the FDA approval process, the PO 00000 Frm 00079 Fmt 4701 Sfmt 4702 24073 Center for Devices and Radiological Health (CDRH) Advisory Panel voted against premarket approval (PMA) in August 2004 because of concerns about proper patient selection as well as the lack of objective endpoints, especially radiographic endpoints. The Panel also mentioned the overall low clinical efficacy rate in the study population. The device subsequently received PMA approval, but only on the condition that it be used in the context of a long term (5 year) follow-up study. We welcome information from commenters that addresses the concerns raised by the CDRH Advisory Panel or other information bearing on the issue of whether this product meets the substantial clinical improvement criterion. We received the following public comments through the new technology town hall meeting process regarding this application for add-on payments. Comment: The applicant asserted that the X STOP Interspinous Process Decompression system has the following advantages: • It retains spinal anatomy and all spinal structures. • The device allows for increased function and less pain after implantation as evidenced by radiographic measures that showed increases in the spinal canal area by 18 percent, diameter by 9 percent, and subarticular diameter (the route that the nerves exit the spine) by 50 percent. In lateral view: area increased by 25 percent and width by 41 percent. • The X STOP is a reversible procedure that causes no damage to facets or disks. • The device allows for a treatment option for patients that cannot undergo surgeries with general anesthesia. • The rate of complications associated with implantation of the device is below 1 percent. Response: We will evaluate these assertions as we further consider this application for new technology add-on payments for the final rule. We also note that the study that the applicant summarized at the town hall meeting for the X STOP used a randomized study that targeted lumbar spinal stenosis patients with mild to moderate symptoms. The control group did not require operative care. We welcome information from the comments that demonstrates how the study populations showed substantial clinical improvement compared to the control group. We note that the town hall meeting produced contradictory information regarding whether this procedure is generally performed in inpatient or E:\FR\FM\25APP2.SGM 25APP2 24074 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules outpatient settings. The presenter indicated that over 90 percent of his patients were treated as outpatients. The manufacturer noted 90 percent of nonU.S. patients and approximately twothirds of U.S. patients since FDA approval have been treated in inpatient settings. While the setting where the procedure is typically performed has no bearing on whether the product represents a substantial clinical improvement, we note that we believe the physician should select the most appropriate site to perform the procedure based on the clinical needs of the patient. wwhite on PROD1PC61 with PROPOSALS2 III. Proposed Changes to the Hospital Wage Index A. Background Section 1886(d)(3)(E) of the Act requires that, as part of the methodology for determining prospective payments to hospitals, the Secretary must adjust the standardized amounts ‘‘for area differences in hospital wage levels by a factor (established by the Secretary) reflecting the relative hospital wage level in the geographic area of the hospital compared to the national average hospital wage level.’’ In accordance with the broad discretion conferred under the Act, we currently define hospital labor market areas based on the definitions of statistical areas established by the Office of Management and Budget (OMB). A discussion of the proposed FY 2007 hospital wage index based on the statistical areas, including OMB’s revised definitions of Metropolitan Areas, appears under section III.B. of this preamble. Beginning October 1, 1993, section 1886(d)(3)(E) of the Act requires that we update the wage index annually. Furthermore, this section provides that the Secretary base the update on a survey of wages and wage-related costs of short-term, acute care hospitals. The survey should measure the earnings and paid hours of employment by occupational category, and must exclude the wages and wage-related costs incurred in furnishing skilled nursing services. This provision also requires us to make any updates or adjustments to the wage index in a manner that ensures that aggregate payments to hospitals are not affected by the change in the wage index. The proposed adjustment for FY 2007 is discussed in section II.B. of the Addendum to this proposed rule. As discussed below in section III.H. of this preamble, we also take into account the geographic reclassification of hospitals in accordance with sections 1886(d)(8)(B) and 1886(d)(10) of the Act VerDate Aug<31>2005 17:10 Apr 24, 2006 Jkt 208001 when calculating the wage index. Under section 1886(d)(8)(D) of the Act, the Secretary is required to adjust the standardized amounts so as to ensure that aggregate payments under the IPPS after implementation of the provisions of sections 1886(d)(8)(B) and (C) and 1886(d)(10) of the Act are equal to the aggregate prospective payments that would have been made absent these provisions. The proposed budget neutrality adjustment for FY 2007 is discussed in section II.A.4.b. of the Addendum to this proposed rule. Section 1886(d)(3)(E) of the Act also provides for the collection of data every 3 years on the occupational mix of employees for short-term, acute care hospitals participating in the Medicare program, in order to construct an occupational mix adjustment to the wage index. A discussion of the occupational mix adjustment that we propose to apply beginning October 1, 2006 (the proposed FY 2007 wage index) appears under section III.C. of this preamble. B. Core-Based Statistical Areas for the Proposed Hospital Wage Index (If you choose to comment on issues in this section, please include the caption ‘‘CBSAs’’ at the beginning of your comment.) The wage index is calculated and assigned to hospitals on the basis of the labor market area in which the hospital is located. In accordance with the broad discretion under section 1886(d)(3)(E) of the Act, beginning with FY 2005, we define hospital labor market areas based on the Core-Based Statistical Areas (CBSAs) established by OMB and announced in December 2003 (69 FR 49027). OMB defines a CBSA, beginning in 2003, as ‘‘a geographic entity associated with at least one core of 10,000 or more population, plus adjacent territory that has a high degree of social and economic integration with the core as measured by commuting ties.’’ The standards designate and define two categories of CBSAs: Metropolitan Statistical Areas (MSAs) and Micropolitan Statistical Areas (65 FR 82235). According to OMB, MSAs are based on urbanized areas of 50,000 or more population, and Micropolitan Statistical Areas (referred to in this discussion as Micropolitan Areas) are based on urban clusters with a population of at least 10,000 but less than 50,000. Counties that do not fall within CBSAs are deemed ‘‘Outside CBSAs.’’ In the past, OMB defined MSAs around areas with a minimum core population of 50,000, and smaller areas were ‘‘Outside MSAs.’’ PO 00000 Frm 00080 Fmt 4701 Sfmt 4702 The general concept of the CBSAs is that of an area containing a recognized population nucleus and adjacent communities that have a high degree of integration with that nucleus. The purpose of the standards is to provide nationally consistent definitions for collecting, tabulating, and publishing Federal statistics for a set of geographic areas. CBSAs include adjacent counties that have a minimum of 25 percent commuting to the central counties of the area. (This is an increase over the minimum commuting threshold of 15 percent for outlying counties applied in the previous MSA definition.) The revised CBSAs established by OMB comprised MSAs and Micropolitan Areas based on Census 2000 data. (A copy of the announcement may be obtained at the following Internet address: https:// www.whitehouse.gov/omb/bulletins/ fy04/b04-03.html.) The revised definitions recognize 49 MSAs and 565 Micropolitan Areas, and extensively changed the composition of many of the MSAs that existed prior to the revisions. The revised area designations resulted in a higher wage index for some areas and a lower wage index for others. Further, some hospitals that were previously classified as urban are now in rural areas. Given the significant payment impacts upon some hospitals because of these changes, we provided a transition period to the new labor market areas in the FY 2005 IPPS final rule (69 FR 49027 through 49034). As part of that transition, we allowed urban hospitals that became rural under the new definitions to maintain their assignment to the MSA where they were previously located for the 3-year period of FY 2005, FY 2006, and FY 2007. Specifically, these hospitals were assigned the wage index of the urban area to which they previously belonged. (For purposes of the wage index computation, the wage data of these hospitals remained assigned to the statewide rural area in which they are located.) The hospitals receiving this transition will not be considered urban hospitals; rather, they will maintain their status as rural hospitals. Thus, the hospital would not be eligible, for example, for a large urban add-on payment under the capital PPS. In other words, it is the wage index, but not the urban or rural status, of these hospitals that is being affected by this transition. The higher wage indices that these hospitals are receiving are also being taken into consideration in determining whether they qualify for the outmigration adjustment discussed in section III.I. of this preamble and the amount of any adjustment. E:\FR\FM\25APP2.SGM 25APP2 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules wwhite on PROD1PC61 with PROPOSALS2 FY 2007 will be the third year of this transition period. We will continue to assign the wage index for the urban area in which the hospital was previously located through FY 2007. In order to ensure this provision remains budget neutral, we will continue to adjust the standardized amount by a transition budget neutrality factor to account for these hospitals. Doing so is consistent with the requirement of section 1886(d)(3)(E) of the Act that any ‘‘adjustments or updates [to the adjustment for different area wage levels] * * * shall be made in a manner that assures that aggregate payments * * * are not greater or less than those that would have been made in the year without such adjustment.’’ Beginning in FY 2008, these hospitals will receive their statewide rural wage index, although they will be eligible to apply for reclassification by the MGCRB both during this transition period and in subsequent years. These hospitals will be considered rural for reclassification purposes. Consistent with the FY 2005 and FY 2006 IPPS final rules, as we did beginning in FY 2006, for FY 2007 we are proposing to provide that hospitals receive 100 percent of their wage index based upon the CBSA configurations. Specifically, we will determine for each hospital a proposed wage index for FY 2007 employing wage index data from FY 2003 hospital cost reports and using the CBSA labor market definitions. VerDate Aug<31>2005 17:10 Apr 24, 2006 Jkt 208001 C. Proposed Occupational Mix Adjustment to the Proposed FY 2007 Index (If you choose to comment on issues in this section, please include the caption ‘‘Occupational Mix Adjustment’’ at the beginning of your comment.) As stated earlier, section 1886(d)(3)(E) of the Act provides for the collection of data every 3 years on the occupational mix of employees for each short-term, acute care hospital participating in the Medicare program, in order to construct an occupational mix adjustment to the wage index, for application beginning October 1, 2004 (the FY 2005 wage index). The purpose of the occupational mix adjustment is to control for the effect of hospitals’ employment choices on the wage index. For example, hospitals may choose to employ different combinations of registered nurses, licensed practical nurses, nursing aides, and medical assistants for the purpose of providing nursing care to their patients. The varying labor costs associated with these choices reflect hospital management decisions rather than geographic differences in the costs of labor. 1. Development of Data for the Proposed Occupational Mix Adjustment In the FY 2005 IPPS final rule (69 FR 49034), we discussed in detail the data we used to calculate the occupational mix adjustment to the FY 2005 wage index. For the proposed FY 2007 wage PO 00000 Frm 00081 Fmt 4701 Sfmt 4702 24075 index, we are proposing to use the same CMS Wage Index Occupational Mix Survey and Bureau of Labor Statistics (BLS) data that we used for the FYs 2005 and 2006 wage indices, with two exceptions. The CMS survey requires hospitals to report the number of total paid hours for directly hired and contract employees in occupations that provide the following services: Nursing, physical therapy, occupational therapy, respiratory therapy, pharmacy, dietary and medical and clinical laboratory. These services each include several standard occupational classifications (SOCs), as defined by the BLS’ Occupational Employment Statistics (OES) survey. For the proposed FY 2007 wage index, we are using revised survey data for 16 hospitals that took advantage of the opportunity we afforded hospitals to submit changes to their occupational mix data during the FY 2007 wage index data collection process (see the discussion of wage data corrections process under section III.J. of this preamble). We also excluded survey data for hospitals that became designated as CAHs since the original survey data were collected and for hospitals for which there are no corresponding cost report data for the FY 2007 wage index. The proposed FY 2007 wage index includes occupational mix data from 3,362 out of 3,580 hospitals (93.9 percent response rate). The results of the occupational mix survey are included in the chart below. BILLING CODE 4120–01–P E:\FR\FM\25APP2.SGM 25APP2 VerDate Aug<31>2005 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules 17:10 Apr 24, 2006 Jkt 208001 PO 00000 Frm 00082 Fmt 4701 Sfmt 4725 E:\FR\FM\25APP2.SGM 25APP2 EP25AP06.019</GPH> wwhite on PROD1PC61 with PROPOSALS2 24076 BILLING CODE 4120–01–C wwhite on PROD1PC61 with PROPOSALS2 2. Calculation of the Proposed FY 2007 Occupational Mix Adjustment Factor and the Proposed FY 2007 Occupational Mix Adjusted Wage Index For the proposed FY 2007 wage index, we are proposing to use the same methodology that we used to calculate the occupational mix adjustment to the FY 2005 and FY 2006 wage indices (69 FR 49042 and 70 FR 47367). We are proposing to use the following steps for VerDate Aug<31>2005 17:10 Apr 24, 2006 Jkt 208001 calculating the proposed FY 2007 occupational mix adjustment factor and the proposed FY 2007 occupational mix adjusted wage index: Step 1—For each hospital, the percentage of the general service category attributable to an SOC is determined by dividing the SOC hours by the general service category’s total hours. Repeat this calculation for each of the 19 SOCs. Step 2—For each hospital, the weighted average hourly rate for an SOC PO 00000 Frm 00083 Fmt 4701 Sfmt 4702 24077 is determined by multiplying the percentage of the general service category (from Step 1) by the national average hourly rate for that SOC from the 2001 BLS OES survey, which was used in calculating the occupational mix adjustment for the FY 2005 wage index. The 2001 OES survey is BLS’ latest available hospital-specific survey. (See Chart 4 in the FY 2005 IPPS final rule, 69 FR 49038.) Repeat this calculation for each of the 19 SOCs. E:\FR\FM\25APP2.SGM 25APP2 EP25AP06.020</GPH> Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules wwhite on PROD1PC61 with PROPOSALS2 24078 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules Step 3—For each hospital, the hospital’s adjusted average hourly rate for a general service category is computed by summing the weighted hourly rate for each SOC within the general category. Repeat this calculation for each of the seven general service categories. Step 4—For each hospital, the occupational mix adjustment factor for a general service category is calculated by dividing the national adjusted average hourly rate for the category by the hospital’s adjusted average hourly rate for the category. (The national adjusted average hourly rate is computed in the same manner as Steps 1 through 3, using instead, the total SOC and general service category hours for all hospitals in the occupational mix survey database.) Repeat this calculation for each of the seven general service categories. If the hospital’s adjusted rate is less than the national adjusted rate (indicating the hospital employs a less costly mix of employees within the category), the occupational mix adjustment factor will be greater than 1.0000. If the hospital’s adjusted rate is greater than the national adjusted rate, the occupational mix adjustment factor will be less than 1.0000. Step 5—For each hospital, the occupational mix adjusted salaries and wage-related costs for a general service category are calculated by multiplying the hospital’s total salaries and wagerelated costs (from Step 5 of the unadjusted wage index calculation in section III.F. of this preamble) by the percentage of the hospital’s total workers attributable to the general service category and by the general service category’s occupational mix adjustment factor (from Step 4 above). Repeat this calculation for each of the seven general service categories. The remaining portion of the hospital’s total salaries and wage-related costs that is attributable to all other employees of the hospital is not adjusted for occupational mix. Step 6—For each hospital, the total occupational mix adjusted salaries and wage-related costs for a hospital are calculated by summing the occupational mix adjusted salaries and wage-related costs for the seven general service categories (from Step 5) and the unadjusted portion of the hospital’s salaries and wage-related costs for all other employees. To compute a hospital’s occupational mix adjusted average hourly wage, divide the hospital’s total occupational mix adjusted salaries and wage-related costs by the hospital’s total hours (from Step 4 of the unadjusted wage index VerDate Aug<31>2005 17:10 Apr 24, 2006 Jkt 208001 calculation in section III.F. of this preamble). Step 7—To compute the occupational mix adjusted average hourly wage for an urban or rural area, sum the total occupational mix adjusted salaries and wage-related costs for all hospitals in the area, then sum the total hours for all hospitals in the area. Next, divide the area’s occupational mix adjusted salaries and wage-related costs by the area’s hours. Step 8—To compute the national occupational mix adjusted average hourly wage, sum the total occupational mix adjusted salaries and wage-related costs for all hospitals in the Nation, then sum the total hours for all hospitals in the Nation. Next, divide the national occupational mix adjusted salaries and wage-related costs by the national hours. The proposed national occupational mix adjusted average hourly wage for FY 2007 is $29.6213. (This figure represents a 100 percent adjustment for occupational mix.) Step 9—To compute the occupational mix adjusted wage index, divide each area’s occupational mix adjusted average hourly wage (Step 7) by the national occupational mix adjusted average hourly wage (Step 8). Step 10—To compute the Puerto Rico specific occupational mix adjusted wage index, follow Steps 1 through 9 above. The proposed Puerto Rico occupational mix adjusted average hourly wage for FY 2007 is $12.9490. (This figure represents a 100 percent adjustment for occupational mix.) An example of the occupational mix adjustment was included in the FY 2005 IPPS final rule (69 FR 49043). For the FY 2006 final wage index, we used the unadjusted wage data for hospitals that did not submit occupational mix survey data. For calculation purposes, this equates to applying the national SOC mix to the wage data for these hospitals, because hospitals having the same mix as the Nation would have an occupational mix adjustment factor equaling 1.0000. In the FYs 2005 and 2006 IPPS final rule (69 FR 49035 and 70 FR 47368), we noted that we would revisit this matter with subsequent collections of the occupational mix data. Because we are using essentially the same survey data for the proposed FY 2007 occupational mix adjustment that we used for FYs 2005 and 2006, with the only exceptions as stated in section III.C.1. of this preamble, we are treating the wage data for hospitals that did not respond to the survey in this same manner for the proposed FY 2007 wage index. In implementing an occupational mix adjusted wage index based on the above PO 00000 Frm 00084 Fmt 4701 Sfmt 4702 calculation, the proposed wage index values for 17 rural areas (36.2 percent) and 204 urban areas (52.8 percent) would decrease as a result of the adjustment. Five rural areas (10.6 percent) and 106 urban areas (27.5 percent) would experience a decrease of 1 percent or greater in their wage index values. The largest negative impact for a rural area would be 1.8 percent and for an urban area, 4.2 percent. Meanwhile, 30 rural areas (63.8 percent) and 178 urban areas (46.1 percent) would experience an increase in their wage index values. Although these results show that rural hospitals would gain the most from an occupational mix adjustment to the wage index, their gains may not be as great as might have been expected. Further, it might not have been anticipated that approximately one-third of rural hospitals would actually fare worse under the adjustment. Overall, a fully implemented occupational mix adjusted wage index would have a redistributive effect on Medicare payments to hospitals. In the FY 2006 IPPS final rule (70 FR 47368), we indicated that, for future data collections, we would revise the occupational mix survey to allow hospitals to provide both salaries and hours data for each of the employment categories that are included on the survey. We also indicated that we would assess whether future occupational mix surveys should be based on the calendar year or if the data should be collected on a fiscal year basis as part of the Medicare cost report. (One logistical problem is that cost report data are collected yearly, but occupational mix survey data are collected only every 3 years.) In a document published in the Federal Register on October 14, 2005 (70 FR 60092), we proposed a new survey, the 2006 Medicare Wage Index Occupational Mix Survey. The 2006 survey provides for the collection of data on hospital-specific wages and hours for a 6-month reporting period (January 1, 2006 through June 30, 2006), as well as additional clarification of the definitions for the occupational categories, an expansion of the registered nurse category to include functional subcategories, the exclusion of average hourly rate data associated with advance practice nurses, and the transfer of each general service category that comprised less than 4 percent of total hospital employees in the 2003 survey to the ‘‘all other occupations’’ category. The results of the 2006 occupational mix survey will be used to adjust the IPPS wage index beginning with FY 2008. On February 10, 2006, we E:\FR\FM\25APP2.SGM 25APP2 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules wwhite on PROD1PC61 with PROPOSALS2 published in the Federal Register a notice with a 30-day comment period for the 2006 survey (71 FR 7047). We will provide a full discussion of the 2006 survey design, the survey results, and the methodology for calculating and applying the new occupational mix adjustment in the FY 2008 IPPS proposed rule. In our continuing efforts to meet the information needs of the public, we are providing via the Internet three additional public use files (PUFs) for the proposed occupational mix adjusted wage index concurrently with the publication of this proposed rule: (1) A file including each hospital’s unadjusted and adjusted average hourly wage (FY 2007 Proposed Rule Occupational Mix Adjusted and Unadjusted Average Hourly Wage by Provider); (2) a file including each CBSA’s adjusted and unadjusted average hourly wage (FY 2007 Proposed Rule Occupational Mix Adjusted and Unadjusted Average Hourly Wage and Pre-Reclassified Wage Index by CBSA); and (3) a file including each hospital’s occupational mix adjustment factors by occupational category (Provider Occupational Mix Adjustment Factors for Each Occupational Category). These additional files are posted on the Internet at https://www.cms.hhs.gov/ AcuteInpatientPPS. We also plan to post these files via the Internet with future applications of the occupational mix adjustment. D. Worksheet S–3 Wage Data for the Proposed FY 2007 Wage Index Update (If you choose to comment on issues in this section, please include the caption ‘‘Wage Data’’ at the beginning of your comment.) The proposed FY 2007 wage index values (effective for hospital discharges occurring on or after October 1, 2006 and before October 1, 2007) in section II.B. of the Addendum to this proposed rule are based on the data collected from the Medicare cost reports submitted by hospitals for cost reporting periods beginning in FY 2003 (the FY 2006 wage index was based on FY 2002 wage data). The proposed FY 2007 wage index includes the following categories of data associated with costs paid under the IPPS (as well as outpatient costs): • Salaries and hours from short-term, acute care hospitals (including paid lunch hours and hours associated with military leave and jury duty). • Home office costs and hours. • Certain contract labor costs and hours (which includes direct patient care, certain top management, pharmacy, laboratory, and nonteaching physician Part A services). VerDate Aug<31>2005 17:10 Apr 24, 2006 Jkt 208001 • Wage-related costs, including pensions and other deferred compensation costs. Consistent with the wage index methodology for FY 2006, the proposed wage index for FY 2007 also excludes the direct and overhead salaries and hours for services not subject to IPPS payment, such as SNF services, home health services, costs related to GME (teaching physicians and residents) and certified registered nurse anesthetists (CRNAs), and other subprovider components that are not paid under the IPPS. The proposed FY 2007 wage index also excludes the salaries, hours, and wage-related costs of hospital-based rural health clinics (RHCs), and Federally qualified health centers (FQHCs) because Medicare pays for these costs outside of the IPPS (68 FR 45395). In addition, salaries, hours, and wage-related costs of CAHs are excluded from the wage index, for the reasons explained in the FY 2004 IPPS final rule (68 FR 45397). Data collected for the IPPS wage index are also currently used to calculate wage indices applicable to other providers, such as SNFs, home health agencies, and hospices. In addition, they are used for prospective payments to IRFs, IPFs, and LTCHs, and for hospital outpatient services. We note that, in the IPPS rules, we do not address comments pertaining to the wage indices for non-IPPS providers. Such comments should be made in response to separate proposed rules for those providers. E. Verification of Worksheet S–3 Wage Data (If you choose to comment on this section, please include the caption ‘‘Wage Data’’ at the beginning of your comment.) The wage data for the proposed FY 2007 wage index were obtained from Worksheet S–3, Parts II and III of the FY 2003 Medicare cost reports. Instructions for completing the Worksheet S–3, Parts II and III are in the Provider Reimbursement Manual, Part I, sections 3605.2 and 3605.3. The data file used to construct the proposed wage index includes FY 2003 data submitted to us as of March 1, 2006. As in past years, we performed an intensive review of the wage data, mostly through the use of edits designed to identify aberrant data. We asked our fiscal intermediaries to revise or verify data elements that resulted in specific edit failures. Some unresolved data elements are included in the calculation of the proposed FY 2007 wage index. We instructed the fiscal intermediaries to complete their data verification of questionable data PO 00000 Frm 00085 Fmt 4701 Sfmt 4702 24079 elements and to transmit any changes to the wage data no later than April 14, 2006. We believe all unresolved data elements will be resolved by the date the final rule is issued. The revised data will be reflected in the final rule. Also, as part of our editing process, we removed the data for 215 hospitals from our database: 178 hospitals designated as CAHs between February 18, 2005, the cutoff date for exclusion of CAHs from the FY 2006 wage index, and February 17, 2006, the cutoff date for CAH exclusion for the FY 2007 wage index (that is, 7 or more days prior to the posting of the preliminary February 24, 2006 PUF), and 30 hospitals were low Medicare utilization hospitals or failed edits that could not be corrected because the hospitals terminated the program or changed ownership. In addition, we removed the wage data for 7 hospitals with incomplete or inaccurate data resulting in zero or negative, or otherwise aberrant, average hourly wages. We have notified the fiscal intermediaries of these hospitals and will continue to work with the fiscal intermediaries to correct these data until we finalize our database to compute the final wage index. The data for these hospitals will be included in the final wage index if we receive corrected data that pass our edits. As a result, the proposed FY 2007 wage index is calculated based on FY 2003 wage data from 3,580 hospitals. In constructing the proposed FY 2007 wage index, we include the wage data for facilities that were IPPS hospitals in FY 2003, even for those facilities that have since terminated their participation in the program as hospitals, as long as those data do not fail any of our edits for reasonableness. We believe that including the wage data for these hospitals is, in general, appropriate to reflect the economic conditions in the various labor market areas during the relevant past period. However, we exclude the wage data for CAHs as discussed in 68 FR 45397. Section 4410 of Pub. L. 105–33 provides that, for the purposes of section 1886(d)(3)(E) of the Act, for discharges occurring on or after October 1, 1997, the area wage index applicable to any hospital that is located in an urban area of a State may not be less than the area wage index applicable to hospitals located in rural areas in the State. This provision is commonly referred to as the ‘‘rural floor.’’ In the August 11, 2004 IPPS final rule (69 FR 49109), we discussed situations where a State has only urban areas and no geographically rural areas, or a State has geographically rural areas but no IPPS hospitals are located in those rural E:\FR\FM\25APP2.SGM 25APP2 wwhite on PROD1PC61 with PROPOSALS2 24080 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules areas. As a result, these States did not have rural IPPS hospitals from which to compute and apply a ‘‘rural floor.’’ In that final rule, we developed a policy for imputing a ‘‘rural floor’’ for these States, effective for the FYs 2005, 2006, and 2007 wage indices, so that a ‘‘rural floor’’ could be applicable to IPPS urban hospitals in those States in the same manner that a ‘‘rural floor’’ is applicable to IPPS urban hospitals in States that have IPPS rural hospitals. We revised the regulations at § 412.64(h) to describe the methodology for computing the imputed ‘‘rural floors’’ for these States and to define an all-urban State. Specifically, § 412.64(h)(5) defines an all-urban State as ‘‘a State with no rural areas * * * or a State in which there are no hospitals classified as rural. A State with rural areas and with hospitals reclassified as rural under § 412.103 is not an all-urban State.’’ We have received questions as to what area wage index CMS would apply in the instance where a new rural IPPS hospital opens in a State that has an imputed ‘‘rural floor’’ because it has rural areas but had no hospitals classified as rural. In addition, we have been asked whether a new IPPS hospital could submit its wages and hours data to be used in computing the wage index, even though the hospital did not file a cost report as an IPPS provider for the cost report base year that is used in calculating that wage index. A new hospital can be an entirely new facility that did not exist before, or it can be a hospital that participated in Medicare under a previous provider number, but has acquired a new Medicare provider number (such as when a CAH converts to IPPS status, or vice versa). As a new IPPS hospital (in this case, rural), the hospital would not yet have filed any wages and hours data on a Medicare cost report. Even in the situation where a new IPPS hospital previously participated in Medicare as another provider type (such as a CAH) and was able to develop its wages and hours data for the wage index base year, consistent with section 1886(d)(3)(E) of the Act which specifies that the wage index must be based on data from shortterm, acute care hospitals, CMS could not include the hospital’s wages and hours from a period during which the hospital was not an IPPS provider. Furthermore, even once the hospital files its first Medicare cost report under the new IPPS provider number, that first cost report is not used in computing the wage index for the hospital’s geographic area until 4 years later. This is because a current fiscal year’s wage index is computed from cost reports that are 4 years prior to that current fiscal year. VerDate Aug<31>2005 17:10 Apr 24, 2006 Jkt 208001 Consequently, the only wage index that would be available for such a new IPPS rural hospital in the first 3 years of the hospital’s existence is the imputed ‘‘rural floor.’’ Therefore, if a new rural IPPS hospital opens in a State that has an imputed ‘‘rural floor’’ and has rural areas, the hospital would receive the imputed ‘‘rural floor’’ as its wage index until its first cost report is contemporaneous with the cost reporting period being used to develop a given fiscal year’s wage index. F. Computation of the Proposed FY 2007 Unadjusted Wage Index (If you choose to comment on issues in this section, please include the caption ‘‘Unadjusted Wage Index’’ at the beginning of your comment.) The method used to compute the proposed FY 2007 wage index without an occupational mix adjustment follows: Step 1—As noted above, we based the proposed FY 2007 wage index on wage data reported on the FY 2003 Medicare cost reports. We gathered data from each of the non-Federal, short-term, acute care hospitals for which data were reported on the Worksheet S–3, Parts II and III of the Medicare cost report for the hospital’s cost reporting period beginning on or after October 1, 2002 and before October 1, 2003. In addition, we included data from some hospitals that had cost reporting periods beginning before October 2002 and reported a cost reporting period covering all of FY 2003. These data were included because no other data from these hospitals would be available for the cost reporting period described above, and because particular labor market areas might be affected due to the omission of these hospitals. However, we generally describe these wage data as FY 2003 data. We note that, if a hospital had more than one cost reporting period beginning during FY 2003 (for example, a hospital had two short cost reporting periods beginning on or after October 1, 2002 and before October 1, 2003), we included wage data from only one of the cost reporting periods, the longer, in the wage index calculation. If there was more than one cost reporting period and the periods were equal in length, we included the wage data from the later period in the wage index calculation. Step 2—Salaries—The method used to compute a hospital’s average hourly wage excludes certain costs that are not paid under the IPPS. In calculating a hospital’s average salaries plus wagerelated costs, we subtracted from Line 1 (total salaries) the GME and CRNA costs reported on Lines 2, 4.01, 6, and 6.01, PO 00000 Frm 00086 Fmt 4701 Sfmt 4702 the Part B salaries reported on Lines 3, 5 and 5.01, home office salaries reported on Line 7, and excluded salaries reported on Lines 8 and 8.01 (that is, direct salaries attributable to SNF services, home health services, and other subprovider components not subject to the IPPS). We also subtracted from Line 1 the salaries for which no hours were reported. To determine total salaries plus wage-related costs, we added to the net hospital salaries the costs of contract labor for direct patient care, certain top management, pharmacy, laboratory, and nonteaching physician Part A services (Lines 9 and 10), home office salaries and wagerelated costs reported by the hospital on Lines 11 and 12, and nonexcluded area wage-related costs (Lines 13, 14, and 18). We note that contract labor and home office salaries for which no corresponding hours are reported were not included. In addition, wage-related costs for nonteaching physician Part A employees (Line 18) are excluded if no corresponding salaries are reported for those employees on Line 4. Step 3—Hours—With the exception of wage-related costs, for which there are no associated hours, we computed total hours using the same methods as described for salaries in Step 2. Step 4—For each hospital reporting both total overhead salaries and total overhead hours greater than zero, we then allocated overhead costs to areas of the hospital excluded from the wage index calculation. First, we determined the ratio of excluded area hours (sum of Lines 8 and 8.01 of Worksheet S–3, Part II) to revised total hours (Line 1 minus the sum of Part II, Lines 2, 3, 4.01, 5, 5.01, 6, 6.01, 7, and Part III, Line 13 of Worksheet S–3). We then computed the amounts of overhead salaries and hours to be allocated to excluded areas by multiplying the above ratio by the total overhead salaries and hours reported on Line 13 of Worksheet S–3, Part III. Next, we computed the amounts of overhead wage-related costs to be allocated to excluded areas using three steps: (1) We determined the ratio of overhead hours (Part III, Line 13) to revised hours (Line 1 minus the sum of Lines 2, 3, 4.01, 5, 5.01, 6, 6.01, 7, 8, and 8.01); (2) we computed overhead wage-related costs by multiplying the overhead hours ratio by wage-related costs reported on Part II, Lines 13, 14, and 18; and (3) we multiplied the computed overhead wage-related costs by the above excluded area hours ratio. Finally, we subtracted the computed overhead salaries, wage-related costs, and hours associated with excluded areas from the E:\FR\FM\25APP2.SGM 25APP2 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules total salaries (plus wage-related costs) and hours derived in Steps 2 and 3. Step 5—For each hospital, we adjusted the total salaries plus wagerelated costs to a common period to determine total adjusted salaries plus wage-related costs. To make the wage adjustment, we estimated the percentage change in the employment cost index (ECI) for compensation for each 30-day increment from October 14, 2002, through April 15, 2004, for private industry hospital workers from the BLS’ Compensation and Working Conditions. We use the ECI because it reflects the price increase associated with total compensation (salaries plus fringes) rather than just the increase in salaries. In addition, the ECI includes managers as well as other hospital workers. This methodology to compute the monthly update factors uses actual quarterly ECI data and assures that the update factors match the actual quarterly and annual percent changes. The factors used to adjust the hospital’s data were based on the midpoint of the cost reporting period, as indicated below. MIDPOINT OF COST REPORTING PERIOD After wwhite on PROD1PC61 with PROPOSALS2 10/14/2002 11/14/2002 12/14/2002 01/14/2003 02/14/2003 03/14/2003 04/14/2003 05/14/2003 06/14/2003 07/14/2003 08/14/2003 09/14/2003 10/14/2003 11/14/2003 12/14/2003 01/14/2004 02/14/2004 03/14/2004 Before .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... 11/15/2002 12/15/2002 01/15/2003 02/15/2003 03/15/2003 04/15/2003 05/15/2003 06/15/2003 07/15/2003 08/15/2003 09/15/2003 10/15/2003 11/15/2003 12/15/2003 01/15/2004 02/15/2004 03/15/2004 04/15/2004 Adjustment factor 1.06058 1.05679 1.05304 1.04915 1.04513 1.04108 1.03713 1.03325 1.02948 1.02584 1.02231 1.01878 1.01510 1.01127 1.00743 1.00367 1.00000 0.99644 For example, the midpoint of a cost reporting period beginning January 1, 2003 and ending December 31, 2003 is June 30, 2003. An adjustment factor of 1.02948 would be applied to the wages of a hospital with such a cost reporting period. In addition, for the data for any cost reporting period that began in FY 2003 and covered a period of less than 360 days or more than 370 days, we annualized the data to reflect a 1-year cost report. Dividing the data by the number of days in the cost report and then multiplying the results by 365 accomplishes annualization. Step 6—Each hospital was assigned to its appropriate urban or rural labor VerDate Aug<31>2005 17:10 Apr 24, 2006 Jkt 208001 market area before any reclassifications under section 1886(d)(8)(B), section 1886(d)(8)(E), or section 1886(d)(10) of the Act. Within each urban or rural labor market area, we added the total adjusted salaries plus wage-related costs obtained in Step 5 for all hospitals in that area to determine the total adjusted salaries plus wage-related costs for the labor market area. Step 7—We divided the total adjusted salaries plus wage-related costs obtained under both methods in Step 6 by the sum of the corresponding total hours (from Step 4) for all hospitals in each labor market area to determine an average hourly wage for the area. Step 8—We added the total adjusted salaries plus wage-related costs obtained in Step 5 for all hospitals in the Nation and then divided the sum by the national sum of total hours from Step 4 to arrive at a national average hourly wage. Using the data as described above, the proposed national average hourly wage is $29.6008. Step 9—For each urban or rural labor market area, we calculated the hospital wage index value by dividing the area average hourly wage obtained in Step 7 by the national average hourly wage computed in Step 8. Step 10—Following the process set forth above, we developed a separate Puerto Rico-specific wage index for purposes of adjusting the Puerto Rico standardized amounts. (The national Puerto Rico standardized amount is adjusted by a wage index calculated for all Puerto Rico labor market areas based on the national average hourly wage as described above.) We added the total adjusted salaries plus wage-related costs (as calculated in Step 5) for all hospitals in Puerto Rico and divided the sum by the total hours for Puerto Rico (as calculated in Step 4) to arrive at an overall proposed average hourly wage of $12.9564 for Puerto Rico. For each labor market area in Puerto Rico, we calculated the Puerto Rico-specific wage index value by dividing the area average hourly wage (as calculated in Step 7) by the overall Puerto Rico average hourly wage. Step 11—Section 4410 of Pub. L. 105– 33 provides that, for discharges on or after October 1, 1997, the area wage index applicable to any hospital that is located in an urban area of a State may not be less than the area wage index applicable to hospitals located in rural areas in that State. (For all-urban States, we established an imputed floor (69 FR 49109). Furthermore, this wage index floor is to be implemented in such a manner as to ensure that aggregate IPPS payments are not greater or less than those that would have been made in the PO 00000 Frm 00087 Fmt 4701 Sfmt 4702 24081 year if this section did not apply. For FY 2007, this change affects 187 hospitals in 62 urban areas. The areas affected by this provision are identified by a footnote in Tables 4A–1 and 4A–2 in the Addendum of this proposed rule. G. Computation of the Proposed FY 2007 Blended Wage Index (If you choose to comment on issues in this section, please include the caption ‘‘Blended Wage Index’’ at the beginning of your comment.) For the final FY 2005 and FY 2006 wage indices, we used a blend of the occupational mix adjusted wage index and the unadjusted wage index. Specifically, we adjusted 10 percent of the FY 2005 and FY 2006 wage index adjustment factor by a factor reflecting occupational mix. We refer readers to the FY 2005 IPPS final rule at 69 FR 49052 and the FY 2006 IPPS final rule at 70 FR 47376 for a detailed discussion of the blended wage index. For FY 2007, we are proposing to apply the same blended wage index as we did in FYs 2005 and 2006, so that 10 percent of the wage index is adjusted by a factor reflecting occupational mix. We believe this is prudent policy because we are relying on the same survey data used in FYs 2005 and 2006. In computing the occupational mix adjustment for the proposed FY 2007 wage index, we used the occupational mix survey data that we collected for the FY 2006 wage index, replacing the survey data for 16 hospitals that submitted revised data, and excluding the survey data for hospitals with no corresponding Worksheet S–3 wage data for the FY 2007 wage index. With 10 percent of the proposed FY 2007 wage index adjusted for occupational mix, the proposed national average hourly wage is $29.6029 and the Puerto Rico-specific average hourly wage is $12.9557. The wage index values for 17 rural areas (36.2 percent) and 200 urban areas (51.8 percent) would decrease as a result of the adjustment. These decreases would be minimal; the largest negative impact for a rural area would be 0.18 percent and for an urban area, 0.42 percent. Conversely, 29 rural areas (61.7 percent) and 173 urban areas (44.8 percent) would benefit from this adjustment, with 1 urban area increasing 2.2 percent and 2 rural areas increasing 0.38 percent. As there are no significant differences between the FY 2006 and the FY 2007 occupational mix survey data and results, we believe it is appropriate to again apply the occupational mix to 10 percent of the proposed FY 2007 wage index. (See Appendix A to this proposed rule for E:\FR\FM\25APP2.SGM 25APP2 24082 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules further analysis of the impact of the occupational mix adjustment on the proposed FY 2007 wage index.) The proposed wage index values for FY 2007 (except those for hospitals receiving wage index adjustments under section 505 of Pub. L. 108–173) are shown in Tables 4A–1, 4A–2, 4B, 4C– 1, 4C–2, and 4F in the Addendum to this proposed rule. Tables 3A and 3B in the Addendum to this proposed rule list the 3-year average hourly wage for each labor market area before the redesignation of hospitals, based on FYs 2005, 2006, 2007 cost reporting periods. Table 3A lists these data for urban areas and Table 3B lists these data for rural areas. In addition, Table 2 in the Addendum to this proposed rule includes the adjusted average hourly wage for each hospital from the FY 2001 and FY 2002 cost reporting periods, as well as the FY 2003 period used to calculate the proposed FY 2007 wage index. The 3year averages are calculated by dividing the sum of the dollars (adjusted to a common reporting period using the method described previously) across all 3 years, by the sum of the hours. If a hospital is missing data for any of the previous years, its average hourly wage for the 3-year period is calculated based on the data available during that period. The proposed wage index values in Tables 4A–1, 4A–2, 4B, 4C–1, 4C–2, and 4F and the average hourly wages in Tables 2, 3A, and 3B in the Addendum to this proposed rule include the proposed occupational mix adjustment. wwhite on PROD1PC61 with PROPOSALS2 H. Proposed Revisions to the Wage Index Based on Hospital Redesignations (If you choose to comment on issues in this section, please include the caption ‘‘Hospital Redesignations and Reclassifications’’ at the beginning of your comment.) 1. General Under section 1886(d)(10) of the Act, the Medicare Geographic Classification Review Board (MGCRB) considers applications by hospitals for geographic reclassification for purposes of payment under the IPPS. Hospitals must apply to the MGCRB to reclassify by September 1 of the year preceding the year during which reclassification is sought. Generally, hospitals must be proximate to the labor market area to which they are seeking reclassification and must demonstrate characteristics similar to hospitals located in that area. The MGCRB issues its decisions by the end of February for reclassifications that become effective for the following fiscal year (beginning October 1). The regulations applicable to VerDate Aug<31>2005 17:10 Apr 24, 2006 Jkt 208001 reclassifications by the MGCRB are located in §§ 412.230 through 412.280. Section 1886(d)(10)(D)(v) of the Act provides that, beginning with FY 2001, a MGCRB decision on a hospital reclassification for purposes of the wage index is effective for 3 fiscal years, unless the hospital elects to terminate the reclassification. Section 1886(d)(10)(D)(vi) of the Act provides that the MGCRB must use the 3 most recent years’ average hourly wage data in evaluating a hospital’s reclassification application for FY 2003 and any succeeding fiscal year. Section 304(b) of Pub. L. 106–554 provides that the Secretary must establish a mechanism under which a statewide entity may apply to have all of the geographic areas in the State treated as a single geographic area for purposes of computing and applying a single wage index, for reclassifications beginning in FY 2003. The implementing regulations for this provision are located at § 412.235. Section 1886(d)(8)(B) of the Act requires the Secretary to treat a hospital located in a rural county adjacent to one or more urban areas as being located in the MSA to which the greatest number of workers in the county commute, if the rural county would otherwise be considered part of an urban area under the standards for designating MSAs and if the commuting rates used in determining outlying counties were determined on the basis of the aggregate number of resident workers who commute to (and, if applicable under the standards, from) the central county or counties of all contiguous MSAs. In light of the new CBSA definitions and the Census 2000 data that we implemented for FY 2005 (69 FR 49027), we undertook to identify those counties meeting these criteria. The eligible counties are identified under section III.H.4. of this preamble. 2. Effects of Reclassification Section 1886(d)(8)(C) of the Act provides that the application of the wage index to redesignated hospitals is dependent on the hypothetical impact that the wage data from these hospitals would have on the wage index value for the area to which they have been redesignated. These requirements for determining the wage index values for redesignated hospitals is applicable both to the hospitals located in rural counties deemed urban under section 1886(d)(8)(B) of the Act and hospitals that were reclassified as a result of the MGCRB decisions under section 1886(d)(10) of the Act. Therefore, as provided in section 1886(d)(8)(C) of the PO 00000 Frm 00088 Fmt 4701 Sfmt 4702 Act,12 the wage index values were determined by considering the following: • If including the wage data for the redesignated hospitals would reduce the wage index value for the area to which the hospitals are redesignated by 1 percentage point or less, the area wage index value determined exclusive of the wage data for the redesignated hospitals applies to the redesignated hospitals. • If including the wage data for the redesignated hospitals reduces the wage index value for the area to which the hospitals are redesignated by more than 1 percentage point, the area wage index determined inclusive of the wage data for the redesignated hospitals (the combined wage index value) applies to the redesignated hospitals. • If including the wage data for the redesignated hospitals increases the wage index value for the urban area to which the hospitals are redesignated, both the area and the redesignated hospitals receive the combined wage index value. Otherwise, the hospitals located in the urban area receive a wage index excluding the wage data of hospitals redesignated into the area. • The wage data for a reclassified urban hospital is included in both the wage index calculation of the area to which the hospital is reclassified (subject to the rules described above) and the wage index calculation of the urban area where the hospital is physically located. • Rural areas whose wage index values would be reduced by excluding the wage data for hospitals that have been redesignated to another area continue to have their wage index values calculated as if no redesignation had occurred (otherwise, redesignated rural hospitals are excluded from the calculation of the rural wage index). • The wage index value for a redesignated rural hospital cannot be reduced below the wage index value for the rural areas of the State in which the hospital is located. • In cases where urban hospitals have reclassified to rural areas under 42 CFR 12 Although section 1886(d)(8)(C)(iv)(I) of the Act also provides that the wage index for an urban area may not decrease as a result of redesignated hospitals if the urban area wage index is already below the wage index for rural areas in the State in which the urban area is located, the provision was effectively made moot by section 4410 of Pub. L. 105–33, which provides that the area wage index applicable to any hospital that is located in an urban area of a State may not be less than the area wage index applicable to hospitals located in rural areas in that State. For all-urban States, CMS established an imputed floor (69 FR 49109). Also, section 1886(d)(8)(C)(iv)(II) of the Act provides that an urban area’s wage index may not decrease as a result of redesignated hospitals if the urban area is located in a State that is composed of a single urban area. E:\FR\FM\25APP2.SGM 25APP2 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules 412.103, the urban hospital wage data are: (a) Included in the rural wage index calculation, unless doing so would reduce the rural wage index; and (b) included in the urban area where the hospital is physically located. 3. FY 2007 MGCRB Reclassifications wwhite on PROD1PC61 with PROPOSALS2 At the time this proposed rule was constructed, the MGCRB had completed its review of FY 2007 reclassification requests. There are 214 hospitals approved by the MGCRB for wage index reclassifications for FY 2007. Because MGCRB wage index reclassifications are effective for 3 years, hospitals reclassified during FY 2005 or FY 2006 are eligible to continue to be reclassified based on prior reclassifications to current MSAs during FY 2007. There were 299 hospitals reclassified for wage index for FY 2006, and 395 hospitals reclassified for wage index for FY 2005. Some of the hospitals that reclassified for FY 2005 and FY 2006 have elected not to continue their reclassifications in FY 2007 because, under the revised labor market area definitions, they are now physically located in the areas to which they previously reclassified. Of all of the hospitals approved for reclassification for FY 2005, FY 2006, and FY 2007, 766 hospitals are in a reclassification status for FY 2007. Prior to FY 2004, hospitals had been able to apply to be reclassified for purposes of either the wage index or the standardized amount. Section 401 of Pub. L. 108–173 established that all hospitals will be paid on the basis of the large urban standardized amount, beginning with FY 2004. Consequently, all hospitals are paid on the basis of the same standardized amount, which made such reclassifications moot. Although there could still be some benefit in terms of payments for some hospitals under the DSH payment adjustment for operating IPPS, section 402 of Pub. L. 108–173 equalized DSH payment adjustments for rural and urban hospitals, with the exception that the rural DSH adjustment is capped at 12 percent (except that RRCs and, effective for discharges occurring on or after October 1, 2006, MDHs have no cap). (A detailed discussion of this application appears in section IV.I. of the preamble of the FY 2005 IPPS final rule (69 FR 49085). The exclusion of MDHs from the 12 percent DSH cap under Pub. L. 109– 171 is discussed under Section IV.F.4. of this preamble.) Under § 412.273, hospitals that have been reclassified by the MGCRB are permitted to withdraw their applications within 45 days of the publication of a proposed rule. The request for withdrawal of an application for reclassification or termination of an existing 3-year reclassification that would be effective in FY 2007 must be received by the MGCRB within 45 days of the publication of this proposed rule. If a hospital elects to withdraw its wage index application after the MGCRB has issued its decision, but within 45 days of the publication of the proposed rule, it may later cancel its withdrawal in a subsequent year and request the MGCRB to reinstate its wage index reclassification for the remaining fiscal year(s) of the 3-year period (§ 412.273(b)(2)(i)). The request to cancel a prior withdrawal must be in writing to the MGCRB no later than the deadline for submitting reclassification applications for the following fiscal year (§ 412.273(d)). For further information about withdrawing, terminating, or canceling a previous withdrawal or termination of a 3-year reclassification for wage index purposes, we refer the reader to § 412.273, as well as the August 1, 2002 IPPS final rule (67 FR 50065) and the August 1, 2001 IPPS final rule (66 FR 39887). Changes to the wage index that result from withdrawals of requests for reclassification, wage index corrections, appeals, and the Administrator’s review process will be incorporated into the wage index values published in the final rule. These changes may affect not only the wage index value for specific geographic areas, but also the wage index value redesignated hospitals receive; that is, whether they receive the wage index that includes the data for both the hospitals already in the area and the redesignated hospitals. Further, the wage index value for the area from which the hospitals are redesignated may be affected. Applications for FY 2008 reclassifications are due to the MGCRB by September 1, 2006. We note that this is also the deadline for canceling a previous wage index reclassification withdrawal or termination under § 412.273(d). Applications and other information about MGCRB reclassifications may be obtained, beginning in mid-July 2006, via the CMS Internet Web site at: https:// www.cms.hhs.gov/mgcrb/, or by calling the MGCRB at (410) 786–1174. The mailing address of the MGCRB is: 2520 Lord Baltimore Drive, Suite L, Baltimore, MD 21244–2670. 4. Proposed FY 2007 Redesignations Under Section 1886(d)(8)(B) of the Act Beginning October 1, 1988, section 1886(d)(8)(B) of the Act required us to treat a hospital located in a rural county adjacent to one or more urban areas as being located in the MSA if certain criteria were met. Prior to FY 2005, the rule was that a rural county adjacent to one or more urban areas would be treated as being located in the MSA to which the greatest number of workers in the county commute, if the rural county would otherwise be considered part of an urban area under the standards published in the Federal Register on January 3, 1980 (45 FR 956) for designating MSAs (and New England County Metropolitan Areas (NECMAs)), and if the commuting rates used in determining outlying counties (or, for New England, similar recognized areas) were determined on the basis of the aggregate number of resident workers who commute to (and, if applicable under the standards, from) the central county or counties of all contiguous MSAs (or NECMAs). Hospitals that met the criteria using the January 3, 1980 version of these OMB standards were deemed urban for purposes of the standardized amounts and for purposes of assigning the wage data index. Effective beginning FY 2005, we use OMB’s 2000 CBSA standards and the Census 2000 data to identify counties qualifying for redesignation under section 1886(d)(8)(B) for the purpose of assigning the wage index to the urban area. The chart below contains the listing of the rural counties designated as urban under section 1886(d)(8)(B) of the Act that we are proposing to use for FY 2007. For discharges occurring on or after October 1, 2006, hospitals located in the first column of this chart will be redesignated for purposes of using the wage index of the urban area listed in the second column. RURAL COUNTIES REDESIGNATED AS URBAN UNDER SECTION 1886(d)(8)(B) OF THE ACT [Based on CBSAs and Census 2000 Data] Rural county CBSA Cherokee, AL ............................................................................................ Macon, AL ................................................................................................ VerDate Aug<31>2005 17:10 Apr 24, 2006 Jkt 208001 PO 00000 Frm 00089 Fmt 4701 Rome, GA. Auburn-Opelika, AL. Sfmt 4702 24083 E:\FR\FM\25APP2.SGM 25APP2 24084 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules RURAL COUNTIES REDESIGNATED AS URBAN UNDER SECTION 1886(d)(8)(B) OF THE ACT—Continued [Based on CBSAs and Census 2000 Data] wwhite on PROD1PC61 with PROPOSALS2 Rural county CBSA Talladega, AL ........................................................................................... Hot Springs, AR ........................................................................................ Windham, CT ............................................................................................ Bradford, FL .............................................................................................. Flagler, FL ................................................................................................ Hendry, FL ................................................................................................ Levy, FL .................................................................................................... Walton, FL ................................................................................................ Banks, GA ................................................................................................ Chattooga, GA .......................................................................................... Jackson, GA ............................................................................................. Lumpkin, GA ............................................................................................. Morgan, GA .............................................................................................. Peach, GA ................................................................................................ Polk, GA ................................................................................................... Talbot, GA ................................................................................................ Bingham, ID .............................................................................................. Christian, IL .............................................................................................. DeWitt, IL .................................................................................................. Iroquois, IL ................................................................................................ Logan, IL ................................................................................................... Mason, IL .................................................................................................. Ogle, IL ..................................................................................................... Clinton, IN ................................................................................................. Henry, IN .................................................................................................. Spencer, IN ............................................................................................... Starke, IN .................................................................................................. Warren, IN ................................................................................................ Boone, IA .................................................................................................. Buchanan, IA ............................................................................................ Cedar, IA .................................................................................................. Allen, KY ................................................................................................... Assumption Parish, LA ............................................................................. St. James Parish, LA ................................................................................ Allegan, MI ................................................................................................ Montcalm, MI ............................................................................................ Oceana, MI ............................................................................................... Shiawassee, MI ........................................................................................ Tuscola, MI ............................................................................................... Fillmore, MN ............................................................................................. Dade, MO ................................................................................................. Pearl River, MS ........................................................................................ Caswell, NC .............................................................................................. Granville, NC ............................................................................................ Harnett, NC ............................................................................................... Lincoln, NC ............................................................................................... Polk, NC ................................................................................................... Los Alamos, NM ....................................................................................... Lyon, NV ................................................................................................... Cayuga, NY .............................................................................................. Columbia, NY ........................................................................................... Genesee, NY ............................................................................................ Greene, NY ............................................................................................... Schuyler, NY ............................................................................................. Sullivan, NY .............................................................................................. Wyoming, NY ............................................................................................ Ashtabula, OH .......................................................................................... Champaign, OH ........................................................................................ Columbiana, OH ....................................................................................... Cotton, OK ................................................................................................ Linn, OR ................................................................................................... Adams, PA ................................................................................................ Clinton, PA ................................................................................................ Greene, PA ............................................................................................... Monroe, PA ............................................................................................... Schuylkill, PA ............................................................................................ Susquehanna, PA ..................................................................................... Clarendon, SC .......................................................................................... Lee, SC ..................................................................................................... Oconee, SC .............................................................................................. Union, SC ................................................................................................. VerDate Aug<31>2005 17:10 Apr 24, 2006 Jkt 208001 PO 00000 Frm 00090 Fmt 4701 Anniston-Oxford, AL. Hot Springs, AR. Hartford-West Hartford-East Hartford, CT. Gainesville, FL. Deltona-Daytona Beach-Ormond Beach, FL. West Palm Beach-Boca Raton-Boynton, FL. Gainesville, FL. Fort Walton Beach-Crestview-Destin, FL. Gainesville, GA. Chattanooga, TN-GA. Atlanta-Sandy Springs-Marietta, GA. Atlanta-Sandy Springs-Marietta, GA. Atlanta-Sandy Springs-Marietta, GA. Macon, GA. Atlanta-Sandy Springs-Marietta, GA. Columbus, GA-AL. Idaho Falls, ID. Springfield, IL. Bloomington-Normal, IL. Kankakee-Bradley, IL. Springfield, IL. Peoria, IL. Rockford, IL. Lafayette, IN. Indianapolis, IN. Evansville, IN-KY. Gary, IN. Lafayette, IN. Ames, IA. Waterloo-Cedar Falls, IA. Iowa City, IA. Bowling Green, KY. Baton Rouge, LA. Baton Rouge, LA. Holland-Grand Haven, MI. Grand Rapids-Wyoming, MI. Muskegon-Norton Shores, MI. Lansing-East Lansing, MI. Saginaw-Saginaw Township North, MI. Rochester, MN. Springfield, MO. Gulfport-Biloxi, MS. Burlington, NC. Durham, NC. Raleigh-Cary, NC. Charlotte-Gastonia-Concord, NC-SC. Spartanburg, NC. Santa Fe, NM. Carson City, NV. Syracuse, NY. Albany-Schenectady-Troy, NY. Rochester, NY. Albany-Schenectady-Troy, NY. Ithaca, NY. Poughkeepsie-Newburgh-Middletown, NY. Buffalo-Niagara Falls, NY. Cleveland-Elyria-Mentor, OH. Springfield, OH. Youngstown-Warren-Boardman, OH-PA. Lawton, OK. Corvallis, OR. York-Hanover, PA. Williamsport, PA. Pittsburgh, PA. Allentown-Bethlehem-Easton, PA-NJ. Reading, PA. Binghamton, NY. Sumter, SC. Sumter, SC. Greenville, SC. Spartanburg, SC. Sfmt 4702 E:\FR\FM\25APP2.SGM 25APP2 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules 24085 RURAL COUNTIES REDESIGNATED AS URBAN UNDER SECTION 1886(d)(8)(B) OF THE ACT—Continued [Based on CBSAs and Census 2000 Data] Rural county CBSA Meigs, TN ................................................................................................. Bosque, TX ............................................................................................... Falls, TX ................................................................................................... Fannin, TX ................................................................................................ Grimes, TX ............................................................................................... Harrison, TX ............................................................................................. Henderson, TX ......................................................................................... Milam, TX ................................................................................................. Van Zandt, TX .......................................................................................... Willacy, TX ................................................................................................ Buckingham, VA ....................................................................................... Floyd, VA .................................................................................................. Middlesex, VA ........................................................................................... Page, VA .................................................................................................. Shenandoah, VA ...................................................................................... Island, WA ................................................................................................ Mason, WA ............................................................................................... Wahkiakum, WA ....................................................................................... Jackson, WV ............................................................................................. Roane, WV ............................................................................................... Green, WI ................................................................................................. Green Lake, WI ........................................................................................ Jefferson, WI ............................................................................................ Walworth, WI ............................................................................................ As in the past, hospitals redesignated under section 1886(d)(8)(B) of the Act are also eligible to be reclassified to a different area by the MGCRB. Affected hospitals are permitted to compare the reclassified wage index for the labor market area in Tables 4C–1 and 4C–2 in the Addendum of this proposed rule into which they have been reclassified by the MGCRB to the wage index for the area to which they are redesignated under section 1886(d)(8)(B) of the Act. Hospitals may withdraw from an MGCRB reclassification within 45 days of the publication of this proposed rule. wwhite on PROD1PC61 with PROPOSALS2 5. Reclassifications Under Section 508 of Pub. L. 108–173 Under section 508 of Pub. L. 108–173, a qualifying hospital could appeal the wage index classification otherwise applicable to the hospital and apply for reclassification to another area of the State in which the hospital is located (or, at the discretion of the Secretary, to an area within a contiguous State). We implemented this process through notices published in the Federal Register on January 6, 2004 (69 FR 661), and February 13, 2004 (69 FR 7340). Such reclassifications are applicable to discharges occurring during the 3-year period beginning April 1, 2004, and ending March 31, 2007. Under section 508(b), reclassifications under this process do not affect the wage index computation for any area or for any other hospital and cannot be effected in a budget neutral manner. VerDate Aug<31>2005 17:10 Apr 24, 2006 Jkt 208001 Cleveland, TN. Waco, TX. Waco, TX. Dallas-Plano-Irving, TX. College Station-Bryan, TX. Longview, TX. Dallas-Plano-Irving, TX. Austin-Round Rock, TX. Dallas-Plano-Irving, TX. Brownsville-Harlingen, TX. Charlottesville, VA. Blacksburg-Christiansburg-Radford, VA. Virginia Beach-Norfolk-Newport News, VA. Harrisonburg, VA. Winchester, VA-WV. Seattle-Bellevue-Everett, WA. Olympia, WA. Longview, WA. Charleston, WV. Charleston, WV. Madison, WI. Fond du Lac, WI. Milwaukee-Waukesha-West Allis, WI. Milwaukee-Waukesha-West Allis, WI. Some hospitals currently receiving a section 508 reclassification are eligible to reclassify to that same area under the standard reclassification process as a result of the new labor market definitions that we adopted for FY 2005. The governing regulations indicate that ‘‘if a hospital is already reclassified to a given geographic area for wage index purposes for a 3-year period, and submits an application to the same area for either the second or third year of the 3-year period, that application will not be approved.’’ However in the FY 2006 IPPS final rule (70 FR 47382), we stated that hospitals that indicated in their FY 2007 MGCRB applications that they agreed to waive their section 508 reclassification for the first 6 months of FY 2007 if they were granted a 3-year reclassification under the traditional MGCRB process will not be subject to the rule cited above. Thus, in applying for a 3-year MGCRB reclassification beginning in FY 2007, hospitals that are already reclassified to the same area under section 508 should have indicated in their MGCRB reclassification requests that if they receive the MGCRB reclassification, they would forfeit the section 508 reclassification for the first 6 months of FY 2007. Under 1886(d)(10)(D)(v) of the Act, CMS has the authority to ‘‘establish procedures’’ under which a hospital may elect to terminate a reclassification before the end of a 3-year period. In the FY 2006 IPPS final rule (70 FR 47382), PO 00000 Frm 00091 Fmt 4701 Sfmt 4702 we discussed our decision to exercise this authority to establish a procedural rule for section 508 hospitals to retain their section 508 reclassification through its expiration on March 31, 2007, and reclassify under the regulations at 42 CFR Part 412, Subpart L, for the second half of FY 2007. The following procedural rules will apply for section 508 hospitals that wish to reclassify for the second half of FY 2007 (April 1, 2007, through September 30, 2007): For section 508 hospitals applying for individual reclassification under § 412.230— (a) Hospitals must have applied for reclassification through the MGCRB by the September 1, 2005 deadline. (b) Section 508 hospitals that are approved by the MGCRB for reclassification will have 45 days from the date this FY 2007 IPPS proposed rule is published to cancel their section 1886(d)(10) reclassification for either the first 6 months of FY 2007 or for the entire fiscal year. Hospitals should note that if they fail to cancel their section 1886(d)(10) reclassification by the deadline, they will not receive their section 508 wage adjustment in FY 2007. To further clarify— • Hospitals that cancel their section 1886(d)(10) reclassification for the first 6 months receive their section 508 reclassification for October 1, 2006, through March 31, 2007, and their section 1886(d)(10) reclassification for E:\FR\FM\25APP2.SGM 25APP2 wwhite on PROD1PC61 with PROPOSALS2 24086 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules April 1, 2007, through September 30, 2009. • Hospitals that cancel their section 1886(d)(10) reclassification for the entire year will receive their section 508 reclassification for October 1, 2006, through March 31, 2007 and their home area wage index for April 1, 2007, through September 30, 2007. • Hospitals that do not cancel their section 1886(d)(10) reclassification will receive their section 1886(d)(10) reclassification, not their section 508 reclassification, for the entire fiscal year. Hospital groups that include a section 508 hospital were also permitted to submit section 1886(d)(10) reclassification applications by the September 1, 2005 deadline. However, in order for a group reclassification to be approved, either of the following conditions needed to be met: (a) The section 508 hospital that is part of the group waived its section 508 reclassification for the first half of FY 2007. This is necessary because the regulations at §§ 412.232 and 412.234 state that all hospitals in a county must apply for reclassification as a group. The hospitals either agreed to receive the same reclassification or failed to qualify as a group. The Administrator upheld this policy in an MGCRB appeal for FY 2006. (b) Each member of the group agreed, in writing, at the time the application was submitted September 1, 2005, that they cancelled the group reclassification if granted for the first 6 months of FY 2007. The section 1886(d)(10) reclassification then is effective only from April 1, 2007, through September 30, 2007. In the FY 2006 final rule, we stated that, under this scenario, the section 508 hospital receives its section 508 reclassification from October 1, 2006, through March 31, 2007, and the remainder of the group receives the home wage index for that time period. For April 1, 2007, through September 30, 2009, the section 508 hospital and the remainder of the group receive the group reclassification. The group may also cancel the April 1, 2007 through September 30, 2009 group reclassification within 45 days of publication of this proposed rule. We will apply a similar rule for purposes of the out-migration adjustment for FY 2007 discussed in section III.I. of this preamble. The statute states that a hospital cannot receive an out-migration adjustment if it is reclassified under section 1886(d)(10) of the Act. Therefore, eligible hospitals that are not reclassified during any part of FY 2007 will, by default, receive an out-migration adjustment during that time period. If the hospital is VerDate Aug<31>2005 17:10 Apr 24, 2006 Jkt 208001 reclassified for all of FY 2007, the hospital will be ineligible for the outmigration adjustment. If a hospital has a half fiscal year reclassification, the hospital will be eligible for the outmigration adjustment for the portion of the fiscal year that it is not reclassified. The procedural rules described in the FY 2006 IPPS final rule were intended to address specific circumstances where individual and group reclassifications involve a section 508 hospital. The rules were designed to recognize the special circumstances of section 508 hospital reclassifications ending mid-year during FY 2007 and were intended to provide flexibility in our regulations that would allow previously approved reclassifications to continue through March 31, 2007, and new reclassifications to begin April 1, 2007, upon the conclusion of the section 508 reclassifications. We have received questions about the application of these special procedural rules to non-section 508 hospitals that are part of group applications that previously were awarded an individual reclassification that continues into FY 2007. These hospitals are concerned that the procedural rules imply that such prior reclassification would be terminated beginning October 1, 2006, because the rules specify that ‘‘the remainder of the group receives the home wage index’’ for the period October 1, 2006, through March 31, 2007, if the group reclassification application specified that the section 1886(d)(10) group reclassification would not begin until April 1, 2007. We did not specifically contemplate preexisting individual reclassifications when we drafted the special procedural rules for group reclassifications that involve section 508 hospitals. However, we did not intend to adopt a less favorable policy for nonsection 508 hospitals in a group with a pending individual geographic reclassification than we did for section 508 hospitals. Thus, we are clarifying our procedural rule with respect to nonsection 508 hospitals with preexisting individual reclassifications that are part of group reclassifications that include a section 508 hospital. For the first half of FY 2007, we intend to either apply (a) the area wage index where the hospital is physically located if there is no reclassification pending, or (b) the hospital’s individual reclassification wage index if the hospital was part of a group awarded a group reclassification and the group followed the procedural rules for postponing reclassification until April 1, 2007. However, once the hospital begins its new section 1886(d)(10) reclassification for the period April 1, PO 00000 Frm 00092 Fmt 4701 Sfmt 4702 2007, through September 30, 2009, any prior reclassifications are permanently terminated, consistent with 42 CFR 412.274(b)(2)(ii). In fact, because any withdrawal of the group reclassification must be received within 45 days of the publication of this proposed rule, failure to meet this deadline would effectively permanently terminate any remaining years of the individual reclassification. Further, a non-section 508 hospital that is part of a group reclassification that includes a section 508 hospital that will not begin until April 1, 2007, will have the option of canceling its preexisting reclassification for the entire year consistent with section 412.274(b)(1)(ii) within 45 days of publication of this proposed rule. Under this scenario, the hospital would receive its home wage index for the first half of the year and the approved group reclassification wage index for the second half of the year. We are also reiterating that the special procedural rules that we have adopted for half fiscal year reclassifications and terminations are intended only to address the special circumstances created by section 508 of Pub. L. 108–173 with respect to reclassifications beginning and ending mid-way through a fiscal year. These special procedural rules do not change any of the permanent provisions currently in effect with respect to reclassifications under subpart L of 42 CFR Part 412. As an example: Suppose Hospital A is a non-section 508 hospital that was part of a group reclassification application for FYs 2007 through 2009 and such group contained a section 508 hospital. In accordance with our special section 508 procedural rule, the entire group would be considered to have agreed it would waive its group reclassification for the first half of FY 2007. Hospital A also is currently (for FY 2006) reclassified from Area X to Area Y for FYs 2006 through 2008. For the first half of FY 2007, Hospital A will continue to receive its individual reclassification to Area Y; for the second half of FY 2007, it will receive the group reclassification. Hospital A may terminate its individual reclassification (termination must be received within 45 days of publication of this proposed rule), in which case it will receive its home wage index for the first half of FY 2007 and the group reclassification for the second half. Acceptance of the group reclassification effectively permanently terminates the individual reclassification to Area Y. Hospital A’s group also has the option of withdrawing its group reclassification (withdrawal must be received within 45 days of publication of this proposed rule E:\FR\FM\25APP2.SGM 25APP2 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules wwhite on PROD1PC61 with PROPOSALS2 and all members of the group must agree). If such withdrawal occurs, the default rule is that Hospital A receives its FYs 2006 through 2008 individual reclassification for all of FY 2007. If Hospital A wishes to receive its home wage index (plus any outmigration adjustment, if applicable), it must also terminate the individual reclassification for all of FY 2007 (termination must be received within 45 days of publication of this proposed rule). We show the reclassifications effective under the one-time appeal process in Table 9B in the Addendum to this proposed rule. All section 1886(d)(10) reclassifications are listed in Table 9A in the Addendum to this proposed rule. 6. Proposed Wage Indices for Reclassified Hospitals and Proposed Reclassification Budget Neutrality Factor Under the procedural rules described under section III.H.5. of this preamble, different wage indices may be in effect for the first 6 months and the second 6 months of FY 2007. Specifically, section 508 hospitals that were approved for individual reclassification under § 412.230 have the opportunity to cancel their section 1886(d)(10) reclassification for the first 6 months within 45 days of the publication of this proposed rule and receive their section 508 reclassifications for October 1, 2006, through March 31, 2007, and their section 1886(d)(10) reclassifications for April 1, 2007, through September 30, 2009. The special procedural rule also applied to urban county group applications including a section 508 hospital. In order for the hospital to retain its section 508 reclassification for the first 6 months, each member of the group must have agreed in writing, at the time the application was submitted, that they cancel the group reclassification if granted for the first 6 months of FY 2007. Under this scenario, the section 508 hospital receives its section 508 reclassification from October 1, 2006, through March 31, 2007, and the remainder of the group receives their preexisting individual reclassification or home wage index for that time period. For April 1, 2007, through September 30, 2009, the section 508 hospital and the remainder of the group receive the group reclassification. The half fiscal year section 1886(d)(10) reclassifications permitted under these procedural rules present issues related to the calculation of the reclassified wage indices and reclassification budget neutrality factor. Section 1886(d)(8)(C) of the Act VerDate Aug<31>2005 17:10 Apr 24, 2006 Jkt 208001 provides requirements for determining the wage index values for both hospitals located in rural counties deemed urban under section 1886(d)(8)(B) of the Act and hospitals that were reclassified as a result of the MGCRB decisions under section 1886(d)(10) of the Act. As provided in the statute, we are required to calculate a separate wage index for hospitals reclassified to an area if including the wage data for the reclassified hospitals would reduce the area wage index by more than 1 percent. Conceivably, we could calculate one reclassified wage index for FY 2007 that would include the wage data of hospitals that are reclassified to the area for any part of FY 2007. However, we are aware of situations in which including the wage data from hospitals only reclassifying for the second half of the fiscal year would change the wage index for reclassified hospitals for the entire fiscal year, even though the reclassification would only be in effect during the second half of the fiscal year. We believe it would be unfair to have wage indices affected for the first half of the fiscal year by including the wage data for hospital reclassifications in effect only for the second half of the fiscal year. We believe that the most equitable approach to this issue would be to calculate separate wage indices for reclassified hospitals for the first and second half of FY 2007. Therefore, we are proposing to issue two separate reclassified wage indices for affected areas (one effective from October 1, 2006, through March 31, 2007, and a second reclassified wage index effective April 1, 2007, through September 30, 2007). The reclassified wage indices would be calculated based on the wage data for hospitals reclassified to the area in the respective half of the fiscal year. The half fiscal year reclassifications also have implications for budget neutrality. The overall effect of geographic reclassification is required by section 1886(d)(8)(D) of the Act to be budget neutral. We apply an adjustment to the IPPS standardized amounts to ensure that the effects of geographic reclassification are budget neutral. Because we are proposing to calculate two separate reclassification wage indices for the first half and the second half of FY 2007, it is conceivable that we could apply budget neutrality separately for first and second half fiscal year reclassifications. Under this scenario, we would issue two separate IPPS standardized amounts for FY 2007. However, we believe this approach would be administratively burdensome and perhaps cause confusion in the provider community. For this reason, PO 00000 Frm 00093 Fmt 4701 Sfmt 4702 24087 we are proposing an alternative approach. We are proposing to calculate one budget neutrality adjustment that reflects the average of the adjustments required for first and second half fiscal year reclassifications, respectively, as discussed in section II.A.4.b. of the Addendum to this proposed rule. I. Proposed FY 2007 Wage Index Adjustment Based on Commuting Patterns of Hospital Employees (If you choose to comment on issues in this section, please include the caption ‘‘Out-Migration Adjustment’’ at the beginning of your comment.) In accordance with the broad discretion under section 1886(d)(13) of the Act, as added by section 505 of Pub. L. 108–173, beginning with FY 2005, we established a process to make adjustments to the hospital wage index based on commuting patterns of hospital employees. The process, outlined in the FY 2005 IPPS final rule (69 FR 49061), provides for an increase in the wage index for hospitals located in certain counties that have a relatively high percentage of hospital employees who reside in the county but work in a different county (or counties) with a higher wage index. Such adjustments to the wage index are effective for 3 years, unless a hospital requests to waive the application of the adjustment. A county will not lose its status as a qualifying county due to wage index changes during the 3-year period, and counties will receive the same wage index increase for those 3 years. However, a county that qualifies in any given year may no longer qualify after the 3-year period, or it may qualify but receive a different adjustment to the wage index level. Hospitals that receive this adjustment to their wage index are not eligible for reclassification under section 1886(d)(8) or section 1886(d)(10) of the Act. Adjustments under this provision are not subject to the IPPS budget neutrality requirements under section 1886(d)(3)(E) or section 1886(d)(8)(D) of the Act. Hospitals located in counties that qualify for the wage index adjustment are to receive an increase in the wage index that is equal to the average of the differences between the wage indices of the labor market area(s) with higher wage indices and the wage index of the resident county, weighted by the overall percentage of hospital workers residing in the qualifying county who are employed in any labor market area with a higher wage index. We have employed the prereclassified wage indices in making these calculations. We are proposing that hospitals located in the qualifying counties E:\FR\FM\25APP2.SGM 25APP2 wwhite on PROD1PC61 with PROPOSALS2 24088 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules identified in Table 4J in the Addendum to this proposed rule that have not already reclassified through section 1886(d)(10) of the Act, redesignated through section 1886(d)(8) of the Act, received a section 508 reclassification, or requested to waive the application of the out-migration adjustment will receive the wage index adjustment listed in the table for FY 2007. We used the same formula described in the FY 2005 final rule (69 FR 49064) to calculate the out-migration adjustment. This proposed adjustment was calculated as follows: Step 1. Subtract the wage index for the qualifying county from the wage index for the higher wage area(s). Step 2. Divide the number of hospital employees residing in the qualifying county who are employed in such higher wage index area by the total number of hospital employees residing in the qualifying county who are employed in any higher wage index area. Multiply this result by the result obtained in Step 1. Step 3. Sum the products resulting from Step 2 (if the qualifying county has workers commuting to more than one higher wage area). Step 4. Multiply the result from Step 3 by the percentage of hospital employees who are residing in the qualifying county and who are employed in any higher wage index area. The proposed adjustments calculated for qualifying hospitals are listed in Table 4J in the Addendum to this proposed rule. These adjustments would be effective for each county for a period of 3 fiscal years. Hospitals that received the adjustment in FY 2006 will be eligible to retain that same adjustment for FY 2007. For hospitals in newly qualified counties, adjustments to the wage index are effective for 3 years, beginning with discharges occurring on or after October 1, 2006. As previously noted, hospitals receiving the wage index adjustment under section 1886(d)(13)(F) of the Act are not eligible for reclassification under sections 1886(d)(8) or (d)(10) of the Act, or under section 508 of Pub. L. 108–173, unless they waive such out-migration adjustment. As announced in the FYs 2005 and 2006 final rules, hospitals redesignated under section 1886(d)(8) of the Act or reclassified under section 1886(d)(10) of the Act or under section 508 of Pub. L. 108–173 will be deemed to have chosen to retain their redesignation or reclassification, unless they explicitly notify CMS that they elect to receive the out-migration adjustment instead within 45 days from the publication of this proposed rule. VerDate Aug<31>2005 17:10 Apr 24, 2006 Jkt 208001 Waiver notification should be sent to the following address: Centers for Medicare and Medicaid Services, Center for Medicare Management, Attention: Wage Index Adjustment Waivers, Division of Acute Care, Room C4–08– 06, 7500 Security Boulevard, Baltimore, MD 21244–1850. In addition, under § 412.273, hospitals that have been reclassified by the MGCRB are permitted to terminate existing 3-year reclassifications within 45 days of publication of this proposed rule. Hospitals that are eligible to receive the out-migration wage index adjustment and that withdraw their application for reclassification automatically receive the wage index adjustment listed in Table 4J in the Addendum to this proposed rule. Requests for withdrawal of an application for reclassification or termination of an existing 3-year reclassification will be effective in FY 2007 and must be received by the MGCRB within 45 days of the publication of this proposed rule. Requests to waive section 1886(d)(8) redesignations for FY 2007 must be received by CMS within 45 days of the publication of this proposed rule. In addition, hospitals that wished to retain their redesignation/reclassification under section 1886(d)(8), section 1886(d)(10), or section 508 (instead of receiving the out-migration adjustment) for FY 2007 do not need to submit a formal request to CMS; they will automatically retain their redesignation/ reclassification status for FY 2007. Hospitals should carefully review the wage index adjustment that they would receive under this provision (as listed in Table 2 in the Addendum to this proposed rule) in comparison to the wage index adjustment that they would receive under the MGCRB reclassification (Table 9 in the Addendum to this proposed rule). J. Process for Requests for Wage Index Data Corrections (If you choose to comment on issues in this section, please include the caption ‘‘Wage Index Data Corrections’’ at the beginning of your comment.) In the FY 2005 IPPS final rule (68 FR 27194), we revised the process and timetable for application for development of the wage index, beginning with the FY 2005 wage index. The preliminary and unaudited Worksheet S–3 wage data and occupational mix survey files for FY 2007 were made available on October 7, 2005, through the Internet on the CMS Web site at: https://www.cms.hhs.gov/ AcuteInpatientPPS. In a memorandum dated October 7, 2005, we instructed all PO 00000 Frm 00094 Fmt 4701 Sfmt 4702 Medicare fiscal intermediaries to inform the IPPS hospitals they service of the availability of the wage index data files and the process and timeframe for requesting revisions (including the specific deadlines listed below). We also instructed the fiscal intermediaries to advise hospitals that these data are also made available directly through their representative hospital organizations. If a hospital wished to request a change to its data as shown in the October 7, 2005 wage and occupational mix data files, the hospital was to submit corrections along with complete, detailed supporting documentation to its fiscal intermediary by December 5, 2005. Hospitals were notified of this deadline and of all other possible deadlines and requirements, including the requirement to review and verify their data as posted on the preliminary wage index data file on the Internet, through the October 7, 2005 memorandum referenced above. In the October 7, 2005 memorandum, we also specified that a hospital could only request revisions to the occupational mix data for the reporting period that the hospital used in its original FY 2005 wage index occupational mix survey. That is, a hospital that submitted occupational mix data for the 12-month reporting period could not switch to submitting data for the 4-week reporting period and vice versa. Further, a hospital could not submit an occupational mix survey for the periods beginning before January 1, 2003, or after January 11, 2004. In addition, a hospital that did not submit an occupational mix survey for the FY 2005 wage index was not permitted to submit a survey for the FY 2007 wage index. The fiscal intermediaries notified the hospitals by mid-February 2006 of any changes to the wage index data as a result of the desk reviews and the resolution of the hospitals’ early December 2005 change requests. The fiscal intermediaries also submitted the revised data to CMS by mid-February 2006. CMS published the proposed wage index PUFs that included hospitals’ revised wage data on February 24, 2006. Also, in a memorandum dated February 14, 2006, we instructed fiscal intermediaries to notify all hospitals regarding the availability of the proposed wage index PUFs and the criteria and process for requesting corrections and revisions to the wage index data. Hospitals had until March 13, 2006, to submit requests to the fiscal intermediaries for reconsideration of adjustments made by the fiscal intermediaries as a result of the desk review, and to correct errors E:\FR\FM\25APP2.SGM 25APP2 wwhite on PROD1PC61 with PROPOSALS2 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules due to CMS’s or the fiscal intermediary’s mishandling of the wage index data. Hospitals were also required to submit sufficient documentation to support their requests. After reviewing requested changes submitted by hospitals, fiscal intermediaries are to transmit any additional revisions resulting from the hospitals’ reconsideration requests by April 14, 2006. The deadline for a hospital to request CMS intervention in cases where the hospital disagreed with the fiscal intermediary’s policy interpretations is April 21, 2006. Hospitals should also examine Table 2 in the Addendum to this proposed rule. Table 2 contains each hospital’s adjusted average hourly wage used to construct the wage index values for the past 3 years, including the FY 2003 data used to construct the proposed FY 2007 wage index. We note that the hospital average hourly wages shown in Table 2 only reflect changes made to a hospital’s data and transmitted to CMS by March 1, 2006. We will release a final wage data PUF in early May 2006 to hospital associations and the public on the Internet at https://www.cms.hhs.gov/ AcuteInpatientPPS. The May 2006 PUF will be made available solely for the limited purpose of identifying any potential errors made by CMS or the fiscal intermediary in the entry of the final wage data that result from the correction process described above (revisions submitted to CMS by the fiscal intermediaries by April 14, 2006). If, after reviewing the May 2006 final file, a hospital believes that its wage data are incorrect due to a fiscal intermediary or CMS error in the entry or tabulation of the final wage data, it should send a letter to both its fiscal intermediary and CMS outlining why the hospital believes an error exists and to provide all supporting information, including relevant dates (for example, when it first became aware of the error). CMS and the fiscal intermediaries must receive these requests no later than June 12, 2006. (We note that the June 12, 2006 date is revised from the June 9, 2006 date originally specified in the October 7, 2005 letter to hospitals.) Requests mailed to CMS should be sent to: Centers for Medicare & Medicaid Services, Center for Medicare Management, Attention: Wage Index Team, Division of Acute Care, C4–08– 06, 7500 Security Boulevard, Baltimore, MD 21244–1850. Each request also must be sent to the fiscal intermediary. The fiscal intermediary will review requests upon receipt and contact CMS immediately to discuss its findings. VerDate Aug<31>2005 17:10 Apr 24, 2006 Jkt 208001 At this point in the process, that is, after the release of the May 2006 wage index data file, changes to the hospital wage data will only be made in those very limited situations involving an error by the fiscal intermediary or CMS that the hospital could not have known about before its review of the final wage index data file. Specifically, neither the intermediary nor CMS will approve the following types of requests: • Requests for wage data corrections that were submitted too late to be included in the data transmitted to CMS by fiscal intermediaries on or before April 14, 2006. • Requests for correction of errors that were not, but could have been, identified during the hospital’s review of the February 24, 2006 wage index data file. • Requests to revisit factual determinations or policy interpretations made by the fiscal intermediary or CMS during the wage index data correction process. Verified corrections to the wage index received timely by CMS and the fiscal intermediaries (that is, by June 12, 2006) will be incorporated into the final wage index to be published by August 1, 2006, to be effective October 1, 2006. We created the processes described above to resolve all substantive wage index data correction disputes before we finalize the wage and occupational mix data for the FY 2007 payment rates. Accordingly, hospitals that do not meet the procedural deadlines set forth above will not be afforded a later opportunity to submit wage index data corrections or to dispute the fiscal intermediary’s decision with respect to requested changes. Specifically, our policy is that hospitals that do not meet the procedural deadlines set forth above will not be permitted to challenge later, before the Provider Reimbursement Review Board, the failure of CMS to make a requested data revision. (See W. A. Foote Memorial Hospital v. Shalala, No. 99–CV–75202–DT (E.D. Mich. 2001) and Palisades General Hospital v. Thompson, No. 99–1230 (D.D.C. 2003.) We refer the reader also to the FY 2000 final rule (64 FR 41513) for a discussion of the parameters for appealing to the Provider Reimbursement Review Board for wage index data corrections. Again, we believe the wage index data correction process described above provides hospitals with sufficient opportunity to bring errors in their wage index data to the fiscal intermediaries’ attention. Moreover, because hospitals will have access to the final wage index data by early May 2006, they have the opportunity to detect any data entry or tabulation errors made by the fiscal PO 00000 Frm 00095 Fmt 4701 Sfmt 4702 24089 intermediary or CMS before the development and publication of the final FY 2007 wage index by August 1, 2006, and the implementation of the FY 2007 wage index on October 1, 2006. If hospitals avail themselves of the opportunities afforded to provide and make corrections to the wage data, the wage index implemented on October 1 should be accurate. Nevertheless, in the event that errors are identified by hospitals and brought to our attention after June 12, 2006, we retain the right to make midyear changes to the wage index under very limited circumstances. Specifically, in accordance with § 412.64(k)(1) of our existing regulations, we make midyear corrections to the wage index for an area only if a hospital can show that: (1) The fiscal intermediary or CMS made an error in tabulating its data; and (2) the requesting hospital could not have known about the error or did not have an opportunity to correct the error, before the beginning of the fiscal year. For purposes of this provision, ‘‘before the beginning of the fiscal year’’ means by the June deadline for making corrections to the wage data for the following fiscal year’s wage index. This provision is not available to a hospital seeking to revise another hospital’s data that may be affecting the requesting hospital’s wage index for the labor market area. As indicated earlier, since CMS makes the wage data available to a hospital on the CMS Web site prior to publishing both the proposed and final IPPS rules, and the fiscal intermediaries notify hospitals directly of any wage data changes after completing their desk reviews, we do not expect that midyear corrections would be necessary. However, under our current policy, if the correction of a data error changes the wage index value for an area, the revised wage index value will be effective prospectively from the date the correction is made. In the FY 2006 IPPS final rule (70 FR 47385), we revised § 412.64(k)(2) to specify that, effective on October 1, 2005, that is beginning with the FY 2006 wage index, a change to the wage index can be made retroactive to the beginning of the Federal fiscal year only when: (1) The fiscal intermediary or CMS made an error in tabulating data used for the wage index calculation; (2) the hospital knew about the error and requested that the fiscal intermediary and CMS correct the error using the established process and within the established schedule for requesting corrections to the wage data, before the beginning of the fiscal year for the applicable IPPS update (that is, by the June 12, 2006 deadline for the FY 2007 wage index); and (3) CMS agreed E:\FR\FM\25APP2.SGM 25APP2 24090 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules wwhite on PROD1PC61 with PROPOSALS2 that the fiscal intermediary or CMS made an error in tabulating the hospital’s wage data and the wage index should be corrected. In those circumstances where a hospital requests a correction to its wage data before CMS calculates the final wage index (that is, by the June deadline), and CMS acknowledges that the error in the hospital’s wage data was caused by CMS’s or the fiscal intermediary’s mishandling of the data, we believe that the hospital should not be penalized by our delay in publishing or implementing the correction. As with our current policy, we indicated that the provision is not available to a hospital seeking to revise another hospital’s data. In addition, the provision cannot be used to correct prior years’ wage data; it can only be used for the current Federal fiscal year. In other situations, we continue to believe that it is appropriate to make prospective corrections to the wage index in those circumstances where a hospital could not have known about or did not have the opportunity to correct the fiscal intermediary’s or CMS’s error before the beginning of the fiscal year (that is, by the June deadline). We note that, as with prospective changes to the wage index, the final retroactive correction will be made irrespective of whether the change increases or decreases a hospital’s payment rate. In addition, we note that the policy of retroactive adjustment will still apply in those instances where a judicial decision reverses a CMS denial of a hospital’s wage data revision request. K. Labor-Related Share for the Wage Index for FY 2007 (If you choose to comment on issues in this section, please include the caption ‘‘Labor-Related Share’’ at the beginning of your comment.) Section 1886(d)(3)(E) of the Act directs the Secretary to adjust the proportion of the national prospective payment system base payment rates that are attributable to wages and wagerelated costs by a factor that reflects the relative differences in labor costs among geographic areas. It also directs the Secretary to estimate from time to time the proportion of hospital costs that are labor-related: ‘‘The Secretary shall adjust the proportion (as estimated by the Secretary from time to time) of hospitals’ costs which are attributable to wages and wage-related costs of the DRG prospective payment rates * * *’’ We refer to the portion of hospital costs attributable to wages and wage-related costs as the labor-related share. The labor-related share of the prospective payment rate is adjusted by an index of VerDate Aug<31>2005 17:10 Apr 24, 2006 Jkt 208001 relative labor costs, which is referred to as the wage index. In its June 2001 Report to Congress, MedPAC recommended that the Secretary ‘‘should reevaluate current assumptions about the proportion of providers’ costs that reflect resources purchased in local and national markets.’’ (Report to the Congress: Medicare in Rural America, Recommendation 4D, page 80.) MedPAC recommended that the labor-related share include the weights for wages and salaries, fringe benefits, contract labor, and other labor-related costs for locally purchased inputs only. MedPAC noted that this would likely result in a lower labor-related share, which would decrease the amount of the national base payment amount adjusted by the wage index. As a result, hospitals located in low-wage markets (those with a wage index less than 1.0) would receive higher payments, while those located in high-wage labor markets would receive lower payments. In our proposed and final rules updating the IPPS for FY 2003 (67 FR 31447, May 9, 2002 and 67 FR 50041, August 1, 2002), we discussed the methodology that we have used to determine the labor-related share. We noted that, at that time, the results of employing that methodology suggested that an increase in the labor-related share (from 71.066 percent to 72.495 percent) was warranted. However, we decided not to propose such an increase in the labor-related share until we conducted further research to determine whether a different methodology for determining the labor-related share should be adopted. Section 403 of Pub. L. 108–173 amended section 1886(d)(3)(E) of the Act to provide that the Secretary must employ 62 percent as the labor-related share unless this ‘‘would result in lower payments to a hospital than would otherwise be made.’’ However, this provision of Pub. L. 108–173 did not change the legal requirement that the Secretary estimate ‘‘from time to time’’ the proportion of hospitals’ costs that are ‘‘attributable to wages and wagerelated costs.’’ In fact, section 404 of Pub. L. 108–173 required the Secretary to develop a frequency for revising the weights used in the hospital market basket, including the labor-related share, to reflect the most current data more frequently than once every 5 years. We believe that this reflected Congressional intent that hospitals receive payment based on either a 62percent labor-related share, or the laborrelated share estimated from time to time by the Secretary, depending on PO 00000 Frm 00096 Fmt 4701 Sfmt 4702 which labor-related share resulted in a higher payment. Section 404 further required us to include in the final IPPS rule for FY 2006 an explanation of the reasons for, and options considered, in determining the frequency for revising the weights used in the hospital market basket, including the labor-related share. In addition, we have continued our research into the assumptions employed in calculating the labor-related share. Our research involves analyzing the compensation share separately for urban and rural hospitals, using regression analysis to determine the proportion of costs influenced by the area wage index, and exploring alternative methodologies to determine whether all or only a portion of professional fees and nonlabor intensive services should be considered labor-related. In the FY 2006 IPPS final rule (70 FR 47392), we presented our analysis and conclusions regarding the frequency and methodology for updating the laborrelated share for FY 2006. We also recalculated a labor-related share of 69.731 percent, using the FY 2002-based PPS market basket for discharges occurring on or after October 1, 2005. In addition, we implemented this revised and rebased labor-related share in a budget neutral manner, but consistent with section 1886(d)(3)(E) of the Act, we did not take into account the additional payments that would be made as a result of hospitals with a wage index less than or equal to 1.0 being paid using a labor-related share lower than the labor-related share of hospitals with a wage index greater than 1.0. The labor-related share is used to determine the proportion of the national PPS base payment rate to which the area wage index is applied. In this proposed rule, we are not making any changes to the national average proportion of operating costs that are attributable to wages and salaries, fringe benefits, professional fees, contract labor, and labor intensive services. Therefore, we are continuing to use a labor-related share of 69.731 percent for discharges occurring on or after October 1, 2006, as reflected in Tables 1A and 1B in the Addendum to this proposed rule. We note that section 403 of Pub. L. 108–173 amended sections 1886(d)(3)(E) and 1886(d)(9)(C)(iv) of the Act to provide that the Secretary must employ 62 percent as the labor-related share unless this employment ‘‘would result in lower payments to a hospital than would otherwise be made.’’ We also are continuing to use a laborrelated share for the Puerto Rico-specific standardized amounts of 58.7 percent for discharges occurring on or after E:\FR\FM\25APP2.SGM 25APP2 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules wwhite on PROD1PC61 with PROPOSALS2 October 1, 2006. Consistent with our methodology for determining the national labor-related share, we added the Puerto Rico-specific relative weights for wages and salaries, fringe benefits, contract labor, nonmedical professional fees, and other labor-intensive services to determine the labor-related share. Puerto Rico hospitals are paid based on 75 percent of the national standardized amounts and 25 percent of the Puerto Rico-specific standardized amounts. For Puerto Rico hospitals, the national labor-related share will always be 62 percent because the wage index for all Puerto Rico hospitals is less than 1.0. A Puerto Rico-specific wage index is applied to the Puerto Rico-specific portion of payments to the hospitals. The labor-related share of a hospital’s Puerto Rico-specific rate will be either 62 percent or the Puerto Rico-specific labor-related share depending on which results in higher payments to the hospital. If the hospital has a Puerto Rico-specific wage index of greater than 1.0, we will set the hospital’s rates using a labor-related share of 62 percent for the 25 percent portion of the hospital’s payment determined by the Puerto Rico standardized amounts because this amount will result in higher payments. Conversely, a hospital with a Puerto Rico-specific wage index of less than 1.0 will be paid using the Puerto Ricospecific labor-related share of 58.7 percent of the Puerto Rico-specific rates because the lower labor-related share will result in higher payments. The Puerto Rico labor-related share of 58.7 percent for FY 2007 is reflected in the Table 1C of the Addendum of this proposed rule. L. Proxy for the Hospital Market Basket (If you choose to comment on issues in this section, please include the caption ‘‘Hospital Market Basket Proxy’’ at the beginning of your comment.) In the FY 2006 IPPS final rule (70 FR 47387), we changed the base year cost structure for the IPPS hospital index for the hospital market basket for operating costs from FY 1997 to FY 2002. As discussed in that final rule, the IPPS hospital index primarily uses the BLS data as price proxies, which are grouped in one of the three BLS categories. The categories are Producer Price Indexes (PPIs), Consumer Price Indexes (CPIs), and Employment Cost Indexes (ECIs), discussed in detail in the FY 2006 IPPS final rule (70 FR 47388 through 47391). We evaluate the price proxies using the criteria of reliability, timeliness, availability, and relevance. The PPIs, CPIs, and ECIs selected by us and used for this proposed rule meet these criteria as described in the FY 2006 IPPS final VerDate Aug<31>2005 17:10 Apr 24, 2006 Jkt 208001 rule. We believe they continue to be the best measures of price changes for the cost categories. Beginning April 2006 with the publication of March 2006 data, the BLS’ ECI will use a different classification system, the North American Industrial Classification System (NAICS), instead of the Standard Industrial Codes (SIC), which will no longer exist. We have consistently used the ECI as the data source for our wages and salaries and other price proxies in the IPPS market basket and are not making any changes to the usage at this time. However, we are soliciting comments on our continued use of the BLS ECI data in light of the BLS change in system usage to the NAICS-based ECI. IV. Other Decisions and Proposed Changes to the IPPS for Operating Costs and GME Costs A. Reporting of Hospital Quality Data for Annual Hospital Payment Update (§ 412.64(d)(2)) (If you choose to comment on issues in this section, please include the caption ‘‘Hospital Quality Data’’ at the beginning of your comment.) 1. Background Section 5001(a) of Public Law 109– 171 (DRA of 2005) sets out new requirements for the Reporting Hospital Quality Data for Annual Payment Update (RHQDAPU) program. The RHQDAPU program was established to implement section 501(b) of Public Law 108–173 (MMA). It builds on our ongoing voluntary Hospital Quality Initiative which is intended to empower consumers with quality of care information to make more informed decisions about their health care while also encouraging hospitals and clinicians to improve the quality of care. Section 5001(a) of Public Law 109– 171 revises the mechanism used to update the standardized amount for payment for hospital inpatient operating costs. New sections 1886(b)(3)(B)(viii)(I) and (II) of the Act provide that the payment update for FY 2007 and each subsequent fiscal year will be reduced by 2.0 percentage points for any ‘‘subsection (d) hospital’’ that does not submit certain quality data in a form and manner, and at a time, specified by the Secretary. New sections 1886(b)(3)(B)(viii)(III) and (IV) of the Act require that we expand the ‘‘starter set’’ of 10 quality measures that we have used since 2003. In expanding these measures, we must begin to adopt the baseline set of performance measures as set forth in a 2005 report issued by the Institute of PO 00000 Frm 00097 Fmt 4701 Sfmt 4702 24091 Medicine (IOM) of the National Academy of Sciences under section 238(b) of Public Law 108–173, effective for payments beginning with FY 2007. The IOM measures include the Hospital Quality Alliance (HQA) measures, the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) patient perspective survey, and three structural measures. We discuss the IOM report more fully in section IV.B. of the preamble to this proposed rule. New sections 1886(b)(3)(B)(viii)(V) and (VI) of the Act require that, effective for payments beginning with FY 2008, we add other quality measures that reflect consensus among affected parties, and provide the Secretary with the discretion to replace any quality measures or indicators in appropriate cases, such as where all hospitals are effectively in compliance with a measure, or the measures or indicators have been subsequently shown to not represent the best clinical practice. Thus, the Secretary has broad discretion to replace measures on the basis that they are not appropriate. New section 1886(b)(3)(B)(viii)(VII) of the Act requires that we establish procedures for making quality data available to the public after ensuring that a hospital has the opportunity to review, in advance, its data that are to be made public. In addition, this section requires that we report quality measures of process, structure, outcome, patients’ perspective on care, efficiency, and costs of care that relate to services furnished in inpatient settings on the CMS Web site. Like the provisions of section 501(b) of Public Law 108–173, the provisions of section 5001(a) of Public Law 109– 171 do not apply to hospitals and hospital units excluded from the IPPS, or to payments to hospitals under other prospective payment systems such as the hospital outpatient PPS. New section 1886(b)(3)(B(viii)(I) of the Act also provides that any reduction will apply only with respect to the fiscal year involved, and will not be taken into account for computing the applicable percentage increase for a subsequent fiscal year. Initially, section 1886(b)(3)(B)(vii) of the Act provided for a reduction of 0.4 percentage points to the update percentage increase for each of FYs 2005 through 2007 for any ‘‘subsection (d) hospital’’ that did not submit data on the starter set of 10 quality measures established by the Secretary of Health and Human Services as of November 1, 2003. Section 5001(a) of Public Law 109–171 limits the 0.4 percentage point reduction to FY 2005 and FY 2006, and E:\FR\FM\25APP2.SGM 25APP2 24092 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules establishes a 2.0 percentage point reduction for FY 2007 and subsequent fiscal years. The starter set of 10 quality measures we established as of November 1, 2003 are: Heart Attack (Acute Myocardial Infarction) • Was aspirin given to the patient upon arrival to the hospital? • Was aspirin prescribed when the patient was discharged? • Was a beta-blocker given to the patient upon arrival to the hospital? • Was a beta-blocker prescribed when the patient was discharged? • Was an ACE inhibitor given for the patient with heart failure? Heart Failure (HF) • Did the patient get an assessment of his or her heart function? • Was an ACE inhibitor given to the patient? wwhite on PROD1PC61 with PROPOSALS2 Pneumonia (PNE) • Was an antibiotic given to the patient in a timely way? • Had the patient received a pneumococcal vaccination? • Was the patient’s oxygen level assessed? We adopted these measures after the Secretary of HHS initiated a partnership with several collaborators intended to promote hospital quality improvement and public reporting of hospital quality information. These collaborators include the American Hospital Association, the Federation of American Hospitals, the Association of American Medical Colleges, the Joint Commission on Accreditation of Healthcare Organizations (JCAHO), the National Quality Forum (NQF), the American Medical Association, the ConsumerPurchaser Disclosure Project, the American Association of Retired Persons, the American Federation of Labor-Congress of Industrial Organizations, the Agency for Healthcare Research and Quality, as well as CMS, Quality Improvement Organizations (QIOs), and others. This collaboration, originally known as the National Voluntary Hospital Reporting Initiative, is now known as the HQA. Hospital data are submitted through the QualityNet Exchange secure Web site (www.qnetexchange.org). This Web site meets or exceeds all current Health Insurance Portability and Accountability Act requirements. Data from this initiative were initially used to populate the Hospital Compare Web site, www.hospitalcompare.hhs.gov. This Web site assists beneficiaries and the general public by providing VerDate Aug<31>2005 17:10 Apr 24, 2006 Jkt 208001 information on hospital quality of care for consumers who need to select a hospital. It further serves to encourage consumers to work with their doctors and hospitals to discuss the quality of care they provide to patients, thereby providing an additional incentive to improve the quality of that care. This starter set of 10 quality measures has been endorsed by the NQF and is a subset of measures currently collected for the JCAHO as part of its certification program. We chose these 10 quality measures in order to collect data that will: (1) Provide useful and valid information about hospital quality to the public; (2) provide hospitals with a sense of predictability about public reporting expectations; (3) begin to standardize data and data collection mechanisms; and (4) foster hospital quality improvement. Many hospitals have participated in the HQA, and are continuing to submit data to the QIO Clinical Warehouse. Since the HQA released the starter set of 10 quality measures, it has continued to release additional quality measures, and has released 11 additional NQF-endorsed quality measures to date. Many HQAparticipating hospitals have been voluntarily reporting on these additional quality measures, although only the starter set of 10 quality measures were subject to potential reductions in hospitals’ annual payment update percentages under section 501(b) of Public Law 108–173. To implement section 501(b) of Public Law 108–173, we created the RHQDAPU program. Originally, the program set out the form, manner, and timeframes for hospitals to submit data regarding the starter set of 10 quality measures. For the FY 2005 payment update, we permitted hospitals to withdraw from the RHQDAPU program at any time up to August 1, 2004. Hospitals that withdrew from the program did not receive the full payment update and, instead, received a reduction of 0.4 percentage points in their payment update. We did not establish a deadline for withdrawal for the FY 2006 payment update. For FY 2006, in order to receive a full payment update, hospitals were required to continuously submit to the QIO Clinical Warehouse abstracted data regarding the starter set of 10 quality measures each calendar quarter according to the schedule found on the QualityNet Exchange Web site. New participants were required to submit these data using the same schedule, starting with the quarter they began discharging patients. The data for each quarter had to be submitted on time and pass all of the edits and consistency PO 00000 Frm 00098 Fmt 4701 Sfmt 4702 checks required in the QIO Clinical Warehouse. Hospitals that did not treat a condition or that had very few discharges were not penalized, and they received the full payment update if they submitted appropriate data on each of the 10 quality measures that they treated for patients who were discharged during the reporting periods. 2. New Procedures for Hospital Reporting of Quality Data We are proposing to amend our regulations at § 412.64(d)(2) to reflect the 2.0 percentage point reduction in the payment update for FY 2007 and subsequent fiscal years for hospitals that do not comply with requirements for reporting quality data as provided for under section 5001(a) of Public Law 109–171. We are also revising the RHQDAPU program’s procedures to reflect our experience with this program and to implement section 5001(a) of Public Law 109–171, including the new requirement for reporting of an expanded set of quality measures. In addition to publication in this proposed rule, all revised procedures will be added to the ‘‘Reporting Hospital Quality Data for Annual Payment Update Reference Checklist’’ section of the QualityNet Exchange Web site. This checklist also contains all of the forms to be completed by hospitals participating in the program. In order to participate in the hospital reporting initiative, hospitals must follow these steps: • Identify a QualityNet Exchange Administrator who follows the registration process and submits the information through the QIO. This must be done regardless of whether the hospital uses a vendor for transmission of data. • Complete the revised ‘‘Reporting Hospital Quality Data for Annual Payment Update Notice of Participation’’ form. All hospitals must send this form to their QIO, no later than August 1, 2006. In addition, before participating hospitals initially begin reporting data, they must register with the QualityNet Exchange, regardless of the method used for submitting data. • Continue to collect data for all 10 ‘‘starter set’’ quality measures (or begin collecting such data, if newly participating in the program), and submit the data to the QIO Clinical Warehouse either using the CMS Abstraction & Reporting Tool (CART), the JCAHO ORYX Core Measures Performance Measurement System, or another third-party vendor tool that has met the measurement specification requirements for data transmission to QualityNet Exchange. The QIO Clinical E:\FR\FM\25APP2.SGM 25APP2 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules Warehouse will submit the data to CMS on behalf of the hospitals. The submission will be done through QualityNet Exchange. Because the information in the QIO Clinical Warehouse is considered QIO information, it is subject to the stringent QIO confidentiality regulations in 42 CFR part 480. We are proposing that hospitals continue to submit data regarding the starter set of 10 quality measures because the existing data submission schedule that we will use for the FY 2007 update relies on discharges that occurred in calendar year (CY) 2005. Because the first three quarters of CY 2005 data already have been submitted, we are not proposing to require hospitals to submit any additional CY 2005 data to address the new quality measures in the anticipated expanded 21 quality measures discussed below. However, we again note that many hospitals have been providing data on these additional measures since they were first included in the HQA set, although these measures did not affect hospitals’ annual payment adjustment under the RHQDAPU program implementing section 501(b) of Public Law 108–173. • For the FY 2007 update, hospitals also will be required to complete and return a written form on which they pledge to submit data on the following set of expanded quality measures (anticipated 21 clinical quality measures), starting with discharges that occur in CY 2006. These expanded quality measures are the HQA-released measures that the 2005 IOM report recommended we use as expanded ‘‘starter’’ measures. As discussed above, new section 1886(b)(3)(B)(viii)(IV) of the Act requires us to begin to adopt the baseline set of performance measures set forth in the 2005 IOM report effective for payments beginning with FY 2007. Hospitals will be required to submit data on the expanded measures to the QIO Clinical Warehouse beginning with discharges that occur in the first calendar quarter of 2006 (January through March discharges). The deadline for hospitals to submit their data for first quarter 2006 is August 15, 2006. The expanded measures are: wwhite on PROD1PC61 with PROPOSALS2 Heart Attack (Acute Myocardial Infarction) • Aspirin at arrival • Aspirin prescribed at discharge • ACE inhibitor (ACE–I) or Angiotensin Receptor Blocker (ARBs) for left ventricular systolic dysfunction • Beta blocker at arrival • Beta blocker prescribed at discharge VerDate Aug<31>2005 17:10 Apr 24, 2006 Jkt 208001 • Thrombolytic agent received within 30 minutes of hospital arrival • Percutaneous Coronary Intervention (PCI) received within 120 minutes of hospital arrival • Adult smoking cessation advice/ counseling Heart Failure (HF) • Left ventricular function assessment • ACE inhibitor (ACE–I) or Angiotensin Receptor Blocker (ARBs) for left ventricular systolic dysfunction • Discharge instructions • Adult smoking cessation advice/ counseling Pneumonia (PNE) • Initial antibiotic received within 4 hours of hospital arrival • Oxygenation assessment • Pneumococcal vaccination status • Blood culture performed before first antibiotic received in hospital • Adult smoking cessation advice/ counseling • Appropriate initial antibiotic selection • Influenza vaccination (collected but not publicly reported—subject to change) Surgical Infection Prevention (SIP) • Prophylactic antibiotic received within 1 hour prior to surgical incision • Prophylactic antibiotics discontinued within 24 hours after surgery end time Further, as recommended in the IOM report, we will be implementing the HCAHPS patient survey in October 2006, to measure patients’ perspectives of care. HCAHPS is designed to make ‘‘apples to apples’’ comparisons of patients’ perspectives on hospital care including communications with doctors, communications with nurses, responsiveness of hospital staff, cleanliness and quietness of the hospital, pain control, communication about medicines, and discharge information. More information on this survey can be found on our Web site: www.cms.hhs.gov/HospitalQualityInits/ downloads/HospitalHCAHPSFactSheet 200512.pdf. We intend to report the first three quarters of these survey data in late 2007 on the Web site: www.hospitalcompare.hhs.gov. HCAHPS was endorsed by the NQF in May 2005. However, at this time, we do not anticipate including HCAHPS as a part of the revised FY 2007 ‘‘Reporting Hospital Quality Data for Annual Payment Update Notice of Participation’’ form. We believe that our proposed procedure will meet the requirement of section 1886(b)(3)(B)(viii)(IV) of the Act that, PO 00000 Frm 00099 Fmt 4701 Sfmt 4702 24093 ‘‘for payments beginning with fiscal year 2007, in expanding the number of measures, under subclause (III), the Secretary shall begin to adopt’’ the IOM report’s set of baseline measures. Section 1886(b)(3)(B)(viii)(III) of the Act states that we must expand, for FY 2007 and each subsequent fiscal year, the set of measures that the Secretary determines to be ‘‘appropriate’’ for the measurement of the quality of care furnished by hospitals in inpatient settings beyond the original quality measures that applied in FY 2005 and FY 2006. We believe that the statute gives the Secretary the discretion to choose what ‘‘begin to adopt’’ should involve in FY 2007 and the number of additional measures, if any, that would be ‘‘appropriate’’ during that time. In proposing our revised procedures, designing the methods that hospitals will use to report during FY 2007, establishing an anticipated set of expanded measures based on the IOM report, and revising RHQDAPU materials, we believe that we have met the statutory requirements. We will continue to explore the feasibility of adopting additional measures for purpose of the FY 2008 update, including the HCAHPS and structure measures described in the IOM report and other measures that reflect consensus among affected parties, as required by new section 1886(b)(3)(B)(viii)(III) through (V) of the Act. For the FY 2007 update, we specify that hospitals must submit these complete data in accordance with the joint CMS/JCAHO sampling requirements located on the QualityNet Exchange Web site. These requirements specify that hospitals are required to submit a random sample or complete population of cases for each of three topics (acute myocardial infarction, heart failure, and pneumonia) covered by the starter set of 10 quality measures. These requirements include all Medicare and non-Medicare patients discharged from hospitals. Hospitals are expected to continuously meet these sampling requirements for the starter set of 10 quality measures for discharges in each quarter. We do not anticipate significant additional burden on hospitals regarding the starter set of 10 quality measures or the anticipated 21 clinical quality measures because all JCAHOaccredited hospitals are currently required to adhere to these sampling requirements in acute myocardial infarction, heart failure, pneumonia, and surgical infection prevention for E:\FR\FM\25APP2.SGM 25APP2 wwhite on PROD1PC61 with PROPOSALS2 24094 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules accreditation and core measure reporting purposes. For the FY 2007 update, hospitals may withdraw from the revised RHQDAPU program at any time up to August 1, 2006. If a hospital withdraws from the program, it will receive a 2.0 percentage point reduction in its payment update. For the FY 2007 update, we will continue to require that hospitals meet the chart validation requirements that we implemented in the FY 2006 IPPS final rule. There were no chart-audit validation criteria in place for FY 2005. Based upon our experience with the FY 2005 submissions and our requirement for reliable and valid data, in the FY 2006 IPPS final rule, we established additional requirements for the data that hospitals were required to submit in order to receive the full FY 2006 payment update (70 FR 47421 and 47422). These requirements, as well as additional information on validation requirements, will continue and are being placed on the QualityNet Exchange Web site. For the FY 2007 payment update, hospitals must pass our validation requirement of a minimum of 80 percent reliability, based upon our chart-audit validation process, for the first three quarters of data from CY 2005. These data were due to the QIO Clinical Warehouse by July 15, 2005 (first quarter CY 2005 discharges), November 15, 2005 (second quarter CY 2005 discharges), and February 15, 2006 (third quarter CY 2005 discharges). We use confidence intervals to determine if a hospital has achieved an 80-percent reliability aggregated over the three quarters. The use of confidence intervals allows us to establish an appropriate range below the 80-percent reliability threshold that demonstrates a sufficient level of validity to allow the data to still be considered valid. We estimate the percent reliability based upon a review of five charts, and then calculate the upper 95-percent confidence limit for that estimate. If this upper limit is above the required 80percent reliability, the hospital data are considered validated. We are using the design-specific estimate of the variance for the confidence interval calculation, which, in this case, is a stratified single stage cluster sample, with unequal cluster sizes. (For reference, see Cochran, William G.: Sampling Techniques, John Wiley & Sons, New York, chapter 3, section 3.12 (1977); and Kish, Leslie: Survey Sampling, John Wiley & Sons, New York, chapter 3, section 3.3 (1964).) Each quarter is VerDate Aug<31>2005 17:10 Apr 24, 2006 Jkt 208001 treated as a stratum for variance estimation purposes. We use a two-step process to determine if a hospital is submitting valid data. In the first step, we calculate the percent agreement for all of the variables submitted in all of the charts. If a hospital falls below the 80-percent cutoff, we restrict the comparison to those variables associated with the starter set of 10 quality measures. We recalculate the percent agreement and the estimated 95-percent confidence interval and again compare to the 80percent cutoff point. If a hospital passes under this restricted set of variables, the hospital is considered to be submitting valid data for purposes of the revised RHQDAPU program. Under the standard appeal process, all hospitals are given the detailed results of the Clinical Data Abstraction Center (CDAC) reabstraction along with their estimated percent reliability and the upper bound of the 95-percent confidence interval. If a hospital does not meet the required 80-percent threshold, the hospital has 10 working days to appeal these results to their QIO. The QIO will review the appeal with the hospital and make a final determination on the appeal. The QIO receives from the hospital the element or elements that are to be evaluated during the appeal process, along with the hospital’s rationale for the difference between the hospital’s abstraction and the CDAC abstraction. In this validation appeal process, the QIO reviews the appeal using the medical record to evaluate the data elements that are being appealed. This process allows for an independent review and is designed to find coding errors on the part of abstractors. QIO appeal decisions are based on the data that the hospital submitted to the QIO Clinical Warehouse. The QIO has 20 calendar days to make a final decision. The QIO can either uphold or reverse the CDAC validation decision. If the QIO does not agree with the hospital’s appeal, the original results stand. However, if the QIO agrees with the hospital, new validation results are calculated and provided to the hospital through the usual processes. This validation appeal process is described in detail at the QualityNet Exchange Web site. In reviewing the hospital data, we plan to combine the samples for first quarter, second quarter, and third quarter (15 cases) into a single stratified sample to determine whether the 80percent reliability level is met. This gives us the greatest accuracy when estimating the reliability level. The confidence interval approach accounts for the variation in coding among the PO 00000 Frm 00100 Fmt 4701 Sfmt 4702 five charts pulled each quarter and for the entire year around the overall hospital mean score (on all individual data elements compared). The closer each case’s reliability score is to the hospital mean score, the tighter the confidence interval established for that hospital. A hospital may code each chart equally inaccurately, achieve a tight confidence interval, and not pass, even though its overall score is just below the passing threshold (75 percent, for example). A hospital with more variation among charts will achieve a broader confidence interval, which may allow it to pass, even though some charts score very low and others score very high. We believe we have adopted the most suitable statistical tests for the hospital data we are trying to validate. We are particularly interested in comments from hospitals on this passing threshold, the confidence interval, and the sampling approach. Based on analytical results from FY 2006, we found confidence intervals using only five charts widely varied in size. As a result of these findings, we decided to combine multiple quarters of validation samples into a single stratified sample to shrink and/or decrease the variation and produce a more reliable estimate of abstraction reliability to determine if any changes in our methodology are required. We will make any necessary revisions to the sampling methodology and the statistical approach through manual issuances and other guidance to hospitals. The CMS Quality Improvement Group will continue to study methods for improving the validation process for hospital submission in regard to completeness and adherence to sampling requirements. Current validation sampling assesses abstraction accuracy, but submission completeness and adherence to sampling requirements are critical prerequisites to produce accurate hospital quality measures. For the FY 2007 update, we plan to revise and post up-to-date confidence interval information on the QualityNet Exchange Web site explaining the application of the confidence interval to the overall validation results. The data are being validated at several levels. There are consistency and internal edit checks to ensure the integrity of the submitted data; there are external edit checks to verify expectations about the volume of the data received. We are proposing that hospitals attest to the completeness and accuracy of the data submitted to the QIO Clinical Warehouse in order to improve aspects of the validation checks. In order to E:\FR\FM\25APP2.SGM 25APP2 wwhite on PROD1PC61 with PROPOSALS2 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules meet this requirement, for each quarter, hospitals will have to sign off on the volume of the data submitted. We plan to provide additional information to explain the data completeness requirement and as well as a form to be completed on the QualityNet Exchange Web site. We will continue to display quality information for public viewing as required by new section 1886(b)(3)(B)(viii)(VII) of the Act. Before we display this information, hospitals will be permitted to review their information as we have it recorded. For hospitals that CMS has determined do not meet the RHQDAPU program requirements for the applicable fiscal year who wish to appeal this determination, the appeals process set forth in 42 CFR Part 405, Subpart R (a Provider Reimbursement Review Board (PRRB) appeal) applies. However, we believe it may be appropriate to establish a structured reconsideration process to precede the PRRB appeal. Currently, hospitals submit letters detailing their reasons for requesting that CMS reconsider its decision that the hospital did not meet the RHQDAPU program requirements. We are proposing to continue this process for FY 2007 RHQDAPU program decisions. However, we are proposing to establish a deadline of November 1, 2006, for hospitals to make such requests related to the FY 2007 RHQDAPU decisions, which will give hospitals a minimum of 30 days to submit reconsideration requests from the dates that the decisions are made public. Further, we are proposing that the November 1, 2006 deadline also would apply to FY 2005 and FY 2006 RHQDAPU program decisions and that a November 1 deadline would apply in all future fiscal years. CMS will officially respond to the letters submitted by hospitals. Further, we are seeking public comment specifically on the need for a more structured reconsideration process to precede any PRRB appeal for FY 2008 and subsequent fiscal years. We also are seeking comment on what such a process would entail. For example, we would expect that such a process, if established, would include— • A limited time, such as 30 days from the public release of the decision, for requesting a reconsideration; • Who in a hospital organization can request such a reconsideration and be notified of its outcome; • The specific factors that CMS will consider in such a reconsideration, such as an inability to submit data timely due to CMS systems failures; • Specific requirements for submitting a reconsideration request, VerDate Aug<31>2005 17:10 Apr 24, 2006 Jkt 208001 such as a written request for reconsideration specifically stating all reasons and factors, including specific data elements, why the hospital believes it did meet the RHQDAPU program requirements; • Specific CMS components that would participate in the reconsideration process; and • The timeframe, such as 60 days, for CMS to provide its reconsideration decision to the hospital. We are also soliciting comments on the reasons for not establishing such a reconsideration process. 3. Electronic Medical Records In the FY 2006 IPPS final rule, we encouraged hospitals to take steps toward the adoption of electronic medical records (EMRs) that will allow for reporting of clinical quality data from the EMRs directly to a CMS data repository (70 FR 47420). We intend to begin working toward creating measures specifications and a system or mechanism, or both, that will accept the data directly without requiring the transfer of the raw data into an XML file as is currently done. The Department continues to work cooperatively with other Federal agencies in the development of Federal health architecture data standards. We encourage hospitals that are developing systems to conform them to both industry standards and, when developed, the Federal Health Architecture Data standards, and to ensure that the data necessary for quality measures are captured. Ideally, such systems will also provide point-ofcare decision support that enables high levels of performance on the measures. Hospitals using EMRs to produce data on quality measures will be held to the same performance expectations as hospitals not using EMRs. Due to the low volume of comments we received on this issue in response to the FY 2006 IPPS rule, in this proposed rule for FY 2007, we again are inviting comments on these requirements and options. In section IV.B.6. of the preamble to this proposed rule, we are also inviting comments on the potential role of effective, interoperable, health information on technology in valuebased purchasing. B. Value-Based Purchasing (If you choose to comment on issues in this section, please include the caption ‘‘Value-Based Purchasing’’ at the beginning of your comment.) 1. Introduction CMS has undertaken a number of activities to improve the quality and PO 00000 Frm 00101 Fmt 4701 Sfmt 4702 24095 efficiency of care delivered to Medicare beneficiaries. Currently, there are several different fee-for-service payment systems under Medicare that are used to pay health professionals and other providers based on the number and complexity of services provided to patients. In general, all providers to which a specific Medicare payment system applies receive the same amount for a service, regardless of its quality or efficiency. As a result, Medicare’s payment systems can direct more resources to hospitals that deliver care that is not of the highest quality or include unnecessary services (for example, duplicative tests and services or services to treat avoidable complications). Therefore, we are examining the concept of ‘‘value-based purchasing,’’ which may use a range of incentives to achieve identified quality and efficiency goals, as a means of promoting better quality of care and more effective resource use in the Medicare payment systems. In considering the concept of value-based purchasing, we are working closely with stakeholder partners, including health professionals and providers. In this proposed rule, we are seeking public comment on value-based purchasing as related specifically to hospitals. In this section, we discuss CMS’ and Congress’ initial steps toward hospital value-based purchasing, which include the Premier Hospital Quality Incentive Demonstration, the RHQDAPU program authorized by section 501(b) of Public Law 108–173 (MMA), and the extended and expanded RHQDAPU program authorized by section 5001(a) of Public Law 109–171 (DRA). (The RHQDAPU program is also discussed in section IV.A. of the preamble to this proposed rule.) In addition, we discuss the issues that must be considered in developing a plan to implement a value-based purchasing plan beginning with FY 2009 for Medicare payments for subsection (d) hospitals. This plan is required by section 5001(b) of the DRA. For each of the required planning issues (measures, data infrastructure, payment methodology, and public reporting), we discuss CMS’ activities to date and solicit comments on outstanding policy questions. Next, we discuss options for implementation of section 5001(c) of Public Law 109–171, which authorizes quality adjustment to DRG payments for certain conditions that were not present on hospital admission. We are soliciting input about detailed design considerations related to each of these issues and the advantages and disadvantages of possible approaches to E:\FR\FM\25APP2.SGM 25APP2 24096 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules demonstration indicates that quality is continuing to improve, particularly for the poorest performing hospitals. Additional information on the Premier Hospital Quality Incentive Demonstration is available on the CMS Web site at: https://www.cms.hhs.gov/ HospitalQualityInits/ 35_HospitalPremier.asp. 2. Premier Hospital Quality Incentive Demonstration One of the ways in which CMS is testing innovative potential approaches to improving quality is through demonstrations and pilot projects. The demonstration most relevant to hospitals is the Premier Hospital Quality Incentive Demonstration. Premier, Inc., a nationwide alliance of not-for-profit hospitals, submitted an unsolicited proposal for consideration by CMS.13 We have partnered with Premier to conduct a demonstration that is designed to test whether the quality of inpatient care for Medicare beneficiaries improves when financial incentives are provided. Under the demonstration, about 270 hospitals are voluntarily providing data on 34 quality measures related to 5 clinical conditions: Heart attack, heart failure, pneumonia, coronary artery bypass graft, and hip and knee replacements. Using the quality measures, CMS identifies hospitals with the highest quality performance in each of the five clinical areas. Hospitals scoring in the top 10 percent in each clinical area receive a 2-percent bonus payment in addition to the regular Medicare DRG payment for the measured condition. Hospitals in the second highest 10 percent receive a 1-percent bonus payment. In the third year of the demonstration, hospitals that do not achieve absolute improvements above the demonstration’s first year composite score baseline (the lowest 20 percent) for that condition will have their DRG payments reduced by 1 or 2 percent, depending on how far their performance is below the baseline. Following the first year of the demonstration (FY 2004), CMS awarded a total of $8.85 million to participating hospitals in the top two deciles for each clinical area. In the aggregate, quality of care improved in all five clinical areas that were measured. Preliminary information from the second year of the wwhite on PROD1PC61 with PROPOSALS2 planning and implementing hospital value-based purchasing. Finally, we discuss and invite comments on how to encourage hospitals to effectively use health information technology to improve efficiency, processes, and health care outcomes, through, for example, adopting interoperable health information technology. 3. RHQDAPU Program 13 The Premier Hospital Quality Incentive Demonstration was authorized under section 402 of Public Law 90–248, Social Security Amendments of 1967 (42 U.S.C. 1395b–1). This section authorizes certain types of demonstration projects that waive compliance with the regular payment methods used in the Medicare program. VerDate Aug<31>2005 17:10 Apr 24, 2006 Jkt 208001 We believe that the acts of collecting and submitting performance data and of publicly reporting comparative information about hospital performance seems to be a strong incentive to encourage hospital accountability. Measurement and reporting can help focus the attention of hospitals and consumers on specific goals and on hospitals’ performance relative to those goals. a. Section 501(b) of Public Law 108–173 (MMA) Since 2003, we have operated the Hospital Quality Initiative,14 which is designed to stimulate improvements in hospital care by standardizing hospital performance measures and data transmission to ensure that all payers, hospitals, and oversight and accrediting entities use the same measures when publicly reporting on hospital performance. Section 501(b) of Public Law 108–173 authorized us to link the collection of data for an initial starter set of 10 quality measures to the Medicare annual update of the standardized payment amount for hospital inpatient operating costs (also known as the RHQDAPU program). For FYs 2005 and 2006, hospitals that met the RHQDAPU program’s requirements received the full annual payment update to their inpatient operating costs, while hospitals that did not comply received an update that was reduced by 0.4 percentage points. For FY 2005, virtually every hospital in the country that was eligible to participate submitted data (98.3 percent), and approximately 96 percent of all participating hospitals met the requirements to receive the full update. The data regarding the starter set of 10 quality measures as well as additional, voluntarily-reported data on other quality measures, are available to the public through the Hospital Compare Web site at: https:// www.hospitalcompare.hhs.gov. 14 For more information about CMS’ Hospital Quality Initiative, see https://www.cms.hhs.gov/ HospitalQualityInits/. PO 00000 Frm 00102 Fmt 4701 Sfmt 4702 b. Section 5001(a) of Public Law 109– 171 (DRA) As discussed in section IV.A. of this preamble, for FY 2007 and each subsequent year, section 5001(a) of Public Law 109–171 amended section 1886(b)(3)(B) of the Act and made changes to the program established under section 501(b) of Public Law 108– 173. These changes require us to expand the number of measures for which data must be submitted, and to change the percentage point reduction in the annual payment update from 0.4 percentage points to 2.0 percentage points for subsection (d) hospitals that do not report the required quality measures in a form and manner, and at a time, specified by the Secretary. Effective for payments beginning with FY 2007, new section 1886(b)(3)(B)(viii)(IV) of the Act requires the Secretary to begin to adopt the expanded set of performance measures set forth in the IOM’s 2005 report entitled, ‘‘Performance Measurement: Accelerating Improvement.’’ 15 Those measures include the HQA measures, the HCAHPS patient perspective survey, and three structural measures.16 Effective for payments beginning with FY 2008, the Secretary must add other measures that reflect consensus among affected parties and may replace existing measures as appropriate. New section 1886(b)(3)(B)(viii)(VII) of the Act requires the Secretary to post hospital quality data on these measures on the CMS Web site. Additional information on the Hospital Quality Initiative is available on the CMS Web site at: https:// www.cms.hhs.gov/HospitalQualityInits. 4. Plan for Implementing Hospital Value-Based Purchasing Beginning with FY 2009 Section 5001(b) of Public Law 109– 171 requires us to develop a plan to implement hospital value-based purchasing beginning with FY 2009. The plan must consider the following issues: (a) The ongoing development, selection, and modification process for measures of quality and efficiency in hospital inpatient settings; (b) the reporting, collection, and validation of quality data; (c) the structure of payment adjustments, including the determination of thresholds of improvements in quality that would 15 Institute of Medicine, ‘‘Performance Measurement: Accelerating Improvement,’’ December 1, 2005, available at https://www.iom.edu/ CMS/3809/19805/31310.aspx. 16 The three structural measures are: (1) Computerized provider order entry; (2) intensive care intensivists; and (3) evidence-based hospital referrals. E:\FR\FM\25APP2.SGM 25APP2 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules substantiate a payment adjustment, the size of such payments, and the sources of funding for the payments; and (d) the disclosure of information on hospital performance. Section 5001(b) of Public Law 109–171 also calls for us to consult with affected parties and to consider relevant demonstrations in developing the plan. Each of these issues (measure development and refinement, data infrastructure, incentives, and public reporting) is discussed below, along with our activities to date and outstanding policy questions. We are seeking comments on these issue areas and outstanding policy questions. wwhite on PROD1PC61 with PROPOSALS2 a. Measure Development and Refinement As we explore the potential connections between performance measurement and incentives, we would like to better understand how to develop valid, meaningful, current performance measures that are aligned with other hospital measurement activities, and an enterprise for development, validation, consensus building, and maintenance of these measures. In addition, before measures could be used to compare the relative quality or cost of care provided by hospitals, we believe that the information would need to be appropriately adjusted to account for relevant differences among hospitals and among their patients. The availability of appropriate measures on which consensus might be achieved depends on the state of the art of research on measure development. We believe that it is desirable for performance measures to be based on appropriate evidence, effectively related to desired outcomes, derived in a transparent fashion involving consultation with experts and affected hospitals, and routinely updated. MedPAC’s 2005 Report to Congress 17 stated that measures should be evidence-based; that collecting and analyzing data should not be unduly burdensome for the provider or for CMS; that risk adjustment should be sufficient to deter providers from avoiding patients who might lower performance scores; that most providers should be able to improve on the measures; that measures should apply to a broad range of care and providers; that measures should capture aspects of care that are under the control of the providers being measured; and that 17 Medicare Payment Advisory Commission: Report to Congress: Medicare Payment Policy, March 2005, pp. 186–187, available at: https://www. medpac.gov/publications/generic_report_ display.cfm?report_type_id=1&sid=2&subid=0. VerDate Aug<31>2005 17:10 Apr 24, 2006 Jkt 208001 areas of care being measured should be those needing improvement. The IOM’s December 2005 report, ‘‘Performance Measurement: Accelerating Improvement’’ (previously cited under footnote #15) recommended that measure sets should build on the work of key public- and private-sector organizations; that national performance measures that have been approved through ongoing consensus processes led by major stakeholder groups are an appropriate starting point; that the limited scope of current measures should be broadened to address efficiency, equity, and patientcenteredness; that quality, costs, and outcomes of care should be measured over longer time intervals; and that measures be applicable to more than one setting so that providers can share accountability for a patient’s care (pp. 8–11). The plan for hospital value-based purchasing mandated by Pub. L. 109– 171 must address the ongoing development, selection, and modification process for measures of quality and efficiency in hospital inpatient settings. We have worked collaboratively in defining consistent, meaningful performance measures for hospitals and other providers for a number of years. The efforts of CMS and its stakeholder partners to develop standardized performance measures increase the likelihood that the measures will be valid, reliable, and widely accepted as viable indicators of performance. Standardized measures also reduce the burden for hospitals that would otherwise have to report different measures to multiple entities, such as accrediting bodies and State agencies. CMS and the HQA (which includes representatives from consumers, hospitals, health professionals, purchasers, and accreditation organizations) collectively selected a starter set of 10 consensus-derived quality measures for public reporting, which was incorporated into the RHQDAPU program authorized by section 501(b) of Pub. L. 108–173. (See section IV.A. of this preamble for a detailed discussion of the RHQDAPU program.) The measures were endorsed by the NQF, a nonprofit voluntary organization that represents a broad range of health care stakeholders and endorses consensus-based national performance standards. CMS has also worked with the JCAHO to align hospital performance measures that we share in common, thereby reducing hospitals’ reporting burden. In April and September 2005, CMS and the HQA identified additional NQFendorsed measures of hospital PO 00000 Frm 00103 Fmt 4701 Sfmt 4702 24097 performance. In section IV.A. of the preamble to this proposed rule, we list these measures and propose to require hospital reporting on these measures under an expanded version of the RHQDAPU program authorized by section 5001(a) of Pub. L. 109–171. These measures are discussed in more detail on the CMS Web site at: https:// www.cms.hhs.gov/HospitalQualityInits/ downloads/ HospitalHQA2004_2007200512.pdf. An additional two outcome measures of 30-day mortality for heart attack and heart failure have been endorsed by the NQF for public reporting. Further, in October 2006, we will be implementing the HCAHPS survey of inpatient perceptions of their hospital care experiences, with the intention that an aggregate HCAHPS measure will become a publicly reported performance measure. HCAHPS was endorsed by the NQF in May 2005. Beyond these, we could also consider including measures from the Surgical Care Improvement Project, measures relating to a hospital’s use of information technology that result in improved patient outcomes, implementation of data standards, and preventable readmissions as quality reporting measures under the RHQDAPU program or the hospital value-based purchasing program. b. Data Infrastructure Implementing measures on which to base a value-based purchasing system would require an infrastructure that could collect appropriate information from hospitals, store and aggregate it as necessary, and prepare it for use in determining appropriate incentives. Hospitals would likely need to be able to generate appropriate data as input for calculation of the measures. For some measures, data that hospitals already submit with claims for payment or for some other administrative purpose may be sufficient. For other measures, hospitals might need to provide information regarding their structure and resources or about the specifics of medical care provided to patients or the outcomes of that care. For that information, hospitals may need special software to assist with data collection and secure channels by which they can transmit data. We are interested in receiving comments on how to develop an infrastructure that would facilitate the efficient transmission and storage of data, and especially, as discussed in sections IV.A.3. and IV.B.6. of the preamble to this proposed rule, in comments on how electronic medical and health record systems could help improve care and be integrated into or facilitate the data collection process. E:\FR\FM\25APP2.SGM 25APP2 wwhite on PROD1PC61 with PROPOSALS2 24098 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules Implementation would require communication channels and data warehouses with sufficient capacity and flexibility to acquire and store data from hospitals. We are considering how we might validate the submitted data, determine incentives based on that data, and transmit these values to Medicare’s fiscal intermediaries. The potential infrastructure would need to be extremely secure and afford the most privacy protection permitted by law. It would also need to minimize the burden of data collection and transmission on providers. It would need to be accurate, efficient, and cost-effective for CMS to administer. The plan for hospital value-based purchasing mandated by Pub. L. 109– 171 must address the reporting, collection, and validation of quality data. Over the past few years, we have developed a data collection and reporting infrastructure for the RHQDAPU program that can transmit performance measurement data via secure channels for its submission, storage, analysis, validation and reporting. Specifically, to facilitate data collection, we have developed the CART software to assist hospitals in the collection of clinical and administrative data used to measure performance improvement. CART, which is provided to hospitals free of charge, is a powerful application that hospitals and their designees can use to abstract clinical data needed for performance measurement from medical records. This tool was designed and developed by CMS with input from the JCAHO and the Medicare QIOs. We have also developed the QualityNet Exchange system for secure transmission of data to the QIO Clinical Warehouse. QNetExchange.org is the CMS-approved Web site for secure communications and data exchange between two or more of the following: Hospitals, performance measurement system vendors, end stage renal disease networks and facilities, QIOs, and CMS. For data warehousing, we have a claims warehouse for Medicare Part A data, which maintains the claims for the most recent 42 months. We also have a QIO Clinical Warehouse that currently contains information on the starter set of 10 quality measures collected under the RHQDAPU program, as well as additional voluntarily reported measures. We must assess the validity of the RHQDAPU information because of its use for quality improvement, public reporting, and determining hospitals’ annual payment updates under the RHQDAPU program. Validation activities assess the reliability of the data that a hospital has submitted, as VerDate Aug<31>2005 17:10 Apr 24, 2006 Jkt 208001 evidenced by the consistency between a hospital’s abstraction and reabstraction by an independent party. We are currently using a contractor, the CDAC, to carry out the validation process under the RHQDAPU program. Hospitals are required to submit certain quality data to the QIO Clinical Warehouse within 4.5 months of the end of each quarterly reporting period. The steps in the validation process are: (1) Check for duplicates; (2) draw a sample; (3) obtain copies of medical records; (4) request and complete CDAC abstraction; (5) post results on QualityNet Exchange for hospitals’ review; and (6) resolve validation appeals. We are seeking comments on how the data submission and validation processes that we currently use for the RHQDAPU program might be adaptable to a hospital value-based purchasing program. One of the key challenges we face in considering implementation of hospital value-based purchasing is minimizing the length of time between our receipt of data and our ability to provide feedback to hospitals on the data. Some of the hospitals that are participating in the RHQDAPU program and the Premier Hospital Quality Incentive Demonstration have asked for more timely feedback on their performance. We recognize that a long delay between the provision of services and feedback about the quality of those services may impede both improvement efforts and a hospital’s motivation to improve. The current lag time between the end of the quarterly reporting period and the availability of performance feedback under the RHQDAPU program is approximately 9 months. Hospitals have 4.5 months to complete their paper medical records and to submit information to the QIO Clinical Warehouse, which roughly coincides with JCAHO’s timeline for submission of data to their ORYX Core Measure Performance Measurement System. Another 4.5 months are required to accomplish the steps in the validation process. We are considering options to decrease the overall length of time between our receipt of data and our ability to provide feedback to hospitals, and we are interested in comments on these options. First, we are considering whether more frequent data submissions, such as monthly submissions, would decrease the time between the provision of services and feedback about the quality of those services. We are aware that some hospitals and their vendors already submit quality data on a monthly basis to JCAHO. However, unless we reduced PO 00000 Frm 00104 Fmt 4701 Sfmt 4702 the sample size per reporting period, the process of validating each month the same number of records that are currently validated each quarter would increase costs significantly. On the other hand, if we reduced the sample size per reporting period, the monthly numbers might be too small to provide for adequate validation. Second, we could shorten the data submission period, which is a significant source of lag time. This option would require hospitals to submit information to the data warehouse more quickly, which could increase the possibility that hospitals would submit less complete data. In addition, this option would require coordination with JCAHO to keep submission timelines congruent, which reduces hospitals’ reporting burden. Third, we could eliminate the validation appeals process, which would reduce the lag time by up to 2 months. Fourth, we could create an expanded role for the third party vendors that assist hospitals with submitting quality data to CMS and JCAHO. For example, CMS could certify third party vendors to also provide standardized validation services and quick performance feedback to their hospital customers. c. Incentive Methodology While measurement of the quality of care and of resources use may be advantageous in itself, we are considering whether and what kind of incentives can further improve outcomes. The potential design of incentives in a value-based purchasing system presents many choices. The implementation plan for hospital valuebased purchasing mandated by Pub. L. 109–171 must address the structure of payment adjustments, including the determination of thresholds of improvements in quality that would substantiate a payment adjustment, the size of such payments, and the sources of funding for the value-based payments. We are interested in comments on the merits of and alternatives to all of the approaches to the design of a value-based purchasing methodology that are discussed below. (1) How Should Incentives Be Structured? A number of options exist for the structure of potential incentives. The incentive methodology could include differential incentives depending on whether hospitals exceed a particular standard of performance. To reflect expectations of continued improvement among hospitals, the standard could be raised in predictable steps over time. Alternatively, incentives could be structured to reward hospitals that E:\FR\FM\25APP2.SGM 25APP2 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules improve from a baseline level of performance. These approaches could be combined to develop an incentive methodology that includes both attaining benchmarks and improving care. (2) What Level of Incentive Is Needed? Value-based purchasing incentives should be targeted to that needed to achieve a desired level of performance. Our experience with implementing section 501(b) of Pub. L. 108–173 (discussed in section IV.A. of this preamble) indicates that a targeted incentive, coupled with active management by CMS, can encourage reporting on quality measures. Nearly every eligible hospital has been willing and able to submit the required data in order to receive the full payment update under the RHQDAPU program. Similarly, our experience with the Premier Hospital Quality Incentive Demonstration indicates that a 1 or 2 percent bonus, coupled with potential reductions for poor performance, may stimulate improvement. Further experience in ascertaining how hospitals respond to incentives will be important for examining incentives over time. wwhite on PROD1PC61 with PROPOSALS2 (3) What Should Be the Source of Incentives? The President’s FY 2007 Budget indicates support for identifying and testing ‘‘budget-neutral incentives that will stimulate Medicare providers to improve performance on quality and efficiency measures.’’ 18 We do not believe that providing additional aggregate funding to finance performance-based incentives is either supportable or necessary. One approach might be to examine how we could identify and apply measurable savings achieved by reducing care that is unnecessary or otherwise inappropriate. For example, we may examine possibilities of improving care coordination, whether this could produce measurable savings, and whether some of the savings generated in one payment system could be used for incentives in another, as long as these reforms do not provide inappropriate incentives to stop providing necessary care. For instance, appropriate quality of care and effective resource use in hospitals and other institutional providers might generate savings that could be used for incentives for both physicians and facilities. 18 Budget of the United States Government, Fiscal year 2007, available at: https://www.whitehouse.gov/ omb/budget/fy2007/. VerDate Aug<31>2005 17:10 Apr 24, 2006 Jkt 208001 (4) What Should The Form Of Incentives Be? Potential approaches for incentives include making an add-on payment to the base payment for individual inpatient hospital services or providing periodic, lump-sum payments on a monthly, quarterly, or annual basis. Under the RHQDAPU program, hospitals that do not submit the required data receive a decrease in the standardized payment amount made for all inpatient operating costs for the applicable fiscal year. In a hospital value-based purchasing system, perservice payments might be made only in connection with the services directly associated with the particular measure for which the hospital achieved a good result. Alternatively, lump-sum payments might be made on a periodic basis to hospitals that achieve particular performance targets. The preferable approach may depend on operational concerns, the strength of incentive effects, and other aspects of the design. We welcome comments on this issue. (5) What Should the Timing of Incentives Be in Relation to Performance? Any value-based purchasing system should seek a balance between rewarding desired performance close to when it occurs and ensuring the accuracy of both performance measurement and incentives. Given the lag times for collecting and reviewing different types of data, some measures may be calculated quickly after the period of performance, while data lag times for other measures may be longer. For instance, structural measures could affect incentives soon after they are collected. Other measures that are based on experience over a time interval may require some time for measured events to manifest. An example of this type of measure would be the rate of mortality within 30 days of hospitalization. (6) How Should We Develop Composite Scores? Encouraging improved performance could be facilitated by valid and reliable methods to aggregate performance data into single composite scores. Composite scoring may also improve consumer understanding of complex performance indicators by combining measures of many dimensions of care into a single score. One example of a composite scoring methodology that we used for the Premier Hospital Quality Incentive Demonstration (discussed in detail above) is a modification of the ‘‘opportunity model,’’ which can be used to address individual weighting, PO 00000 Frm 00105 Fmt 4701 Sfmt 4702 24099 missing data, and sensitivity to case volumes. For example, a hospital that has few or no cases for a particular dimension of care could receive a low score, yet that measure is equally weighted with others in the composite. Under the opportunity model, a composite may be developed for a disease category by dividing the total number of successful interventions by the total number of opportunities for the same targeted interventions. Some of the advantages of the opportunity model are that individual measures are weighted by the volume of opportunities for the associated intervention for a particular hospital; missing values for a particular aspect of care provided by an individual hospital would not prevent that hospital from being represented in a public report; and composite measures may easily accommodate the addition of individual measures. The ‘‘appropriate care measure’’ (ACM) is another composite scoring methodology, which we used in connection with the QIOs. The ACM scoring methodology is patient-centric. For a hospital to receive credit for treating a patient well, the hospital must have met the standard for every measure applicable to that patient’s condition. There are also a number of proprietary composite measures, such as those used by Solucient, Healthgrades, CareScience, and U.S. News & World Report. We are interested in comments on the use of composite scoring for hospital value-based purchasing and on the various composite scoring methodologies. Value-based purchasing methods are still under development, and anticipating their potential effects on the health care system is difficult. We understand that unintended consequences may result from the implementation of these methods. We believe that we will need to assess incentives and evaluate their effects so that we can revise them quickly as we learn more about their impact on hospitals and on inpatient hospital services provided to Medicare beneficiaries. d. Public Reporting The plan for hospital value-based purchasing mandated by Pub. L. 109– 171 must address the public disclosure of information on hospital performance. CMS currently provides public reporting of quality information through the ‘‘Compare’’ Web sites for hospitals, nursing homes, home health agencies, E:\FR\FM\25APP2.SGM 25APP2 24100 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules and dialysis facilities.19 The Compare Web sites provide comparative quality information to consumers and others to help guide choices and drive improvements in the quality of care delivered in these settings. Besides providing Medicare beneficiaries and their health professionals with information to assist them in making informed health care decisions, public reporting of comparative performance data also provides information that is useful to health care consumers who are not Medicare beneficiaries. For example, a consumer who has a Health Savings Account can access CMS’ Hospital Compare Web site to gather comparative quality information to assist in choosing a high quality hospital. CMS is contributing to the Administration’s Consumer-Directed Health Care Initiative by working with our private- and public-sector partners to make health care information more transparent and available to consumers than ever before. (Refer to section IV.M. of this preamble for more information.) We are interested in comments on how we can further stimulate public reporting to increase the transparency and meaningfulness of healthcare performance information. wwhite on PROD1PC61 with PROPOSALS2 5. Considerations Related to Certain Conditions, Including HospitalAcquired Infections Medicare’s IPPS encourages hospitals to treat patients efficiently. Hospitals receive the same DRG payment for stays that vary in length. In many cases, complications acquired in the hospital do not generate higher payments than the hospital would otherwise receive for other cases in the same DRG. To this extent, the IPPS does encourage hospitals to manage their patients well and to avoid complications, when possible. However, complications, such as infections, acquired in the hospital can trigger higher payments in two ways. First, the treatment of complications can increase the cost of hospital stays enough to generate outlier payments. However, the outlier payment methodology requires that hospitals experience large losses on outlier cases (in FY 2006, hospitals must lose $23,600 before a case qualifies for outlier payments, and the hospital would then only receive 80 percent of its costs above the outlier threshold). 19 See CMS’ Hospital Compare Web site, available at: https://www.hospitalcompare.hhs.gov/; Nursing Home Compare Web site, available at: https:// www.medicare.gov/NHCompare; Home Health Compare Web site, available at: https:// www.medicare.gov/HHCompare/Home.asp; Dialysis Facility Compare Web site, available at: https:// www.medicare.gov/Dialysis. VerDate Aug<31>2005 17:10 Apr 24, 2006 Jkt 208001 Second, there are about 121 sets of DRGs that split based on the presence or absence of a complication or comorbidity (CC). The CC DRG in each pair would generate a higher Medicare payment. If an infection acquired during the beneficiary’s hospital stay is one of the conditions on the CC list, the result may be a higher payment to the hospital under a CC DRG. (See section II.C. of this preamble for a detailed discussion of proposed DRG reforms.) Section 5001(c) of Pub. L. 109–171 requires the Secretary to identify, by October 1, 2007, at least two conditions that are (a) high cost or high volume or both, (b) result in the assignment of a case to a DRG that has a higher payment when present as a secondary diagnosis, and (c) could reasonably have been prevented through the application of evidence-based guidelines. For discharges occurring on or after October 1, 2008, hospitals would not receive additional payment for cases in which one of the selected conditions was not present on admission. That is, the case would be paid as though the secondary diagnosis was not present. Section 5001(c) provides that we can revise the list of conditions from time to time, as long as it contains at least two conditions. Section 5001(c) also requires hospitals to submit the secondary diagnoses that are present at admission when reporting payment information for discharges on or after October 1, 2007. We are interested in input about which conditions and which evidence-based guidelines should be selected. 6. Promoting Effective Use of Health Information Technology We recognize the potential for health information technology (HIT) to facilitate improvements in the quality and efficiency of health care services. One recent RAND study found that broad adoption of electronic health records could save more than $81 billion annually and, at the same time, improve quality of care.20 The largest potential savings that the study identified was in the hospital setting because of shorter hospital stays promoted by better coordinated care; less nursing time spent on administrative tasks; better use of medications in hospitals; and better utilization of drugs, laboratory services, and radiology services in hospital outpatient settings. The study also identified potential quality gains through enhanced patient safety, 20 RAND News Release: Rand Study Says Computerizing Medical Records Could Save $81 Billion Annually and Improve the Quality of Medical Care, September 14, 2005, available at: https://rand.org/news/press.05/09.14.html. PO 00000 Frm 00106 Fmt 4701 Sfmt 4702 decision support tools for evidencebased medicine, and reminder mechanisms for screening and preventive care. Despite such large potential benefits, the study found that only about 20 to 25 percent of hospitals have adopted HIT systems. It is important to note the caveats to the RAND study. The projected savings are across the health care sector, and any Federal savings would be a reduced percentage. In addition, there are significant assumptions made in the RAND study. National savings are projected in some cases based on one or two small studies. Also, the study assumes patient compliance, in the form of participation in disease management programs and following medical advice. For these reasons, extreme caution should be used in interpreting these results. In summary, there are mixed signals about the potential of HIT to reduce costs. Some studies have indicated that HIT adoption does not necessarily lead to lower costs and improved quality. In addition, some industry experts have stated that factors such as an aging population, medical advances, and increasing provider expenses would make any projected savings impossible. In his 2004 State of the Union Address, President Bush announced a plan to ensure that most Americans have electronic health records within 10 years.21 One part of this plan involves developing voluntary standards and promoting the adoption of interoperable HIT systems that use these standards. The 2007 Budget states that ‘‘The Administration supports the adoption of health information technology (IT) as a normal cost of doing business to ensure patients receive high quality care.’’ Over the past several years, CMS has undertaken several activities to promote the adoption and effective use of HIT in coordination with other Federal agencies and with the Office of the National Coordinator for Health Information Technology. One of those activities is promotion of data standards for clinical information, as well as for claims and administrative data. In addition, through our 8th Scope of Work contract with the QIOs, we are offering assistance to hospitals on how to adopt and redesign care processes to effectively use HIT to improve the quality of care for Medicare beneficiaries, including computerized physician order entry (CPOE) and bar coding systems. In section IV.A.3. of the 21 Transforming Health Care: The President’s Health Information Technology Plan, available at: https://www.whitehouse.gov/infocus/technology/ economic_policy200404/chap3.html. E:\FR\FM\25APP2.SGM 25APP2 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules preamble to this proposed rule, we again invite comments on streamlining the submission of clinical quality data by using standards-based electronic medical records. (We use the term ‘‘electronic medical records’’ in section IV.A.3. of the preamble to this proposed rule instead of the term ‘‘electronic health records’’ that is used in this section in order to maintain consistency with our request for comments in the FY 2006 IPPS final rule.) Finally, our Premier Hospital Quality Incentive Demonstration provides additional financial payments for hospitals that achieve improvements in quality, which effective HIT systems can facilitate. We are considering the role of interoperable HIT systems in increasing the quality of hospital services while avoiding unnecessary costs. As noted above, the Administration supports the adoption of HIT as a normal cost of doing business. While payments under the IPPS do not vary depending on the adoption and use of HIT, hospitals that leverage HIT to provide better quality services may more efficiently reap the reward of any resulting cost savings. In addition, the adoption and use of HIT may contribute to improved processes and outcomes of care, including shortened hospital stays and the avoidance of adverse drug reactions. We are seeking comments on our statutory authority to encourage the adoption and use of HIT. We also are seeking comments on the appropriate role of HIT in any value-based purchasing program, beyond the intrinsic incentives of the IPPS, to provide efficient care, encourage the avoidance of unnecessary costs, and increase quality of care. In addition, we are seeking comments on promotion of the use of effective HIT through hospital conditions of participation, perhaps by adding a requirement that hospitals use HIT that is compliant with and certified in its use of the HIT standards adopted by the Secretary. We anticipate that the American Health Information Community will provide advice to the Secretary on these issues. wwhite on PROD1PC61 with PROPOSALS2 C. Sole Community Hospitals (SCHs) (§ 412.92) and Medicare-Dependent, Small Rural Hospitals (MDHs) (§ 412.108) 1. Background Under the IPPS, special payment protections are provided to a sole community hospital (SCH). Section 1886(d)(5)(D)(iii) of the Act defines an SCH as a hospital that, by reason of factors such as isolated location, weather conditions, travel conditions, absence of other like hospitals (as VerDate Aug<31>2005 17:10 Apr 24, 2006 Jkt 208001 determined by the Secretary), or historical designation by the Secretary as an essential access community hospital, is the sole source of inpatient hospital services reasonably available to Medicare beneficiaries. The regulations that set forth the criteria that a hospital must meet to be classified as an SCH are located in § 412.92. Under the IPPS, separate special payment protections also are provided to a Medicare-dependent, small rural hospital (MDH). Section 1886(d)(5)(G)(iv) of the Act defines an MDH as a hospital that is located in a rural area, has not more than 100 beds, is not an SCH, and that has a high percentage of Medicare discharges (not less than 60 percent in its 1987 cost reporting year or in 2 of its most recent 3 audited and settled Medicare cost reporting years). The regulations that set forth the criteria that a hospital must meet to be classified as an MDH are located in § 412.108. Although SCHs and MDHs are paid under special payment methodologies, they are section 1886(d) hospitals. Like all section 1886(d) IPPS hospitals, SCHs and MDHs are paid for their discharges based on the DRG weights calculated under section 1886(d)(4) of the Act. Effective with hospital cost reporting periods beginning on or after October 1, 2000, section 1886(d)(5)(D)(i) of the Act (as amended by section 6003(e) of Pub. L. 101–239) and section 1886(b)(3)(I) of the Act (as added by section 405 of Pub. L. 106–113 and further amended by section 213 of Pub. L. 106–554), provide that SCHs are paid based on whichever of the following rates yields the greatest aggregate payment to the hospital for the cost reporting period: • The Federal rate applicable to the hospital; • The updated hospital-specific rate based on FY 1982 costs per discharge; • The updated hospital-specific rate based on FY 1987 costs per discharge; or • The updated hospital-specific rate based on FY 1996 costs per discharge. For purposes of payment to SCHs for which the FY 1996 hospital-specific rate yields the greatest aggregate payment, payments for discharges during FYs 2001, 2002, and 2003 were based on a blend of the FY 1996 hospital-specific rate and the greater of the Federal rate or the updated FY 1982 or FY 1987 hospital-specific rate. For discharges during FY 2004 and subsequent fiscal years, payments based on the FY 1996 hospital-specific rate are 100 percent of the updated FY 1996 hospital-specific rate. For each cost reporting period, the fiscal intermediary determines which of PO 00000 Frm 00107 Fmt 4701 Sfmt 4702 24101 the payment options will yield the highest rate of payment to the SCH. Payments are automatically made at the highest rate using the best data available at the time the fiscal intermediary makes the determination. However, it may not be possible for the fiscal intermediary to determine in advance precisely which of the rates will yield the highest payment by year’s end. In many instances, it is not possible to forecast the outlier payments, the amount of the DSH adjustment, or the IME adjustment, all of which are applicable only to payments based on the Federal rate. The fiscal intermediary makes a final adjustment at the close of the cost reporting period after it determines precisely which of the payment rates would yield the highest payment to the hospital. If an SCH disagrees with the fiscal intermediary’s determination regarding the final amount of program payment to which it is entitled, it has the right to appeal the fiscal intermediary’s decision in accordance with the procedures set forth in Subpart R of Part 405, which concern provider payment determinations and appeals. Through and including FY 2006, under section 1886(d)(5)(G) of the Act, MDHs are paid based on the Federal national rate or, if higher, the Federal national rate plus 50 percent of the difference between the Federal national rate and the updated hospital-specific rate based on FY 1982 or FY 1987 costs per discharge, whichever is higher. However, section 5003 of Pub. L. 109– 171 (DRA) modified these rules for discharges occurring on or after October 1, 2006. Section 5003(c) changed the 50percent adjustment to 75 percent. Section 5003(b) requires that an MDH use the 2002 cost reporting year as its base year (that is, the FY 2002 hospitalspecific rate), if that use results in a higher payment. An MDH does not have the option to use its FY 1996 hospitalspecific rate. We discuss our proposed changes to implement section 5003 of the DRA in section IV.C.4 of this preamble. 2. Volume Decrease Adjustment for SCHs and MDHs (If you choose to comment on the issues in this section, please include the caption (‘‘SCH/MDH Volume Decrease Adjustment’’ at the beginning of your comment.) Section 1886(d)(5)(D)(ii) of the Act requires that the Secretary make a payment adjustment to an SCH that experiences a decrease of more than 5 percent in its total number of inpatient discharges from one cost reporting period to the next, if the circumstances E:\FR\FM\25APP2.SGM 25APP2 wwhite on PROD1PC61 with PROPOSALS2 24102 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules leading to the decline in discharges were beyond the SCH’s control. Section 1886(d)(5)(G)(iii) of the Act requires that the Secretary make a payment adjustment to an MDH that experiences a decrease of more than 5 percent in its total number of inpatient discharges from one cost reporting period to the next, if the circumstances leading to the decline in discharges were beyond the MDH’s control. These adjustments were designed to compensate an SCH or MDH for the fixed costs it incurs in the year following the reduction in discharges (this is, the second year), which it may be unable to reduce. Such costs include the maintenance of necessary core staff and services. However, we believe that not all staff costs can be considered fixed costs. Using a standardized formula specified by us, the SCH or MDH must demonstrate that it appropriately adjusted the number of staff in inpatient areas of the hospital based on the decrease in the number of inpatient days. This formula examines nursing staff in particular. If an SCH or MDH has an excess number of nursing staff, the cost of maintaining those staff members is deducted from the total adjustment. One exception to this policy is that no SCH or MDH may reduce its number of staff to a level below what is required by State or local law. In other words, an SCH or MDH will not be penalized for maintaining a level of staff that is consistent with State or local requirements. The process for determining the amount of the volume decrease adjustment can be found in section 2810.1 of the Provider Reimbursement Manual. Fiscal intermediaries are responsible for establishing whether an SCH or MDH is eligible for a volume decrease adjustment and, if so, the amount of the adjustment. To qualify for this adjustment, the SCH or MDH must demonstrate that: (a) A 5 percent or more decrease of total discharges has occurred; and (b) the circumstance that caused the decrease in discharges was beyond the control of the hospital. Once the fiscal intermediary has established that the SCH or MDH satisfies these two requirements, it will calculate the adjustment. The adjustment amount is determined by subtracting the second year’s DRG payment from the lesser of: (a) The second year’s costs minus any adjustment for excess staff; or (b) the previous year’s costs multiplied by the appropriate IPPS update factor minus any adjustment for excess staff. The SCH or MDH receives the difference in a lump-sum payment. The adjustment for excess staff is currently broken into two parts: The VerDate Aug<31>2005 17:10 Apr 24, 2006 Jkt 208001 routine acute care area (excluding intensive care unit areas) excess staff adjustment and the intensive care unit excess staff adjustment. (For purposes of this section of the preamble, any subsequent references to the routine acute care area of an SCH or MDH refer to the routine acute care area excluding any intensive care unit areas.) In order to determine whether or not the hospital is appropriately staffing its routine acute care and its intensive care unit area, the fiscal intermediary compares the hospital’s actual number of nursing staff in each area with the staffing of like-size hospitals in the same census region. Currently, fiscal intermediaries obtain average nurse staffing data from the American Hospital Association’s HAS/ Monitrend Data Book. (More information on the HAS/Monitrend Data Book follows.) If a hospital employs more than the reported average number of nurses in the routine acute care or intensive care unit area for hospitals of its size and census region, the fiscal intermediary reduces the amount of the adjustment by the cost of maintaining the additional staff. The amount of the reduction is calculated by multiplying the actual number of nursing staff above the reported average by the average nurse salary for that hospital as reported on the Medicare cost report. The complete process for determining the amount of the adjustment can be found at section 2810.1 of the Provider Reimbursement Manual. Representatives from several SCH and MDH hospitals have contacted CMS with concerns regarding the current use of the HAS/Monitrend data for determining the volume decrease adjustment for SCHs and MDHs. Because the most recent HAS/ Monitrend Data Book was published in 1989 and is no longer updated, the hospitals expressed concern that the information in the publication is too outdated for current use. Therefore, in this proposed rule, we are presenting for public comment a new methodology for calculating the adjustment for excess staff under section IV.C.2.b. of this preamble. a. HAS/Monitrend Data From the mid-1960’s to 1989, the Healthcare Administrative Services Division of the American Hospital Association (AHA) published biannually the HAS/Monitrend Data Book, a collection of aggregate hospital statistics. Hospitals completed surveys based on 6 months of data; these data were categorized into one of five bedsize groups and into one of nine census regions. The bed size groups were 0–49, 50–99, 100–199, 200–399, and 400 or PO 00000 Frm 00108 Fmt 4701 Sfmt 4702 more beds. The census regions include: (1) New England (Connecticut, Maine, Massachusetts, New Hampshire, Rhode Island, and Vermont); (2) Middle Atlantic (New Jersey, New York, and Pennsylvania); (3) South Atlantic (Delaware, District of Columbia, Florida, Georgia, Maryland, North Carolina, South Carolina, Virginia, and West Virginia); (4) East North Central (Illinois, Indiana, Michigan, Ohio, and Wisconsin); (5) East South Central (Alabama, Kentucky, Mississippi, and Tennessee); (6) West North Central (Iowa, Kansas, Minnesota, Missouri, Nebraska, North Dakota, and South Dakota); (7) West South Central (Arkansas, Louisiana, Oklahoma, and Texas); (8) Mountain (Arizona, Colorado, Idaho, Montana, Nevada, New Mexico, Utah, and Wyoming); and (9) Pacific (Alaska, California, Hawaii, Oregon, and Washington). The survey collected data on nearly 400 items pertaining to utilization, resource allocation, departmental productivity, departmental direct expenses, and staffing. In order for aggregate data to be published for a category, at least three hospitals in the same census region and bed-size group had to have responded to the survey. For the final 1989 publication, 996 acute care hospitals completed the survey. CMS has used the HAS/Monitrend Data Book since 1984 to determine the volume decrease adjustment for SCHs; the data also have been used for the volume decrease adjustment for MDHs since 1990. In particular, CMS has used the HAS/Monitrend data on the number of paid nursing hours per patient day (‘‘paid hours/patient day’’) in both the general acute care area (‘‘Medical and Surgical Units’’) and the intensive care unit (‘‘Med & Surg Intensive Care Unit’’). More information on the HAS/ Monitrend Data Book is available from the American Hospital Association, 840 North Lake Shore Drive, Chicago, Illinois 60611. b. HAS/Monitrend Data Book Replacement Alternative Below, we are proposing an alternative method for determining an SCH’s or MDH’s target number of core staff using data from the Medicare cost report and the occupational mix survey. However, this methodology would only establish one combined average number of nursing hours per patient day for both the inpatient routine care and the intensive care unit areas. We are proposing to use the Medicare cost report and occupational mix survey data beginning with requests for adjustments for FY 2008 cost reports. We welcome E:\FR\FM\25APP2.SGM 25APP2 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules wwhite on PROD1PC61 with PROPOSALS2 comments from the public on this proposal. (1) Occupational Mix Survey As discussed in section III.C. of the preamble to this proposed rule, the CMS occupational mix survey collects from each hospital data on the mix of employees in the areas of the hospital payable under the IPPS for a limited number of hospital occupational categories. These categories (nursing, therapy, medical and clinical laboratory, dietary, and pharmacy) each include several SOCs, as defined by the BLS, that may be used by hospitals with different mixes to provide specific aspects of patient care. For example, hospitals may choose to employ different combinations of registered nurses, licensed practical nurses, and nurses’ aides for the purpose of providing nursing care to their patients. The varying labor costs associated with these choices reflect hospital management decisions rather than geographic differences in the costs of labor. The data collected on the survey are used to adjust hospitals’ wage data to account for each hospital’s SOC mix within the general occupational categories. Hospitals completed the first occupational mix survey using FY 2003 data. A second survey will be completed this year (FY 2006). Under this proposed method, we would calculate the nursing hours per inpatient day for each SCH or MDH by dividing the number of paid nursing hours (for registered nurses, licensed practical nurses, and nursing aides) reported on the occupational mix survey by the number of inpatient days reported on the Medicare cost report. The results would be grouped into the same bed-size groups and census regions as the HAS/Monitrend Data Book. CMS would publish the mean number of nursing hours per patient day for each census region and bed-size group in the Federal Register. (We are proposing to include licensed practical nurse and nursing aide hours as well as registered nurse hours to reflect the various levels of nursing staff employed by hospitals to provide direct patient care.) The results that would be published in the Federal Register would be the target number of core nursing hours per patient day. For purposes of the volume decrease adjustment, the published data would be utilized in the same way as VerDate Aug<31>2005 17:10 Apr 24, 2006 Jkt 208001 the HAS/Monitrend data: the fiscal intermediary would multiply the SCH’s or MDH’s number of inpatient days by the applicable published hours per patient day. This figure would be divided by the average number of worked hours per year per nurse (for example, 2,080 for a standard 40-hour week). The result would be the target number of core nursing staff for the particular SCH or MDH. If necessary, the cost of any excess staff (number of FTEs that exceed the published number) would be removed from the second year’s costs or, if applicable, the previous year’s costs multiplied by the IPPS update factor when determining the volume decrease adjustment. Because we are considering registered nurses, licensed practical nurses, and nursing aides, the fiscal intermediary would calculate the excess staff adjustment by multiplying the number of excess staff by the average salary among the three groups, taking into account how many registered nurses, licensed practical nurses, and nursing aides work at the facility. (For instance, if the hospital’s average salary for a registered nurse is $50,000 and the hospital’s average salary for a licensed practical nurse is $30,000 and the hospital employs 5 registered nurses, 3 licensed practical nurses, and no nursing aides, the calculated average salary would be $42,500 for one FTE (((5 × $50,000) + (3 × $30,000))/8 = $42,500). We are proposing to use the results of the FY 2006 occupational mix survey and begin applying the proposed methodology for adjustments resulting from a decrease in discharges between FYs 2007 to 2008. Because the occupational mix survey is conducted once every 3 years, we would update the data set every 3 years. We are proposing to use the FY 2006 survey results and not to utilize the FY 2003 survey results to take into account comments we received in response to the first set of results from the occupational mix survey, and to ensure that hospitals have had some experience with the occupational mix survey before it is used in determining these adjustments. Because we have used the HAS/Monitrend data for so many years, we believe it is appropriate to continue to use these data for one more year and wait for the results of the FY 2006 survey. This will give hospitals an opportunity to have some experience with the occupational mix survey before PO 00000 Frm 00109 Fmt 4701 Sfmt 4702 24103 it is used in these adjustments, and will allow us to compare the data from the FY 2006 occupational mix survey with the data reported in the 2003 survey, if necessary. However, for purposes of describing how we would implement this methodology, we have applied the proposed calculation to the FY 2003 occupational mix survey data. While we are not proposing to use the FY 2003 data, we believe that it is the best data available at this time to help explain our proposed methodology. To calculate the results below, we merged the FY 2003 occupational mix survey results into the FY 2003 cost report file. We eliminated all observations for non-IPPS providers, providers who failed to complete the occupational mix survey, and providers for which provider numbers, bed counts and/or day counts were missing. We also only included providers with 12 months’ worth of data. This resulted in a pool of approximately 3,541 providers. For each provider in this pool, we calculated the number of nursing hours by adding the number of registered nurse, license practical nurse, and nursing aide hours reported on the occupational mix survey. We divided the result of this calculation by the total number of inpatient days reported on the cost report to determine the number of nursing hours per patient day. For purposes of calculating the census regional averages for the various bedsize groups, we are proposing to only include observations that fall within 3 standard deviations of the mean of all observations, thus removing potential outliers in the data. Below are the results of this calculation. We realize that, in the chart, some results may appear to be anomalous (for example, 0–49 beds for census regions 4, 6, and 8). We believe a small number of outlier data may have skewed the mean, which was the basis for identifying data within 3 standard deviations to include in the calculations. Therefore, we are soliciting comments on whether we should consider another method for determining the appropriateness of using available data in calculating the average number of nursing hours per patient day. For instance, in this case, the results are based on the inclusion of data within 3 standard deviations of the mean. Alternatively, we could use another measure of central tendency. E:\FR\FM\25APP2.SGM 25APP2 24104 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules PAID NURSING HOURS PER PATIENT DAY Census region Number of beds 1 0–49 ............................................. 50–99 ........................................... 100–199 ....................................... 200–399 ....................................... 400 or more ................................. 2 3 4 5 6 7 8 9 16.38 13.71 11.98 12.40 13.32 8.33 11.07 10.99 12.19 9.42 19.26 15.66 14.38 14.19 12.77 30.76 17.37 13.44 13.00 15.39 11.72 13.69 11.93 10.57 9.51 26.70 15.53 17.03 16.20 19.70 20.50 12.51 13.91 11.35 12.36 31.00 16.63 14.33 14.06 17.64 17.39 16.11 13.32 15.33 13.32 wwhite on PROD1PC61 with PROPOSALS2 (2) American Hospital Association Annual Hospital Survey In the process of evaluating different sources of data to replace the HAS/ Monitrend Data Book, we considered using the results of the AHA’s Annual Hospital Survey. This survey includes over 700 data fields that cover facilities and services, utilization, finances, and staffing. On average, 6,000 hospitals complete the survey each year. Section E of the Annual Survey Database includes total facility staffing data. FTE counts are available for registered nurses, practical and vocational nurses, nursing assistive personnel, and other personnel. However, FTEs in outpatient areas, excluded units, and nursing home units within the hospital are also included in the aggregated FTE counts. It is not possible to separately identify how many of the total reported nursing FTEs are attributable to the general acute care facility and how many to a distinct part unit or outpatient facility. Due to varying staffing needs in distinct part units and outpatient areas, we believe that any calculation of average staffing for the inpatient acute care area should consist of data solely from this area of the hospital. Nevertheless, we are requesting comments on this alternative, and possible means for addressing the issue of staffing outside the inpatient acute care area. 3. Mandatory Reporting Requirements for Any Changes in the Circumstances Under Which a Hospital Was Designated as an SCH or MDH (If you choose to comment on the issues in this section, please include the caption (‘‘SCH/MDH Changes in Qualification Status’’ at the beginning of your comment.) Under § 412.92(b)(3) and § 412.108(b)(4) respectively, once a facility has been designated as an SCH or MDH, the classification remains in effect without need for reapproval unless there is a change in the hospital’s circumstances. Currently, the regulations do not contain an explicit requirement that an SCH report to CMS a change in circumstances that would affect its status as an SCH. Likewise, the VerDate Aug<31>2005 17:10 Apr 24, 2006 Jkt 208001 current regulations for MDHs do not contain an explicit requirement that an MDH report to CMS a change in the circumstances affecting its MDH status. However, the fiscal intermediary is required to evaluate on an ongoing basis whether a hospital continues to qualify for MDH status. We have become aware of several hospitals that have maintained SCH or MDH status after the original circumstances that led to the respective classification changed. We are proposing to amend § 412.92(b)(3) for SCHs and § 412.108(b)(4) for MDHs to require an SCH or MDH to report to its appropriate CMS Regional Office when the circumstances under which the hospital was approved for SCH or MDH status have changed. At that time, the CMS Regional Office will determine whether the SCH or MDH continues to meet the criteria for classification under § 412.92 or § 412.108. If an SCH or MDH no longer meets these criteria, the CMS Regional Office will issue a letter canceling the classification within 30 days of its determination. If the circumstances affecting a hospital’s SCH or MDH classification change and the hospital does not disclose the information to the CMS Regional Office, CMS will cancel the hospital’s SCH or MDH designation effective on the earliest discernable date on which the fiscal intermediary can determine that the hospital no longer met the criteria for classification. For MDHs, this reporting requirement is in addition to the fiscal intermediary’s ongoing evaluations of whether a hospital continues to qualify for MDH status as set out in our existing regulations at § 412.108(b)(5). 4. Proposed Payment Changes for MDHs Under the DRA of 2005 (Proposed § 412.79 and Existing §§ 412.90(j) and 412.108) (If you choose to comment on this section, please include the caption ‘‘Payments to MDHs’’ at the beginning of your comment.) a. Background Under § 412.108(a) of our regulations, in order to be classified as an MDH, a PO 00000 Frm 00110 Fmt 4701 Sfmt 4702 hospital must: (1) Be located in a rural area (as defined in 42 CFR Part 412, Subpart D); (2) have 100 or fewer beds (as defined at § 412.105(b)) during the cost reporting period; (3) must not be classified as an SCH (as defined in § 412.92); and (4) have no less than 60 percent of its inpatient days or discharges attributable to inpatients receiving Medicare Part A benefits during either its cost reporting period beginning in FY 1987, or in two of the last three of its audited cost reports that have been settled. MDHs have been eligible for a series of special payment rates under the IPPS. Section 6003(f) of Pub. L. 101–239 created the first IPPS special payment methodology for MDHs. Effective for cost reporting periods beginning on or after April 1, 1990, and ending on or before March 31, 1993, an MDH was paid based on whichever of the following rates yielded the greatest aggregate payment for the cost reporting period: • The Federal payment rate applicable to the MDH; • The MDH’s updated hospitalspecific rate based on its FY 1982 base period costs per discharge; or • The MDH’s updated hospitalspecific rate based on its FY 1987 base period costs per discharge. Section 13501(e)(1) Pub. L. 103–66 extended the MDH payment provisions through 1994 and provided that, for discharges occurring after March 31, 1993, if an MDH’s applicable hospitalspecific rate exceeded the Federal payment rate, the additional payment was limited to 50 percent of the amount by which the applicable updated hospital-specific rate exceeded the Federal rate. These provisions expired effective for cost reporting periods beginning on or after October 1, 1994. Section 4204(a)(3) of Pub. L. 105–33 amended sections 1886(d)(5)(G)(i) and (d)(5)(G)(ii)(II) of the Act to reinstate these special MDH payment provisions, including the 50-percent limitation, for cost reporting periods ‘‘beginning on or after October 1, 1997, and before October 1, 2001.’’ Section 321(b)(1) of Pub. L. 106–113 made a technical E:\FR\FM\25APP2.SGM 25APP2 wwhite on PROD1PC61 with PROPOSALS2 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules amendment to these provisions of the Act (which describes the time periods for which some of the special payment provisions apply and the time periods during which a hospital may be considered an MDH under section 1886(d)(1)(G)(iv) of the Act) by striking the language ‘‘beginning on or after October 1, 1997, and before October 1, 2001’’ and replacing it with ‘‘discharges occurring on or after October 1, 1997, and before October 1, 2001’’. This change was made effective as if included in Pub. L. 105–33. Pub. L. 106–113 also provided for a 5-year extension of the MDH special payment provisions. Section 404(a) of that law further amended sections 1886(d)(1)(G)(i) and (d)(1)(G)(ii)(II) of the Act by striking the phrase ‘‘and before October 1, 2001’’ and inserting the phrase ‘‘and before October 1, 2006’’. Section 5003(a) of Pub. L. 109–171 (DRA of 2005) amended the MDH special payment provisions in the Act. It amended section 1886(d)(5)(G) of the Act and made a conforming amendment under section 1886(b)(3)(D) of the Act to provide for another 5-year extension of the special MDH payment methodology. Under this extension, a revised special MDH payment methodology will apply for discharges occurring on or after October 1, 2006, and before October 1, 2011. As stated earlier, currently, MDHs are paid using whichever rate yields the greatest aggregate payment: The Federal payment rate or, if higher, the Federal payment rate plus 50 percent of the difference between the Federal payment rate and the updated hospital-specific rate based on FY 1982 or FY 1987 base period costs per discharge. Section 5003(b) of Pub. L. 109–171 provides that, for discharges occurring on or after October 1, 2006, and before October 1, 2011, an MDH’s updated hospital-specific rate will be the FY 2002 base period costs per discharges if the FY 2002 based hospital-specific rate results in a payment increase. In cases where no payment increase results from using FY 2002 hospital-specific rate, an MDH will continue to be paid based on the higher of its updated FY 1982 or FY 1987 hospital-specific rates, if using one of those rates results in a payment higher than that under the Federal payment rate. (Unlike an SCH, an MDH does not have the option of using its updated FY 1996 hospital-specific rate.) Under section 5003(c) of Pub. L. 109– 171, for discharges occurring on or after October 1, 2006, and before October 1, 2011, if an MDH’s applicable hospitalspecific rate exceeded the Federal payment rate, the additional payment is VerDate Aug<31>2005 17:10 Apr 24, 2006 Jkt 208001 limited to 75 percent (as opposed to the previous 50 percent) of the amount by which the applicable updated hospitalspecific rate exceeded the Federal rate. Section 5003(d) of Pub. L. 109–171 enhances the DSH adjustment for MDHs for discharges occurring on or after October 1, 2006. We discuss our proposals to implement this provision in section IV.F.4. of this preamble. b. Proposed Regulation Changes We are proposing to amend our regulations to implement section 5003(a) through (c) of Pub. L. 109–171. We are proposing to add a new § 412.79 that describes how we would compute and update the MDH hospital-specific rate based on its FY 2002 base period. In addition, we are proposing to revise § 412.90(j) to reflect the extension of the MDH special payment provisions to discharges occurring before October 1, 2011. We also are proposing to amend § 412.108 by revising paragraph (a) and adding a new paragraph (c)(2)(iii) to reflect the changes to the special payment methodology effective for discharges occurring on or after October 1, 2006, and before October 1, 2011. As a part of our proposed amendments to § 412.90(j) and § 412.108(a), we are making two technical corrections. Section 412.90(j) describes when an MDH may receive a special payment adjustments, while § 412.108(a) discusses the definition of an MDH. Each of these sections now refers to ‘‘cost reporting periods beginning on or after April 1, 1990 and before October 1, 1994, or beginning on or after October 1, 1997 and before October 1, 2006’’. However, as noted above, sections 1886(d)(5)(G)(i) and (d)(5)(G)(ii)(II) of the Act, the provisions of the Act from which these time periods were drawn, were amended by Pub. L. 106–113. Sections 321(b)(1) and 404(a) of Pub. L. 106–113 amended sections 1886(d)(5)(G)(i) and (d)(5)(ii)(II) of the Act so that the phrase in each section ‘‘beginning on or after October 1, 1997, and before October 1, 2001’’ was replaced with the phrase ‘‘discharges occurring on or after October 1, 1997, and before October 1, 2006’’. (Section 5003(a)(1) of Pub. L. 109–171 changed the ending date in these provisions from ‘‘before October 1, 2006’’ to ‘‘before October 1, 2011’’.) Therefore, we are removing the incorrect phrase ‘‘beginning on or after October 1, 1997’’ from each of these regulations and inserting the phrase, ‘‘discharges occurring on or after October 1, 1997’’, to conform the regulations to the statute. PO 00000 Frm 00111 Fmt 4701 Sfmt 4702 24105 5. Proposed Technical Change In paragraph (b)(2)(iv) of § 412.92, we are proposing to correct the spelling of the word ‘‘adjustment’’ by changing it to ‘‘adjustment’’. D. Rural Referral Centers (§ 412.96) (If you choose to comment on issues in this section, please include the caption ‘‘Rural Referral Centers’’ at the beginning of your comment.) Under the authority of section 1886(d)(5)(C)(i) of the Act, the regulations at § 412.96 set forth the criteria that a hospital must meet in order to qualify under the IPPS as a rural referral center. For discharges occurring before October 1, 1994, rural referral centers received the benefit of payment based on the other urban standardized amount rather than the rural standardized amount. Although the other urban and rural standardized amounts are the same for discharges occurring on or after October 1, 1994, rural referral centers continue to receive special treatment under both the DSH payment adjustment and the criteria for geographic reclassification. Section 402 of Pub. L. 108–173 raised the DSH adjustment for other rural hospitals with less than 500 beds and rural referral centers. Other rural hospitals with less than 500 beds are subject to a 12 percent cap on DSH payments. Rural referral centers are not subject to the 12 percent cap on DSH payments that is applicable to other rural hospitals (with the exception of rural hospitals with 500 or more beds). Rural referral centers are not subject to the proximity criteria when applying for geographic reclassification, and they do not have to meet the requirement that a hospital’s average hourly wage must exceed 106 percent of the average hourly wage of the labor market area where the hospital is located. Section 4202(b) of Pub. L. 105–33 states, in part, ‘‘[a]ny hospital classified as a rural referral center by the Secretary * * * for fiscal year 1991 shall be classified as such a rural referral center for fiscal year 1998 and each subsequent year.’’ In the August 29, 1997 final rule with comment period (62 FR 45999), we also reinstated rural referral center status for all hospitals that lost the status due to triennial review or MGCRB reclassification, but not to hospitals that lost rural referral center status because they were now urban for all purposes because of the OMB designation of their geographic area as urban. However, subsequently, in the August 1, 2000 final rule (65 FR 47089), we indicated that we were revisiting that decision. Specifically, we stated that we would E:\FR\FM\25APP2.SGM 25APP2 24106 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules permit hospitals that previously qualified as a rural referral center and lost their status due to OMB redesignation of the county in which they are located from rural to urban to be reinstated as a rural referral center. Otherwise, a hospital seeking rural referral center status must satisfy the applicable criteria. We used the definitions of ‘‘urban’’ and ‘‘rural’’ specified in Subpart D of 42 CFR Part 412. One of the criteria under which a hospital may qualify as a rural referral center is to have 275 or more beds available for use (§ 412.96(b)(1)(ii)). A rural hospital that does not meet the bed size requirement can qualify as a rural referral center if the hospital meets two mandatory prerequisites (a minimum CMI and a minimum number of discharges) and at least one of three optional criteria (relating to specialty composition of medical staff, source of inpatients, or referral volume) (§ 412.96(c)(1) through (c)(5)). (See also the September 30, 1988 Federal Register (53 FR 38513).) With respect to the two mandatory prerequisites, a hospital may be classified as a rural referral center if— • The hospital’s CMI is at least equal to the lower of the median CMI for urban hospitals in its census region, excluding hospitals with approved teaching programs, or the median CMI for all urban hospitals nationally; and • The hospital’s number of discharges is at least 5,000 per year, or, if fewer, the median number of discharges for urban hospitals in the census region in which the hospital is located. (The number of discharges criterion for an osteopathic hospital is at least 3,000 discharges per year, as specified in section 1886(d)(5)(C)(i) of the Act.) 1. Case-Mix Index Section 412.96(c)(1) provides that CMS will establish updated national and regional CMI values in each year’s annual notice of prospective payment rates for purposes of determining rural referral center status. The methodology we use to determine the national and regional CMI values is set forth in regulations at § 412.96(c)(1)(ii). The proposed national median CMI value for FY 2007 includes all urban hospitals nationwide, and the proposed regional values for FY 2007 are the median values of urban hospitals within each census region, excluding those hospitals with approved teaching programs (that is, those hospitals receiving indirect medical education payments as provided in § 412.105). These proposed values are based on discharges occurring during FY 2005 (October 1, 2004 through September 30, 2005) and include bills posted to CMS’ records through December 2005. We are proposing that, in addition to meeting other criteria, if they are to qualify for initial rural referral center status for cost reporting periods beginning on or after October 1, 2006, rural hospitals with fewer than 275 beds must have a CMI value for FY 2005 that is at least— • 1.3365; or • The median CMI value (not transfer-adjusted) for urban hospitals (excluding hospitals with approved teaching programs as identified in § 412.105) calculated by CMS for the census region in which the hospital is located. The proposed median CMI values by region are set forth in the following table: Case-mix index value Region wwhite on PROD1PC61 with PROPOSALS2 1. 2. 3. 4. 5. 6. 7. 8. 9. New England (CT, ME, MA, NH, RI, VT) .................................................................................................................................. Middle Atlantic (PA, NJ, NY) ..................................................................................................................................................... South Atlantic (DE, DC, FL, GA, MD, NC, SC, VA, WV) ......................................................................................................... East North Central (IL, IN, MI, OH, WI) .................................................................................................................................... East South Central (AL, KY, MS, TN) ....................................................................................................................................... West North Central (IA, KS, MN, MO, NE, ND, SD) ................................................................................................................ West South Central (AR, LA, OK, TX) ...................................................................................................................................... Mountain (AZ, CO, ID, MT, NV, NM, UT, WY) ......................................................................................................................... Pacific (AK, CA, HI, OR, WA) ................................................................................................................................................... The preceding numbers will be revised in the final rule to the extent required to reflect the updated FY 2005 MedPAR file, which will contain data from additional bills received through March 2006. Hospitals seeking to qualify as rural referral centers or those wishing to know how their CMI value compares to the criteria should obtain hospitalspecific CMI values (not transferadjusted) from their fiscal intermediaries. Data are available on the Provider Statistical and Reimbursement (PS&R) System. In keeping with our policy on discharges, these CMI values are computed based on all Medicare patient discharges subject to DRG-based payment. 2. Discharges Section 412.96(c)(2)(i) provides that CMS will set forth the national and regional numbers of discharges in each year’s annual notice of prospective payment rates for purposes of determining rural referral center status. As specified in section 1886(d)(5)(C)(ii) of the Act, the national standard is set at 5,000 discharges. We are proposing to update the regional standards based on discharges for urban hospitals’ cost reporting periods that began during FY 2003 (that is, October 1, 2002 through September 30, 2003), which is the latest available cost report data we had at that time. Therefore, we are proposing that, in addition to meeting other criteria, a hospital, if it is to qualify for initial rural referral center status for cost reporting periods beginning on or after October 1, 2006, must have as the number of discharges for its cost reporting period that began during FY 2003 a figure that is at least— • 5,000 (3,000 for an osteopathic hospital); or • The median number of discharges for urban hospitals in the census region in which the hospital is located, as indicated in the following table: Number of discharges Region 1. New England (CT, ME, MA, NH, RI, VT) .................................................................................................................................. 2. Middle Atlantic (PA, NJ, NY) ..................................................................................................................................................... VerDate Aug<31>2005 17:10 Apr 24, 2006 Jkt 208001 PO 00000 Frm 00112 Fmt 4701 1.2678 1.2701 1.1781 1.3156 1.2009 1.2856 1.2445 1.3024 1.3620 Sfmt 4702 E:\FR\FM\25APP2.SGM 25APP2 7,360 10,170 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules Number of discharges Region 3. 4. 5. 6. 7. 8. 9. South Atlantic (DE, DC, FL, GA, MD, NC, SC, VA, WV) ......................................................................................................... East North Central (IL, IN, MI, OH, WI) .................................................................................................................................... East South Central (AL, KY, MS, TN) ....................................................................................................................................... West North Central (IA, KS, MN, MO, NE, ND, SD) ................................................................................................................ West South Central (AR, LA, OK, TX) ...................................................................................................................................... Mountain (AZ, CO, ID, MT, NV, NM, UT, WY) ......................................................................................................................... Pacific (AK, CA, HI, OR, WA) ................................................................................................................................................... These numbers will be revised in the final rule based on the latest available cost report data. We note that the median number of discharges for hospitals in each census region is greater than the national standard of 5,000 discharges. Therefore, 5,000 discharges is the minimum criterion for all hospitals. We reiterate that if an osteopathic hospital is to qualify for rural referral center status for cost reporting periods beginning on or after October 1, 2006, the hospital would be required to have at least 3,000 discharges for its cost reporting period that began during FY 2003. E. Indirect Medical Education (IME) Adjustment (§ 412.105) (If you choose to comment on issues in this section, please include the caption ‘‘IME Adjustment’’ at the beginning of your comment.) 1. Background wwhite on PROD1PC61 with PROPOSALS2 24107 Section 1886(d)(5)(B) of the Act provides that prospective payment hospitals that have residents in an approved graduate medical education (GME) program receive an additional payment to reflect the higher indirect patient care costs of teaching hospitals relative to nonteaching hospitals. The regulations regarding the calculation of this additional payment, known as the indirect medical education (IME) adjustment, are located at § 412.105. The Balanced Budget Act of 1997 (Pub. L. 105–33) established a limit on the number of allopathic and osteopathic residents that a hospital may include in its full-time equivalent (FTE) resident count for direct GME and IME payment purposes. Under section 1886(h)(4)(F) of the Act, a hospital’s unweighted FTE count of residents may not exceed the hospital’s unweighted FTE count for its most recent cost reporting period ending on or before December 31, 1996. Under section 1886(d)(5)(B)(v) of the Act, the limit on the FTE resident count for IME purposes is effective for discharges occurring on or after October 1, 1997. A similar limit is effective for direct GME purposes for VerDate Aug<31>2005 17:10 Apr 24, 2006 Jkt 208001 cost reporting periods beginning on or after October 1, 1997. 2. IME Adjustment Factor for FY 2007 The IME adjustment to the DRG payment is based in part on the applicable IME adjustment factor. The IME adjustment factor is calculated using a hospital’s ratio of residents to beds, which is represented as r, and a formula multiplier, which is represented as c, in the following equation: c × [{1 + r} .405 ¥1]. The formula is traditionally described in terms of a certain percentage increase in payment for every 10-percent increase in the resident-to-bed ratio. Section 502(a) of Public Law 108–173 modified the formula multiplier (c) to be used in the calculation of the IME adjustment. Prior to the enactment of Public Law 108–173, the formula multiplier was fixed at 1.35 for discharges occurring during FY 2003 and thereafter. Section 502(a) modified the formula multiplier beginning midway through FY 2004 and provided for a new schedule of formula multipliers for FY 2005 and thereafter. In the FY 2005 IPPS rule, we announced the schedule of formula multiplier to be used in the calculation of the IME adjustment and incorporated the schedule in our regulations at § 412.105(d)(3)(viii) through (d)(3)(xii). In this proposed rule, we are specifying that for any discharges occurring during FY 2007, the formula multiplier is 1.32. We estimate that application of the mandated formula multiplier for FY 2007 will result in an increase of 5.38 percent in IME payment for every approximately 10-percent increase in the resident-to-bed ratio from FY 2006 to FY 2007. 3. Technical Change To Revise CrossReference We are proposing to revise the crossreferences included in paragraph (f)(1)(ii)(C) of § 412.105 that specify the criteria for counting FTE residents who spend time in nonprovider settings for IME payment adjustment purposes. Currently, this paragraph only cites the criteria set forth in §§ 413.78(c) or 413.78(d). We should have also cited the PO 00000 Frm 00113 Fmt 4701 Sfmt 4702 10,117 8,983 7,427 7,346 7,060 9,832 7,680 provisions of § 413.78(e), which state that the time residents spend in nonprovider settings such as freestanding clinics, nursing homes, and physicians’ offices in connection with approved programs may be included in determining the number of FTE residents in the calculation of a hospital’s resident count if other applicable conditions specified in paragraph (e) are met. We note that in sections IV.H.2., 3., 4., and 5. of the preamble of this proposed rule, we discuss other proposed policy changes and clarifications to the methodology for counting FTE residents for the purposes of direct GME payments, which would be applicable to IME payments also. F. Payment Adjustment for Disproportionate Share Hospitals (DSHs) (§ 412.106) (If you choose to comment on issues in this section, please include the caption ‘‘DSH Adjustment’’ at the beginning of your comment.) 1. Background Section 1886(d)(5)(F) of the Act provides for additional payments to subsection (d) hospitals that serve a disproportionate share of low-income patients. The Act specifies two methods for a hospital to qualify for the Medicare disproportionate share hospital (DSH) adjustment. Under the first method, hospitals that are located in an urban area and have 100 or more beds may receive a DSH payment adjustment if the hospital can demonstrate that, during its cost reporting period, more than 30 percent of its net inpatient care revenues are derived from State and local government payments for care furnished to indigent patients. These hospitals are commonly known as ‘‘Pickle hospitals.’’ The second method, which is also the most commonly used method for a hospital to qualify, is based on a complex statutory formula under which payment adjustments are based on the level of the hospital’s DSH patient percentage, which is the sum of two fractions: The ‘‘Medicare fraction’’ and the ‘‘Medicaid fraction.’’ The Medicare fraction is computed by E:\FR\FM\25APP2.SGM 25APP2 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules dividing the number of patient days that are furnished to patients who were entitled to both Medicare Part A and Supplemental Security Income (SSI) benefits by the total number of patient days furnished to patients entitled to benefits under Medicare Part A. The Medicaid fraction is computed by dividing the number of patient days furnished to patients who, for those DSH Patient Percentage = 2. Technical Corrections We are proposing to make a technical correction to § 412.106(a)(1)(iii) to reflect the statutory requirement at section 1886(d)(8)(E) of the Act that hospitals reclassified under § 412.103 are considered rural for purposes of this DSH regulation. We are also proposing to correct the regulation to eliminate the reference to § 412.62(f). These corrections reflect current policy and already-existing statutory requirements. wwhite on PROD1PC61 with PROPOSALS2 3. Proposed Reinstatement of Inadvertently Deleted Provisions on DSH Payment Adjustment Factors In an interim final rule published in the Federal Register on June 13, 2001 (66 FR 32174 and 32194) (which was finalized in the Federal Register on August 1, 2001 (66 FR 39827)), we incorporated into our regulations at § 412.106(d)(2) the provisions of section 211(b) of Public Law 106–554. Section 211(b) amended section 1886(d)(5)(F) of the Act to revise the calculation of the disproportionate share percentage adjustment for hospitals affected by the revised DSH qualifying threshold percentages specified in section 211(a) of Public Law 106–554. When the section 211 changes were incorporated into the Code of Federal Regulations at § 412.106(d)(2), the regulation text at § 412.106(d)(2)(v) was inadvertently deleted during the transcribing of the new text into the existing regulations. Section 412.106(d)(2)(v) specifies the payment adjustment factors for hospitals that meet the following criteria under § 412.106(c)(2) for discharges occurring on or after April 1, 1990, and before October 1, 1991, and on or after October 1, 1991: Hospitals located in an urban area, that have 100 or more beds, and that can demonstrate that, during their cost reporting period, more than 30 percent of their net inpatient care revenues are derived from State and local government payments for care furnished to indigent patients. We are proposing to reinstate the inadvertently deleted text of § 412.106(d)(2)(v). We note that this is a correction to the regulations; we are not proposing to change the payment VerDate Aug<31>2005 17:10 Apr 24, 2006 Jkt 208001 Medicare, SSI Days Medicaid, Non-Medicare Days + Total Medicare Days Total Patient Days adjustment factors for hospitals that meet the criteria under § 412.106(c)(2). 4. Enhanced DSH Adjustment for MDHs The DSH adjustment factor for most categories of hospitals is capped at 12 percent. Urban hospitals with more than 100 beds, rural hospitals with more than 500 beds, and rural referral centers, are exempt from this cap. Section 5003(d) of Public Law 109– 171 (DRA of 2005) amended section 1886(d)(5)(F) of the Act to revise the DSH payment adjustment factor for MDHs, effective for discharges occurring on or after October 1, 2006. Specifically, section 5003(d) amended section 1886(d)(5)(F)(xiv)(II) of the Act to exclude MDHs from the 12-percent DSH adjustment factor cap. For all discharges occurring on or after October 1, 2006, the fiscal intermediary will not apply the cap when calculating the DSH payments. These payments will be subject to revision upon final settlement of the cost reporting period. We note that this change will not affect the calculation of the disproportionate patient percentage. We are proposing to amend the regulations at § 412.106 to include this provision under proposed new paragraph (d)(2)(iv)(D). G. Geographic Reclassifications (§§ 412.103, 412.230, and 412.234) (If you choose to comment on issues in this section, please include the caption ‘‘Geographic Reclassifications’’ at the beginning of your comment.) 1. Background With the creation of the MGCRB, beginning in FY 1991, under section 1886(d)(10) of the Act, hospitals could request reclassification from one geographic location to another for the purpose of using the other area’s standardized amount for inpatient operating costs or the wage index value, or both (September 6, 1990 interim final rule with comment period (55 FR 36754), June 4, 1991 final rule with comment period (56 FR 25458), and June 4, 1992 proposed rule (57 FR 23631)). As a result of legislative changes under section 402(b) of Public PO 00000 days, were eligible for Medicaid but were not entitled to benefits under Medicare Part A by the number of total hospital patient days in the same period. Frm 00114 Fmt 4701 Sfmt 4702 Law 108–7, section 402 of Public Law 108–89, and section 401 of Public Law 108–173, the standardized amount reclassification criterion for large urban and other areas is no longer necessary or appropriate and has been removed from our reclassification policy. We implemented this policy in the FY 2005 IPPS final rule (69 FR 49103). As a result, hospitals can request reclassification for the purposes of the wage index only and not the standardized amount. Implementing regulations in Subpart L of 42 CFR part 412 (§§ 412.230 et seq.) set forth criteria and conditions for reclassifications for purposes of the wage index from rural to urban, rural to rural, or from an urban area to another urban area, with special rules for SCHs and rural referral centers. Under section 1886(d)(8)(E) of the Act, an urban hospital may file an application to be treated as being located in a rural area if certain conditions are met. The regulations implementing this provision are located under § 412.103. Effective with reclassifications for FY 2003, section 1886(d)(10)(D)(vi)(II) of the Act provides that the MGCRB must use the average of the 3 years of hourly wage data from the most recently published data for the hospital when evaluating a hospital’s request for reclassification. The regulations at § 412.230(d)(2)(ii) stipulate that the wage data are taken from the CMS hospital wage survey used to construct the wage index in effect for prospective payment purposes. To evaluate applications for wage index reclassifications for FY 2007, the MGCRB used the 3-year average hourly wages published in Table 2 of the August 12, 2005 IPPS final rule (70 FR 47508). These average hourly wages are taken from data used to calculate the wage indexes for FY 2004, FY 2005, and FY 2006, based on cost reporting periods beginning during FY 2000, FY 2001, and FY 2002, respectively. 2. Reclassifications Under Section 508 of Public Law 108–173 As we discuss in section III.H.5. of the preamble of this proposed rule, under section 508 of Public Law 108–173, a E:\FR\FM\25APP2.SGM 25APP2 EP25AP06.022</GPH> 24108 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules wwhite on PROD1PC61 with PROPOSALS2 qualifying hospital could appeal the wage index classification otherwise applicable to the hospital and apply for reclassification to another area of the State in which the hospital is located (or, at the discretion of the Secretary, to an area within a contiguous State). Such reclassifications are applicable to discharges occurring during the 3-year period beginning April 1, 2004, and ending March 31, 2007. Under section 508(b), reclassifications under this process do not affect the wage index computation for any area or for any other hospital and cannot be achieved in a budget neutral manner. Some hospitals currently receiving a section 508 reclassification are eligible to reclassify to that same area under the standard reclassification process as a result of the new labor market definitions that we adopted for FY 2005. In applying for a 3-year MGCRB reclassification beginning in FY 2007, hospitals that are already reclassified to the same area under section 508 should have indicated in their MGCRB reclassification requests that if they receive the MGCRB reclassification, they would forfeit the section 508 reclassification for the first 6 months of FY 2007. We refer readers to section III.H.5. of the preamble of this proposed rule for a discussion of our updated procedural rules established under section 1886(d)(10)(D)(v) of the Act in which a section 508 hospital may retain its section 508 reclassification through its expiration on March 31, 2007, and accept a reclassification approved by the MGCRB for the second half of FY 2007 (April 1, 2007, through September 30, 2007). We also clarify the procedural rules for an already individually reclassified hospital that is part of a group that includes a section 508 hospital. 3. Multicampus Hospitals (§ 412.230(d)(2)(iii)) Subsequent to the publication of the FY 2005 IPPS final rule, we became aware of a situation in which, as a result of the new labor market areas implemented in FY 2005 for the IPPS, a multicampus hospital previously located in a single MSA is now located in more than one CBSA. Under our existing policy, a multicampus hospital with campuses located in the same labor market area receives a single wage index. However, if the campuses are located in more than one labor market area, payment for each discharge is determined using the wage index value for the MSA (or Metropolitan Divisions, where applicable) in which the campus of the hospital is located. Prior to FY VerDate Aug<31>2005 17:10 Apr 24, 2006 Jkt 208001 2006, the criteria for a hospital being reclassified to another wage area by the MGCRB did not address the circumstances under which a single campus of a multicampus hospital may seek reclassification. The regulations require that a hospital provide data from the CMS hospital wage survey for the average hourly wage comparison that is used to support a request for reclassification. Because a multicampus hospital is required to report data for the entire hospital on a single cost report, there is no wage survey data for the individual hospital campus that can be used in a reclassification application. In the FY 2006 IPPS final rule (70 FR 47444 through 47446 and 47487), we modified the reclassification rules at § 412.230(d)(2)(iii) to allow campuses of multicampus hospitals located in separate wage index areas to support a reclassification application to an area where another campus is located using the average hourly (composite) wage data submitted on the cost report for the entire multicampus hospital as its hospital-specific data. This special rule applies for reclassification applications for FY 2006, FY 2007, and FY 2008 and will not be in effect for FY 2009 reclassification requests. Because reclassification applications to the MGCRB for FY 2009 must be filed in September 2007, or 1 month before the effective date of the FY 2008 IPPS rule, we are addressing whether to propose to extend the special rule for multicampus hospitals beyond FY 2008 in this FY 2007 proposed rule. In the FY 2006 IPPS final rule, we indicated that we would continue to explore options that would allow individual campuses of multicampus hospitals to submit wage data necessary for geographic reclassification and also monitor the number of multicampus hospitals affected by this provision (70 FR 47445 and 47446). After reviewing this situation further, we believe that if a campus of a multicampus hospital applies for reclassification, it should be required to support its application with campus specific data. Because a cost report is filed for an entire hospital, the campus would have to obtain a separate provider number and be treated for Medicare payment purposes as an independent entity in order to be able to provide wage data for the specific campus. If a hospital were to make a change in FY 2007 to its organizational structure to provide campus specific data to support a reclassification application, the earliest fiscal year that the campus would be eligible to reclassify would be FY 2012 because the cost report data that are used for PO 00000 Frm 00115 Fmt 4701 Sfmt 4702 24109 geographic reclassification precede the payment year by 5 years (that is, FY 2003 cost report data will be used to determine the FY 2008 geographic reclassifications). To our knowledge, only one hospital has used the special rule for multicampus hospitals. This hospital has since joined a successful FY 2007 urban county group reclassification application to the same area to which it was approved under the multicampus hospital rule. Thus, this hospital is no longer required to meet the multicampus hospital rule. Given that there is only one hospital that has used this rule and this hospital was able to reclassify under the normal reclassification rules, we believe the special reclassification rule that applies to multicampus hospitals is no longer needed. Therefore, we are proposing not to extend the special rule beyond FY 2008. For reclassification requests for FY 2009 and thereafter, a campus of a multicampus hospital would be required to obtain a separate provider number in order to provide the required wage data from the CMS hospital wage survey for the average hourly wage comparison in its MGCRB reclassification application. 4. Urban Group Hospital Reclassifications (§ 412.234(a)(3)(iii)) Section 412.234(a)(3)(iii) of the regulations sets forth criteria for urban hospitals to be reclassified as a group for FY 2007 and thereafter. Under these criteria, ‘‘hospitals located in counties that are in the same Combined Statistical Area (CSA) (under the MSA definitions announced by the OMB on June 6, 2003) as the urban area to which they seek redesignation qualify as meeting the proximity requirement for reclassification to the urban area to which they seek redesignation.’’ Last year, several commenters brought to our attention that, while the CSA standard allows for urban county group reclassifications in large urban areas throughout the United States (including 10 of the 11 CBSAs containing Metropolitan Divisions), the CSA standard precludes urban county group reclassifications between three Metropolitan Divisions within one CBSA in Florida. They urged us to modify our policy to also allow hospitals located in counties that are in the same CBSA (in the case of Metropolitan Divisions) as the area to which they seek redesignation to be considered to have met the proximity requirement. We agree with the commenter’s proposed modification. The proximity standard for group reclassifications is intended to allow all E:\FR\FM\25APP2.SGM 25APP2 24110 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules wwhite on PROD1PC61 with PROPOSALS2 of a county’s hospitals to reclassify to an adjacent area where there is sufficient economic integration that there can be an expectation that both areas are competing in a similar labor market area. We believe there is sufficient economic integration between Metropolitan Divisions within a CBSA that urban county reclassifications within a CBSA or a CSA should be permitted. A CBSA, as defined by the OMB, is a ‘‘geographic entity associated with at least one core of 10,000 or more population, plus adjacent territory that has a high degree of social and economic integration with the core as measured by commuting ties.’’ Therefore, we are proposing to revise § 412.234(a)(3) by adding a new paragraph (iv) to expand the proximity criteria to allow urban county groups to apply for reclassification to another area within the same CBSA. We are proposing to require that, beginning with FY 2008, hospitals must be located in counties that are in the same CSA or CBSA (under the MSA definitions announced by OMB on June 6, 2003) as the urban area to which they seek redesignation to qualify as meeting the proximity requirement for reclassification to the urban area to which they seek redesignation. 5. Effect of Change of Ownership on Urban County Group Reclassifications (§§ 412.230, 412.234, and 489.18) We have received questions asking for clarification of our policy regarding whether newly constructed hospitals and hospitals that do not accept assignment of the previous owner’s provider agreement can join an urban county group reclassification. The Medicare regulations at § 412.230 require that, for individual hospital reclassifications, a hospital must provide a weighted 3-year average of its average hourly wages using data from the CMS hospital wage survey used to construct the wage index in effect for prospective payment purposes. Section 489.18(c) of the regulations provides that, when there is a change of ownership, the existing provider agreement will automatically be assigned to the new owner when there is a change of ownership as defined in the rules. Section 412.230(d)(2)(iv) of the regulations specifies that, in situations where a hospital becomes a new provider and the existing hospital’s provider agreement is not assigned under § 489.18, the wage data associated with the previous hospital’s provider number will not be used in calculating the new hospital’s 3-year average hourly wage. This policy is consistent with how we treat hospitals whose VerDate Aug<31>2005 17:10 Apr 24, 2006 Jkt 208001 ownership has changed for other Medicare payment purposes. The regulations also state that once a new hospital has accumulated at least 1 year of wage data using survey data from the CMS hospital wage survey used to determine the wage index, it is eligible to apply for reclassification on the basis of those data. While the regulations preclude a new provider from individually reclassifying until the hospital accumulates at least 1 year of wage data from the CMS hospital wage survey used to determine the wage index, a new provider may join a group reclassification under § 412.234. Under § 412.234, all hospitals in an urban county must apply for redesignation as a group. If we did not permit a new hospital to join group reclassifications, all hospitals in the county would not be part of the reclassification application and the urban county group would be precluded from reclassifying for 3 years until the new hospital accumulated at least 1 year of wage data. We believe it would be inequitable to preclude a group reclassification merely because there was one newly constructed hospital or one hospital in the county changed ownership and did not accept the prior owner’s provider agreement. Alternatively, we believe that allowing group applications without a new hospital would be inconsistent with our regulations and unfair to new hospitals because it would put them at a competitive disadvantage with other hospitals in the county. Because such reclassifications are effective for 3 years, a new hospital that was not allowed to join a group reclassification would have to accept a lower wage index than all other hospitals in the county with which it competes for labor for up to 3 years. 6. Requested Reclassification for Hospitals Located in a Single Hospital MSA Surrounded by Rural Counties In the FY 2006 IPPS final rule (70 FR 47448), we presented a commenter’s concern about the special circumstances of a hospital located in a single hospital MSA surrounded by rural counties in relation to the wage index and the rules governing geographic reclassification. The commenter stated that an isolated hospital in a single hospital MSA is at a competitive disadvantage because the rural hospitals that surround the hospital have been reclassified to higher wage index areas or have been designated as rural referral centers, SCHs, MDHs, or CAHs. The urban hospital is ineligible for reclassification to a higher wage index area either as an individual hospital or as part of a group under the existing regulations. The PO 00000 Frm 00116 Fmt 4701 Sfmt 4702 commenter emphasized that this concern is especially significant given the fact that an isolated hospital in a single hospital MSA is the only hospital in its urban area, and, therefore, has an even greater obligation to the communities it serves. The commenter advocated a change to the urban county group reclassification regulations whereby a hospital in a single hospital MSA surrounded by rural counties would be able to reclassify to the closest urban area that is part of a CSA located in the same State as the hospital. We did not adopt this suggested policy under the IPPS for FY 2006 because we did not believe it would be prudent to adopt the suggested policy in a final rule without first soliciting public comment. The commenter’s suggestion presents a number of issues on which we seek comment. First a single hospital in an urban area receives a wage index value that directly reflects the wages it pays, undiluted by those of any other hospital. Thus, it would appear that in such cases, the wage index is operating with substantial precision in adjusting the wage-related portion of the payment to accord with the actual wage experience of the hospital in question. We have sought comment on the circumstances facing single hospitals in urban areas in past rulemaking. The justification for reclassifying a hospital that is receiving a wage index reflecting its own wages in this way is not readily apparent. Second, it is open to question why this hospital’s situation provides justification for special treatment under the wage index. We understand it is one of two 1886(d) hospitals located in an urban county entirely surrounded by rural counties and that it is within a modest distance of a number of hospitals that have received one form or another of special payment status relating to their rural locations. We are interested in receiving comment on whether these aspects indicate the need for a special wage index reclassification provision. Third, the commenter’s suggested policy would allow a hospital to reclassify to a labor market area that is further away than other, closer urban labor market areas. We are concerned that such a reclassification would be inconsistent with the proximity standard we have generally used to reflect local labor markets. Each of these aspects of the suggested policy might affect a significant number of other hospitals and thus be viewed as having widespread precedent that we invite comment upon. E:\FR\FM\25APP2.SGM 25APP2 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules wwhite on PROD1PC61 with PROPOSALS2 H. Payment for Direct Graduate Medical Education 1. Background (If you choose to comment on issues in this section, please include the caption ‘‘GME Payments’’ at the beginning of your comment.) Section 1886(h) of the Act, as added by section 9202 of the Consolidated Omnibus Budget Reconciliation Act (COBRA) of 1985 (Pub. L. 99–272) and implemented in regulations at existing §§ 413.75 through 413.83, establishes a methodology for determining payments to hospitals for the costs of approved graduate medical education (GME) programs. Section 1886(h)(2) of the Act, as added by COBRA, sets forth a methodology for the determination of a hospital-specific, base-period per resident amount (PRA) that is calculated by dividing a hospital’s allowable costs of GME for a base period by its number of residents in the base period. The base period is, for most hospitals, the hospital’s cost reporting period beginning in FY 1984 (that is, the period beginning between October 1, 1983, through September 30, 1984). Medicare direct GME payments are calculated by multiplying the PRA times the weighted number of full-time equivalent (FTE) residents working in all areas of the hospital (and nonhospital sites, when applicable), and the hospital’s Medicare share of total inpatient days. The base year PRA is updated each year for inflation. However, as specified in section 1886(h)(2)(D)(ii) of the Act, for cost reporting periods beginning on or after October 1, 1993, through September 30, 1995, each hospitalspecific PRA for the previous cost reporting period is not updated for inflation for any FTE residents who are not either a primary care or an obstetrics and gynecology resident. As a result, hospitals that train primary care and obstetrics and gynecology residents, as well as nonprimary care residents in FY 1994 or FY 1995, have two separate PRAs: One for primary care and obstetrics and gynecology residents and one for nonprimary care residents. Pub. L. 106–113 amended section 1886(h)(2) of the Act, effective October 1, 2000, to establish a methodology for the use of a national average PRA in computing direct GME payments for cost reporting periods beginning on or after October 1, 2000. Specifically, Pub. L. 106–113 established a ‘‘floor’’ for FY 2001 such that a hospital-specific PRA should not be less than 70 percent of the locality-adjusted national average PRA. In addition, it established a ‘‘ceiling’’ that froze or limited the annual inflation adjustment to a hospital-specific PRA if VerDate Aug<31>2005 17:10 Apr 24, 2006 Jkt 208001 the PRA exceeded 140 percent of the locality-adjusted national average PRA. Section 511 of Pub. L. 106–554 increased the ‘‘floor’’ established by Pub. L. 106–113 to equal 85 percent of the locality-adjusted national average PRA for PRAs in existence in FY 2002. Existing regulations at § 413.77(d)(2)(iii) specify that, for purposes of calculating direct GME payments, each hospitalspecific PRA is compared to the floor (for FY 2001 and FY 2002) and the ceiling (for FY 2001 through 2013) to determine whether a hospital-specific PRA should be revised. We note that, under existing regulations at § 413.77(c), if a hospital-specific PRA for FY 2001 or FY 2002 is revised due to application of the floor PRA, the revised PRA is the starting point for the PRA in future years, subject to the annual inflation adjustment and any other applicable adjustments. Section 1886(h)(4)(F) of the Act established caps on the number of allopathic and osteopathic residents that hospitals may count for purposes of calculating direct GME payments. For most hospitals, the caps were the number of allopathic and osteopathic FTE residents training in the hospital’s most recent cost reporting period ending on or before December 31, 1996. Section 422 of Pub. L. 108–173 amended section 1886(h)(7) of the Act and provided for reductions to the resident caps of teaching hospitals that were training a number of FTE residents below their cap in a reference period, and authorized a ‘‘redistribution’’ of FTE resident slots to hospitals that could demonstrate a likelihood of using the additional resident slots within the first three cost reporting periods beginning on or after July 1, 2005. 2. Determination of Weighted Average Per Resident Amounts (PRAs) for Merged Teaching Hospitals (§ 413.77) (If you choose to comment on issues in this section, please include the caption ‘‘GME: PRA for Merged Hospitals’’ at the beginning of your comment.) As stated in the background section above, in accordance with section 1886(h) of the Act, Medicare pays teaching hospitals for the direct costs of GME based on the per resident direct GME costs in a base year. For most hospitals, the base year is FY 1984 (cost reporting periods beginning between October 1, 1983, and September 30, 1984). Although section 1886(h) of the Act provides for the establishment of a PRA for a hospital that trained residents in the 1984 base year, the statute does not address how to treat the PRA(s) of PO 00000 Frm 00117 Fmt 4701 Sfmt 4702 24111 teaching hospitals that subsequently merge. Our policy has always been that when two or more teaching hospitals merge, we determine a weighted PRA for the surviving merged hospital using direct GME costs and resident data from the base year cost report for each teaching hospital involved in the merger. This policy was detailed in Questions and Answers on Medicare GME Payments Issued on November 8, 1990: ‘‘[When] two hospitals merge * * * the merged hospital’s per resident amount * * * [is] based on the weighted average of the per resident amounts of both hospitals.’’ We believe this is an equitable way to determine a PRA for the surviving merged hospital because it is based on the relative costs and sizes of the GME training programs in the respective facilities. Moreover, we believe this policy minimizes the role Medicare GME payments play in the choice of the surviving hospital entity. For example, there is no incentive to choose the surviving hospital based in part on the hospitals’ relative PRAs. To calculate the weighted average PRA for the merged entity, the fiscal intermediary begins by determining the base year PRAs and the base year FTE resident counts of the hospitals that merge. The weighted average PRA is calculated by adding the product of each hospital’s base year PRA and its base year FTE resident count, and dividing that number by the total number of the base year FTE residents for those hospitals. When our current methodology was first established for calculating the new PRA for a merged hospital, we adopted a policy to use base year PRAs and FTE resident counts. It was appropriate and workable to use data from the PRA base year because the base year data (usually for the 1984 fiscal year) associated with the hospital-specific PRAs were easily accessible. However, these data are now often over 20 years old and it has become administratively burdensome for both CMS and the fiscal intermediaries to access base year information in calculating the weighted average of the PRAs for merged hospitals. In addition to it being administratively burdensome to use base year cost report data, where a hospital has two PRAs—one for primary care and obstetrics and gynecology residents and another for nonprimary care residents, these two PRAs are not being taken into account in developing the weighted average PRA for the merged hospital. As discussed earlier, hospitals that were training nonprimary care residents in FYs 1994 and 1995 E:\FR\FM\25APP2.SGM 25APP2 wwhite on PROD1PC61 with PROPOSALS2 24112 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules have a separate nonprimary care PRA because there was no update for inflation applied to the PRA for nonprimary care residents in those years (§ 413.77(c)(2)). Accordingly, many teaching hospitals currently have two PRAs: One for primary care and obstetrics and gynecology residents and one for all other residents. (Hospitals that first train residents after FY 1995 would only have a single PRA, even if they train both primary care residents and nonprimary care residents.) Because the current methodology for calculating the weighted average PRA for a merged teaching hospital is based solely on data from the PRA base year (which is usually prior to the years during which the PRAs were not adjusted for inflation to reflect nonprimary care residents), this methodology does not take into account that the merged hospitals may currently have more than one PRA. Effective for cost reporting periods beginning on or after October 1, 2006, rather than use direct GME count of residents and PRA from hospitals’ base year cost reports, we are proposing to simplify and revise the weighted average PRA methodology for determining a merged teaching hospital’s PRA by using FTE resident data and PRA data from the most recently settled cost reports of the merging hospitals. It is less administratively burdensome to use these data, since these data are more recent and, therefore, more accessible. In addition, these data would reflect both a primary care and obstetrics and gynecology PRA and, if applicable, a nonprimary care resident PRA. We note that prior to FY 2003, our policy for calculating the PRA for a new teaching hospital was to calculate the PRA based on the lower of the new teaching hospital’s actual cost per resident in its base period or a weighted average of all the PRAs of existing teaching hospitals in the same geographic wage area, as that term is used under the prospective payment system (existing § 413.77(e)(1)). (For ease of discussion, we refer to a hospital that did not participate in Medicare or that did not have any approved medical residency training programs during the period beginning between October 1, 1983, through September 30, 1984, and has since commenced participating in Medicare and begun training residents in an approved program, as a ‘‘new teaching hospital.’’) The weighted average PRA of teaching hospitals within a particular geographic wage area was determined using the base year PRA and the base year FTE resident count of each respective teaching hospital within the geographic wage area. However, as VerDate Aug<31>2005 17:10 Apr 24, 2006 Jkt 208001 discussed in the August 1, 2002 IPPS final rule (67 FR 50067) effective October 1, 2002, we revised our policy to use PRAs and FTE resident data from the most recently settled cost reports of teaching hospitals in the same CBSA as the new teaching hospitals, rather than data from the 1984 base year (existing § 413.77(e)(1)(ii)(B)). We revised this policy for establishing PRAs for new teaching hospitals because it is less administratively burdensome to use data from the hospitals’ most recently settled cost reports and because the more recent data takes into account that hospitals have a primary care PRA and a nonprimary care PRA. In this proposed rule, we are proposing a similar policy revision for establishing a merged teaching hospital’s PRA. We are proposing that the fiscal intermediaries would use the following steps to calculate the weighted average PRA for the merged teaching hospital: Step 1: Identify the primary care and obstetrics and gynecology FTE resident count, the nonprimary care FTE resident count for hospitals with two PRAs, or the single FTE resident count for hospitals with a single PRA, for each teaching hospital involved in the merger. (Use the sum of the FTE resident counts from line 3.07, line 3.08, and line 3.11 of the hospital’s most recently settled Medicare cost report, CMS 2552–96, Worksheet E–3, Part IV.) Step 2: Identify the PRAs (either a hospital’s primary care and obstetrics and gynecology PRA and nonprimary care PRA or, if applicable, a hospital’s single PRA) from the most recently settled cost report for each hospital involved in the merger, and update the PRAs using the CPI–U inflation factor to coincide with the fiscal year end of the surviving teaching hospital. For example, if the surviving teaching hospital’s fiscal year end is December 31, 2006, and the most recently settled cost report of the teaching hospital(s) involved in the merger is June 30, 2003, the PRAs from this cost report would be updated for inflation to December 31, 2006. Step 3: Calculate the weighted average PRA for the single merged hospital using the PRAs and FTE resident counts from Step 1 and Step 2. For each teaching hospital in the merger: (a) For hospitals with two PRAs, multiply the primary care PRA by the number of primary care and obstetrics and gynecology FTE residents. (b) For hospitals with two PRAs, multiply the nonprimary care PRA by the number of nonprimary care FTE residents. PO 00000 Frm 00118 Fmt 4701 Sfmt 4702 (c) For hospitals with a single PRA, multiple the single PRA by the hospital’s total number of FTE residents. (d) Add the products from applicable Steps 3(a), (b), and (c) for all teaching hospitals that merged. (e) Add the number of FTE residents from Step 1 for all hospitals. (f) Divide the sum from Step 3(d) by the sum from Step 3(e). The result is the weighted average PRA for the merged hospital. As mentioned above, many hospitals currently have two PRAs, one for primary care residents and another for nonprimary care residents. An advantage to using data from the most recently settled cost reports of the hospitals involved in a merger is that the two PRAs are taken into account in determining the weighted average PRA for the merged hospital. Because two PRAs would be taken into account under this proposal, we considered whether a primary care PRA and a nonprimary care PRA should therefore be determined for the merged hospital. Although it would be possible to determine and retain two PRAs for a merged hospital when one or more hospitals involved in the merger had two PRAs, we are not proposing to do so. We are proposing that a single PRA also be determined for the merged hospital in this situation because it is more administratively straightforward for the fiscal intermediaries and the merged hospitals and since the merged hospital itself was not in existence in the years that the two PRAs were established (FY 1994 and FY 1995), we do not believe it is necessary to retain the two PRAs. Furthermore, because the two existing PRAs are taken into account when establishing the single PRA for the merged hospital, and the statutory provision that resulted in the creation of two PRAs has no continuing effect (because the updates were prohibited only for FY 1994 and FY 1995), we see no compelling reason to continue to carry two PRAs for a merged hospital. The following is an example of how to calculate a weighted average PRA under this proposed revised methodology: Example: Assume that Hospital A, Hospital B, and Hospital C merge and Hospital B with a fiscal year end of December 31, 2006, is the surviving hospital. In their respective most recently settled cost reports, Hospital A has 200 primary care and obstetrics and gynecology FTE residents and 150 nonprimary care FTE residents, and Hospital B has 50 primary care and obstetrics and gynecology FTE residents and 60 nonprimary care FTE residents. E:\FR\FM\25APP2.SGM 25APP2 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules wwhite on PROD1PC61 with PROPOSALS2 Hospital C became a teaching hospital in 2000 and has 25 FTE residents. After updating the primary care and nonprimary care PRAs for inflation by the CPI–U to December 31, 2006, Hospital A has a primary care PRA of $120,000 and a nonprimary care PRA of $115,000, Hospital B has a primary care PRA of $100,000 and a nonprimary care PRA of $97,000, and Hospital C has a single PRA of $90,000. (a) Primary care: Hospital A: $120,000 × 200 FTEs = $24,000,000 Hospital B: $100,000 × 50 FTEs = $5,000,000 (b) Nonprimary care: Hospital A: $115,000 × 150 FTEs = $17,250,000 Hospital B: $97,000 × 60 FTEs = $5,820,000 (c) Single PRA: Hospital C: $90,000 × 25 FTEs = $2,250,000 (d) $24,000,000 + $5,000,000 + $17,250,000 + $5,820,000 + $2,250,000 = $54,320,000 (e) 200 + 50 + 150 + 60 + 25 = 485 total FTEs (f) $54,320,000/485 FTEs = $112,000, the weighted average of the hospitals involved in the merger for fiscal year end December 31, 2006. 3. Determination of Per Resident Amounts (PRAs) for New Teaching Hospitals (§ 413.77(e)) (If you choose to comment on issues in this section, please include the caption GME: PRA for New Teaching Hospitals’’ at the beginning of your comment.) As we discussed earlier in the background portion of this section, the hospital-specific, base-period PRA used in the payment methodology for determining Medicare direct GME payments is calculated by dividing a hospital’s allowable direct costs of GME in a base period by its number of residents in that base period. In the case of a hospital that did not train residents in its FY 1984 cost reporting period, a PRA is determined by comparing and taking the lower of a PRA based on direct GME costs and FTE residents in a base year or the updated weighted mean value of PRAs of all hospitals located in the same geographic wage area. For ease of discussion, we refer to a hospital that did not participate in Medicare or have any approved medical residency training programs during the base period beginning between October 1, 1983, through September 30, 1984, and has since commenced participating in Medicare and begun training residents in an approved program, as a ‘‘new teaching hospital.’’ A new teaching hospital’s PRA is established VerDate Aug<31>2005 17:10 Apr 24, 2006 Jkt 208001 by using the lower of its hospitalspecific PRA based on the actual allowable direct GME costs and FTE residents during a base period as defined in § 413.77(e) or the updated weighted mean value of PRAs of other teaching hospitals in the same geographic area. Existing regulations at § 413.77(e) specify that the base year for establishing a PRA for a new teaching hospital is the first cost reporting period in which the new teaching hospital participates in Medicare and the residents are on duty during the first month of that period. If the new teaching hospital begins training residents but does not have residents on duty during the first month of the first cost reporting period in which training occurs, the new teaching hospital is paid on a reasonable cost basis under § 413.77(e) for any GME costs incurred by that hospital during that period. The intent of this policy for new teaching hospitals is to make a more accurate determination of a PRA based on the hospital’s per resident direct GME costs in a cost reporting period in which GME costs have been incurred for that entire period. As we noted in a response to comments in a final rule published in the Federal Register on September 29, 1989 (54 FR 40310), we believe that where the new teaching hospital’s cost reporting period begins on a date other than July 1 (the beginning of the academic year), for example, October 1 or January 1, the cost reporting period that includes costs and resident counts from the first year of the training program may not be reflective of the actual average costs per resident of the program because the full complement of residents might not be on duty, and those that are on duty might be receiving a salary for as few as 1 or 2 months of the cost reporting period. In the usual case, training in the program would continue into the following cost reporting period and residents would thus be on duty in the first month of this next cost reporting period. Consequently, our existing regulations at § 413.77(e)(1) specify that the PRA is to be determined by using the cost and resident data from the first cost reporting period during which residents are training in the first month of the cost reporting period. It has come to our attention that, in rare instances, it is possible for a new teaching hospital, either through happenstance or by purposeful gaming of the policy, to continue to be reimbursed for direct GME costs on a reasonable cost basis even beyond the first cost reporting period during which residents begin training at the hospital PO 00000 Frm 00119 Fmt 4701 Sfmt 4702 24113 as long as no residents are on duty at the new teaching hospital in the first month of the subsequent cost reporting period(s). We believe this scenario is contrary to the statutory intent of section 1886(h) of the Act, which instructs that instead of payment on a reasonable cost basis, the Secretary is to determine and base direct GME payments on a PRA for each hospital with a residency program. For that reason, we are proposing to revise § 413.77(e)(1) and (e)(1)(i) to provide that we will make a PRA determination even where residents are not on duty in the first month of a cost reporting period but where residents began training at the hospital in the prior cost reporting period. Effective for cost reporting periods beginning on or after October 1, 2006, if a new teaching hospital begins training residents in a cost reporting period beginning on or after October 1, 2006, and no residents are on duty during the first month of that period, the fiscal intermediary establishes a PRA for the hospital using: (1) The cost and resident data from the cost reporting period immediately following the one for which GME training at the hospital was first reported (that is, the base period); or (2) the updated weighted mean value of PRAs of all hospitals located in the same geographic wage area. We note that, as with existing policy, the proposed base year need not be a full cost reporting year. Even where that cost reporting period may be a short (less than 12 months) cost reporting period, we believe an appropriate PRA will be determined since the number of FTEs will be commensurate with the costs incurred in this short cost reporting period. 4. Requirements for Counting and Appropriate Documentation of FTE Residents: Clarification (§§ 413.75(d), 413.78(b) and (e), 413.80, and 413.81) (If you choose to comment on issues in this section, please include the caption ‘‘FTE Resident Count and Documentation’’ at the beginning of your comment.) Despite the fact that current policies concerning the counting of FTE residents for IME and direct GME payment purposes have been in effect since October 1985, we continue to receive questions on the proper counting and appropriate documentation for FTE residents for IME and direct GME payment purposes. As a result of these continuing questions, we are clarifying in this proposed rule the policies that apply in determining hospitals’ FTE resident counts for Medicare GME payment purposes. E:\FR\FM\25APP2.SGM 25APP2 wwhite on PROD1PC61 with PROPOSALS2 24114 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules In the existing regulations at § 413.78(b) for direct GME payments, we specify that no individual may be counted as more than one FTE, and that a hospital cannot claim the time spent by residents training at another hospital. Therefore, if a resident spends time training in more than one hospital or except as provided at § 413.78(e) in a nonprovider setting, the resident counts as a partial FTE based on the proportion of time the resident trains at the hospital or nonprovider setting to the resident’s total time worked. (The same provisions apply to part-time residents as specified in § 413.78(b).) A similar policy exists at § 412.105(f)(1)(ii) and (iii) for purposes of counting FTE residents for IME payment purposes. As we have explained in previous Federal Register documents (55 FR 36064, September 4, 1990 and 67 FR 50077, August 1, 2002), these policies apply even when a hospital actually incurs the cost of training the resident(s) at another hospital(s). For example, during a cost reporting year, a full-time resident trains at Hospital A for 6 months and trains at Hospital B for 6 months. Hospital A is paying the salary and fringe benefits of the resident for the entire year. In this case, each hospital would only count 0.5 of an FTE for that resident. Hospital A would not be able to count the entire FTE for that resident, regardless of the fact that it incurred all of the training costs for the resident during that training year. We also have become aware of issues that have arisen due to a hospital’s failure to document the number of FTE residents claimed on its cost report. Proper documentation is required so that Medicare fiscal intermediaries can determine where and when a resident(s) is training and to allow the fiscal intermediary to make payment to the hospital based on the percentage of time the resident(s) spends at each training facility to the total time trained. A rotation schedule is the primary documentation that can support the direct GME and IME resident counts but other similar documentation may be acceptable. The following is a situation of which we learned that illustrates how inadequate documentation resulted in inappropriate counting of FTEs. Two hospitals, Hospital C and D, were ‘‘associated’’ with each other, with residents training at both hospitals. However, instead of differentiating between the number of FTEs and the actual amount of time spent at each hospital, Hospitals C and D totaled their respective FTEs and split them 50/50. Splitting the FTE count 50/50 resulted in inappropriate payment to both VerDate Aug<31>2005 17:10 Apr 24, 2006 Jkt 208001 hospitals. Hospitals are not permitted to decide among themselves how their FTEs will be counted. A hospital may not count a greater number of FTE residents than is actually training at the hospital (or its nonhospital sites) during the year. Each hospital must maintain its own records which demonstrate, for the entire cost reporting period, the amount of time that the resident trained at the hospital and, if applicable, a nonhospital site. Furthermore, to the extent that residents train in nonhospital sites, the hospital claiming the FTEs in the nonhospital site must meet the requirements at § 413.78(e). Situations such as the one described above involving Hospital C and Hospital D are particularly harmful when one or more of the hospitals involved incorrectly report FTEs in the cost reporting period used to establish one or more of the hospitals’ FTE resident caps, and as a result, the caps are incorrectly established. Unless the incorrect caps are revised pursuant to our regulations regarding review and revision of agency determinations, those caps will be applied to the hospital(s) in future years. For instance, we have learned of situations where a hospital’s FTE resident caps were established incorrectly a number of years earlier and, due to administrative finality of settled cost reports, can no longer be adjusted. However, going forward, the hospital’s count of FTEs must be based on where the residents are training and can only reflect the number of residents actually training in the hospital (or its nonhospital sites). In order to ensure that FTEs are being properly counted, hospitals are required to furnish specific documentation to support the number of FTE residents included in the hospital’s FTE count. Section 413.75(d) specifies the requirements concerning documentation of FTE residents. Proper documentation must include the following information: The name and social security number of the resident; the type of residency program in which the individual participates and the number of years the resident has completed in all types of residency programs; the dates the resident is assigned to the hospital and any hospital-based providers (similar to the rotation schedule); the dates the resident is assigned to other hospitals, or other freestanding providers, and any nonprovider setting during the cost reporting period, if any; and the name of the employer paying the resident’s salary. In addition, the documentation should include the name of the medical, osteopathic, dental, or podiatric school from which the resident graduated and the date of graduation, and whether the PO 00000 Frm 00120 Fmt 4701 Sfmt 4702 resident is a foreign medical graduate, including documentation concerning whether the resident has satisfied the regulatory requirements for foreign medical graduates at § 413.80. The information must be certified by an official of the hospital and, if different, an official responsible for administering the residency program. Again, proper documentation on where and when a FTE resident is training during a cost reporting period is essential in order for the hospital to receive direct GME and IME payments based on the proper number of FTE resident(s). Inaccurate, incomplete, or inappropriate documentation will lead to Medicare disallowing certain FTE residents from being counted for purposes of direct GME and IME payments. We note that we are not expanding or making any changes to current policy for proper documentation of FTEs. Rather, we are clarifying the existing regulations concerning proper counting and documentation of FTEs. 5. Resident Time Spent in Nonpatient Care Activities as Part of Approved Residency Programs (§§ 413.9 and 413.78(a)) In section IV.H.4. of this preamble, we discussed the importance of properly documenting where and when residents are training in a particular hospital or nonhospital site, in order for that hospital to count those FTE residents for purposes of direct GME and IME payment. In addition, it is important for hospitals to be able to document the activities in which residents are engaged because there are certain activities that are not allowable for direct GME or IME payment purposes, even though those activities may be performed as part of an approved residency program. Specifically, it has come to our attention that there may be some confusion in the provider community as to whether the time that residents spend in nonpatient care activities that are part of the approved residency program may be counted for the purpose of direct GME and IME payments. We have most recently received questions as to whether the time residents spend in nonhospital sites in didactic activities such as journal clubs or classroom lectures may be included in determining the allowable FTE resident counts. To respond to these inquiries and to resolve any confusion, we are clarifying our policy concerning the counting of time spent in nonpatient care activities for the purpose of direct GME and IME payments in both hospital and nonhospital settings. With respect to training in nonhospital settings, the time that E:\FR\FM\25APP2.SGM 25APP2 wwhite on PROD1PC61 with PROPOSALS2 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules residents spend in nonpatient care activities as part of an approved program, including didactic activities, cannot be included in a hospital’s direct GME or IME FTE resident count. This longstanding policy is based on the statutory requirements for counting FTE residents training in nonhospital sites. For the purpose of direct GME payments, providers have been allowed since July 1, 1987, to count the time residents spend training in nonhospital sites under certain conditions. Section 1886(h)(4)(E) of the Act specifies that the implementing regulations concerning computation of direct GME for training in nonhospital sites ‘‘shall provide that only time spent in activities relating to patient care shall be counted and that all the time so spent by a resident under an approved medical residency training program shall be counted towards the determination of full-time equivalency, without regard to the setting in which the activities are performed, if the hospital incurs all, or substantially all, of the costs for the training program in that setting’’ (emphasis added). For IME payment purposes, hospitals were first allowed to count the time residents spend training in nonhospital sites for discharges occurring on or after October 1, 1997. Section 1886(d)(5)(B)(iv) of the Act was amended by Pub. L. 105–33 in 1997 to provide that ‘‘all the time spent by an intern or resident in patient care activities under an approved medical residency program at an entity in a nonhospital setting shall be counted towards the determination of full-time equivalency if the hospital incurs all, or substantially all, of the costs for the training program in that setting’’ (emphasis added). We understand that, as part of an approved medical residency program, residents are often required to participate in didactic and ‘‘scholarly’’ activities such as educational conferences, journal clubs, and seminars. Some of these activities may take place in nonhospital sites, such as freestanding clinics or physicians’ offices, or in conference rooms at nonhospital settings. In implementing section 1886(h)(4)(E) of the Act for direct GME payment purposes, we specifically stated that ‘‘only time spent in activities relating to patient care may be counted [in nonhospital sites]’’ (54 FR 40292, September 29, 1989). In 1998, when we implemented the statute allowing FTE residents to be counted in nonhospital sites for IME, we reiterated that a hospital may only count resident training time ‘‘in nonhospital sites for indirect and direct GME, respectively, if VerDate Aug<31>2005 17:10 Apr 24, 2006 Jkt 208001 the resident is involved in patient care’’ (63 FR 40986, July 31, 1998). While we have not explicitly defined in regulations ‘‘patient care activities,’’ we have applied the plain meaning of that term. In addition, we note that the scope of the term ‘‘patient care’’ had been well-established in the Medicare program even prior to issuance of the first rules on counting FTE residents for purposes of direct GME and IME payments. For example, prior to the IPPS, acute care hospitals were paid by Medicare for inpatient services based on their reasonable operating costs, or costs relating to the provision of reasonable and necessary ‘‘patient care.’’ The longstanding regulation at 42 CFR 413.9, entitled ‘‘Costs related to patient care,’’ states that ‘‘all payments to providers of services must be based on the reasonable cost of services covered under Medicare and related to the care of beneficiaries.’’ Thus, the scope of costs recognized as reasonable under Medicare had been limited to those relating to ‘‘patient care,’’ or to those relating to covered services for the care of beneficiaries. Although the agency appears to have made a conflicting statement in a letter directed to a particular individual implying that didactic time spent in nonhospital settings could be counted for direct GME and IME, that statement was inaccurate. We have applied and continue to apply the plain meaning of the statutory terms ‘‘patient care activities’’ and ‘‘activities relating to patient care’’ in the context of approved GME programs. That is, the plain meaning of patient care activities would certainly not encompass didactic activities. Rather, the plain meaning refers to the care and treatment of particular patients, or to services for which a physician or other practitioner may bill. Time spent by residents in such patient care activities may be counted for direct GME and IME payment purposes in the nonhospital site. Time spent by residents in other activities in the nonhospital site that do not involve the care and treatment of particular patients, such as didactic or ‘‘scholarly’’ activities, is not allowable for direct GME and IME payment purposes. We note that there is a difference in the rules for counting FTE resident time for IME and direct GME payments when residents are training in a hospital. For direct GME payment purposes, under § 413.78(a), ‘‘residents in an approved program working in all areas of the hospital complex may be counted.’’ As explained in the September 29, 1989 Federal Register document (54 FR PO 00000 Frm 00121 Fmt 4701 Sfmt 4702 24115 40286), the hospital complex consist of the hospital and the hospital-based providers and subproviders. Therefore, the distinction between patient care activities and nonpatient care activities is not relevant to direct GME FTE count determinations when the residents are training in the hospital complex. However, for IME payment purposes, consistent with the regulations at § 413.9, only time spent in patient care activities in the hospital may be counted. It has been our longstanding policy that, regardless of the site of training, ‘‘* * * we do not include residents in the IME count to the extent that the residents are not involved in furnishing patient care * * *’’ (66 FR 39897, August 1, 2001). 6. Medicare GME Affiliated Groups: Technical Changes to Regulations (If you choose to comment on issues in this section, please include the caption ‘‘GME Affiliated Group Technical Changes’’ at the beginning of your comment.) In the FY 2005 IPPS final rule (69 FR 49112 and 49254 through 49265), we redesignated the contents of § 413.86 (which contained the regulations governing Medicare payment for direct GME) as §§ 413.75 through 413.83 and made corresponding cross-reference changes in the text of these regulations. We have discovered that under the definition of ‘‘Medicare GME affiliated group’’ under § 413.75(b), we incorrectly cited the cross-reference to the rotation requirements for GME affiliated groups in paragraphs (1), (2), and (3), as ‘‘§ 413.79(g)(2)’’. In this proposed rule, we are proposing to correct the crossreference for the rotation requirements in paragraphs (2) and (3) of the definition to read ‘‘§ 413.79(f)(2)’’. In the FY 2006 IPPS final rule (70 FR 47457 and 47489), we made additional changes in certain sections of the GME redesignated regulations to correct cross-references to other parts of 42 CFR Chapter IV relating to the definitions of the ‘‘urban’’ and ‘‘rural’’ location of a hospital. In one of the corrections, in paragraph (1) under the definition of ‘‘Medicare GME affiliated group’’ under § 413.75(b), we inadvertently dropped the language in that paragraph relating to the rotational requirements for these groups, including the incorrect crossreference to § 413.79(g)(2). We are proposing to correct the language of paragraph (1) under the definition of ‘‘Medicare GME affiliated group’’ under § 413.75(b) by adding the dropped language and correcting the crossreference to read ‘‘§ 413.79(f)(2).’’ In the FY 2006 IPPS final rule (70 FR 47454 and 47489), we revised E:\FR\FM\25APP2.SGM 25APP2 24116 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules wwhite on PROD1PC61 with PROPOSALS2 § 413.79(e)(1)(iv) to provide that a new urban teaching hospital that qualifies for an adjustment to its FTE cap for a newly approved program may enter into a Medicare GME affiliation agreement, but only if the resulting adjustments to its direct GME and IME caps are ‘‘positive adjustments.’’ We specified in the preamble of that final rule that this provision is effective for affiliation agreements entered into on or after October 1, 2005. However, we inadvertently did not include this effective date in the regulation text. We are proposing to revise § 413.79(e)(1)(iv) to include the effective date as part of the text of that section. In addition, we are proposing to correct a cross-reference in the introductory text of paragraph (f) of § 413.79 relating to Medicare GME affiliated groups. The cross-reference to ‘‘paragraph (e)(3)’’ of § 413.79 should read ‘‘paragraph (d)’’ of that section. This proposed change is necessary to accurately cite the reference to our rules regarding the 3-year rolling average. I. Payment for the Costs of Nursing and Allied Health Education Activities: Clarification (§ 413.85) (If you choose to comment on issues in this section, please include the caption ‘‘Nursing and Allied Health Education Activities’’ at the beginning of your comment.) In addition to direct GME and IME payments to hospitals for the direct and indirect costs incurred for their graduate medical education programs in medicine, osteopathy, dentistry, and podiatry, Medicare makes payments to hospitals for two other categories of education-related costs for which different payment policies apply: • Approved nursing and allied health education programs operated by the hospital. The costs of these programs are excluded from the definition of inpatient hospital operating costs and are not included in the calculation of the per discharge payment rates for hospitals paid under the IPPS, or in the calculation of payments to hospitals and hospital units excluded from the IPPS that are subject to the rate-of-increase ceiling. These costs are separately identified and ‘‘passed through’’ (that is, paid separately on a reasonable cost basis). • All other costs that can be categorized as educational programs and activities (for example, continuing education, on the job training, or seminars). These costs are considered to be part of the hospitals’ normal operating costs and payment for these costs is included in the per discharge payment amount for hospitals subject to VerDate Aug<31>2005 17:10 Apr 24, 2006 Jkt 208001 the IPPS, the IRF PPS, or the LTCH PPS and the prospective per diem payment amount for facilities under the IPF PPS. Similarly, these costs are considered to be part of the hospitals’ normal operating costs and are included as reasonable costs that are subject to the TEFRA rate-of-increase limits applicable to hospitals that continue to receive payments subject to those limits, including cancer and children’s hospitals. Regulations governing payment for the costs of approved and allied health education activities are located at 42 CFR 413.85. In the FY 2004 IPPS final rule (68 FR 45429), we revised the regulations at § 413.85(h)(3) to further clarify the difference between provider-operated and continuing education programs. We revised the regulations to state that, effective October 1, 2003, programs in which employees participate that do not lead to the ability to practice and begin employment in a nursing or allied health specialty are also treated as normal operating costs. We now realize that when we revised § 413.85(h)(3) to include this clarification, we inadvertently did not specify that the provision was applicable to trainees as well as employees. In the preamble of the FY 2004 IPPS final rule, we stated that because § 413.85(h)(3) refers to education that will not lead to the ability to practice and begin employment, we intended the provisions to apply not only to employees but to trainees as well. Therefore, in this proposed rule, we are proposing to make a technical change to § 413.85(h)(3) to make it applicable to both employees and trainees. This proposed technical change would clarify that the educational activities in which employees or trainees participate, but that do not lead to the ability to practice and begin employment in a nursing or allied health specialty, are treated as normal operating costs. We note that we are not proposing to expand or make any changes to the current payment policy for nursing and allied health education activities; rather, we are merely proposing to clarify the language of the existing regulations. J. Hospital Emergency Services Under EMTALA (§ 489.24) (If you choose to comment on issues in this section, please include the caption ‘‘EMTALA’’ at the beginning of your comment.) 1. Background Sections 1866(a)(1)(I), 1866(a)(1)(N), and 1867 of the Act impose specific obligations on certain Medicare- PO 00000 Frm 00122 Fmt 4701 Sfmt 4702 participating hospitals and CAHs. (Throughout this section of this proposed rule, when we reference the obligation of a ‘‘hospital’’ under these sections of the Act and in our regulations, we mean to include CAHs as well.) These obligations concern individuals who come to a hospital emergency department and request examination or treatment for medical conditions, and apply to all of these individuals, regardless of whether they are beneficiaries of any program under the Act. The statutory provisions cited above are frequently referred to as the Emergency Medical Treatment and Labor Act (EMTALA), also known as the patient antidumping statute. EMTALA was passed in 1986 as part of the Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA), Pub. L. 99–272. Congress enacted these antidumping provisions in the Social Security Act to ensure that individuals with emergency medical conditions are not denied essential lifesaving services because of a perceived inability to pay. Under section 1866(a)(1)(I)(i) of the Act, a hospital that fails to fulfill its EMTALA obligations under these provisions may be liable for termination of its Medicare provider agreement, which would result in loss of all Medicare and Medicaid payments. In general, section 1867 of the Act sets forth requirements for medical screening examinations for individuals who come to the hospital and request examination or treatment for a medical condition. The section further provides that if a hospital finds that such an individual has an emergency condition, it is obligated to provide that individual with either necessary stabilizing treatment or an appropriate transfer to another medical facility where stabilization can occur. The EMTALA statute also outlines the obligation of hospitals to receive appropriate transfers from other hospitals. Section 1867(g) of the Act states that a participating hospital that has specialized capabilities or facilities (such as burn units, shock-trauma units, neonatal intensive care units or (with respect to rural areas) regional referral centers as identified by the Secretary in regulation) shall not refuse to accept an appropriate transfer of an individual who requires these specialized capabilities or facilities if the hospital has the capacity to treat the individual. The regulations implementing section 1867 of the Act are found at 42 CFR 489.24. E:\FR\FM\25APP2.SGM 25APP2 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules 2. Role of the EMTALA Technical Advisory Group (TAG) Section 945 of Pub. L. 108–173 (MMA) required the Secretary to establish a Technical Advisory Group (TAG) to provide the Secretary with advice concerning issues related to EMTALA regulations and implementation. Section 945 of Pub. L. 108–173 further requires that the EMTALA TAG be composed of 19 members, including the Administrator of CMS, the Inspector General of HHS, hospital representatives and physicians representing various specialties, patient representatives, and representatives of organizations involved in EMTALA enforcement. The EMTALA TAG was first established in 2005 and held three meetings during that year. At each of its meetings, the EMTALA TAG heard testimony from representatives of physician groups, hospital associations, and others regarding EMTALA issues and concerns. As explained more fully below in sections IV.K.3. and 4. of this preamble, we are proposing to revise the EMTALA regulations at § 489.24 based on the recommendations adopted and forwarded to the Secretary by the EMTALA TAG. wwhite on PROD1PC61 with PROPOSALS2 3. Definition of ‘‘Labor’’ As noted in the background portion of this section, the EMTALA statute and regulations require that if an individual comes to a hospital emergency department and a request is made on the individual’s behalf for examination or treatment for a medical condition, the hospital is obligated to provide that individual with an appropriate medical screening examination within the capability of the hospital. If the individual is found to have an emergency medical condition, the hospital is obligated by EMTALA to provide either necessary stabilizing treatment or an appropriate transfer to another medical facility where stabilization can occur. Section 489.24(b) of the regulations defines the key terms used in the section. The term ‘‘emergency medical condition’’ is defined as— ‘‘A medical condition manifesting itself by acute symptoms of sufficient severity (including severe pain, psychiatric disturbances and/or symptoms of substance abuse) such that the absence of immediate medical attention could reasonably be expected to result in placing the health of the individual (or, with respect to a pregnant woman, the health of the woman or her unborn child) in serious jeopardy; serious impairment to bodily VerDate Aug<31>2005 17:10 Apr 24, 2006 Jkt 208001 functions; or serious dysfunction of any bodily organ or part; or with respect to a pregnant woman who is having contractions, that there is inadequate time to effect a safe transfer to another hospital before delivery; or that transfer may pose a threat to the health and safety of the woman or the unborn child.’’ This definition is identical to the definition of ‘‘emergency medical condition’’ in section 1867(e)(1) of the Act. In recognition of the fact that this definition gives special consideration to women in labor, the term ‘‘labor’’ is itself defined, in paragraph (b) of § 489.24, to mean ‘‘the process of childbirth beginning with the latent or early phases of labor and continuing through the delivery of the placenta.’’ The definition further states: ‘‘A woman experiencing contractions is in true labor unless a physician certifies that, after a reasonable period of observation, the woman is in false labor.’’ A woman found to be in false labor is considered not to have an emergency medical condition and that finding thus means that the hospital has no further EMTALA obligation to her. The CMS interpretative guidelines used by State surveyors in EMTALA investigations provide that once an individual has presented to a hospital seeking emergency care, the determination as to whether an emergency medical condition exists is made by the examining physician(s) or other qualified medical person actually caring for the individual at the treating facility. The guidelines further provide that the medical screening examination must be conducted by one or more individuals who are determined to be qualified by the hospital bylaws or rules and regulations and who meet the hospital condition of participation in 42 CFR 482.55 regarding emergency services personnel and direction. (Of course, these individuals would not be expected or permitted to perform any screening functions other than those which they are allowed to perform under State scope of practice laws.) However, consistent with the definition of ‘‘labor’’ at § 489.24(b), the guidelines also state that if a qualified medical person other than a physician determines that a woman is in false labor, a physician must certify the diagnosis. The guidelines permit this certification to be made based either on actual examination of the patient or on a telephone consultation with the qualified medical person who actually examined the patient. (Medicare State Operations Manual, Appendix V— Interpretive Guidelines—Responsibility PO 00000 Frm 00123 Fmt 4701 Sfmt 4702 24117 of Participating Hospitals in Emergency Cases, TAG A–406.) At its meeting held on June 15–17, 2005, the EMTALA TAG heard testimony from representatives of both physician and nonphysician professional societies regarding the competence of practitioners other than physicians to certify false labor. In particular, a representative of the American College of Nurse-Midwives stated that the current requirement that allows only a physician to certify false labor is overly restrictive and does not adequately recognize the training and competence of certified nursemidwives. Testimony was also presented by the American College of Obstetricians and Gynecologists, which recommended amending the EMTALA regulations to allow certified nursemidwives and other qualified medical persons to determine whether a woman is in false labor. After extensive consideration of the issue, the members of the EMTALA TAG voted to recommend to the Secretary that the definition of ‘‘labor’’ at § 489.24(b) be amended to permit certified nurse-midwives and other qualified medical personnel to certify false labor. The TAG recommended deleting the second sentence, which states that a woman experiencing contractions is in true labor unless a physician certifies that, after a reasonable time of observation, the woman is in false labor. We agree with the TAG’s recommendation that other health care practitioners besides physicians should be allowed to certify false labor, and believe that the recommendation is consistent with CMS’ current policy regarding who may conduct medical screening examinations. However, we do not believe such a change can be best accomplished by simply deleting the second sentence of the current definition of ‘‘labor’’ in the existing regulations because doing so would also remove the explicit statement that a woman experiencing contractions is in labor unless she has been found to be in false labor. To achieve the principal objective of the EMTALA TAG recommendation without compromising the protections of EMTALA for women having contractions, we are proposing to modify the definition of ‘‘labor’’ in § 489.24(b) by revising the second sentence of that definition to state that a woman experiencing contractions is in true labor unless a physician, certified nurse-midwife, or other qualified medical person acting within his or her scope of practice as defined in hospital medical staff bylaws and State law, certifies that, after a reasonable time of E:\FR\FM\25APP2.SGM 25APP2 24118 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules observation, the woman is in false labor. The effect of this change would be to have a single, uniform policy on the personnel who are authorized to make a determination as to whether an individual has an emergency medical condition. wwhite on PROD1PC61 with PROPOSALS2 4. Application of EMTALA Requirements to Hospitals Without Dedicated Emergency Departments Section 489.24(b) of the regulations outlines when a hospital will be considered to be a hospital with a ‘‘dedicated emergency department’’ and makes it clear that only a hospital with a dedicated emergency department has an EMTALA responsibility with respect to an individual for whom no appropriate transfer is sought but who comes to the hospital seeking examination or treatment for a medical condition. However, it has come to CMS’ attention that our policy regarding the application of EMTALA to hospitals that have specialized capabilities but are without dedicated emergency departments may be less well understood as it relates to individuals for whom an appropriate transfer is sought. It has been CMS’ longstanding policy that any Medicare-participating hospital with a specialized capability must, in accordance with section 1867(g) of the Act, accept, within the capacity of the hospital, an appropriate transfer from a requesting hospital. This policy has been applied to hospitals without regard to whether they have dedicated emergency departments. In fact, in the past, CMS has taken enforcement actions against hospitals with specialized capabilities that failed to accept appropriate transfers under EMTALA when the hospitals had the capacity to treat the transferred individuals. At its meeting held on October 26–28, 2005, the EMTALA TAG heard testimony from representatives of physician groups, hospital associations, and others regarding EMTALA compliance by specialty hospitals that typically do not have dedicated emergency departments. After extensive consideration and discussion of the issues raised and views presented, the members of the EMTALA TAG voted to recommend to the Secretary that hospitals with specialized capabilities (as defined in § 489.24(f) of the regulation) that do not have a dedicated emergency department be bound by the same responsibility to accept an appropriate transfer under EMTALA as hospitals with a dedicated emergency department. VerDate Aug<31>2005 17:10 Apr 24, 2006 Jkt 208001 We agree with the EMTALA TAG’s assessment. We believe that the recommendation is consistent with CMS’ current policy and highlights the need to clarify CMS’ policy regarding hospitals with specialized capabilities. Therefore, in this proposed rule, we are proposing to modify the regulations at § 489.24(f) to specifically indicate that any participating hospital with specialized capabilities or facilities, even if it does not have a dedicated emergency department, may not refuse to accept an appropriate transfer if the hospital has the capacity to treat the individual. We note that this proposed revision does not reflect any change in current CMS policy. We further note that the revision would not require hospitals without dedicated emergency departments to open dedicated emergency departments nor would it impose any EMTALA obligation on those hospitals with respect to individuals who come to the hospital as their initial point of entry into the medical system seeking a medical screening examination or treatment for a medical condition. Although this proposed revision seeks only to clarify, rather than change, current policy, we nevertheless, welcome comments on what effect, if any, commenters believe this proposed clarification may have on EMTALA compliance and patient health and safety. 5. Clarification of Reference to ‘‘Referral Centers’’ The language of the existing regulations at § 489.24(f) duplicates the language of section 1867(g) of the Act in that it identifies, as an example of a hospital with specialized capabilities, ‘‘(with respect to rural areas) regional referral centers identified by the Secretary in regulation)’’. Because the term ‘‘regional referral centers’’ is not used elsewhere in the Medicare regulations, it is unclear whether the reference is to referral centers as defined in 42 CFR 412.96, which must be located in rural areas and meet other criteria spelled out in that section, or to any facilities that are located in rural areas and accept patients on referral. To maintain consistency in the Medicare regulations and avoid confusion as to which facilities are considered to have specialized capabilities for purposes of EMTALA, we are proposing to amend § 489.24 by clarifying that ‘‘regional referral centers’’ are those centers meeting the requirements of § 412.96. PO 00000 Frm 00124 Fmt 4701 Sfmt 4702 K. Other Proposed Technical Changes 1. Proposed Cross-Reference Correction in Regulations on Limitations on Beneficiary Charges (§ 412.42) (If you choose to comment on issues in this section, please include the caption ‘‘Cross-Reference § 412.42’’ at the beginning of your comment.) We are proposing to amend § 412.42 to correct an obsolete cross-reference. Paragraph (d) of § 412.42 contains a cross-reference to ‘‘§ 405.310(k).’’ This section was redesignated as § 411.15(k) in 1989 (54 FR 41737, October 11, 1989). We are proposing to amend paragraph (d) of § 412.42 to delete the obsolete cross-reference and insert the correct cross-reference. 2. Proposed Cross-Reference Corrections in Regulations on Payment Denials Based on Admissions and Quality Reviews (§ 412.48) (If you choose to comment on issues in this section, please include the caption ‘‘Cross-Reference § 412.48’’ at the beginning of your comment.) We are proposing to amend § 412.48 to correct an obsolete cross-reference. Paragraph (b) of § 412.48 contains a cross-reference to ‘‘§§ 405.330 through 405.332’’. Section 405.330 was redesignated as § 411.400, and § 405.332 was redesignated as § 411.402 in 1989 (54 FR 41746, October 11, 1989). (There was no § 405.331.) We are proposing to amend paragraph (b) of § 412.48 to delete the obsolete cross-references and to insert the correct cross-references. 3. Proposed Cross-Reference Correction in Regulations on Outlier Payments (§ 412.84) (If you choose to comment on issues in this section, please include the caption ‘‘Technical Correction: Outliers’’ at the beginning of your comment.) On June 9, 2003, we published a final rule in the Federal Register (68 FR 34494) that amended the portion of the hospital IPPS regulations that sets out the methodology for determining payments for extraordinarily high-cost cases (outliers). We changed the methodology because we concluded that, in certain cases, hospitals were dramatically and inappropriately increasing charges, thereby inflating CCRs, resulting in overestimation of these hospitals’ costs per case, a critical factor in determining outlier payments. As a part of these methodology changes, we required that outlier payments be reconciled using a hospital’s settled cost report for the cost reporting year in which the outlier discharge occurred. This approach E:\FR\FM\25APP2.SGM 25APP2 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules wwhite on PROD1PC61 with PROPOSALS2 meant that there would be some delay in computing the final outlier payment. To address this issue, we added § 412.84(m), which provided that reconciled outlier payments would be adjusted to account for the time value of any underpayments or overpayments. We inadvertently included in paragraph (m) of § 412.84 a crossreference to paragraph (h)(3) of § 412.84. The cross-reference should be to paragraph (i)(4), which sets out the requirement for reconciling outlier payments when the cost report for the year in which the discharge occurred is settled. We are proposing to amend paragraph (m) of § 412.84 to correct the cross-reference to read ‘‘paragraph (i)(4)’’ of § 412.84. 4. Removing References to Two Paper Claims Forms (If you choose to comment of the issues in this section, please include the caption ‘‘Claims Forms References’’ at the beginning of your comment.) Section 1862(a)(22) of the Act generally requires electronic submission of initial Medicare claims requesting payment for items and services. Section 1862(h) of the Act provides for limited exceptions when paper claims still may be used. Our existing regulations at 42 CFR 424.32 set out the requirements for submitting electronic and paper claims for payment, as well as when the exceptions apply and paper forms still may be used. Our existing regulations at paragraph (b) of § 424.32 list six forms that are to be used for submitting paper claims. We have evaluated the use of two of these forms, Form CMS–1490U (Request for Medicare Payment by Organization) and Form CMS–1491 (Request for Medicare Payment—Ambulance). We found that these forms have limited use, we would incur expensive costs in redesigning these forms to comply with other reporting requirements, and that an alternate form is available to claim payments. For these reasons, we intend to no longer use these forms. Therefore, we are proposing to remove the references to these forms from paragraph (b) of § 424.32. Form CMS–1490U is a paper claim form used by employers, unions, employer-employee organizations that pay physicians and suppliers for their services to employees, group practice prepayment plans, and health maintenance organizations. Form CMS– 1490U is used to claim payment from carriers for bills already paid by these entities. We concluded that this form should no longer be used for several reasons. It is duplicative of Form CMS– 1500 (Health Insurance Claim Form), VerDate Aug<31>2005 17:10 Apr 24, 2006 Jkt 208001 which also may be used to claim payment for these services. We have encouraged suppliers to submit their paper claims using the Form CMS–1500. Unlike Form CMS–1500, Form CMS– 1490U cannot accommodate an additional reporting requirement, the National Provider Identifier (NPI), without an expensive redesign. Finally, according to our records, relatively few suppliers currently use the form. The CMS component that supplies blank copies of this form for users reported that, between 2002 and 2005, only 2,550 copies of Form CMS–1490U were ordered by carriers. A 2005 survey of Part B carriers indicated that requests for the form are very low and that receipts of the form vary from very few to none. Form CMS–1491 is a paper claim form used by ambulance suppliers to apply for payment for ambulance services. We concluded that this form should no longer be used for several reasons. It also is duplicative of Form CMS–1500, which also may be used to claim payment for ambulance services. In addition, we have encouraged suppliers to submit their paper ambulance claims using the Form CMS– 1500. Unlike Form CMS–1500, Form CMS–1491 cannot accommodate the NPI without an expensive redesign and usage of this form is low. A recent survey of carriers, initiated by Joint Signature Memorandum RO–2324, Request for Information Concerning the CMS–1491, issued October 30, 2003, from the Centers for Medicare Management, was conducted to ascertain the usage of Form CMS–1491. The results of the survey showed that fewer than 2 percent (1.71 percent) of all suppliers of ambulance services currently use the Form CMS–1491. CMS received approximately 240,000 ambulance claims using Form CMS– 1491 during the period from October 1, 2002, to September 30, 2003. These data were used for the most recent OMB renewal under the Paperwork Reduction Act. Since the last OMB renewal approval in 2001, CMS has printed a total of 1,620,000 forms at a cost of $42,890. L. Rural Community Hospital Demonstration Program (If you choose to comment on issues in this section, please include the caption ‘‘Rural Community Hospital Demonstration Program’’ at the beginning of your comment.) In accordance with the requirements of section 410A(a) of Pub. L. 108–173, the Secretary has established a 5-year demonstration program (beginning with selected hospitals’ first cost reporting PO 00000 Frm 00125 Fmt 4701 Sfmt 4702 24119 period beginning on or after October 1, 2004) to test the feasibility and advisability of establishing ‘‘rural community hospitals’’ for Medicare payment purposes for covered inpatient hospital services furnished to Medicare beneficiaries. A rural community hospital, as defined in section 410A(f)(1), is a hospital that: • Is located in a rural area (as defined in section 1886(d)(2)(D) of the Act) or is treated as being located in a rural area under section 1886(d)(8)(E) of the Act; • Has fewer than 51 beds (excluding beds in a distinct part psychiatric or rehabilitation unit) as reported in its most recent cost report; • Provides 24-hour emergency care services; and • Is not designated or eligible for designation as a CAH. As we indicated in the FY 2005 IPPS final rule (69 FR 49078), in accordance with sections 410A(a)(2) and (a)(4) of Pub. L.108–173 and using 2002 data from the U.S. Census Bureau, we identified 10 States with the lowest population density from which to select hospitals: Alaska, Idaho, Montana, Nebraska, Nevada, New Mexico, North Dakota, South Dakota, Utah, and Wyoming (Source: U.S. Census Bureau Statistical Abstract of the United States: 2003). Nine rural community hospitals located within these States are currently participating in the demonstration program for FY 2007. (Of the 13 hospitals that participated in the first 2 years of the demonstration program, 4 hospitals located in Nebraska have withdrawn from the program; they have become CAHs.) Under the demonstration program, participating hospitals are paid the reasonable costs of providing covered inpatient hospital services (other than services furnished by a psychiatric or rehabilitation unit of a hospital that is a distinct part), applicable for discharges occurring in the first cost reporting period beginning on or after the October 1, 2004, implementation date of the demonstration program. Payments to the participating hospitals will be the lesser amount of the reasonable cost or a target amount in subsequent cost reporting periods. The target amount in the second cost reporting period is defined as the reasonable costs of providing covered inpatient hospital services in the first cost reporting period, increased by the inpatient prospective payment update factor (as defined in section 1886(b)(3)(B) of the Act) for that particular cost reporting period. The target amount in subsequent cost reporting periods is defined as the preceding cost reporting period’s target E:\FR\FM\25APP2.SGM 25APP2 wwhite on PROD1PC61 with PROPOSALS2 24120 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules amount, increased by the inpatient prospective payment update factor (as defined in section 1886(b)(3)(B) of the Act) for that particular cost reporting period. Covered inpatient hospital services are inpatient hospital services (defined in section 1861(b) of the Act), and include extended care services furnished under an agreement under section 1883 of the Act. Section 410A of Pub. L. 108–173 requires that ‘‘in conducting the demonstration program under this section, the Secretary shall ensure that the aggregate payments made by the Secretary do not exceed the amount which the Secretary would have paid if the demonstration program under this section was not implemented.’’ Generally, when CMS implements a demonstration program on a budget neutral basis, the demonstration program is budget neutral in its own terms; in other words, the aggregate payments to the participating providers do not exceed the amount that would be paid to those same providers in the absence of the demonstration program. This form of budget neutrality is viable when, by changing payments or aligning incentives to improve overall efficiency, or both, a demonstration program may reduce the use of some services or eliminate the need for others, resulting in reduced expenditures for the demonstration program’s participants. These reduced expenditures offset increased payments elsewhere under the demonstration program, thus ensuring that the demonstration program as a whole is budget neutral or yields savings. However, the small scale of this demonstration program, in conjunction with the payment methodology, makes it extremely unlikely that this demonstration program could be viable under the usual form of budget neutrality. Specifically, cost-based payments to the nine participating small rural hospitals are likely to increase Medicare outlays without producing any offsetting reduction in Medicare expenditures elsewhere. Therefore, a rural community hospital’s participation in this demonstration program is unlikely to yield benefits to the participant if budget neutrality were to be implemented by reducing other payments for these providers. In order to achieve budget neutrality for this demonstration program for FY 2007, we are proposing to adjust the national inpatient PPS rates by an amount sufficient to account for the added costs of this demonstration program. We are proposing to apply budget neutrality across the payment VerDate Aug<31>2005 17:10 Apr 24, 2006 Jkt 208001 system as a whole rather than merely across the participants in this demonstration program. As we discussed in the FY 2005 and FY 2006 IPPS final rules (69 FR 49183 and 70 FR 47462), we believe that the language of the statutory budget neutrality requirements permits the agency to implement the budget neutrality provision in this manner. For FY 2007, using the most recent cost report data (that is, data for FY 2004), adjusted to account for the increased estimated costs for the remaining nine participating hospitals, we estimate that the proposed adjusted amount would be $9,197,870. This proposed estimated adjusted amount reflects the estimated difference between the participating hospitals’ costs and the IPPS payment based on data from the hospitals’ cost reports. We discuss the proposed payment rate adjustment that would be required to ensure the budget neutrality of the demonstration program for FY 2007 in section II.A.4. of the Addendum to this proposed rule. M. Health Care Information Transparency Initiative (If you choose to comment of issues in this section, please include the caption ‘‘Transparency of Health Care Information’’ at the beginning of your comment.) The United States faces a dilemma in health care. Although the rate of increase in health care spending slowed last year, costs are still growing at an unsustainable rate. The United States spends $1.9 trillion on health care, or 16 percent of the gross domestic product (GDP). By 2015, projections are that health care will consume 20 percent of GDP. The Medicare program alone consumes 3.4 percent of the GDP; by 2040, it will consume 8.1 percent of the GDP and by 2070, 14 percent of the GDP. Part of the reason health care costs are rising so quickly is that most consumers of health care—the patients—are frequently not aware of the actual cost of their care. Health insurance shields them from the full cost of services, and they do have only limited information about the quality and costs of their care. Consequently, consumers do not have the incentive or means to carefully shop for providers offering the best value. Thus, providers of care are not subject to the competitive pressures that exist in other markets for offering quality services at the best possible price. Reducing the rate of increase in health care prices and avoiding health services of little value could help to stem the growth in health care spending, and potentially translate into fewer PO 00000 Frm 00126 Fmt 4701 Sfmt 4702 individuals who are unable to afford health insurance. Part of the President’s health care agenda is to expand Health Savings Accounts (HSAs), which would provide consumers with greater financial incentives to compare providers in terms of price and quality, and choose those that offer the best value. In order to exercise such choices, consumers must have accessible and useful information on price and quality of health care items and services. Typically, health care providers do not publicly quote or publish their prices. Moreover, list prices, or charges, generally differ from the actual prices negotiated and paid by different health plans. Thus, even if consumers were financially motivated to shop for the best price, it would be very difficult at the current time for them to access usable information. Similarly, individuals have very little information available to them about the quality of care that they receive. Although there are preliminary steps underway to rectify that fact, including the hospital quality reporting initiative in which a significant number of acute care hospitals are participating (see sections IV.A and IV.B of this preamble), those data are nascent and consumers lack sufficient information on which to base a judgment about where to receive care based on quality of care. For these reasons, the Department intends to launch a major health care information transparency initiative in 2006. This effort will build on steps already taken by CMS to make quality and price information available. For example, we currently collect quality information and publish it through the CMS Hospital Compare Web site, which we reference in other parts of this proposed rule. We also make available unprecedented information on the prices of drugs to beneficiaries in the Medicare prescription drug plan for each pharmacy in the United States. We intend to take further steps to collect and publish useful information on quality and cost. The Department intends to identify several regions in the United States where health care costs are high, and where there is significant interest in reducing health care costs and improving health care quality. The Department will use its leadership role in health care policy to help lead change in those areas. The Secretary also has significant regulatory authority as well. In this proposed rule, we are soliciting comments on several proposals that the Secretary might adopt to increase the transparency of quality and pricing E:\FR\FM\25APP2.SGM 25APP2 wwhite on PROD1PC61 with PROPOSALS2 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules information, and how this can be used to attenuate the growth in health care costs. In addition, we are soliciting comments from the public on additional ways that we could use our regulatory authority to enhance transparency of quality and pricing information. Several possibilities exist. First, we could publish a list of hospital charges either for every region of the country or for selected regions of the country. In addition, we could publish the rates that Medicare actually pays to a particular hospital for every DRG or for selected DRGs that could be adjusted to take into account the hospital’s labor market area, teaching hospital status, and DSH status. Some might argue that publishing these payment rates does not provide meaningful information to consumers because Medicare payment rates are not set by the market, but rather by a statutory payment formula. In addition, providing information on hospital payments only does not disclose the true cost of an episode of care because it would not take into account the cost of physician services, laboratory tests, and other procedures that go along with hospital charges. On the other hand, Medicare payment rates may provide a helpful benchmark, especially for uninsured individuals, to determine whether the charges they see on a hospital bill bear any relationship to what third-party fee-for-service payors pay to the hospital. A second option would be for the Secretary to use his authority to establish conditions of participation for hospitals to propose a rule that relates to charges for uninsured patients. For example, the conditions of participation could include a requirement that hospitals post their prices and/or post their policies regarding discounts or other assistance for uninsured patients. Yet another alternative to posting Medicare DRG payment rates would be to make publicly available the total Medicare payments for an episode of care. For example, one of the most common inpatient hospital procedures under the Medicare program (based on total dollars spent) is hip replacement surgery. Under this proposal, we could make publicly available the expected total payment for an episode of care for hip replacement surgery, including the inpatient hospital stay, physician payments (including the surgeon and the anesthesiologist), and payments for post-acute care services such as services provided in an IRF, SNF, or LTCH. We are currently assessing methods for making such information available and are seeking comments on how to do so as quickly and effectively as possible. VerDate Aug<31>2005 17:10 Apr 24, 2006 Jkt 208001 We are seeking comment on any ways in which the Department can encourage transparency in health care quality and pricing whether through its leadership on voluntary initiative or through regulatory requirements. We also are seeking comment on the Department’s statutory authority to impose such requirements. Discussion of particular options in this proposed rule should not be taken as an indication that the Department will adopt any of these proposals. Rather, the proposals are included here to foster comment on possible options to promote the aims of transparency of quality and pricing information and the Department’s authority and ability potentially to implement these options. The Department is anxious to receive comments on any of these proposals, or on other options that may be available that the Department could adopt either through voluntary initiatives or through its regulatory authority. V. Proposed Changes to the PPS for Capital-Related Costs (If you choose to comment on issues in this section, please include the caption ‘‘Capital PPS’’ at the beginning of your comment.) A. Background Section 1886(g) of the Act requires the Secretary to pay for the capital-related costs of inpatient acute hospital services ‘‘in accordance with a PPS established by the Secretary.’’ Under the statute, the Secretary has broad authority in establishing and implementing the PPS for hospital inpatient capital-related costs. We initially implemented the PPS for capital-related costs in the August 30, 1991 IPPS final rule (56 FR 43358), in which we established a 10-year transition period to change the payment methodology for Medicare hospital inpatient capital-related costs from a reasonable cost-based methodology to a prospective methodology (based fully on the Federal rate). Federal fiscal year (FFY) 2001 was the last year of the 10-year transition period established to phase in the PPS for hospital inpatient capital-related costs. For cost reporting periods beginning in FY 2002, capital PPS payments are based solely on the Federal rate for most acute care hospitals (other than certain new hospitals and hospitals receiving certain exception payments). The basic methodology for determining capital prospective payments using the Federal rate is set forth in § 412.312. For the purpose of calculating payments for each discharge, the standard Federal rate is adjusted as follows: PO 00000 Frm 00127 Fmt 4701 Sfmt 4702 24121 (Standard Federal Rate) x (DRG Weight) x (Geographic Adjustment Factor (GAF)) x (Large Urban Add-on, if applicable) x (COLA for hospitals located in Alaska and Hawaii) x (1 + Capital DSH Adjustment Factor + Capital IME Adjustment Factor, if applicable). Hospitals also may receive outlier payments for those cases that qualify under the threshold established for each fiscal year as specified in § 412.312(c) of the regulations. The regulations at § 412.348(f) provide that a hospital may request an additional payment if the hospital incurs unanticipated capital expenditures in excess of $5 million due to extraordinary circumstances beyond the hospital’s control. This policy was originally established for hospitals during the 10-year transition period, but as we discussed in the August 1, 2002 IPPS final rule (67 FR 50102), we revised the regulations at § 412.312 to specify that payments for extraordinary circumstances are also made for cost reporting periods after the transition period (that is, cost reporting periods beginning on or after October 1, 2001). Additional information on the exception payment for extraordinary circumstances in § 412.348(f) can be found in the FY 2005 IPPS final rule (69 FR 49185 and 49186). During the transition period, under §§ 412.348(b) through (e), eligible hospitals could receive regular exception payments. These exception payments guaranteed a hospital a minimum payment percentage of its Medicare allowable capital-related costs depending on the class of hospital (§ 412.348(c)), but were available only during the 10-year transition period. After the end of the transition period, eligible hospitals can no longer receive this exception payment. However, even after the transition period, eligible hospitals receive additional payments under the special exceptions provisions at § 412.348(g), which guarantees all eligible hospitals a minimum payment of 70 percent of its Medicare allowable capital-related costs provided that special exceptions payments do not exceed 10 percent of total capital IPPS payments. Special exceptions payments may be made only for the 10 years from the cost reporting year in which the hospital completes its qualifying project, and the hospital must have completed the project no later than the hospital’s cost reporting period beginning before October 1, 2001. Thus, an eligible hospital may receive special exceptions payments for up to 10 years beyond the end of the capital PPS transition period. Hospitals eligible for E:\FR\FM\25APP2.SGM 25APP2 wwhite on PROD1PC61 with PROPOSALS2 24122 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules special exceptions payments were required to submit documentation to the intermediary indicating the completion date of their project. (For more detailed information regarding the special exceptions policy under § 412.348(g), refer to the August 1, 2001 IPPS final rule (66 FR 39911 through 39914) and the August 1, 2002 IPPS final rule (67 FR 50102).) Under the PPS for capital-related costs, § 412.300(b) of the regulations defines a new hospital as a hospital that has operated (under current or previous ownership) for less than 2 years. (For more detailed information, see the August 30, 1991 final rule (56 FR 43418).) During the 10-year transition period, a new hospital was exempt from the capital PPS for its first 2 years of operation and was paid 85 percent of its reasonable costs during that period. Originally, this provision was effective only through the transition period and, therefore, ended with cost reporting periods beginning in FY 2002. Because we believe that special protection to new hospitals is also appropriate even after the transition period, as discussed in the August 1, 2002 IPPS final rule (67 FR 50101), we revised the regulations at § 412.304(c)(2) to provide that, for cost reporting periods beginning on or after October 1, 2002, a new hospital (defined under § 412.300(b)) is paid 85 percent of its Medicare allowable capital-related costs through its first 2 years of operation, unless the new hospital elects to receive fully prospective payment based on 100 percent of the Federal rate. (Refer to the August 1, 2001 IPPS final rule (66 FR 39910) for a detailed discussion of the statutory basis for the system, the development and evolution of the system, the methodology used to determine capitalrelated payments to hospitals both during and after the transition period, and the policy for providing exception payments.) Section 412.374 provides for the use of a blended payment amount for prospective payments for capital-related costs to hospitals located in Puerto Rico. Accordingly, under the capital PPS, we compute a separate payment rate specific to Puerto Rico hospitals using the same methodology used to compute the national Federal rate for capitalrelated costs. In general, hospitals located in Puerto Rico are paid a blend of the applicable capital PPS Puerto Rico rate and the applicable capital PPS Federal rate. Prior to FY 1998, hospitals in Puerto Rico were paid a blended capital PPS rate that consisted of 75 percent of the capital PPS Puerto Rico specific rate and 25 percent of the capital PPS Federal VerDate Aug<31>2005 17:10 Apr 24, 2006 Jkt 208001 rate. However, effective October 1, 1997 (FY 1998), in conjunction with the change to the operating PPS blend percentage for Puerto Rico hospitals required by section 4406 of Pub. L. 105– 33, we revised the methodology for computing capital PPS payments to hospitals in Puerto Rico to be based on a blend of 50 percent of the capital PPS Puerto Rico rate and 50 percent of the capital PPS Federal rate. Similarly, in conjunction with the change in operating PPS payments to hospitals in Puerto Rico for FY 2005 required by section 504 of Pub. L. 108–173, we again revised the methodology for computing capital PPS payments to hospitals in Puerto Rico to be based on a blend of 25 percent of the capital PPS Puerto Rico rate and 75 percent of the capital PPS Federal rate effective for discharges occurring on or after October 1, 2004. B. Treatment of Certain Urban Hospitals Reclassified as Rural Hospitals Under § 412.103 We are proposing technical changes to §§ 412.316(b) and 412.320(a)(1) to clarify that hospitals reclassified as rural under § 412.103 are not eligible for the large urban add-on payment or for the capital DSH adjustment. These proposed changes would reflect our historic policy that hospitals reclassified as rural under § 412.103 also will be considered rural under the capital PPS. Since the genesis of the capital PPS in FY 1992, the same geographic classifications used under the operating PPS also have been used under the capital PPS. These proposed changes and clarifications are necessary because we inadvertently made an error when we updated our capital PPS regulations to incorporate OMB’s new CBSA definitions for IPPS hospital labor market areas beginning in FY 2005. In the FY 2005 IPPS final rule (69 FR 49187 through 49188), in order to incorporate the new CBSA designations and the provisions of the newly established § 412.64, which incorporated the CBSA-based geographic classifications, we revised § 412.316(b) and § 412.320 to specify that, effective for discharges occurring on or after October 1, 2004, the capital PPS payment adjustments are based on the geographic classifications under § 412.64. However, § 412.64 does not reference the provisions of § 412.103 regarding the urban-to-rural reclassifications, as was previously found in § 412.63(b)(1). We believe that this error must be corrected in order to maintain our historic policy for treating urban-torural hospital reclassifications under the PO 00000 Frm 00128 Fmt 4701 Sfmt 4702 operating PPS the same for purposes of the capital PPS. Therefore, we are proposing to specify under §§ 412.316(b)(2) and (b)(3) and 412.320(a)(1)(ii) and (a)(1)(iii) that, for discharges on or after October 1, 2006, hospitals that are reclassified from urban to rural under § 412.103 would be considered rural. C. Other Technical Corrections Relating to the Capital PPS Geographic Adjustment Factors We are proposing to make technical corrections to the regulations under paragraphs (a) and (c) of § 412.316. Specifically, we are proposing to make a technical change under § 412.316(a) to correct the cross-reference to ‘‘§ 412.63(k)’’ to clarify that the same wage index that applies to hospitals under the operating PPS is used to determine the geographic adjustment factor (GAF) under the capital PPS. We would cross-refer instead to subpart D of Part 412 to capture the applicable requirements in their entirety. This technical correction does not change any current payment policies because the regulation, as written, makes clear that the GAF adjustment for local cost variation under the capital PPS is based on a hospital’s operating PPS wage index value. Thus, the same payment policies that are in effect prior to FY 2007 (that is, the GAF is based on a hospital’s operating PPS wage index value) would continue in effect for FY 2007 and beyond; the only change in the regulation would be a correction of the erroneous cross-reference. In addition, we are proposing to make a technical correction under § 412.316(c) to correct the crossreference to ‘‘§ 412.115’’ to clarify that, for hospitals located in Alaska and Hawaii, the same COLA factor that applies to these hospitals under the operating PPS is used to determine the COLA factor under the capital PPS. The existing regulation erroneously references the COLA factor used to determine payment under § 412.115, which is not related to the operating PPS COLA factor or any other payment factors. Again, we would cross-refer instead to subpart D of Part 412 to capture the applicable requirements in their entirety. This proposed technical correction would not change any current payment policy; rather it would make clear that the capital PPS COLA factor is based on the hospital’s COLA factor under the operating PPS. This proposed technical correction reflects our historic policy that the COLA factor under the capital PPS is based on the hospital’s operating PPS COLA factor, which is how the capital PPS COLA E:\FR\FM\25APP2.SGM 25APP2 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules factor has been determined since the implementation of the capital PPS in FY 1992. Thus, the same payment policy that has been in effect prior to FY 2007 (that is, the use of the operating PPS COLA factor as shown in the table in section II.B.2 of the Addendum of this proposed rule in determining a hospital’s capital PPS COLA factor) would continue to be in effect for FY 2007 and beyond; the only change in the regulation would be a correction of the erroneous cross-reference. VI. Proposed Changes for Hospitals and Hospital Units Excluded From the IPPS (If you choose to comment on issues in this section, please include the caption ‘‘Excluded Hospitals and Units’’ at the beginning of your comment.) A. Payments to Excluded Hospitals and Hospital Units (§ 413.40) wwhite on PROD1PC61 with PROPOSALS2 1. Payments to Existing and New Excluded Hospitals and Hospital Units Historically, hospitals and hospital units excluded from the prospective payment system received payment for inpatient hospital services they furnished on the basis of reasonable costs, subject to a rate-of-increase ceiling. An annual per discharge limit (the target amount as defined in § 413.40(a)) was set for each hospital or hospital unit based on the hospital’s own cost experience in its base year. The target amount was multiplied by the Medicare discharges and applied as an aggregate upper limit (the ceiling as defined in § 413.40(a)) on total inpatient operating costs for a hospital’s cost reporting period. Prior to October 1, 1997, these payment provisions applied consistently to all categories of excluded providers (rehabilitation hospitals and units (now referred to as IRFs), psychiatric hospitals and units (now referred to as IPFs), LTCHs, children’s hospitals, and cancer hospitals). Payment for children’s hospitals and cancer hospitals that are excluded from the IPPS continues to be subject to the rate-of-increase ceiling based on the hospital’s own historical cost experience. (We note that, in accordance with § 403.752(a) of the regulations, RNHCIs are also subject to the rate-ofincrease limits established under § 413.40 of the regulations.) For IPFs, IRFs, and LTCHs, reasonable cost payment provisions changed significantly for cost reporting periods beginning on or after October 1, 1997. Section 1886(b)(3)(H) of the Act established caps on the target amounts for cost reporting periods beginning on or after October 1, 1997, through September 30, 2002, for certain existing VerDate Aug<31>2005 17:10 Apr 24, 2006 Jkt 208001 hospitals and hospital units excluded from the IPPS. Section 413.40(c)(4)(iii) of the implementing regulations states that ‘‘In the case of a psychiatric hospital or unit, rehabilitation hospital or unit, or long-term care hospital, the target amount is the lower of amounts specified in paragraph (c)(4)(iii)(A) or (c)(4)(iii)(B) of this section.’’ Accordingly, in general, for ‘‘existing’’ IPFs, IRFs, or LTCHs for the applicable 5-year period, the target amount is the lower of: the hospital-specific target amount (§ 413.40(c)(4)(iii)(A)) or the 75th percentile cap (§ 413.40(c)(4)(iii)(B)). For cost reporting periods beginning on or after October 1, 2002, all IRFs are paid 100 percent of the adjusted Federal rate under the IRF PPS. Therefore, an IRF, considered existing under section 1886(b)(3)(H) of the Act would have no portion of its payment subject to § 413.40(c)(4)(ii) of the regulations for cost reporting periods beginning on or after October 1, 2002. For cost reporting periods beginning on or after October 1, 2002, to the extent an IPF or LTCH has all or a portion of its payment determined under reasonable cost principles, the target amounts for the reasonable cost-based portion of the payment are determined in accordance with section 1886(b)(3)(A)(ii) of the Act and the regulations at § 413.40(c)(4)(ii). Section 413.40(c)(4)(ii) states, ‘‘Subject to the provisions of [§ 413.40] paragraph (c)(4)(iii) of this section, for subsequent cost reporting periods, the target amount equals the hospital’s target amount for the previous cost reporting period increased by the update factor for the subject cost reporting period unless the provisions of [§ 413.40] paragraph (c)(5)(ii) of this section apply.’’ Thus, because § 413.40(c)(4)(ii) indicates that the provisions of that paragraph are subject to the provisions of § 413.40(c)(4)(iii), which are applicable only for cost reporting periods beginning on or after October 1, 1997, through September 30, 2002, the target amount for FY 2003 is determined by updating the target amount for FY 2002 by the applicable update factor. For example, if a provider was paid the cap amount in FY 2002, the target amount for FY 2003 would be the amount paid in FY 2002, updated to FY 2003 (that is, the target amount from the previous year increased by the applicable update factor). As discussed below, IPFs, IRFs, and LTCHs are now paid under separate PPSs, although some are subject to transition payment provisions. In addition, a new method of determining the payment amount for ‘‘new’’ excluded providers was PO 00000 Frm 00129 Fmt 4701 Sfmt 4702 24123 established under section 1886(b)(7) of the Act. The law was applicable for three classes of excluded providers— IRFs, IPFs, and LTCHs—with a first cost reporting period beginning on or after October 1, 1997. For the first two cost reporting periods, these ‘‘new’’ excluded providers would be paid the lesser of their net inpatient operating costs or 110 percent of the national median of target amounts for its class of hospitals for cost reporting periods ending during FY 1996. This amount was updated to the first cost reporting period the hospital received payment, and adjusted for differences in area wage levels, as implemented in the regulations at § 413.40(f)(2)(ii). For the third and subsequent cost reporting periods, § 413.40(c)(4)(v) applies. The 110 percent of the national median payment limits for new providers under TEFRA (§ 413.40(f)(2)(ii)) do not apply to those LTCHs or IPFs whose first cost reporting period begins on or after the date the particular class of hospitals implemented their respective PPS because they are paid 100 percent of their Federal PPS rate. IRFs are paid 100 percent of the Federal rate under the IRF PPS for cost reporting periods beginning on or after October 1, 2002. Therefore, the 110 percent of the median payment limitations are not applicable to IRFs for cost reporting periods beginning on or after that date. 2. Separate PPS for IRFs Section 1886(j) of the Act, as added by section 4421(a) of Pub. L. 105–33, provided for the phase-in of a case-mix adjusted PPS for inpatient hospital services furnished by IRFs for cost reporting periods beginning on or after October 1, 2000, and before October 1, 2002, with payments based entirely on the adjusted Federal prospective payment for cost reporting periods beginning on or after October 1, 2002. Section 1886(j) of the Act was amended by section 125 of Pub. L. 106–113 to require the Secretary to use a discharge as the payment unit under the PPS for inpatient hospital services furnished by IRFs and to establish classes of patient discharges by functional-related groups. Section 305 of Pub. L. 106–554 further amended section 1886(j) of the Act to allow IRFs, subject to the blend methodology, to elect to be paid the full Federal prospective payment rather than the transitional period payments specified in the Act. On August 7, 2001, we issued a final rule in the Federal Register (66 FR 41316) establishing the PPS for IRFs, effective for cost reporting periods beginning on or after January 1, 2002. E:\FR\FM\25APP2.SGM 25APP2 24124 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules There was a transition period for cost reporting periods beginning on or after January 1, 2002, and ending before October 1, 2002. For cost reporting periods beginning on or after October 1, 2002, payments are based entirely on the adjusted Federal prospective payment rate determined under the IRF PPS. wwhite on PROD1PC61 with PROPOSALS2 3. Separate PPS for LTCHs In accordance with the requirements of section 123 of Pub. L. 106–113, as modified by section 307(b) of Pub. L. 106–554, we established a per discharge, DRG-based PPS for LTCHs as described in section 1886(d)(1)(B)(iv) of the Act for cost reporting periods beginning on or after October 1, 2002, in a final rule issued on August 30, 2002 (67 FR 55954). The LTCH PPS uses information from LTCH hospital patient records to classify patients into distinct LTC–DRGs based on clinical characteristics and expected resource needs. Separate payments are calculated for each LTC–DRG with additional adjustments applied. On May 7, 2004, we issued in the Federal Register a final rule (69 FR 25673) that updated the payment rates for the LTCH PPS and made policy changes effective for a new LTCH PPS rate year of July 1, 2004 through June 30, 2005. For the LTCH PPS rate year of July 1, 2005 through June 30, 2006, we issued in the Federal Register a final rule (70 FR 24168) that further updated the payment rates and made policy changes. The 5-year period for LTCHs to transition from reasonable cost-based reimbursement to the fully Federal prospective rate will end with cost reporting periods beginning on or after October 1, 2005, and before October 1, 2006. 4. Separate PPS for IPFs In accordance with section 124 of the BBRA and section 405(g)(2) of Pub. L. 108–173, we established a PPS for inpatient hospital services furnished in IPFs (that is, psychiatric hospitals and psychiatric units of acute care hospitals). On November 15, 2004, we issued in the Federal Register a final rule (69 FR 66922) that established the IPF PPS, effective for IPF cost reporting periods beginning on or after January 1, 2005. Under the final rule, we compute a Federal per diem base rate to be paid to all IPFs for inpatient psychiatric services based on the sum of the average routine operating, ancillary, and capital costs for each patient day of psychiatric care in an IPF, adjusted for budget neutrality. The Federal per diem base rate is adjusted to reflect certain patient characteristics, including age, specified VerDate Aug<31>2005 17:10 Apr 24, 2006 Jkt 208001 DRGs, selected high-cost comorbidities, days of the stay, and certain facility characteristics, including a wage index adjustment, rural location, indirect teaching costs, the presence of a fullservice emergency department, and COLAs for IPFs located in Alaska and Hawaii. We have established a 3-year transition period during which IPFs whose first cost reporting periods began before January 1, 2005, will be paid based on a blend of reasonable costbased payment and IPF PPS payments. For cost reporting periods beginning on or after January 1, 2008, all IPFs will be paid 100 percent of the Federal per diem payment amount. 5. Grandfathering of Hospitals-WithinHospitals (HwHs) and Satellite Facilities (If you choose to comment on this section, please include the caption ‘‘Hospitals-Within-Hospitals’’ at the beginning of your comment.) Existing regulations at 42 CFR 412.22(e) define a hospital-within-ahospital (HwH) as a hospital that occupies space in a building also used by another hospital, or in one or more separate buildings located on the same campus as buildings used by another hospital. In order to be paid outside of the IPPS as an excluded hospital, a HwH is required to demonstrate compliance with requirements at § 412.22(e)(1) through (e)(3), as applicable, which were established to create operational and organizational separateness between the HwH and the host hospital with which it is colocated. The existing regulations at § 412.22(h), relating to satellite facilities of hospitals excluded from the IPPS, define a satellite facility as a part of a hospital that provides inpatient services in a building also used by another hospital, or in one or more entire buildings located on the same campus as buildings used by another hospital. Section 412.25(e), relating to satellite facilities of excluded hospital units, defines a satellite facility as a part of a hospital unit that provides inpatient services in a building also used by another hospital, or in one or more entire buildings located on the same campus as buildings used by another hospital. There are significant similarities between the definition of a satellite facility and the definition of a HwH as it relates to their co-location with other Medicare hospital-level providers (hosts). There are also similarities in our policy concerns about the potential for patient-shifting (and its consequences for the Medicare program) between the co-located entities and their hosts. PO 00000 Frm 00130 Fmt 4701 Sfmt 4702 Regarding HwHs and satellite facilities, particularly LTCH HwHs and satellite facilities of LTCHs, which were the original entities that we regulated beginning with FY 1995, we have repeatedly expressed our concerns (for example, in the FY 2005 IPPS final rule (69 FR 49191)) that a HwH’s or a satellite facility’s ‘‘configuration could result in patient admission, treatment, and discharge patterns that are guided more by attempts to maximize Medicare payments than by patient welfare.’’ (69 FR 48916 and 49191). We further believe that ‘‘the unregulated linking of an IPPS hospital and a hospital excluded from the IPPS could lead to two Medicare payments for what was essentially one episode of patient care.’’ (69 FR 48916 and 49191). Therefore, we established ‘‘separateness and control’’ criteria to govern these relationships with host hospitals, at § 412.22(e) for HwHs, and at §§ 412.22(h) and 412.25(e) for satellite facilities of excluded hospitals and satellite facilities of hospital units, respectively. Moreover, for each type of entity, we provided for the ‘‘grandfathering’’ of existing facilities, thereby exempting those that were in existence prior to the establishment of the ‘‘separateness and control’’ requirements from compliance with the criteria. At § 412.22(f), we provided for the grandfathering of HwHs that were in existence on or before September 30, 1995 or for HwHs that changed the terms and conditions under which they operated between September 30, 1995 and before October 1, 2003, and continued to operate under the terms and conditions in effect on September 30, 2003. At § 412.22(h)(3) and (h)(4) we grandfathered of satellite facilities that were part of a hospital, that were in existence on September 30, 1999, and that met certain other conditions. Further, at § 412.25(e)(3) and (e)(4), we grandfathered satellite facilities that were part of a hospital unit, were in existence on September 30, 1999, and that met certain other conditions. The regulations addressing ‘‘separateness and control’’ policies for each of the above types of entities are presently not entirely uniform. This situation has arisen, in part, because the policies were implemented at different times and also because there are differences among the types of entities. (For example, in the FY 2003 IPPS final rule (67 FR 49982 and 50105), we included a detailed discussion of the ‘‘performance of basic functions’’ test utilized for HwHs and how this test was not applicable to satellite facilities.) There are also differences between E:\FR\FM\25APP2.SGM 25APP2 wwhite on PROD1PC61 with PROPOSALS2 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules specific features of the grandfathering provisions for HwHs and satellite facilities, despite the fact that, as noted above, the intent of each of the grandfathering provisions was the same (for HwHs at § 412.22(f), for satellite facilities of hospitals at § 412.22(h)(3)(i) and (h)(4), and for satellite facilities of hospital units at § 412.25(e)(3) and (e)(4)). The regulations exempt certain of these entities from compliance with the ‘‘separateness and control’’ criteria governing the relationships with their host hospitals as long as they continue to operate under the same ‘‘terms and conditions,’’ including the number of beds and square footage considered to be part of the hospital or satellite facility, for purposes of Medicare participation and payment in effect as of the date that they were grandfathered. This particular policy was adopted because we believed that those entities that were designated as grandfathered, versus those that were required to meet the ‘‘separateness and control’’ requirements, should not be permitted to alter their operations from the ‘‘snapshot in time’’ taken when they were grandfathered and thus benefit even more from this status. (LTCH HwHs and satellite facilities of LTCHs that are not grandfathered are also subject to a payment adjustment at § 412.534 related to Medicare discharges of patients who were admitted from their host hospitals.) In other words, we believed that grandfathered facilities received a benefit not enjoyed by nongrandfathered facilities—namely, they were free from compliance with the ‘‘separateness and control’’ regulations and we did not want to allow these entities to realize additional economic advantages by expansion that would increase their Medicare payments by virtue of their grandfathered status. Furthermore, it has been our policy that if a grandfathered HwH or satellite facility of the HwH chooses not to operate under the same terms and conditions in effect as of its grandfathering, it could still be paid under the applicable excluded hospital payment system if it changed its relationship with its host to the extent that it has come into compliance with the applicable ‘‘separateness and control’’ requirements. Because the underlying rationale for the grandfathering policies for both HwHs and satellite facilities of HwHs is the same, upon review of these various provisions, we believe that, where appropriate, the grandfathering provisions should be consistent. Under the authority of section 1871(a)(1) of the Act, which authorizes the Secretary to prescribe such regulations as may be VerDate Aug<31>2005 17:10 Apr 24, 2006 Jkt 208001 necessary to carry out the administration of the Medicare program, we are proposing the following revisions to make the policies consistent. As set forth below, we are proposing to revise the HwH provision at § 412.22(f) to include an exception to the requirement that a grandfathered HwH be operated under the terms and conditions in effect on October 1, 2003, that corresponds to the existing exceptions for HwH satellite facilities and for satellite facilities of hospital units at § 412.22(h)(4) and 412.25(e)(4), respectively. (As provided in § 412.22(f), the original September 1, 1995, ‘‘snapshot in time’’ date for grandfathered HwHs was extended to hospitals that changed the terms and conditions under which they operated between September 1, 1995, and before October 1, 2003, in the FY 2004 IPPS final rule (68 FR 45462).) Specifically, we are proposing a corresponding change to the HwH grandfathering provision at § 412.22(f)(3) that would allow for increases or decreases in square footage, or decreases in the number of beds of the HwH that are needed for specific circumstances beyond the control of the facility. We are specifying that increases or decreases in square footage or decreases in the number of beds that are required because of the relocation of a facility to permit construction or renovation necessary for compliance with Federal, State, or local law affecting the physical facility or because of catastrophic events such as fires, floods, earthquakes, or tornadoes. (64 FR 14535) We are proposing to add some phraseology to the existing provision in § 412.22(h)(4) for consistency with the regulations for grandfathered satellite facilities cited above. As noted above, our existing grandfathering regulations at §§ 412.22(f), 412.22(h)(3) and (h)(4), and 412.25(e)(3) and (e)(4) require that the grandfathered entity make no change in either its square footage or number of beds in order to retain its grandfathered status. In establishing grandfathering provisions, generally, we intended to protect certain existing hospitals and satellite facilities from ‘‘the potentially adverse impact of recent, more specific regulations that we now believe to be essential to the goals of the Medicare program’’ (68 FR 45463). Moreover, it was our intention that our ‘‘snapshot in time’’ policy prevented grandfathered entities that were advantaged more than their nongrandfathered peer facilities as a result of their protected status from realizing additional benefits by changing their ‘‘terms and conditions’’ PO 00000 Frm 00131 Fmt 4701 Sfmt 4702 24125 that could increase their Medicare reimbursement. However, as noted above, we did provide that a grandfathered HwH or satellite facility would have the option of changing square footage or number of beds if it decided to forego its grandfathered status and comply with the applicable ‘‘separateness and control’’ regulations. Recently, several grandfathered LTCH HwHs and satellite facilities questioned whether a decrease in their square footage or their number of beds would result in negating their grandfathered status, because compliance with the each of the above cited grandfathering provisions require that they continue to operate under the same terms and conditions, including the number of beds and square footage considered to be part of the hospital, the satellite facility, or the hospital unit in effect on the day that the grandfathering policy was implemented. We also have been urged to modify our policies to allow these grandfathered entities to increase in square footage and number of beds without requiring compliance with the ‘‘separateness and control’’ policies discussed above. Clearly, under existing regulations, a decrease or an increase in square footage or number of beds would result in a loss of status as a grandfathered HwH or hospital satellite facility (unless § 412.22(h)(4) or § 412.25(b)(3) applies) because the existing regulations prohibit any change in the terms and conditions of operation, as described above. We had two objectives in establishing our grandfathering policy. The first was to allow existing HwHs and satellite facilities to continue to be paid outside of the IPPS, despite the fact that, among other factors, no demonstration of operational or organizational separateness between these grandfathered entities and their host hospitals were required, as they were for HwHs established after September 30, 1995, and for satellite facilities established after September 30, 1999. However, the second objective was to ensure that these entities would not make changes that would lead to increased costs to the Medicare program. The nexus of these two objectives has been the basis of our ‘‘snapshot in time’’ policy discussed above. (For HwHs, as noted above, the ‘‘snapshot in time’’ date for changes in ‘‘terms and conditions’’ was extended to before October 1, 2003, if the HwH changed its terms and conditions under which it operated after September 30, 1995, but before October 1, 2003, in the FY 2004 IPPS final rule (68 FR 45462).) As a result of the requests that we reconsider our policy for an HwH or E:\FR\FM\25APP2.SGM 25APP2 wwhite on PROD1PC61 with PROPOSALS2 24126 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules satellite facility that decreases or increases square footage or number of beds, we revisited the requirement for grandfathered entities to continue to operate under the ‘‘same terms and conditions’’ in effect when they were grandfathered. We have determined that, although increases in square footage or number of beds would confer additional benefits on grandfathered entities, as compared with those HwHs and satellite facilities that were required to comply with ‘‘separateness and control’’ policies at §§ 412.22(e), 412.22(h), and 412.25(e) by allowing expansion and result in additional costs to the Medicare program, this would not be the case regarding a decrease in either the square footage or the numbers of beds because a decrease in the number of beds or square footage would not result in additional costs to the Medicare program. Therefore, we are proposing revisions to the regulations at § 412.22(f) for grandfathered HwHs and at §§ 412.22(h) and 412.25(e)(5) for grandfathered satellites of hospitals and satellites of hospital units, respectively, to allow these entities to decrease their square footage or number of beds, or both, without jeopardizing their grandfathered status. Specifically, we are proposing to add a new paragraph (f)(3) to § 412.22; a new paragraph (h)(5) to § 412.22(h) (existing paragraphs (h)(5) through (h)(7) would be redesignated as paragraphs (h)(6) through (h)(8), respectively); and a new paragraph (e)(5) to § 412.25 (existing paragraph (e)(5) would be redesignated as paragraph (e)(6)). We are also proposing to revise the introductory text to paragraph (f) of § 412.22; paragraphs (h)(1), (h)(3), and (h)(4) of § 412.22; and paragraph (e)(3) of § 412.25. Because grandfathered HwHs or grandfathered satellite facilities may be co-located with an acute care hospital or may be co-located with another excluded hospital (69 FR 49198), we want to emphasize that under our proposed policy revisions described above, where the HwH or satellite facility decreases its number of beds or square footage, there could be an impact on the host hospital if it is also grandfathered from compliance with the ‘‘separateness and control’’ requirements. (Because excluded hospitals are prohibited from having excluded hospital units under § 412.25(a)(1)(ii), this discussion is limited to HwHs and satellite facilities of hospitals.) For example, if grandfathered HwH ‘‘A’’ is co-located with another hospital excluded from the IPPS, hospital ‘‘B’’ (which is a rehabilitation hospital), a decrease in VerDate Aug<31>2005 17:10 Apr 24, 2006 Jkt 208001 the number of beds in hospital ‘‘A’’ could impact the grandfathered status of hospital ‘‘B’’ if hospital ‘‘B’’ absorbed the extra beds. In such a case, if the determination were made that hospital ‘‘B’’ would expand, in order to maintain status as an excluded hospital, hospital ‘‘B’’ would then have to meet the applicable ‘‘separateness and control’’ requirements at § 412.22(e). 6. Proposed Changes to the Methodology for Determining LTCH Cost-to-Charge Ratios (CCRs) and the Reconciliation of High-Cost and ShortStay Outlier Payments Under the LTCH PPS a. Background In the June 9, 2003 high-cost outlier final rule (68 FR 34498), we made revisions to our policies concerning the determination of LTCHs’ CCRs and the reconciliation of high-cost and shortstay outlier payments under the LTCH PPS. As we stated in that final rule, (68 FR 34507), because the LTCH PPS highcost outlier and short-stay outlier policies are modeled after the IPPS outlier policy, we believe they are susceptible to the same payment vulnerabilities and, therefore, merited revision. Specifically, because we believe that a hospital has the ability to inappropriately increase its outlier payments during the time lag between the current charges and the CCR from the settled cost report, through dramatic charge increases, we established new regulations under the LTCH PPS that would allow fiscal intermediaries to use more up-to-date data when determining the CCRs for each LTCH. We revised our regulations to specify that fiscal intermediaries will use either the most recent settled cost report or the most recent tentative settled cost report, whichever is from the later cost reporting period, because, in many cases, using CCRs from tentative settled cost report reduces the time lag for updating CCRs by a year or more. However, even the later CCRs calculated from the tentative settled cost reports would overestimate costs for hospitals that have continued to increase charges much faster than costs during the time between the tentative settled cost report and the time when the claim is processed. Therefore, we also revised the regulations to specify that, in the event more recent charge data indicate that an alternative CCR would be more appropriate, CMS has the authority to direct the fiscal intermediary to change the LTCH’s CCR to reflect the change evidenced by the more recent data. In addition, we further revised the regulations to allow a PO 00000 Frm 00132 Fmt 4701 Sfmt 4702 hospital to contact its fiscal intermediary to request that its CCR, otherwise applicable, be changed if the LTCH presents substantial evidence that its CCR is inaccurate. (68 FR 34497 and 34506 through 34508) Also in the June 9, 2003 final rule, we noted that as hospitals raise their charges faster than their costs increase, over time their CCRs will decline. If hospitals continue to increase charges at a faster rate than their costs increase over a long period of time, or if they increase charges at extreme rates, their CCRs may fall below the range considered reasonable and fiscal intermediaries may assign a statewide average CCR. These statewide averages are generally considerably higher than the threshold. Therefore, prior to the change in the regulations, these hospitals benefited from an artificially high ratio being applied to their already high charges. Furthermore, hospitals could continue to increase charges faster than costs, without any further downward adjustment to their CCR. Consequently, in that same final rule, we revised the regulations to specify that a fiscal intermediary may use a statewide average CCR if it is unable to determine an accurate CCR in one of three circumstances (discussed in greater detail below). (68 FR 34499 through 34500 and 34506 through 34507) In addition, in the June 9, 2003 final rule (68 FR 34500 through 34501 and 34506 through 34508), we noted that we had become increasingly aware that some hospitals had taken advantage of the former outlier policy by increasing their charges at extremely high rates, knowing that there would be a time lag before their CCRs would be adjusted to reflect the higher charges. We believed that even the revisions to the regulations described above would not completely eliminate all such opportunity. We explained that we believed that a hospital would still be able to dramatically increase its charges by far above the rate-of-increase in costs during any given year. Because this possibility was of great concern, we added a provision to our regulations to provide that outlier payments would become subject to reconciliation when hospitals’ cost reports are settled. Because we continue to have these same concerns, in the RY 2007 LTCH PPS proposed rule (71 FR 4648, 4674 through 4676, and 4690 through 4692), we discussed our current methodology for determining hospitals’ CCRs under the LTCH PPS high-cost and short-stay outlier policies, and we presented proposals to refine our methodology for determining the annual CCR ceiling and E:\FR\FM\25APP2.SGM 25APP2 wwhite on PROD1PC61 with PROPOSALS2 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules statewide average CCRs. In that same proposed rule, we also discussed our existing policy for the reconciliation of LTCH PPS high-cost and short-stay outlier payments, along with our proposal to codify in Subpart O of 42 CFR Part 412 those policies, including proposed modifications and editorial clarifications to those existing policies. Historically, annual updates to LTCH CCR ceiling and statewide average CCRs have been effective on October 1. In that RY 2007 LTCH PPS proposed rule, we proposed that the proposed revisions to the policies governing the determination of LTCHs’ CCRs and the reconciliation of high-cost and short-stay outlier payments would be effective October 1, 2006. In addition, our proposal stated that the LTCH CCR ceiling and statewide average CCRs that would be effective October 1, 2006, would be presented in the annual IPPS proposed and final rules. We received a few specific comments concerning the proposed changes to the policies governing the determination of LTCHs’ CCRs. Several other commenters referenced one of the specific comments on the proposed changes to the methodology for determining LTCH CCRs in their own comments on the RY 2007 LTCH PPS proposed rule. Based on one commenter’s synopsis of our proposed changes concerning the determination of LTCH’s CCRs, we believe that the commenters clearly understood the nature and purpose of the proposed changes. However, the commenter pointed out that, in the RY 2007 LTCH PPS proposed rule, we did not provide an analysis of the effect of this proposed change, nor did we provide an example of the new CCR values under this proposed methodology. Another commenter did not ‘‘object in concept to the proposed combination of [IPPS] operating and capital cost-to-charge ratios’’ (to compute a ‘‘total’’ CCR for each IPPS hospital by adding together each hospital’s operating CCR and its capital CCR) from which to compute the LTCH CCR ceiling and applicable statewide average CCRs. However, the commenter also pointed out that we did not provide any impact data and requested that we defer adoption of that proposed change until such data are provided for comment. Therefore, we are proposing in this IPPS proposed rule the same changes to the policies governing the determination of LTCHs’ CCRs and the reconciliation of high-cost and short-stay outlier payments that we proposed in the RY 2007 LTCH PPS proposed rule. We are including in this proposed rule the values of the proposed LTCH CCR VerDate Aug<31>2005 17:10 Apr 24, 2006 Jkt 208001 ceiling (discussed below in this section) and the proposed statewide average LTCH CCRs (as shown in Table 8C of the Addendum to this IPPS proposed rule) that would be effective October 1, 2006, based on our proposed policy changes (along with the values of the proposed LTCH CCRs that would be determined under our current methodology). b. High-Cost Outliers Under the broad authority conferred upon the Secretary by section 123 of the BBRA as amended by section 307(b) of BIPA, when we implemented the LTCH PPS, we established an adjustment for additional payments for outlier cases that have extraordinarily high-costs relative to the costs of most discharges at § 412.525(a). Providing additional payments for outliers strongly improves the accuracy of the LTCH PPS in determining resource costs at the patient level and hospital level. Specifically, under § 412.525(a), we make outlier payments for any discharge if the estimated cost of the case exceeds the adjusted LTCH PPS payment for the LTC–DRG plus a fixed-loss amount. Under the LTCH PPS high-cost outlier policy, the LTCH’s loss is limited to the fixed-loss amount and a fixed percentage of costs above the marginal cost factor. We calculate the estimated cost of a case by multiplying the overall hospital CCR by the Medicare allowable covered charge. In accordance with § 412.525(a)(3), we pay outlier cases 80 percent of the difference between the estimated cost of the patient case and the outlier threshold (the sum of the adjusted Federal prospective payment for the LTC-DRG and the fixed-loss amount). (1) CCR Ceiling As noted above, we determine the estimated cost of the case by multiplying the LTCH’s overall CCR by the Medicare allowable charges for the case. As we discussed in greater detail in the June 9, 2003 IPPS high-cost outlier final rule (68 FR 34506 through 34516), because the LTCH PPS high-cost outlier policy (§ 412.525) is modeled after the IPPS outlier policy, we believed that it and the short-stay outlier policy (§ 412.529) are susceptible to the same payment vulnerabilities that became evident under the IPPS and, therefore, merited revision. Thus, we revised the high-cost outlier policy at § 412.525(a) and the short-stay policy at § 412.529 in that same final rule for the determination of LTCHs’ CCRs and the reconciliation of outlier payments. Under the LTCH PPS, a single prospective payment per discharge is PO 00000 Frm 00133 Fmt 4701 Sfmt 4702 24127 made for both inpatient operating and capital-related costs. Therefore, we compute a single ‘‘overall’’ or ‘‘total’’ CCR for LTCHs based on the sum of their operating and capital-related costs (as described in Chapter 3, section 150.24, of the Medicare Claims Processing Manual (CMS Pub. 100–4) as compared to total charges. Specifically, a LTCH’s CCR is calculated by dividing an LTCH’s total Medicare costs (that is, the sum of its operating and capital inpatient routine and ancillary costs) divided by its total Medicare charges (that is, the sum of its operating and capital inpatient routine and ancillary charges). (Instructions regarding the changes established in the June 9, 2003 IPPS high-cost outlier final rule for both LTCHs and IPPS hospitals can be found in Program Transmittal A–03–058 (Change Request 2785; July 3, 2003)). As a result of the changes established in the June 9, 2003 IPPS high-cost outlier final rule, as we discussed in previous LTCH PPS final rules (RY 2004, 68 FR 34144 through 34146; RY 2005, 69 FR 25687 through 25690; and RY 2006, 70 FR 24192 through 24194), under our current policy, an LTCH is assigned the applicable statewide average CCR if, among other things, an LTCH’s CCR is found to be in excess of the applicable maximum CCR threshold (that is, the combined IPPS operating and capital CCR ceiling). As we explained in that same final rule (68 FR 34507), CCRs above this threshold are most likely due to faulty data reporting or entry, and, therefore, these CCRs should not be used to identify and make payments for outlier cases. Such data are clearly errors and should not be relied upon. Thus, under our established policy, if an LTCH’s CCR is above the applicable ceiling, the applicable combined IPPS statewide average CCR is assigned to the LTCH instead of the CCR computed from data in its most recent (settled or tentatively settled) cost report. As we explained in the RY 2006 LTCH PPS final rule (70 FR 24192), we believe it is appropriate to use the combined IPPS operating and capital CCR ceiling and the applicable combined IPPS statewide average CCRs in determining LTCHs’ CCRs because LTCHs’ cost and charge structures are similar to that of IPPS acute care hospitals. For instance, LTCHs are certified as acute care hospitals, as set forth in section 1861(e) of the Act, to participate as a hospital in the Medicare program, and these hospitals, in general, are paid as LTCHs only because their Medicare average length of stay is greater than 25 days (§ 412.23(e)). Furthermore, as also explained in that E:\FR\FM\25APP2.SGM 25APP2 wwhite on PROD1PC61 with PROPOSALS2 24128 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules same final rule, prior to qualifying as a LTCH under § 412.23(e)(2)(i), a hospital generally is paid as an acute care hospital under the IPPS during the period in which it demonstrates that it has an average length of stay of greater than 25 days. In addition, because there are less than 400 LTCHs, and they are unevenly geographically distributed throughout the United States, there may not be sufficient LTCH CCR data to determine an appropriate LTCH PPS CCR ceiling using LTCH data. As noted above, under the LTCH PPS, there is a single prospective payment per discharge for both inpatient operating and capital-related costs, and therefore, we compute a single ‘‘overall’’ or ‘‘total’’ CCR for LTCHs based on the sum of their Medicare operating and capital-related costs and charges. However, under the IPPS, Medicare per discharge payments to acute care hospitals for the costs of inpatient operating services are made under the ‘‘operating IPPS’’ and per discharge payments to acute care hospitals for inpatient capital-related costs are made under the ‘‘capital IPPS.’’ Because separate payments are made to acute care hospitals under the IPPS for operating and capital-related costs, separate operating and capital CCRs are calculated and used in determining IPPS high-cost outlier payments. Accordingly, under the IPPS, a separate ‘‘operating’’ CCR ceiling and a ‘‘capital’’ CCR ceiling are determined annually. As we explained above and as stated in annual instructions (Program Transmittal A–02–093 (Change Request 2288, September 27, 2002); Program Transmittal A–03–073 (Change Request 2891, August 22, 2003); Program Transmittal 309 (Change Request 3459, October 1, 2004); and Program Transmittal 692 (Change Request 4046, September 30, 2005)), under our current policy, if a LTCH’s CCR is above the applicable ‘‘combined’’ IPPS operating and capital CCR ceiling (that is, adding the separate IPPS operating ceiling and the capital CCR ceiling together), the applicable statewide average CCR is assigned to the LTCH. For instance, for FY 2006, the IPPS operating CCR ceiling is 1.254 and the IPPS capital CCR ceiling is 0.169 (70 FR 47496). Therefore, under our current policy, the ‘‘combined’’ operating and capital CCR ceiling is 1.423 (1.254 + 0.169 = 1.423) as specified in Program Transmittal 692 (Change Request 4046, September 30, 2005). Because LTCHs have a single ‘‘total’’ CCR (rather than separate operating and capital CCRs), under the broad authority of section 123 of the BBRA and section 307(b)(1) of BIPA, we are proposing to VerDate Aug<31>2005 17:10 Apr 24, 2006 Jkt 208001 revise § 412.525(a)(4) to specify that, for discharges occurring on or after October 1, 2006, if, among other things, a LTCH’s CCR is in excess of the LTCH CCR ceiling (which would be calculated as 3 standard deviations above the corresponding national geometric mean total CCR (established and published annually by CMS)), the fiscal intermediary may use a statewide average CCR (also established annually by CMS and discussed in more detail below). (We note, as discussed in greater detail below in this section, in conjunction with this proposed change in the calculation of the LTCH CCR ceiling, we are also proposing a change in our methodology for calculating the applicable statewide average CCRs under the LTCH PPS to be based on hospital-specific ‘‘total’’ CCRs.) Specifically, under proposed revised § 412.525(a)(4)(iv)(C)(2), for discharges occurring on or after October 1, 2006, we are proposing that we would determine the single ‘‘total’’ CCR ceiling, based on IPPS CCR data, by first calculating the total (that is, operating and capital) CCR for each hospital and then determining the average total CCR for all hospitals. For example, if a hospital’s operating CCR is 0.432 and its capital CCR is 0.027, its total CCR would be 0.459 (0.432 + 0.027 = 0.459). This calculation would be repeated for all hospitals in order to determine total CCRs for all hospitals. Next, those total CCRs would be used to determine the average total CCR and standard deviation across all hospitals. The LTCH CCR ceiling would then be established at 3 standard deviations from the mean total CCR, rather than determining the LTCH total CCR ceiling by adding the separate IPPS operating CCR and capital CCR ceilings, which are each separately determined at 3 standard deviations from the average operating CCR and average capital CCR, respectively, as we do under our current policy (as demonstrated above). Under this proposed policy, we would use the same IPPS CCR data that we currently use to annually determine the separate IPPS operating CCR and capital CCR ceilings (that we add together under our current policy to determine the annual CCR ceiling for LTCHs) to compute IPPS hospitalspecific total CCRs that would be used to determine the single LTCH total CCR ceiling. We believe that determining a LTCH CCR ceiling based on IPPS total (operating and capital-related) Medicare costs and charges rather than adding the separate IPPS CCR ceilings determined from operating CCRs and capital CCRs, respectively, would be more consistent with the LTCH PPS single payment, PO 00000 Frm 00134 Fmt 4701 Sfmt 4702 which does not differentiate payments between operating and capital-related costs. Our rationale for proposing to continue to use IPPS data to determine the LTCH CCR ceiling annually continues to be the same as the one stated above. To summarize, our current methodology (that is, using the ‘‘combined’’ IPPS CCR ceiling) calculates two separate IPPS CCRs (an operating CCR and a capital CCR) by taking 3 standard deviations from the average of all IPPS operating CCRs and 3 standard deviations from the average of all IPPS capital CCRs separately to determine the IPPS operating CCR ceiling and IPPS capital CCR ceiling, respectively. Then we added the IPPS operating CCR ceiling and the IPPS capital CCR ceiling together to get a combined’’ LTCH CCR ceiling. The proposed methodology would add each IPPS hospital’s operating CCR and its capital CCR together first to get a ‘‘total’’ CCR for each IPPS hospital, and then determine the average (that is, national geometric mean) of all of those total CCRs across all IPPS hospitals. Next we would take 3 standard deviations above the corresponding national geometric mean total CCR to calculate the LTCH CCR ceiling. The underlying data upon which this calculation is based, that is, the IPPS CCRs, would remain the same. Based on the most recent complete IPPS total CCR data from the December 2005 update to the Provider-Specific File, we are proposing a total CCR ceiling of 1.313 under the LTCH PPS that would be effective October 1, 2006. We note that this proposed ceiling was determined based on the same data used to determine the separate proposed IPPS operating CCR ceiling (1.25) and the proposed IPPS capital CCR ceiling (0.158) discussed in section II.A.4.c. of the Addendum to this proposed rule. Furthermore, we are proposing that, if more recent data are available (that is, data from the March 2006 update to the Provider-Specific File, for example), we would use those data to determine the final total CCR ceiling under the LTCH PPS for FY 2007 using the proposed methodology described above. The LTCH CCR ceiling determined under our current ‘‘combined’’ methodology would result in a slightly higher LTCH CCR ceiling (that is, 1.25 + 0.158 = 1.408) for FY 2007 compared to the proposed ‘‘total’’ CCR ceiling of 1.313 for FY 2007. However, we note that, based on CCRs from the December 2005 update of the Provider-Specific File, there were no LTCHs that have a CCR that is greater than the proposed ceiling of 1.313 (the highest LTCH CCR in the database of 363 LTCHs is 1.132). E:\FR\FM\25APP2.SGM 25APP2 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules wwhite on PROD1PC61 with PROPOSALS2 As we explained in the RY 2007 LTCH PPS proposed rule (71 FR 4675), we are proposing to amend § 412.525 by adding a new paragraph (a)(4)(iv)(C)(2) to reflect the refined methodology for determining the annual CCR ceiling under the LTCH PPS. We are proposing that the revision would be effective for discharges occurring on or after October 1, 2006, rather than July 1, 2006, because we are proposing to continue to use the same IPPS data used to determine the individual IPPS operating and capital CCR ceilings established and published annually in the IPPS proposed and final rules. Because both the separate IPPS operating and capital CCRs ceilings and the LTCH ‘‘total’’ CCR ceiling would be determined using the same data, we believe it would be administratively expedient to continue to establish the LTCH CCR ceiling to be effective for discharges occurring on or after October 1 of each year. (As stated previously, this is consistent with our current policy, where the LTCH CCR ceiling is updated annually on October 1.) Therefore, under this proposal, the public would continue to consult the annual IPPS proposed and final rules for changes to the LTCH CCR ceiling that would be effective for discharges occurring on or after October 1. Under this proposal, the current LTCH CCR ceiling established for discharges occurring on or after October 1, 2005, in the FY 2006 IPPS final rule would remain in effect for discharges occurring on or before September 30, 2006. (2) Statewide Average CCRs In the June 9, 2003 IPPS high-cost outlier final rule, we also established our existing policy for discharges occurring on or after August 8, 2003, that, in addition to assigning the applicable statewide average CCR to a LTCH whose CCR is above the ceiling, the fiscal intermediary may use the applicable statewide average CCR for LTCHs for whom data with which to calculate a CCR are not available (for example, missing or faulty data) or for new LTCHs that have not yet submitted their first Medicare cost report. (For this purpose, a ‘‘new’’ LTCH is defined as an entity that has not accepted assignment of an existing hospital’s provider agreement in accordance with § 489.18.) We note that, consistent with our current policy, either CMS or the hospital may request the use of a different (higher or lower) CCR based on substantial evidence that such a CCR more accurately reflects the hospital’s actual costs and charges. This applies to new LTCHs (as defined above) as well. For instance, CMS may determine that the applicable statewide average CCR VerDate Aug<31>2005 17:10 Apr 24, 2006 Jkt 208001 should not be applied to hospitals that convert from acute care IPPS hospitals to LTCHs (and receive a new LTCH provider number). Rather, the cost and charge data from the IPPS hospital’s cost report (even if they are for more or less than a 12-month cost reporting period) would be used to determine the LTCH’s CCR. Thus, in addition to proposing to revise our methodology for determining the annual CCR ceiling under the LTCH PPS for discharges occurring on or after October 1, 2006, under the broad authority of section 123 of the BBRA and section 307(b)(1) of BIPA, we are proposing to revise § 412.525(a)(4), for discharges occurring on or after October 1, 2006, to codify in Subpart O of 42 CFR Part 412 the remaining LTCH PPS high-cost policy changes that were established in the June 9, 2003 IPPS high-cost outlier final rule (68 FR 34506 through 34513), including proposed modifications and editorial clarifications to those existing policies established in that final rule, which are discussed in greater detail below in this section. We are proposing these additional revisions to § 412.525(a)(4) because we believe that making these revisions would more precisely describe the application of those policies as they relate to the determination of LTCH CCRs and because these proposed changes would be consistent with the proposed changes to the calculation of the LTCH CCR ceiling discussed above in this section. Specifically, we are proposing to specify in new § 412.525(a)(4)(iv)(C) that the fiscal intermediary may use a statewide average CCR, which would be established annually by CMS, if it is unable to determine an accurate CCR for a LTCH in one of the following three circumstances: (1) New LTCHs that have not yet submitted their first Medicare cost report (for this purpose, consistent with current policy, a new LTCH would be defined as an entity that has not accepted assignment of an existing hospital’s provider agreement in accordance with § 489.18); (2) LTCHs whose CCR is in excess of the LTCH CCR ceiling (that is, 3 standard deviations above the corresponding national geometric mean total CCR, as discussed in greater detail previously in this proposed rule); and (3) other LTCHs for whom data with which to calculate a CCR are not available (for example, missing or faulty data). (Other sources of data that the fiscal intermediary may consider in determining an LTCH’s CCR included data from a different cost reporting period for the LTCH, data from the cost reporting period preceding the period in which the hospital began PO 00000 Frm 00135 Fmt 4701 Sfmt 4702 24129 to be paid as an LTCH (that is, the period of at least 6 months that it was paid as a short-term acute care hospital), or data from other comparable LTCHs, such as LTCHs in the same chain or in the same region.) In addition, under proposed § 412.525(a)(4)(iv)(C), for discharges occurring on or after October 1, 2006, we are proposing that we would annually establish statewide average ‘‘total’’ CCRs (as explained below in this section) for use under the LTCH PPS based on IPPS data rather than assigning the combined (operating and capitalrelated) statewide average CCRs (Transmittal 692 (Change Request 4046, September 30, 2005)). Specifically, under this proposed policy, we would use the same IPPS CCR data that we currently use to annually establish the separate IPPS operating and capital statewide CCRs (that we add together under our current policy to determine the applicable ‘‘combined’’ statewide average CCR for LTCHs) to compute statewide average total CCRs by first calculating the total (that is, operating and capital) CCR for each hospital and then determining the weighted average total CCR for all hospitals in each State rather than adding together the separate applicable IPPS operating and capital statewide weighted average CCRs as we do under our current policy. We also are proposing that these statewide average ‘‘total’’ (operating and capital) CCRs that would be used under the LTCH PPS would continue to be published annually in the IPPS proposed and final rules, and, therefore, the public would continue to consult the annual IPPS proposed and final rules for changes to the applicable statewide average total CCRs that would be effective for discharges occurring on or after October 1. Under this proposal, the current applicable statewide average operating and capital CCRs, established for discharges occurring on or after October 1, 2005, would remain in effect for discharges occurring on or before September 30, 2006. Our rationale for proposing to establish statewide average ‘‘total’’ CCRs (as described above in this section) based on IPPS data under proposed § 412.525(a)(4)(iv)(C) is the same as the one stated above for proposing to use IPPS data to determine a ‘‘total’’ LTCH CCR ceiling. Under the current methodology, we determine a ‘‘combined’’ statewide average CCRs for LTCHs located in rural areas of a State that accounts for operating and capital costs and charges and a ‘‘combined’’ statewide average CCRs for LTCHs located in urban areas of a State that accounts for operating and capital-related costs and charges. In E:\FR\FM\25APP2.SGM 25APP2 wwhite on PROD1PC61 with PROPOSALS2 24130 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules order to calculate a combined statewide average CCR under our current methodology, we must first calculate separate statewide average operating CCRs and capital CCRs. Under the IPPS, two statewide average operating CCRs are computed for each State: a statewide average CCR for rural areas and a statewide average CCR for urban areas. One statewide average capital CCR is computed for each State (applicable to both urban and rural areas). We use the same capital CCR for urban and rural areas because capital costs are the same regardless of geographic location. Below, we outline our existing methodology for calculating the combined statewide average CCR for a rural LTCH: Step 1: Calculate the weighted average operating CCR for all IPPS hospitals located in rural areas of the State (as shown in the third column of Table 8A of the Addendum to this proposed rule). Step 2: Calculate the weighted average capital CCR for all IPPS hospitals located in the State (both rural and urban areas) (as shown in Table 8B of the Addendum to this proposed rule). Step 3: Add the weighted average rural operating CCR (Step 1) together with the weighted average capital CCR (Step 2) in order to arrive at a ‘‘combined’’ statewide average CCR for LTCHs in rural areas of the State. For example, for a rural LTCH located in Alabama, under our current methodology, the ‘‘combined’’ statewide average CCR for FY 2007 would be 0.360, computed as the operating statewide rural average CCR of 0.334 (Table 8A of the Addendum to this proposed rule) plus the capital statewide average CCR 0.026 (Table 8B of the Addendum to this proposed rule). This same methodology is applied when determining the ‘‘combined’’ statewide average CCR for LTCHs located in urban areas under our current methodology, except that in Step 1 we substitute the average operating CCR for all rural IPPS hospitals with the weighted average operating CCR for all urban IPPS hospitals for the State (as shown in the second column of Table 8A of the Addendum to this proposed rule) and in Step 3, we add the weighted average urban operating CCR in Step 1 to the weighted average capital CCR in Step 2 in order to arrive at a ‘‘combined’’ statewide average CCR for LTCHs in urban areas of the State. Under our proposed methodology for calculating a statewide average ‘‘total’’ CCR under the LTCH PPS that accounts for operating and capital-related costs and charges, first, for each IPPS hospital, we would add its operating CCR and its capital CCR together to VerDate Aug<31>2005 17:10 Apr 24, 2006 Jkt 208001 determine its ‘‘total’’ CCR. Then we would use the ‘‘total’’ CCRs for all urban IPPS hospitals in the State to compute a statewide average total CCR for the urban areas of a State, and we would use the ‘‘total’’ CCR for all rural IPPS hospitals in the State to compute a statewide average CCR for the rural areas of a State. Below, we outline our proposed methodology for calculating the total statewide average CCR for a rural LTCH: Step 1: Calculate the total CCR for each rural IPPS hospital by adding together its operating CCR and its capital CCR. Step 2: Calculate the weighted average total CCR for all rural IPPS hospitals in the State (as shown in the third column of Table 8C of the Addendum to this proposed rule). For example, for a rural LTCH located in Alabama, under our proposed methodology, the proposed ‘‘total’’ statewide average CCR for FY 2007 would be 0.365 (Table 8C of the Addendum to this proposed rule). This same proposed methodology would be applied when determining the ‘‘total’’ statewide average CCR for LTCHs located in urban areas, except that we would replace ‘‘rural IPPS hospitals’’ with ‘‘urban IPPS hospitals’’ in Steps 1 and 2. (The total statewide average CCRs for urban LTCHs is shown in the second column of Table 8A of the Addendum to this proposed rule.) Under this proposal, the underlying data, that is, the IPPS CCRs, would remain the same. Based on the most recent complete IPPS total CCR data from the December 2005 update of the Provider-Specific File, the proposed LTCH PPS statewide average CCRs that would be effective October 1, 2006, are presented in Table 8C of the Addendum to this proposed rule. (We note that, as is the case under the IPPS, all areas in the District of Columbia, New Jersey, Puerto Rico, and Rhode Island are classified as urban, and therefore, there are no proposed rural statewide average total CCRs listed for those jurisdictions in Table 8C of the Addendum to this proposed rule. We also note that, as is the case under the IPPS, although Massachusetts has areas that are designated as rural, there are no short-term acute care IPPS hospitals or LTCHs located in those areas as of March 2006, and therefore, there is no proposed rural statewide average total CCR listed for rural Massachusetts in Table 8C of the Addendum of this proposed rule.) Furthermore, we are proposing that, if more recent data are available (that is, data from the March 2006 update of the Provider-Specific File, for example), we would use those data to determine the final LTCH PPS statewide average CCRs for FY 2007 PO 00000 Frm 00136 Fmt 4701 Sfmt 4702 using the proposed methodology describe above. Comparing the proposed statewide average ‘‘total’’ CCRs in Table 8C of the Addendum to this proposed rule to the ‘‘combined’’ statewide average CCRs that would be calculated using our existing methodology from the proposed operating PPS statewide average CCRs in Table 8A of the Addendum to this proposed rule and the proposed capital PPS statewide average CCRs in Table 8B of the Addendum to this proposed rule shows that the proposed changes to our methodology for determining LTCH statewide average CCRs would result in only minor changes in the average CCR for each State. In particular, the largest decrease in a statewide average CCR (with the exception of Maryland, as discussed below) would be in urban Indiana (¥1.9 percent). However, there are currently no LTCHs located in Indiana. The largest increase in a statewide average CCR would be in urban District of Columbia (2.8 percent), and there are currently only 2 LTCHs located in the District of Columbia. We are proposing to determine the urban and rural statewide average total CCRs for Maryland LTCHs paid under the LTCH PPS using, as a proxy, the national average total CCR for urban IPPS hospitals and the national average total CCR for rural IPPS hospitals, respectively. We are proposing this proxy because we believe that the CCR data on the Provider-Specific File for Maryland hospitals may not be accurate. We believe that the CCR data based on Maryland hospitals’ cost report and charge data may not be accurate because acute care hospitals in Maryland are operating under a waiver of the Medicare’s ratesetting methodologies for inpatient and outpatient services under the authorities of sections 1814(b)(3) and 1833(a)(2) of the Act. The State’s Health Services Cost Review Commission (HSCRC) is the regulatory body that establishes hospital-specific rates for all hospital services in Maryland. Because all Maryland short-term acute care hospitals are paid based on the hospital-specific rates set by the HSCRC rather than under the IPPS, CCRs are not required to determine their Medicare payments (as they are for other acute care hospitals that are not governed under the waiver at sections 1814(b)(3) and 1833(a)(2) of the Act, and who are reimbursed for their treatment of Medicare patients under the IPPS). Therefore, CCRs in the Provider-Specific File for Maryland acute care hospitals, for the most part, are missing (because they are not used for payment). Those CCRs that are input into the Provider- E:\FR\FM\25APP2.SGM 25APP2 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules wwhite on PROD1PC61 with PROPOSALS2 Specific File for Maryland acute care hospitals by the fiscal intermediary are most likely unaudited because they are not used for making payments. For all these reasons, we are concerned that CCRs for Medicare acute care hospitals located in Maryland that are in the Provider-Specific File may not be reliable. Therefore, we believe that they should not be used as proxies for setting the statewide average total CCRs for Maryland LTCHs. We believe it would be more appropriate to establish statewide average total CCRs for Maryland LTCHs based on national average total CCRs of IPPS hospitals that were audited by fiscal intermediaries. We are proposing to establish statewide average total CCRs for Maryland LTCHs based on the national average total CCRs of all IPPS hospitals because we believe that the average of the CCRs of all the IPPS hospitals across the country that were audited by fiscal intermediaries would be based on sufficient rigorous complete data that would be a representative proxy for the ratio of costs-to-charges of LTCHs in Maryland that are subject to LTCH PPS. (We note that, under our proposal, the fiscal intermediary may assign the statewide average CCR in one of three circumstances (that is, ‘‘new’’ LTCHs, as defined above; LTCHs with a CCR that is in excess of the LTCH ceiling; and LTCHs with unavailable data, as discussed above)). However, we are soliciting comments or suggestions for an alternative proxy statewide average CCR to use for LTCHs that are located in Maryland and are paid under the LTCH PPS. (3) Data Used to Determine a CCR Similar to our current policy, we are also proposing to specify under proposed new § 412.525(a)(4)(iv)(B) that, for discharges occurring on or after October 1, 2006, the CCR applied at the time a claim is processed would be based on either the most recent settled cost report or the most recent tentatively settled cost report, whichever is from the latest cost reporting period. Furthermore, we are proposing under proposed new § 412.525(a)(4)(iv)(A) to state that CMS may specify an alternative to the CCR computed under proposed new § 412.525(a)(4)(iv)(B); that is, the CCR computed from the most recent settled cost report or the most recent tentatively settled cost report, whichever is later, or a hospital may also request that the fiscal intermediary use a different (higher or lower) CCR based on substantial evidence presented by the hospital. These proposed revisions to our policy for determining a LTCH’s CCR for discharges occurring VerDate Aug<31>2005 17:10 Apr 24, 2006 Jkt 208001 on or after October 1, 2006, under proposed revised new § 412.525(a)(4)(iv)(A) and (B) are similar to our existing policy established in the June 9, 2003 IPPS high-cost outlier final rule (68 FR 34506 through 34513). In addition, we are proposing a technical correction to existing § 412.525(a)(3) to change the plural reference from cost-tocharge ‘‘ratios’’ to the singular reference to a cost-to-charge ‘‘ratio’’ because, under the LTCH PPS, a single (total) CCR is computed for LTCHs. (4) Reconciliation of High-Cost Outlier Payments Upon Cost Report Settlement In the June 9, 2003 high-cost outlier final rule (68 FR 34508 through 34512), we established a policy for LTCHs that provided that, effective for LTCH PPS discharges occurring on or after August 8, 2003, any reconciliation of outlier payments will be based upon the actual CCR computed from the costs and charges incurred in the period during which the discharge occurs. In that same final rule, we also established that, for discharges occurring on or after August 8, 2003, at the time of any reconciliation, outlier payments may be adjusted to account for the time value of any underpayments or overpayments based upon a widely available index to be established in advance by the Secretary and will be applied from the midpoint of the cost reporting period to the date of reconciliation. These changes regarding the reconciliation of outlier payments under the LTCH PPS were made in conjunction with the changes regarding the determination of LTCHs’ CCRs that we established under § 412.525(a)(4) in the June 9, 2003 IPPS high-cost outlier final rule, as discussed in greater detail in section IV.D.3.b. of this preamble. (We note that the instructions for implementing these regulations under both the IPPS and the LTCH PPS are discussed in further detail in Program Transmittal A–03– 058. Additional information on the administration of the reconciliation process under the IPPS is provided in Program Transmittal 707 (Change Request 3966, October 12, 2005). We note that, in addition to the proposed changes to the high-cost outlier and short-stay outlier policies presented in this proposed rule, we are currently developing additional instructions on the administration of the existing reconciliation process under the LTCH PPS that would be similar to the IPPS reconciliation process.) As discussed above, we are proposing, for discharges occurring on or after October 1, 2006, to codify into the LTCH PPS section of the regulations (Subpart O of 42 CFR Part 412) the provisions PO 00000 Frm 00137 Fmt 4701 Sfmt 4702 24131 governing the determination of LTCHs’ CCRs, including proposed modifications and editorial clarifications to our existing methodology for determining the annual LTCH CCR ceiling and applicable statewide average CCRs under the LTCH PPS. In this proposed rule, under the broad authority of section 123 of the BBRA and section 307(b)(1) of BIPA, we are also proposing to revise § 412.525(a)(4), for discharges occurring on or after October 1, 2006, to codify in Subpart O of 42 CFR Part 412 the provisions discussed above concerning the reconciliation of LTCH PPS outlier payments, including proposed editorial clarifications discussed in greater detail below in this section, that would more precisely describe the application of those policies. We are proposing the additional revisions to § 412.525(a)(4) concerning the reconciliation of outlier payments, which are discussed in greater detail below in this section, because these proposed changes would be consistent with the proposed changes to the calculation of the LTCH CCR ceiling discussed above. Specifically, at proposed new § 412.525(a)(4)(iv)(D), similar to our current policy, we are proposing to specify that, for discharges occurring on or after October 1, 2006, any reconciliation of outlier payments would be based on the CCR calculated based on a ratio of costs to charges computed from the relevant cost report and charge data determined at the time the cost report coinciding with the discharge is settled. In addition, at proposed new § 412.525(a)(4)(iv)(E), similar to our current policy, we are proposing to specify that, for discharges occurring on or after October 1, 2006, at the time of any reconciliation, outlier payments may be adjusted to account for the time value of any underpayments or overpayments. Consistent with our current policy, we also are proposing that such an adjustment would be based upon a widely available index to be established in advance by the Secretary and would be applied from the midpoint of the cost reporting period to the date of reconciliation. We are proposing to make these additions to § 412.525(a)(4) because we believe that such proposed changes reinforce the concept that the LTCH PPS has a single payment rate for inpatient operating and capital-related costs (as discussed in greater detail previously), and because we believe it would be more appropriate and administratively simpler to include all of the regulatory provisions concerning the determination of LTCH PPS outlier payments applicable under the LTCH E:\FR\FM\25APP2.SGM 25APP2 24132 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules PPS regulations in Subpart O of 42 CFR Part 412. c. Short-Stay Outliers (1) Background When we implemented the LTCH PPS, under § 412.529, we established a special payment policy for short-stay outlier cases, that is, LTCH PPS cases with a length of stay that is less than or equal to five-sixths of the geometric average length of stay for each LTC– DRG. As noted previously, generally LTCHs are defined by statute as having an average length of stay of greater than 25 days. We believe that a short-stay outlier payment adjustment results in more appropriate payments, because these cases most likely would not receive a full course of a LTCH-level of treatment in such a short period of time and a full LTC–DRG payment may not always be appropriate. Under the existing short-stay outlier policy at § 412.529, for LTCH PPS discharges with a length of stay of up to and including five-sixths the geometric average length of stay for the LTC–DRG, in general, we adjust the per discharge payment under the LTCH PPS by the least of 120 percent of the estimated cost of the case, 120 percent of the LTC–DRG specific per diem amount multiplied by the length of stay of that discharge, or the full LTC–DRG payment. (We note we have proposed changes to this general payment formula in the RY 2007 LTCH PPS proposed rule (71 FR 4679).) Consistent with the LTCH PPS high-cost outlier policy, we calculate the estimated cost of a case by multiplying the overall hospital CCR by the Medicare allowable covered charge. wwhite on PROD1PC61 with PROPOSALS2 (2) Determination of LTCH CCRs and Reconciliation In the June 9, 2003 IPPS outlier final rule (68 FR 34507), we revised the shortstay policy at § 412.529 (and the highcost outlier policy at § 412.525(a)) because, as we discussed above in this section, we believed that the short-stay outlier (and high-cost outlier) policy are susceptible to the same payment vulnerabilities that became evident under the IPPS and, therefore, merited revision. Therefore, in the regulations under existing § 412.529(c)(5)(ii) and (iii), we established a policy for the determination of LTCH CCRs and the reconciliation of short-stay outlier payments, for discharges occurring on or after August 8, 2003 (§ 412.529(c)(5)(ii)) and October 1, 2003 (§ 412.529(c)(5)(iii)), respectively. (As noted above in this section, in that same final rule, we established the same VerDate Aug<31>2005 17:10 Apr 24, 2006 Jkt 208001 changes to the high-cost outlier policy at existing § 412.525(a)(4)(ii) and (iii).) As we discuss above in this section, we are proposing to revise the existing regulations at § 412.525(a)(4) to codify in Subpart O of 42 CFR Part 412 the provisions governing the determination of LTCHs’ CCRs, including proposed modifications and editorial clarifications to our existing methodology for determining the annual LTCH CCR ceiling and applicable statewide average CCRs under the LTCH PPS, and the provisions governing the reconciliation of high-cost outlier payments. We are proposing these changes, as we discuss in greater detail below in this section, because we believe that such proposed changes would be more consistent with the LTCH PPS single payment rate, and because we believe it would be more appropriate and administratively simpler to include the regulatory provisions that pertain only to LTCHs for the determination of LTCH PPS outlier payments applicable under the LTCH PPS regulations in Subpart O of 42 CFR Part 412 (as opposed to Subpart A). Because CCRs are also used in determining short-stay outlier payments under § 412.529, we are proposing, under the broad authority of section 123 of the BBRA as amended by section 307(b)(1) of BIPA, to revise § 412.529(c) consistent with the proposed changes to § 412.525(a)(4) discussed above in this section. Specifically, we are proposing in new § 412.529(c)(5)(iv)(C)(2) to specify that, for discharges occurring on or after October 1, 2006, if, among other things, a LTCH’s CCR is in excess of the LTCH CCR ceiling (which would be calculated as 3 standard deviations above the corresponding national geometric mean CCR (established and published annually by CMS)), the fiscal intermediary may use a statewide average CCR (also established annually by CMS). (We note that, similar to our current policy, we are also proposing under proposed §§ 412.529(c)(5)(iv)(C)(1) and (3) that the fiscal intermediary may use a statewide average CCR in two other circumstances, which are discussed in greater detail below in this section.) Under our current methodology for determining the LTCH CCR ceiling, we add together the separate IPPS operating CCR ceiling and IPPS capital CCR ceiling, which are determined at 3 standard deviations from the average operating CCR and average capital CCR, respectively. Under proposed § 412.529(c)(5)(iv)(C)(2), for discharges occurring on or after October 1, 2006, we are proposing that we would PO 00000 Frm 00138 Fmt 4701 Sfmt 4702 determine the single ‘‘total’’ CCR ceiling (as we proposed under the high-cost outlier policy at proposed § 412.525(a)(4)(iv)(C)(2), as explained previously in this section) by first calculating the total (that is, operating and capital) CCR for each IPPS hospital and then determining the average total CCR for all IPPS hospitals. For example, if an IPPS hospital’s operating CCR is 0.432 and its capital CCR is 0.027, its total CCR would be 0.459 (0.432 + 0.027 = 0.459). This calculation would be repeated for all IPPS hospitals in order to determine a total CCR for each IPPS hospital. Next, those total CCRs would be used to determine the average total CCR. Once the average total CCR across all IPPS hospitals is determined, we would take 3 standard deviations above the corresponding national geometric mean total CCR (in the previous step) to determine the LTCH CCR ceiling. This proposed change is similar to the proposed change to the LTCH PPS highcost outlier policy discussed previously in this section. (We note, as discussed in greater detail below in this section, in conjunction with this proposed change in the calculation of the LTCH CCR ceiling, we are also proposing a change in our methodology for calculating the applicable statewide average CCRs under the LTCH PPS to be based on ‘‘total’’ hospital-specific CCRs.) Specifically, we are proposing under the short-stay outlier policy at proposed new § 412.529(c)(5)(iv)(C) to use the same IPPS CCR data that we currently use to annually determine the separate IPPS operating CCR and capital CCR ceilings (that we add together under our current policy to determine the annual CCR ceiling for LTCHs) to compute the single LTCH ‘‘total’’ CCR ceiling based on IPPS hospital-specific total (operating and capital-related) Medicare costs and charges, as explained above in this section. In other words, our current methodology (that is, using the ‘‘combined’’ IPPS CCR ceiling) calculates two separate IPPS CCRs (an operating CCR and a capital-related CCR) by taking 3 standard deviations from the average of all IPPS operating CCRs and 3 standard deviations from the average of all IPPS capital CCRs separately to determine the IPPS operating CCR ceiling and the IPPS capital CCR ceiling, respectively. Then we added the IPPS operating CCR ceiling and the IPPS capital CCR ceiling together to get a ‘‘combined’’ LTCH PPS ceiling. The proposed methodology would add each IPPS hospital’s operating CCR and its capital CCR together first, to get a ‘‘total’’ CCR and then take the average of all of those total E:\FR\FM\25APP2.SGM 25APP2 wwhite on PROD1PC61 with PROPOSALS2 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules CCRs across all IPPS hospitals to calculate a ceiling (that is, 3 standard deviations above the corresponding national geometric mean total CCR). The underlying data, upon which this calculation is based, that is, the IPPS CCRs, would remain the same. As we explained in the RY 2007 LTCH PPS proposed rule (71 FR 4691), under this proposal, the total CCR ceiling would continue to be published annually in the IPPS proposed and final rules and, therefore, the public should continue to consult the annual IPPS proposed and final rules for changes to the applicable LTCH PPS statewide average total CCRs that would be effective for discharges occurring on or after October 1, 2006 (because, under this proposal the current applicable combined statewide average CCRs, established for discharges occurring on or after October 1, 2005 in the FY 2006 IPPS final rule, would remain in effect for discharges occurring on or before September 30, 2006.) The rationale for this proposed change to the short-stay outlier policy at proposed § 412.529(c)(5)(iv)(C) mirrors the rationale provided for the proposed changes to the high-cost outlier policy at proposed § 412.525(a)(4)(iv)(C) discussed above in this section. Therefore, in this proposed rule, based on the most recent complete IPPS total CCR data from the December 2005 update of the Provider-Specific File, we are proposing a total CCR ceiling of 1.313 under the LTCH PPS that would be effective October 1, 2006. We note that this proposed ceiling was determined based on the same data used to determine to the separate proposed IPPS operating CCR ceiling (1.25) and the proposed IPPS capital CCR ceiling (0.158) discussed in section II.A.4.c. of the Addendum to this proposed rule. Furthermore, we are proposing that, if more recent data are available (that is, data from the March 2006 update of the Provider-Specific File, for example), we would use that data to determine the final total CCR ceiling under the LTCH PPS for FY 2007 using the proposed methodology described above. As noted previously in this section, the LTCH CCR ceiling determined under our current ‘‘combined’’ methodology would result in a slightly higher LTCH CCR ceiling (that is. 1.25 + 0.158 = 1.408) for FY 2007 compared to the proposed ‘‘total’’ CCR ceiling of 1.313 for FY 2007. However, we note that, based on CCRs from the December 2005 update of the Provider-Specific File, there were no LTCHs that have a CCR that is greater than the proposed ceiling of 1.313 (the highest LTCH CCR in the database of 363 LTCHs is 1.132). VerDate Aug<31>2005 17:10 Apr 24, 2006 Jkt 208001 Consistent with the proposed changes to §§ 412.525(a)(4)(iv)(A) through (C), under the broad authority of section 123 of the BBRA and section 307(b)(1) of BIPA, we are also proposing at new §§ 412.529(c)(5)(iv)(A) through (C), for discharges occurring on or after October 1, 2006, to codify in Subpart O of 42 CFR Part 412 the remaining LTCH PPS short-stay outlier policy changes concerning the determination of LTCHs’ CCRs that were established in the June 9, 2003 IPPS high-cost outlier final rule (68 FR 34506 through 34513), including proposed modifications and editorial clarifications to those existing policies established in that final rule in order to more precisely describe the application of those policies as they relate to LTCHs. Specifically, similar to our current policy and consistent with the proposed changes to the high-cost outlier policy at § 412.525(a)(4) discussed previously in this section, we are proposing in § 412.529(c)(5)(iv)(C) to specify that the fiscal intermediary may use a statewide average CCR, which would be established annually by CMS, if it is unable to determine an accurate CCR for a LTCH in one of the following three circumstances: (1) New LTCHs that have not yet submitted their first Medicare cost report (for this purpose, consistent with current policy, a new LTCH would be defined as an entity that has not accepted assignment of an existing hospital’s provider agreement in accordance with § 489.18); (2) LTCHs whose CCRs are in excess of the LTCH CCR ceiling (that is, 3 standard deviations above the corresponding national geometric mean total CCR); and (3) other LTCHs for whom data with which to calculate a CCR are not available (for example, missing or faulty data). (As noted above, other sources of data that the fiscal intermediary may consider in determining a LTCH’s CCR include data from a different cost reporting period for the LTCH, data from the cost reporting period preceding the period in which the hospital began to be paid as a LTCH (that is, the period of at least 6 months that it was paid as a short-term acute care hospital), or data from other comparable LTCHs, such as other LTCHs in the same chain or in the same region. As also noted above and consistent with our current regulations, either CMS or the hospital may request the use of a different (higher or lower) CCR based on substantial evidence that such a CCR more accurately reflects the hospital’s actual costs and charges. This applies to new LTCHs (as defined above) as well. For instance, CMS may determine that the applicable statewide PO 00000 Frm 00139 Fmt 4701 Sfmt 4702 24133 average CCR should not be applied to hospitals that convert from acute care IPPS hospitals to LTCHs (and receive a new LTCH provider number). Rather, the cost and charge data from the IPPS hospital’s cost report (even if it is for more or less than a 12-month cost reporting period) would be used to determine the LTCH’s CCR.) In addition, similar to our current practice and consistent with the proposed change to the high-cost outlier policy discussed previously in this proposed rule under § 412.525(a)(4)(iv)(C), we are proposing that, under § 412.529(c)(5)(iv)(C), for discharges occurring on or after October 1, 2006, we would annually establish statewide average ‘‘total’’ CCRs for use under the LTCH PPS based on IPPS data by first calculating the total (that is, operating and capital) CCR for each hospital and then determining the weighted average total CCR for all hospitals in each State rather than assigning the combined (operating and capital) statewide weighted average CCRs, as we do under our current policy. Specifically, in proposing to compute statewide average total CCRs, we would use the same IPPS CCR data that we currently use to annually establish the separate IPPS operating statewide average CCRs and capital statewide CCRs (that we add together under our current policy to determine the applicable ‘‘combined’’ statewide average CCR for LTCHs) to compute statewide average total CCRs as explained above in this section. To summarize, our current methodology (that is, using the ‘‘combined’’ IPPS operating and capital statewide average CCRs) calculates two separate IPPS average CCRs for each State (an operating statewide average CCR (one average CCR for urban areas and another average CCR for rural areas) and a capital statewide average (for all areas within each State)) by taking the weighted average of all IPPS operating CCRs in each State (for urban areas and for rural areas separately) and the weighted average of all IPPS capital CCRs in each State (for all areas), and then adding the two averages together for the particular State to get a ‘‘combined’’ statewide average CCR (one for urban areas and one for rural areas). The proposed methodology would add each IPPS hospital’s operating CCR and its capital CCR together first, and then takes the weighted average of all of those total CCRs for all urban IPPS hospitals in the State to get the urban statewide average CCR and for all rural IPPS hospitals in the State to get the rural statewide average CCR. This process is repeated for each State E:\FR\FM\25APP2.SGM 25APP2 wwhite on PROD1PC61 with PROPOSALS2 24134 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules (except Maryland, as discussed below). The underlying data, that is, the IPPS CCRs, would remain the same. In this proposed rule, based on the most recent complete IPPS total CCR data from the December 2005 update of the ProviderSpecific File, the proposed LTCH PPS statewide average CCRs that would be effective October 1, 2006 are presented in Table 8C of the Addendum to this proposed rule. (We note that, as is the case under the IPPS, all areas in the District of Columbia, New Jersey, Puerto Rico, and Rhode Island are classified as urban, and therefore, there are no proposed rural statewide average total CCRs listed for those jurisdictions in Table 8C of the Addendum to this proposed rule. We also note that, as is the case under the IPPS, although Massachusetts has areas that are designated as rural, there are no shortterm acute care IPPS hospitals or LTCHs located in those areas as of March 2006, and therefore, there is no proposed rural statewide average total CCR listed for rural Massachusetts in Table 8C of the Addendum of this proposed rule.) Furthermore, as stated above, we are proposing that, if more recent data are available (that is, data from the March 2006 update of the Provider-Specific File, for example), we would use those data to determine the final LTCH PPS statewide average CCRs for FY 2007 using the proposed methodology described above. As we also noted above, we are proposing to determine the urban and rural statewide average total CCRs for Maryland LTCHs paid under the LTCH PPS using, as a proxy, the national average total CCR for urban IPPS hospitals and the national average total CCR for rural IPPS hospitals, respectively. We are proposing this proxy because we believe that the CCR data on the Provider-Specific File for Maryland hospitals may not be accurate. As discussed in greater detail above, we believe that the CCR data in the Provider-Specific File based on Maryland short-term acute care hospitals’ cost report and charge data may not be reliable because acute care hospitals in Maryland are waived from Medicare’s ratesetting methodologies for inpatient and outpatient services under the authorities of sections 1814(b)(3) and 1833(a)(2) of the Act. The State’s HSCRC is the regulatory body that establishes hospital-specific rates for all hospital services in Maryland. Because Maryland hospitals are paid based on the hospitals-specific rates set by HSCRC rather than under the IPPS, CCRs are not required to determine their Medicare payments (as they are for other acute care hospitals that are not VerDate Aug<31>2005 17:10 Apr 24, 2006 Jkt 208001 governed under the waiver in sections 1814(b)(3) and 1833(a)(2) of the Act, and who are reimbursed for their treatment of Medicare patients under the IPPS). Therefore, as discussed above, CCRs in the Provider-Specific File for Maryland acute care hospitals, for the most part, are missing or unaudited (because they are not used for making payments). Thus, we believe it would be more appropriate to establish statewide average total CCRs for Maryland LTCHs based on a national average total CCRs of IPPS hospitals that were audited by fiscal intermediaries. We are proposing to establish statewide average total CCRs for Maryland based on the national average total CCRs of all IPPS hospitals because we believe that the average of the CCRs of all of the IPPS hospitals across the country that were audited by fiscal intermediaries would be based on sufficient rigorous complete data that would be a representative proxy for the ratio of costs to charges of LTCHs located in Maryland that are subject to the LTCH PPS. (We note, that under our proposal, the fiscal intermediary may assign the statewide average CCR in one of three circumstances (that is, ‘‘new’’ LTCHs, as defined above; LTCHs with a CCR that is in excess of the LTCH CCR ceiling; and LTCHs with unavailable data, as discussed above).) However, we are soliciting comments on suggestions for an alternative proxy statewide average CCR to use for LTCHs that are located in Maryland that are paid under the LTCH PPS. In addition, under this proposal, the statewide average total CCRs would continue to be published annually in the IPPS proposed and final rules and, therefore, the public would continue to consult the annual IPPS proposed and final rules for changes to the applicable LTCH PPS statewide average total CCRs that would be effective for discharges occurring on or after October 1, 2006 (because, under this proposal, the current applicable combined statewide average CCRs, established for discharges occurring on or after October 1, 2005, in the FY 2006 IPPS final rule, would remain in effect for discharges occurring on or before September 30, 2006). Our rationale for this proposed change to the short-stay outlier policy at proposed § 412.529(c)(5)(iv)(C) mirrors the rationale provided for the proposed changes to the high-cost outlier policy at proposed § 412.525(a)(4)(iv)(C) discussed in greater detail above in this section. We also are proposing under § 412.529(c)(5)(iv)(B), similar to our current policy and consistent with the proposed change to the high-cost outlier policy discussed above, for discharges PO 00000 Frm 00140 Fmt 4701 Sfmt 4702 occurring on or after October 1, 2006, that the CCR applied at the time a claim is processed would be based on either the most recent settled cost report or the most recent tentative settled cost report, whichever is from the latest cost reporting period. We are proposing under § 412.529(c)(5)(iv)(A) that CMS may specify an alternative to the CCR computed from the most recent settled cost report or the most recent tentative settled cost report, whichever is later, or a hospital may also request that its fiscal intermediary use a different (higher or lower) CCR based on substantial evidence presented by the hospital. As noted previously in this proposed rule, these proposed revisions to our policy for determining a LTCH’s CCR for discharges occurring on or after October 1, 2006, under proposed revised § 412.529(c)(5)(iv)(A) and (B) are similar to our existing policy established in the June 9, 2003 IPPS high-cost outlier final rule (68 FR 34506 through 34513) and consistent with the proposed changes to the high-cost outlier policy previously discussed in this proposed rule. Furthermore, similar to our current policy and consistent with the proposed change to the high-cost outlier policy discussed previously in this section, under the broad authority under section 123 of the BBRA as amended by section 307(b) of BIPA, we are also proposing under § 412.529(c)(5)(iv), for discharges occurring on or after October 1, 2006, to codify in the LTCH PPS regulations (Subpart O of 42 CFR Part 412) the outlier reconciliation provisions that were established in the June 9, 2003 IPPS high-cost outlier final rule (68 FR 34506 through 34513), including proposed editorial clarifications to those provisions (which are the same as the proposed changes to the high-cost outlier policy discussed above in this section). Specifically, under proposed § 412.529(c)(5)(iv)(D), similar to our current policy and consistent with the proposed change to the high-cost outlier policy, we are proposing to specify that, for discharges occurring on or after October 1, 2006, any reconciliation of outlier payments would be based on the CCR calculated based on a ratio of costs to charges computed from the relevant cost report and charge data determined at the time the cost report coinciding with the discharge is settled. In addition, at proposed § 412.529(c)(5)(iv)(E), similar to our current policy and consistent with the proposed change to the high-cost outlier policy, we are proposing to specify that, for discharges occurring on or after October 1, 2006, at the time of any reconciliation, outlier payments may be E:\FR\FM\25APP2.SGM 25APP2 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules wwhite on PROD1PC61 with PROPOSALS2 adjusted to account for the time value of any underpayments or overpayments. This adjustment would be based upon a widely available index that would be established in advance by the Secretary and would be applied from the midpoint of the cost reporting period to the date of reconciliation. Our rationale for these proposed changes to the shortstay outlier policy at proposed § 412.529(c)(5)(iv)(D) and (E) mirrors the rationale provided for the proposed changes to the high-cost outlier policy at proposed § 412.525(a)(4)(iv)(D) and (E), discussed in greater detail above in this section. 7. Technical Corrections Relating to LTCHs We are proposing to make the following technical changes to various sections of the regulations relating to LTCHs to update or correct crossreferences or to include inadvertently omitted provisions: a. In the following sections, we are proposing to correct several incorrect cross-references in the existing regulations: • In § 412.505(b)(1), changing the cross-reference ‘‘§ 412.22(e) and (h)(5)’’ to the phrase ‘‘§ 412.22(e)(3) and (h)(6), if applicable’’. • In § 412.508(c)(3), changing the cross-reference ‘‘§ 1001.301’’ to ‘‘§ 1001.201.’’ • In § 412.541(b)(2)(i), changing the cross-reference ‘‘§ 412.533(b)’’ to ‘‘§ 412.533(a)(5) and § 412.533(c)’’ to correctly refer to the provisions on the determination of the LTCH PPS rates. b. We are proposing to revise § 412.511 to change the cross-reference ‘‘§ 412.22(e) and (h)(5)’’ to the phrase ‘‘§ 412.22(e)(3) and (h)(6)’’ and to clarify the requirement that LTCHs must meet under §§ 412.22(e)(3) and (h)(6) to report co-location status as part of its overall reporting requirements. c. We are proposing to revise § 412.525(d) by adding new paragraphs (d)(3) and (d)(4) to specify two additional payment adjustments to the per discharge payments under the LTCH PPS that were inadvertently omitted; that is, the special payment under the onsite transfer and readmission policy at § 412.532 and the special payment provisions for LTCH HwHs and satellites of LTCHs at § 412.534. d. We are proposing to revise § 412.532(a)(2) to correct the crossreference to the definition of a satellite facility by changing ‘‘§ 412.22(f)’’ to ‘‘§ 412.22(h)’’. In addition, we are proposing to revise paragraph (b) of § 412.532 to include satellite facilities and SNFs as part of the definition of entities that may be ‘‘co-located’’ or VerDate Aug<31>2005 17:10 Apr 24, 2006 Jkt 208001 ‘‘onsite’’ with a hospital. In existing § 412.532, (a)(2) and (a)(3), we include satellite facilities and SNFs, respectively, within the onsite provider payment policy as entities that may be co-located with a LTCH, but omitted to mention them in § 412.533(b) as being included when we defined ‘‘co-located or onsite’’ facilities. We are proposing to conform § 412.532(b) to include their mention. 8. Proposed Cross-Reference Correction in Authority Citations for 42 CFR Parts 412 and 413 As stated earlier, on November 15, 2004, we published in the Federal Register the final rule establishing a PPS for IPFs (69 FR 66922). As a part of that rule, we amended the authority citations for 42 CFR parts 412 and 413 to include references to section 124 of Public Law 106–113. Section 124 directed us to take various actions regarding a per diem PPS for IPFs. We included incorrect cross-references to the United States Statutes at Large citation for this provision. We are proposing to amend the authority citations for parts 412 and 413 by removing the incorrect crossreference to ‘‘113 Stat. 1515’’ and inserting the correct cross-reference ‘‘113 Stat. 1501A–332’’. B. Critical Access Hospitals (CAHs) (If you choose to comment on this section, please include the caption ‘‘CAHs’’ at the beginning of your comment.) 1. Background Section 1820 of the Act provides for the establishment of Medicare Rural Hospital Flexibility Programs (MRHFPs), under which individual States may designate certain facilities as critical access hospitals (CAHs). Facilities that are so designated and meet the CAH conditions of participation under 42 CFR part 485, Subpart F, will be certified as CAHs by CMS. Regulations governing payments to CAHs for services to Medicare beneficiaries are located in 42 CFR part 413. 2. Sunset of Designation of CAHs as Necessary Providers: Technical Correction Under section 1820(c)(2)(B)(i) of the Act, a CAH is required to be located more than a 35-mile drive (or in the case of mountainous terrain or only secondary roads, a 15-mile drive) from a hospital or another CAH, unless the CAH is certified by the State as a necessary provider of health care services to residents in the area. Section 405(h) of Public Law 108–173 amended PO 00000 Frm 00141 Fmt 4701 Sfmt 4702 24135 section 1820(c)(2)(B)(i)(II) of the Act by adding language that terminated a State’s authority to waive the location requirement for a CAH by designating the CAH as a necessary provider, effective January 1, 2006. As a result of this amendment, as of January 1, 2006, States are no longer able to designate CAH status based upon a determination that an entity is a necessary provider of health care. However, section 405(h) of Public Law 108–173 also included a grandfathering provision for CAHs that are certified as necessary providers prior to January 1, 2006. Under this provision, a CAH that is designated as a necessary provider in its State’s rural health plan prior to January 1, 2006, is permitted to maintain its necessary provider designation. The regulations that specify the location requirements for CAHs described above are set forth at 42 CFR 485.610(c). To implement the amendment made by section 405(h) of Public Law 108–173, we published a final rule in the Federal Register on August 11, 2004 (69 FR 49271) to revise the regulations under paragraph (c) of § 485.610. In that revision, we inadvertently included an erroneous date: In the second sentence of paragraph (c), we stated that a CAH that is designated as a necessary provider as of October 1, 2006, will maintain its necessary provider designation after October 1, 2006. Although a correction notice was published in the Federal Register on October 7, 2004 (69 FR 60252), the notice corrected only the second citation of the date in that paragraph. As a result, the second sentence of § 485.610(c) continues to state, incorrectly, that a CAH that is designated as a necessary provider as of October 1, 2006, will maintain its necessary provider designation as of January 1, 2006. To avoid further confusion, and to ensure that the regulations implementing the CAH location requirement under section 1820(c)(2)(B)(i)(II) of the Act specify that requirement accurately, we are proposing to revise the second sentence of § 485.610(c) to state that a CAH that was designated as a necessary provider on or before December 31, 2005, will maintain its necessary provider designation as of January 1, 2006. We note that this change would merely correct the previous error and does not reflect any change in our policy as to how the statutory provision is implemented. E:\FR\FM\25APP2.SGM 25APP2 24136 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules VII. Payment for Services Furnished Outside the United States (If you choose to comment on this section, please include the caption ‘‘Services Outside the United States’’ at the beginning of your comment.) wwhite on PROD1PC61 with PROPOSALS2 A. Background Section 1862(a)(4) of the Act generally prohibits payment under Medicare for items and services furnished outside the United States. Under sections 1861(x) and 210(i) of the Act, ‘‘United States’’ is defined to include the 50 States, the District of Columbia, Puerto Rico, the Virgin Islands, Guam, and America Samoa. Furthermore, under Public Law 94–241, ‘‘those laws which provide Federal services and financial assistance programs’’ apply to the Northern Mariana Islands to the same extent as they do to Guam. In addition, we have interpreted the term ‘‘United States’’ as including U.S. territorial waters. We consider shipboard services furnished in a port of the United States or within 6 hours before arrival at, or departure from, a port of the United States to be furnished in the United States territorial waters. (54 FR 41723) Therefore, in our regulations at § 411.9(a), we define the United States to include the 50 States, the District of Columbia, Puerto Rico, the Virgin Islands, Guam, American Samoa, the Northern Mariana Islands, and for purposes of services furnished on board ship, the territorial waters adjoining the land areas of the United States. This general prohibition has exceptions, under which payment may be made for inpatient hospital services, emergency inpatient hospital services, and for physician and ambulance services associated with these hospital services that are furnished outside the United States. Payment may be made for inpatient hospital services if a Medicare beneficiary who is a United States resident received these services at a hospital located outside of the United States that either was closer to, or was substantially more accessible from, the beneficiary’s residence than the nearest United States hospital that was adequately equipped and available to treat the beneficiary. Payment may be made for emergency inpatient hospital services if a beneficiary was in the United States (or in Canada while traveling between Alaska and another State without unreasonable delay and by the most direct route) when the emergency arose, and the hospital located outside the United States was closer to, or substantially more accessible from, the place where the emergency arose than the nearest VerDate Aug<31>2005 17:10 Apr 24, 2006 Jkt 208001 available adequately equipped hospital within the United States. Payment may be made for physician and ambulance services furnished in connection with these inpatient and emergency inpatient hospital services. Our existing regulations that implement these statutory provisions are located at 42 CFR 409.3, 409.5, 410.14, 410.66, 411.9, 413.74 and Subparts G and H of Part 424. B. Proposed Clarification of Regulations Services that fall under these exceptions typically are furnished in Canada or Mexico. However, in accordance with section 1814(f) of the Act and the definition of the term ‘‘United States’’ (42 CFR 411.9(a)), it is permissible for Medicare to pay for services furnished in foreign countries other than Canada and Mexico. For example, if a Medicare beneficiary who is in Guam needed emergency inpatient hospital services and the nearest available hospital adequately equipped to treat that beneficiary was located in the Philippines, Medicare payment would be permitted for the services. Several of our existing regulations (§§ 409.3, 409.5, 410.66, and 413.74) specifically refer to services furnished in Canada and Mexico and do not indicate that it is permissible for Medicare payment to be made for services furnished in other foreign countries. The references in these sections also are more limited than the provisions of 42 CFR part 424, subpart H, the portion of our regulations that addresses treatment furnished in a foreign country. Therefore, we are proposing to amend those regulations that refer to Canada and Mexico in order to conform them to the Act and to our other regulations addressing these situations. We also are proposing to make some related technical changes. In §§ 409.3(e) and 424.123(c)(2), we are proposing to change the references from the Joint Commission on Accreditation of Hospitals (JCAH) to the Joint Commission on Accreditation of Healthcare Organizations (JCAHO), the current name of that organization. In § 424.121(c), we are proposing to change the obsolete cross-reference from § 405.313 to the correct cross-reference, § 411.9. VIII. Payment for Blood Clotting Factor Administered to Inpatients With Hemophilia (If you choose to comment on the issues in this section, please add the caption ‘‘Blood Clotting Factor’’ at the beginning of your comment.) PO 00000 Frm 00142 Fmt 4701 Sfmt 4702 Section 1886(a)(4) of the Act excludes the costs of administering blood clotting factors to inpatients with hemophilia from the definition of ‘‘operating costs of inpatient hospital services.’’ Section 6011(b) of Pub. L. 101–239 states that the Secretary of Health and Human Services shall determine the payment amount made to hospitals under Medicare Part A for the costs of administering blood clotting factors to individuals with hemophilia by multiplying a predetermined price per unit of blood clotting factor by the number of units provided to the individual. The regulations governing payment for blood clotting factors furnished to hospital inpatients and for payment for the furnishing fee are located in §§ 412.2(f)(8) and 412.115(b). In FY 2005, we made payments for blood clotting factors furnished to inpatients at 95 percent of average wholesale price (AWP), consistent with the rates then paid under section 1842(o) of the Act for Medicare Part B drugs (including blood clotting factor furnished to beneficiaries who are not inpatients). Section 303 of Pub. L. 108–173 added section 1847A to the Act. Effective January 1, 2005, this section requires that almost all Medicare Part B drugs not paid on a cost or prospective basis be paid at 106 percent of average sales price (ASP), while section 1842(o)(5) of the Act provides for a Medicare Part B payment of a furnishing fee for blood clotting factor. On November 15, 2004, we published regulations in the Federal Register (69 FR 66310 through 66319) that implemented the provisions of section 1847A of the Act. These regulations are codified at Subpart K of Part 414 and § 410.63, respectively. The furnishing fee is updated each calendar year as specified by section 1842(o)(5) of the Act. The furnishing fee for clotting factor for years after CY 2005 is equal to the fee for the previous year increased by the percentage increase in the consumer price index (CPI) for medical care for the 12-month period ending with June of the previous year. This requirement is set forth in our regulations at § 410.63. In the FY 2006 IPPS final rule (70 FR 47473), we amended our regulations at §§ 412.2(f)(8) and 412.115(b) to state that, for discharges occurring on or after October 1, 2005, we make payment for blood clotting factor administered to hospital inpatients using the Medicare Part B payment amounts for blood clotting factor as determined under subpart K of 42 CFR part 414 and for the furnishing fee as determined under § 410.63. E:\FR\FM\25APP2.SGM 25APP2 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules On November 21, 2005, we issued regulations in the Federal Register (70 FR 70225) updating the furnishing fee payment amount for CY 2006. We announced that the increase in the CPI for medical care for the 12 months ending June 30, 2005 was 4.2 percent. Consequently, the furnishing fee for CY 2006, initially established effective January 1, 2005, at $0.14 per unit of clotting factor, for CY 2006 was set at $0.146 per individual unit (I.U.) for blood clotting factor. We indicated in the preamble to that rule that while ‘‘the furnishing fee payment rate is calculated at 3 digits, the actual amount paid to providers and suppliers is rounded to 2 digits.’’ The fiscal intermediaries continue to use the Medicare Part B Drug Pricing File to make payments for blood clotting factor. The furnishing fee is included in the ASP price per unit sent with the Medicare Part B Drug Pricing File that is updated annually. By using the Medicare Part B Drug Pricing File, Medicare will be making consistent payments for blood clotting factor provided to inpatients and outpatients. For further updates on pricing, we refer readers to the Medicare Part B drug pricing regulations. wwhite on PROD1PC61 with PROPOSALS2 IX. Limitation on Payments to Skilled Nursing Facilities for Bad Debt A. Background Under section 1861(v)(1) of the Act and § 413.89 of our existing regulations, Medicare may pay for uncollectible deductible and coinsurance amounts to those entities eligible to receive payment for bad debt. Under our existing regulations, Medicare generally pays 100 percent of allowable bad debt amounts to SNFs, CAHs, rural health clinics, federally qualified health clinics, community mental health clinics, health maintenance organizations reimbursed on a cost basis, competitive medical plans, and health care prepayment plans. To determine if bad debt amounts are allowable, the requirements at § 413.89 and the Provider Reimbursement Manual (PRM) (CMS Pub.15 Part 1, Chapter 3) must be met. However, under our existing regulations, Medicare payments for allowable bad debt amounts for hospitals are reduced by 30 percent. Moreover, Medicare does not pay for bad debt amounts arising from anesthetists’ services paid under a fee schedule. In addition, although Medicare pays end-stage renal disease (ESRD) facilities 100 percent of allowable bad debt claims, these payments are capped at facilities’ VerDate Aug<31>2005 17:10 Apr 24, 2006 Jkt 208001 unrecovered cost (§ 413.178 of the regulations). B. Changes Made by Section 5004 of Pub. L. 109–171 Section 5004 of Pub. L. 109–171 (DRA of 2005) amended section 1861(v)(1) of the Act to mandate that, for cost reporting periods beginning on or after October 1, 2005, Medicare payments to SNFs for certain allowable bad debt amounts be reduced. Specifically, for patients that are not full-benefit dual eligible individuals (as defined in section 1935(c)(6)(A)(ii) of the Act), allowable bad debt amounts attributable to the coinsurance amounts under the Medicare program are reduced by 30 percent (deductibles are not applicable to patients in SNFs). Allowable bad debt amounts for patients that are full-benefit dual eligible individuals (as defined in section 1935(c)(6)(A)(ii) of the Act) will continue to be paid at 100 percent. C. Proposed Regulation Changes We are proposing to conform the Medicare regulations under § 413.89 to the provisions of section 5004 of Pub. L. 109–171. Specifically, we are proposing to revise paragraph (h) by redesignating the existing contents as paragraph (h)(1) and add a new paragraph (h)(2) to reflect this payment limitation. We are proposing to include in proposed paragraph (h)(2) a cross-reference to the definition of ‘‘full-benefit dual eligible individual’’ found at § 423.772 of our regulations. In addition, we are proposing to revise § 413.89(a) to add a cross-reference to the existing limitations on payments to hospitals and the new limitations on payments to SNFs found in paragraph (h), and to correct the cross-reference to the exception for payments for bad debts arising from anesthetists’ services paid under a fee schedule from ‘‘paragraph (h)’’ to ‘‘paragraph (i).’’ X. MedPAC Recommendations (If you choose to comment on issues in this section, please include the caption ‘‘MedPAC Update Recommendation’’ at the beginning of your comment.) We are required by section 1886(e)(4)(B) of the Act to respond to MedPAC’s IPPS recommendations in our annual proposed IPPS rule. We have reviewed MedPAC’s March 2006 ‘‘Report to the Congress: Medicare Payment Policy’’ and have given it careful consideration in conjunction with the proposed policies set forth in this document. MedPAC’s Recommendation 2A states that ‘‘The Congress should increase payment rates for the acute inpatient and outpatient PO 00000 Frm 00143 Fmt 4701 Sfmt 4702 24137 prospective payment systems in 2007 by the projected increase in the hospital market basket index less half of the Commission’s expectation for productivity growth.’’ This recommendation is discussed in Appendix B to this proposed rule. In section II.C. of the preamble of this proposed rule, we further address MedPac’s 2005 recommendations included in Recommendation 1 in the March 2005 Report to Congress on Physician-Owned Specialty Hospitals as well as Recommendation 3, which recommended that the Secretary implement MedPAC’s recommended policies over a transition period. The recommendations in Recommendation 1 relate to refining the DRGs used under the IPPS to more fully capture differences in severity of illness among patients; basing the DRG relative weights on the estimated cost of providing care rather than on charges; and basing the weights on the national average of hospitals’ relative values in each DRG. In section II.E. of the preamble to this proposed rule, we also further address Recommendation 2 of the March 2005 Report on PhysicianOwned Specialty Hospitals, which recommended adjusting the DRG relative weights to account for differences in the prevalence of highcost outlier cases. For further information relating specifically to the MedPAC reports or to obtain a copy of the reports, contact MedPAC at (202) 653–7220, or visit MedPAC’s Web site at: https:// www.medpac.gov. XI. Other Required Information A. Requests for Data From the Public In order to respond promptly to public requests for data related to the prospective payment system, we have established a process under which commenters can gain access to raw data on an expedited basis. Generally, the data are available in computer tape or cartridge format; however, some files are available on diskette as well as on the Internet at https://www.cms.hhs.gov/ providers/hipps. Data files and the cost for each file, if applicable, are listed below. Anyone wishing to purchase data tapes, cartridges, or diskettes should submit a written request along with a company check or money order (payable to CMS–PUF) to cover the cost to the following address: Centers for Medicare & Medicaid Services, Public Use Files, Accounting Division, P.O. Box 7520, Baltimore, MD 21207–0520, (410) 786–3691. Files on the Internet may be downloaded without charge. E:\FR\FM\25APP2.SGM 25APP2 24138 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules 1. CMS Wage Data This file contains the hospital hours and salaries for FY 2003 used to create the proposed FY 2007 prospective payment system wage index. The file will be available by the beginning of February for the NPRM and the beginning of May for the final rule. Processing year 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 Wage data year PPS fiscal year 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 These files support the following: • NPRM published in the Federal Register. • Final Rule published in the Federal Register. Media: Diskette/most recent year on the Internet File Cost: $165.00 per year Periods Available: FY 2007 PPS Update 2. CMS Hospital Wages Indices (Formerly: Urban and Rural Wage Index Values Only) This file contains a history of all wage indices since October 1, 1983. Media: Diskette/most recent year on the Internet File Cost: $165.00 per year Periods Available: FY 2007 PPS Update 3. FY 2007 Proposed Rule Occupational Mix Adjusted and Unadjusted AHW by Provider wwhite on PROD1PC61 with PROPOSALS2 This file includes each hospital’s adjusted and unadjusted average hourly wage. Media: Internet Periods Available: FY 2007 PPS Update 4. FY 2007 Proposed Rule Occupational Mix Adjusted and Unadjusted AHW and Pre-Reclassified Wage Index by CBSA This file includes each CBSA’s adjusted and unadjusted average hourly wage. Media: Internet Periods Available: FY 2007 PPS Update VerDate Aug<31>2005 17:10 Apr 24, 2006 Jkt 208001 5. Provider Occupational Mix Adjustment Factors for Each Occupational Category This file contains each hospital’s occupational mix adjustment factors by occupational category. Media: Internet Periods Available: FY 2007 PPS Update 6. PPS SSA/FIPS MSA State and County Crosswalk This file contains a crosswalk of State and county codes used by the Social Security Administration (SSA) and the Federal Information Processing Standards (FIPS), county name, and a historical list of Metropolitan Statistical Areas (MSAs). Media: Diskette/Internet File Cost: $165.00 per year Periods Available: FY 2007 PPS Update (Note: The PPS–XIII, PPS–XIV, PPS–XV, PPS–XVI, PPS–XVII, PPS–XVIII, PPS–XIX PPS–XX, and PPS–XXI Minimum Data Sets are part of the PPS–XIII, PPS–XIV, PPS–XV, PPS–XVI, PPS–XVII, PPS–XVIII, PPS–XIX, PPS–XX, and PPS–XXI Hospital Data Set Files (refer to item 10 below).) 9. PPS–IX to PPS–XII Capital Data Set The Capital Data Set contains selected data for capital-related costs, interest expense and related information and complete balance sheet data from the Medicare hospital cost report. The data set includes only the most current cost report (as submitted, final settled or reopened) submitted for a Medicare certified hospital by the Medicare fiscal intermediary to CMS. This data set is updated at the end of each calendar quarter and is available on the last day of the following month. Media: Tape/Cartridge File Cost: $770.00 per year 7. Reclassified Hospitals New Wage Index (Formerly: Reclassified Hospitals by Provider Only) This file contains a list of hospitals that were reclassified for the purpose of assigning a new wage index. Two versions of these files are created each year. They support the following: • NPRM published in the Federal Register. • Final Rule published in the Federal Register. Media: Diskette/Internet File Cost: $165.00 per year Periods Available: FY 2007 PPS Update (Note: The PPS–XIII, PPS–XIV, PPS–XV, PPS–XVI, PPS–XVII, PPS–XVIII, PPS–XIX PPS–XX, and PPS–XXI Capital Data Sets are part of the PPS–XIII, PPS–XIV, PPS–XV, PPS–XVI, PPS–XVII, PPS–XVIII, PPS–XIX, PPS XX, and PPS–XXI Hospital Data Set Files (refer to item 10 below).) 8. PPS–IV to PPS–XII Minimum Data Set The Minimum Data Set contains cost, statistical, financial, and other information from Medicare hospital cost reports. The data set includes only the most current cost report (as submitted, final settled, or reopened) submitted for a Medicare participating hospital by the Medicare fiscal intermediary to CMS. This data set is updated at the end of each calendar quarter and is available on the last day of the following month. Media: Tape/Cartridge File Cost: $770.00 per year 10. PPS–XIII to PPS–XXI Hospital Data Set The file contains cost, statistical, financial, and other data from the Medicare Hospital Cost Report. The data set includes only the most current cost report (as submitted, final settled, or reopened) submitted for a Medicarecertified hospital by the Medicare fiscal intermediary to CMS. The data set is updated at the end of each calendar quarter and is available on the last day of the following month. Media: Diskette/Internet File Cost: $2,500.00 Periods beginning on or after PPS–IV ............. PPS–V .............. PPS–VI ............. PPS–VII ............ PPS–VIII ........... PPS–IX ............. PPS–X .............. PPS–XI ............. PPS–XII ............ PO 00000 Frm 00144 Fmt 4701 10/01/86 10/01/87 10/01/88 10/01/89 10/01/90 10/01/91 10/01/92 10/01/93 10/01/94 Sfmt 4702 Periods beginning on or after PPS–IX ............. PPS–X .............. PPS–XI ............. PPS–XII ............ Periods beginning on or after and before 10/01/87 10/01/88 10/01/89 10/01/90 10/01/91 10/01/92 10/01/93 10/01/94 10/01/95 10/01/91 10/01/92 10/01/93 10/01/94 PPS–XIII ........... PPS–XIV ........... PPS–XV ............ PPS–XVI ........... PPS–XVII .......... PPS–XVIII ......... PPS–XIX ........... PPS–XX ............ PPS–XXI ........... E:\FR\FM\25APP2.SGM 25APP2 10/01/95 10/01/96 10/01/97 10/01/98 10/01/99 10/01/00 10/01/01 10/01/02 10/01/03 and before 10/01/92 10/01/93 10/01/94 10/01/95 and before 10/01/96 10/01/97 10/01/98 10/01/99 10/01/00 10/01/01 10/01/02 10/01/03 10/01/04 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules 11. Provider-Specific File This file is a component of the PRICER program used in the fiscal intermediary’s system to compute DRG payments for individual bills. The file contains records for all prospective payment system eligible hospitals, including hospitals in waiver States, and data elements used in the prospective payment system recalibration processes and related activities. Beginning with December 1988, the individual records were enlarged to include pass-through per diems and other elements. Media: Diskette/Internet File Cost: $265.00 Periods Available: FY 2007 PPS Update 12. CMS Medicare Case-Mix Index File This file contains the Medicare casemix index by provider number as published in each year’s update of the Medicare hospital inpatient prospective payment system. The case-mix index is a measure of the costliness of cases treated by a hospital relative to the cost of the national average of all Medicare hospital cases, using DRG weights as a measure of relative costliness of cases. Two versions of this file are created each year. They support the following: • NPRM published in the Federal Register. • Final rule published in the Federal Register. Media: Diskette/most recent year on Internet Price: $165.00 per year/per file Periods Available: FY 1985 through FY 2007 wwhite on PROD1PC61 with PROPOSALS2 13. DRG Relative Weights (Formerly Table 5 DRG) This file contains a listing of DRGs, DRG narrative descriptions, relative weights, and geometric and arithmetic mean lengths of stay as published in the Federal Register. The hard copy image has been copied to diskette. There are two versions of this file as published in the Federal Register: • NPRM. • Final rule. Media: Diskette/Internet File Cost: $165.00 Periods Available: FY 2007 PPS Update 14. PPS Payment Impact File This file contains data used to estimate payments under Medicare’s hospital inpatient prospective payment systems for operating and capital-related costs. The data are taken from various sources, including the Provider-Specific File, Minimum Data Sets, and prior impact files. The data set is abstracted VerDate Aug<31>2005 17:10 Apr 24, 2006 Jkt 208001 from an internal file used for the impact analysis of the changes to the prospective payment systems published in the Federal Register. This file is available for release 1 month after the proposed and final rules are published in the Federal Register. Media: Diskette/Internet File Cost: $165.00 Periods Available: FY 2007 PPS Update 15. AOR/BOR Tables This file contains data used to develop the DRG relative weights. It contains mean, maximum, minimum, standard deviation, and coefficient of variation statistics by DRG for length of stay and standardized charges. The BOR tables are ‘‘Before Outliers Removed’’ and the AOR is ‘‘After Outliers Removed.’’ (Outliers refer to statistical outliers, not payment outliers.) Two versions of this file are created each year. They support the following: • NPRM published in the Federal Register. • Final rule published in the Federal Register. Media: Diskette/Internet File Cost: $165.00 Periods Available: FY 2007 PPS Update 16. Prospective Payment System (PPS) Standardizing File This file contains information that standardizes the charges used to calculate relative weights to determine payments under the prospective payment system. Variables include wage index, cost-of-living adjustment (COLA), case-mix index, disproportionate share, and the Metropolitan Statistical Area (MSA). The file supports the following: • NPRM published in the Federal Register. • Final rule published in the Federal Register. Media: Internet. File Cost: No charge. Periods Available: FY 2007 PPS Update. For further information concerning these data tapes, contact the CMS Public Use Files Hotline at (410) 786–3691. Commenters interested in obtaining or discussing any other data used in constructing this rule should contact Mark Hartstein at (410) 786–4548. B. Collection of Information Requirements Under the Paperwork Reduction Act of 1995 (PRA), we are required to provide 60-day notice in the Federal Register and solicit public comment before a collection of information requirement is submitted to the Office of PO 00000 Frm 00145 Fmt 4701 Sfmt 4702 24139 Management and Budget (OMB) for review and approval. In order to fairly evaluate whether an information collection should be approved by OMB, section 3506(c)(2)(A) of the PRA requires that we solicit comment on the following issues: • The need for the information collection and its usefulness in carrying out the proper functions of our agency. • The accuracy of our estimate of the information collection burden. • The quality, utility, and clarity of the information to be collected. • Recommendations to minimize the information collection burden on the affected public, including automated collection techniques. The following information collection requirements included in this proposed rule and their associated burdens are subject to the PRA. We are soliciting public comment on each of the issues for the following sections of this document that contain information collection requirements. Section 412.64—Reporting of Hospital Quality Data for Annual Hospital Payment Update Section 412.64(d)(2) requires hospitals, in order to qualify for the full annual market basket update, to submit quality data on a quarterly basis to CMS, as specified by CMS. In this proposed rule, we are setting out the specific requirements related to the data that must be submitted for the update for FY 2007. The burden associated with this section is the time and effort associated with collecting, copying and submitting the data. We estimate that there will be approximately 4,000 respondents per year. Of this number, approximately 3,600 hospitals are JCAHO-accredited and are currently collecting measures and submitting data to the JCAHO on a quarterly basis. Of the JCAHOaccredited hospitals, approximately 3,300 are collecting the same measures CMS will be collecting for public reporting. Therefore, there will be no additional burden for these hospitals. Only approximately 300 of the JCAHOaccredited hospitals will need to collect an additional topic in addition to the data already collected for maintaining JCAHO accreditation. In addition, there are approximately 400 hospitals that do not participate in the JCAHO accreditation process. These hospitals will have the additional burden of collecting data on all three topics. For JCAHO-accredited hospitals that are not already collecting all of the required measures, we estimate it will take 25 hours per month per topic for collection. We expect the burden for all E:\FR\FM\25APP2.SGM 25APP2 24140 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules of these hospitals to total 102,000 hours per year, including time allotted for overhead. For non-JCAHO accredited hospitals, we estimate the burden to be 136,000 hours per year. This estimate also includes overhead. The total number of burden hours for all hospitals combined is 238,000. The number of respondents will vary according to the level of voluntary participation. One hundred percent of the data may be collected electronically. Our validation process requires participating hospitals to submit 5 charts per quarter. The burden associated with this requirement is the time and effort associated with collecting, copying, and submitting these charts. It will take approximately 2 hours per hospital to submit the 5 charts per quarter. There will be a total of approximately 19,000 charts (3,800 hospitals × 5 charts per hospital) submitted by the hospitals to CMS per quarter for a total burden of 7,600 hours per quarter and a total annual burden of 30,400 hours. The burden associated with the requirements under § 412.64 are currently approved under OMB Number 0938–0918. OMB approval will expire on December 31, 2008. wwhite on PROD1PC61 with PROPOSALS2 Proposed Revised § 412.92(b)(3) Special Treatment: Sole Community Hospitals Proposed revised § 412.92(b)(3) would require an approved SCH to notify the appropriate CMS Regional Office of any change which would affect its classification as an SCH. The burden associated with this requirement is the time and effort it would take for the SCH to provide such notification to the CMS Regional Office. We estimate that on an annual basis it would take an SCH 1 hour to provide notification. While this requirement is subject to the PRA, we believe the requirement is exempt because it impacts less than 10 SCHs. Proposed Revised § 412.108(b)(4) Special Treatment: MedicareDependent, Small Rural Hospitals Proposed revised § 412.108(b)(4) would require an approved MDH to notify the appropriate CMS Regional Office of any change which would affect its status as an MDH. The burden associated with this requirement is the time and effort it would take for the MDH to provide such notification to the CMS Regional Office. We estimate that on an annual basis it would take an MDH 1 hour to provide notification. While this requirement is subject to the PRA, we believe the requirement is exempt because it impacts less than 10 MDHs. VerDate Aug<31>2005 17:10 Apr 24, 2006 Jkt 208001 If you comment on these information collection and recordkeeping requirements, please mail the copies directly to the following: Centers for Medicare & Medicaid Services, Office of Strategic Operations and Regulatory Affairs, Regulations Development Group, Attn.: Melissa Musutto, CMS–1488–P. Room C4–26–05, 7500 Security Boulevard, Baltimore, MD 21244– 1850; and Office of Information and Regulatory Affairs, Office of Management and Budget Room 10235, New Executive Office Building, Washington, DC 20503, Attn.: Carolyn Lovett, CMS Desk Officer, CMS–1488–P, carolyn_lovett@omb.eop.gov. Fax (202) 395–5167. C. Public Comments Because of the large number of public comments we normally receive on Federal Register documents, we are not able to acknowledge or respond to them individually. We will consider all comments we receive by the date and time specified in the DATES section of this preamble, and, when we proceed with a subsequent document, we will respond to those comments in the preamble to that document. XII. Regulation Text List of Subjects 42 CFR Part 409 42 CFR Part 410 Health facilities, Health professions, Kidney diseases, Laboratories, Medicare, Rural areas, X-rays. 42 CFR Part 412 Administrative practice and procedure, Health facilities, Medicare, Puerto Rico, Reporting and recordkeeping requirements. 42 CFR Part 413 Health facilities, Kidney diseases, Medicare, Puerto Rico, Reporting and recordkeeping requirements. 42 CFR Part 424 Emergency medical services, Health facilities, Health professions, Medicare. 42 CFR Part 485 Grant programs-health, Health facilities, Medicaid, Medicare, Reporting and recordkeeping requirements. 42 CFR Part 489 Health facilities, Medicare, Reporting and recordkeeping requirements. Frm 00146 Fmt 4701 Sfmt 4702 PART 409—HOSPITAL INSURANCE BENEFITS 1. The authority citation for part 409 continues to read as follows: Authority: Secs. 1102 and 1871 of the Social Security Act (42 U.S.C. 1302 and 1395hh). 2. Section 409.3 is amended by revising paragraph (e) under the definition of ‘‘Qualified hospital’’ to read as follows: § 409.3 Definitions. * * * * * Qualified hospital means a facility that—* * * (e) If it is a foreign hospital, is licensed, or approved as meeting the standard for licensing, by the appropriate foreign licensing agency, and for purposes of furnishing nonemergency services to U.S. residents, is accredited by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO), or by a foreign program under standards that CMS finds to be equivalent to those of JCAHO. 3. Section 409.5 is revised to read as follows: § 409.5 Health Facilities, Medicare. PO 00000 For the reasons stated in the preamble of this proposed rule, the Centers for Medicare & Medicaid Services is proposing to amend 42 CFR Chapter IV as follows: General description of benefits. Hospital insurance (Part A of Medicare) helps pay for inpatient hospital or inpatient CAH services and posthospital SNF care. It also pays for home health services and hospice care. There are limitations on the number of days of care that Medicare can pay for and there are deductible and coinsurance amounts for which the beneficiary is responsible. For each type of service, certain conditions must be met as specified in the pertinent sections of this subpart and in part 418 of this chapter regarding hospice care. Conditions for payment of emergency inpatient services furnished by a nonparticipating U.S. hospital and for services furnished in a foreign country are set forth in subparts G and H of part 424 of this chapter. PART 410—SUPPLEMENTARY MEDICAL INSURANCE (SMI) BENEFITS 4. The authority citation for part 410 continues to read as follows: Authority: Secs. 1102 and 1871 of the Social Security Act (42 U.S.C. 1302 and 1395hh). E:\FR\FM\25APP2.SGM 25APP2 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules 5. Section 410.66 is revised to read as follows: § 410.66 Emergency outpatient services furnished by a nonparticipating hospital and services furnished in a foreign country. Conditions for payment of emergency inpatient services furnished by a nonparticipating U.S. hospital and for services furnished in a foreign country are set forth in subparts G and H of part 424 of this chapter. PART 412—PROSPECTIVE PAYMENT SYSTEMS FOR INPATIENT HOSPITAL SERVICES 6. The authority citation for part 412 is revised to read as follows: Authority: Secs. 1102 and 1871 of the Social Security Act (42 U.S.C. 1302 and 1395hh), and sec. 124 of Pub. L. 106–113 (113 Stat. 1501A–332). 7. Section 412.22 is amended by— a. Revising the introductory text of paragraph (f). b. Adding a new paragraph (f)(3). c. Revising paragraph (h)(1). d. In paragraph (h)(2), removing the phrase ‘‘(h)(3), (h)(6), and (h)(7) of this section’’ and adding the phrase ‘‘(h)(3), (h)(7), and (h)(8) of this section’’ in its place. e. Revising the introductory text of paragraph (h)(3). f. Revising paragraph (h)(4). g. Redesignating paragraphs (h)(5), (h)(6), and (h)(7) as paragraphs (h)(6), (h)(7), and (h)(8), respectively. h. Adding a new paragraph (h)(5). The revisions and addition read as follows: § 412.22 Excluded hospitals and hospital units: General rules. wwhite on PROD1PC61 with PROPOSALS2 * * * * * (f) Application for certain hospitals. Except as provided in paragraph (f)(3) of this section, if a hospital was excluded from the prospective payment systems under the provisions of this section on or before September 30, 1995, and at that time occupied space in a building also used by another hospital, or in one or more buildings located on the same campus as buildings used by another hospital, the criteria in paragraph (e) of this section do not apply to the hospital as long as the hospital— * * * * * (3) For cost reporting periods beginning on or after October 1, 2006, in applying the provisions of paragraph (f)(1) or (f)(2) of this section, any hospital that was excluded from the prospective payment systems under the provisions of this section on or before September 30, 1995, and at that time occupied space in a building also used VerDate Aug<31>2005 17:10 Apr 24, 2006 Jkt 208001 by another hospital, or in one or more buildings located on the same campus as buildings used by another hospital— (i) May decrease its square footage or number of beds, or both, without affecting the provisions of paragraph (f)(1) or (f)(2) of this section; (ii) May increase or decrease the square footage or decrease the number of beds considered to be part of the hospital at any time, if these changes are made necessary by relocation of the hospital— (A) To permit construction or renovation necessary for compliance with changes in Federal, State, or local law affecting the physical facility; or (B) Because of catastrophic events such as fires, floods, earthquakes, or tornadoes. * * * * * (h) Satellite facilities. (1) For purposes of paragraphs (h)(2) through (h)(5) of this section, a satellite facility is a part of a hospital that provides inpatient services in a building also used by another hospital, or in one or more entire buildings located on the same campus as buildings used by another hospital. * * * * * (3) Except as provided in paragraphs (h)(4) and (h)(5) of this section, the provisions of paragraph (h)(2) of this section do not apply to— * * * * * (4) In applying the provisions of paragraph (h)(3) of this section, any hospital structured as a satellite facility on September 30, 1999, may increase or decrease the square footage of the satellite facility or may decrease the number of beds in the satellite facility considered to be part of the satellite facility at any time, if these changes are made necessary by relocation of a facility — (i) To permit construction or renovation necessary for compliance with changes in Federal, State, or local law affecting the physical facility; or (ii) Because of catastrophic events such as fires, floods, earthquakes, or tornadoes. (5) For cost reporting periods beginning on or after October 1, 2006, in applying the provisions of paragraph (h)(3) of this section, a satellite facility may decrease its number of beds or square footage, or both, without affecting the provisions of paragraph (h)(3) of this section. * * * * * 8. Section 412.25 is amended by— a. In paragraph (e)(2), removing the cross-reference ‘‘(e)(5)’’ and adding the cross-reference ‘‘(e)(6)’’ in its place. b. Revising paragraph (e)(3). PO 00000 Frm 00147 Fmt 4701 Sfmt 4702 24141 c. Redesignating paragraph (e)(5) as paragraph (e)(6). d. Adding a new paragraph (e)(5). The revision and addition read as follows: § 412.25 Excluded hospital units: Common requirements. * * * * * (e) * * * (3) Except as specified in paragraphs (e)(4) and (e)(5) of this section, the provisions of paragraph (e)(2) of this section do not apply to any unit structured as a satellite facility on September 30, 1999, and excluded from the prospective payment systems on that date, to the extent the unit continues operating under the same terms and conditions, including the number of beds and square footage considered to be part of the unit, in effect on September 30, 1999. * * * * * (5) For cost reporting periods beginning on or after October 1, 2006, in applying the provisions of paragraph (e)(3) of this section, a satellite facility may decrease its number of beds or square footage, or both, without affecting the provision of paragraph (e)(3) of this section. * * * * * § 412.42 [Amended] 9. In paragraph (d) of § 412.42, the cross-reference ‘‘§ 405.310(k)’’ is removed, and the cross-reference ‘‘§ 411.15(k)’’ is added in its place. § 412.48 [Amended] 10. In paragraph (b) of § 412.48, the cross-reference ‘‘§§ 405.330 through 405.332’’ is removed and the crossreference ‘‘§ 411.400 and § 411.402’’ is added in its place. 11. Section 412.64 is amended by— a. Revising paragraph (d)(2). b. Adding a new paragraph (h)(6). The revision and addition read as follows: § 412.64 Federal rates for inpatient operating costs for Federal fiscal year 2005 and subsequent fiscal years. * * * * * (d) * * * (2)(i) In the case of a ‘‘subsection (d) hospital,’’ as defined under section 1886(d)(1)(B) of the Act, that does not submit quality data on a quarterly basis to CMS, in the form and manner specified by CMS, the applicable percentage change specified in paragraph (d)(1) of this section is reduced: (A) For fiscal years 2005 and 2006, by 0.4 percentage points; and E:\FR\FM\25APP2.SGM 25APP2 24142 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules (B) For fiscal year 2007 and subsequent fiscal years, by 2.0 percentage points. (ii) Any reduction of the percentage change will apply only to the fiscal year involved and will not be taken into account in computing the applicable percentage change for a subsequent fiscal year. * * * * * (h) * * * (6) If a new rural hospital that is subject to the hospital inpatient prospective payment system opens in a State that has an imputed rural floor and has rural areas, CMS uses the imputed floor as the hospital’s wage index until the hospital’s first cost report as an inpatient prospective payment system provider is contemporaneous with the cost reporting period being used to develop a given fiscal year’s wage index. * * * * * 12. A new § 412.79 is added to Subpart E to read as follows: wwhite on PROD1PC61 with PROPOSALS2 § 412.79 Determination of the hospitalspecific rate for inpatient operating costs for Medicare-dependent, small rural hospitals based on a Federal fiscal year 2002 base period. (a) Base-period costs—(1) General rule. Except as provided in paragraph (a)(2) of this section, for each MDH, the intermediary determines the MDH’s Medicare Part A allowable inpatient operating costs, as described in § 412.2(c), for the 12-month or longer cost reporting period ending on or after October 1, 2001, and before October 1, 2002. (2) Exceptions. (i) If the MDH’s last cost reporting period ending before October 1, 2002, is for less than 12 months, the base period is the MDH’s most recent 12-month or longer cost reporting period ending before that short cost reporting period. (ii) If the MDH does not have a cost reporting period ending on or after October 1, 2001, and before October 1, 2002, and does have a cost reporting period beginning on or after October 1, 2000, and before October 1, 2001, that cost reporting period is the base period unless the cost reporting is for less than 12 months. In that case, the base period is the MDH’s most recent 12-month or longer cost reporting period ending before that short cost reporting period. (b) Costs on a per discharge basis. The intermediary determines the MDH’s average base-period operating cost per discharge by dividing the total operating costs by the number of discharges in the base period. For purposes of this section, a transfer as described in § 412.4(b) is considered to be a discharge. VerDate Aug<31>2005 17:10 Apr 24, 2006 Jkt 208001 (c) Case-mix adjustment. The intermediary divides the average baseperiod cost per discharge by the MDH’s case-mix index for the base period. (d) Updating base period costs. For purposes of determining the updated base-period costs for cost reporting periods beginning in Federal fiscal year 2002, the update factor is determined using the methodology set forth in § 412.73(c)(14) and (c)(15). (e) DRG adjustment. The applicable hospital-specific cost per discharge is multiplied by the appropriate DRG weighting factor to determine the hospital-specific base payment amount (target amount) for a particular covered discharge. (f) Notice of hospital-specific rate. The intermediary furnishes the MDH a notice of its hospital-specific rate which contains a statement of the hospital’s Medicare Part A allowable inpatient operating costs, number of Medicare discharges, and case-mix index adjustment factor used to determine the hospital’s cost per discharge for the Federal fiscal year 2002 base period. (g) Right to administrative and judicial review. An intermediary’s determination of the hospital-specific rate for a hospital is subject to administrative and judicial review. Review is available to an MDH upon receipt of the notice of the hospitalspecific rate. The notice is treated as a final intermediary determination of the amount of program reimbursement for purposes of subpart R of Part 405 of this chapter, governing provider reimbursement determinations and appeals. (h) Modification of hospital-specific rate. (1) The intermediary recalculates the hospital-specific rate to reflect the following: (i) Any modifications that are determined as a result of administrative or judicial review of the hospitalspecific rate determinations; or (ii) Any additional costs that are recognized as allowable costs for the MDH’s base period as a result of administrative or judicial review of the base-period notice of amount of program reimbursement. (2) With respect to either the hospitalspecific rate determination or the amount of program reimbursement determination, the actions taken on administrative or judicial review that provide a basis for recalculations of the hospital-specific rate include the following: (i) A reopening and revision of the MDH’s base-period notice of amount of program reimbursement under §§ 405.1885 through 405.1889 of this chapter. PO 00000 Frm 00148 Fmt 4701 Sfmt 4702 (ii) A prehearing order or finding issued during the provider payment appeals process by the appropriate reviewing authority under § 405.1821 or § 405.1853 of this chapter that resolved a matter at issue in the MDH’s baseperiod notice of amount of program reimbursement. (iii) An affirmation, modification, or reversal of a Provider Reimbursement Review Board decision by the Administrator of CMS under § 405.1875 of this chapter that resolved a matter at issue in the hospital’s base-period notice of amount of program reimbursement. (iv) An administrative or judicial review decision under §§ 405.1831, 405.1871, or 405.1877 of this chapter that is final and no longer subject to review under applicable law or regulations by a higher reviewing authority, and that resolved a matter at issue in the hospital’s base-period notice of amount of program reimbursement. (v) A final, nonappealable court judgment relating to the base-period costs. (3) The adjustments to the hospitalspecific rate made under paragraphs (h)(1) and (2) of this section are effective retroactively to the time of the intermediary’s initial determination of the rate. (i) Maintaining budget neutrality. CMS makes an adjustment to the hospital-specific rate to ensure that changes to the DRG classifications and recalibrations of the DRG relative weights are made in a manner so that aggregate payments to section 1886(d) hospitals are not affected. § 412.84 [Amended] 13. In paragraph (m) of § 412.84, the cross-reference ‘‘paragraph (h)(3)’’ is removed and the cross-reference ‘‘paragraph (i)(4)’’ is added in its place. 14. Section 412.90 is amended by revising paragraph (j) to read as follows: § 412.90 General rules. * * * * * (j) Medicare-dependent, small rural hospitals. For cost reporting periods beginning on or after April 1, 1990, and before October 1, 1994, and for discharges occurring on or after October 1, 1997, and before October 1, 2011, CMS adjusts the prospective payment rates for inpatient operating costs determined under subparts D and E of this part if a hospital is classified as a Medicare-dependent, small rural hospital. * * * * * 15. Section 412.92 is amended by— E:\FR\FM\25APP2.SGM 25APP2 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules a. In paragraph (b)(2)(iv) of § 412.92, the word ‘‘djustment’’ is removed and the word ‘‘adjustment’’ is added in its place. b. Revising paragraph (b)(3) to read as follows: § 412.92 Special treatment: Sole community hospitals. * * * * * (b) * * * (3) Duration of classification. An approved classification as a sole community hospital remains in effect without need for reapproval unless there is a change in the circumstances under which the classification was approved. An approved sole community hospital must notify the appropriate CMS regional office of any change that would affect its classification as a sole community hospital. If CMS determines that a sole community hospital failed to comply with this requirement, CMS will cancel the hospital’s classification as a sole community hospital effective on the earliest discernable date that the fiscal intermediary can determine that the hospital no longer met the criteria for such classification. * * * * * § 412.105 [Amended] 16. In paragraph (f)(1)(ii)(C) of § 412.105, the cross-reference ‘‘§ 413.78(c) or § 413.78(d)’’ is removed and the cross-reference ‘‘§ 413.78(c), § 413.78(d), or § 413.78(e)’’ is added in its place. 17. Section 412.106 is amended by— a. Revising paragraph (a)(1)(iii). b. Republishing the introductory text of paragraph (d)(2)(iv). c. Revising paragraph (d)(2)(iv)(C)(3). d. Adding a new paragraph (d)(2)(iv)(D). e. Adding a new paragraph (d)(2)(v). The revision and additions read as follows: wwhite on PROD1PC61 with PROPOSALS2 § 412.106 Special treatment: Hospitals that serve a disproportionate share of lowincome patients. (a) * * * (1) * * * (iii) The hospital’s location, in an urban or rural area, is determined in accordance with the definitions in § 412.64, except that a reclassification that results from an urban hospital reclassified as rural as set forth in § 412.103 is classified as rural. * * * * * (d) * * * (2) * * * (iv) If the hospital meets the criteria of paragraph (c)(1)(iv) of this section— * * * * * (C) * * * VerDate Aug<31>2005 17:10 Apr 24, 2006 Jkt 208001 (3) Except as provided in paragraph (d)(2)(iv)(D) of this section, the maximum payment adjustment factor is 12 percent. (D) Effective for discharges occurring on or after October 1, 2006, for a hospital that is classified as a Medicaredependent, small rural hospital under § 412.108, the payment adjustment factor limitation specified in paragraph (d)(2)(iv)(C)(3) does not apply. (v) If the hospital meets the criteria of paragraph (c)(2) of this section, the payment adjustment factor is as follows: (A) 30 percent for discharges occurring on or after April 1, 1990, and before October 1, 1991. (B) 35 percent for discharges occurring on or after October 1, 1991. * * * * * 18. Section 412.108 is amended by— a. Revising paragraph (a)(1) introductory text. b. Revising paragraph (b)(4). c. Adding a new paragraph (c)(2)(iii). The revisions and addition read as follows: § 412.108 Special Treatment: Medicaredependent, small rural hospitals. (a) Criteria for classification as a Medicare-dependent, small rural hospital.—(1) General considerations. For cost reporting periods beginning on or after April 1, 1990, and ending before October 1, 1994, or for discharges occurring on or after October 1, 1997, and before October 1, 2011, a hospital is classified as a Medicare-dependent, small rural hospital if it is located in a rural area (as defined in subpart D of this part) and meets all of the following conditions: * * * * * (b) * * * (4) A determination of MDH status made by the fiscal intermediary is effective 30 days after the date the fiscal intermediary provides written notification to the hospital. An approved MDH status determination remains in effect unless there is a change in the circumstances under which the status was approved. An approved MDH must notify the appropriate CMS regional office of any change that would affect its status as an MDH. If CMS determines that an MDH failed to comply with this requirement, CMS will cancel the hospital’s MDH status effective on the earliest discernable date that the fiscal intermediary can determine that the hospital no longer met the criteria for such status. * * * * * (c) * * * (2) * * * PO 00000 Frm 00149 Fmt 4701 Sfmt 4702 24143 (iii) For discharges occurring during cost reporting periods (or portions thereof) beginning on or after October 1, 2006, and before October 1, 2011, 75 percent of the amount that the Federal rate determined under paragraph (c)(1) of this section is exceeded by the highest of the following: (A) The hospital-specific rate as determined under § 412.73. (B) The hospital-specific rate as determined under § 412.75. (C) The hospital-specific rate as determined under § 412.79. * * * * * 19. Section 412.234 is amended by— a. In paragraph (a)(3)(ii), removing the term ‘‘fiscal year’’ and adding the term ‘‘Federal fiscal year’’ in its place. b. Revising paragraph (a)(3)(iii). c. Adding a new paragraph (a)(3)(iv). The revisions and addition read as follows: § 412.234 Criteria for all hospitals in an urban county seeking redesignation to another urban area. (a) * * * (3) * * * (iii) For Federal fiscal year 2007, hospitals located in counties that are in the same Combined Statistical Area (CSA) (under the MSA definitions announced by the OMB on June 6, 2003) as the urban area to which they seek redesignation qualify as meeting the proximity requirement for reclassification to the urban area to which they seek redesignation. (iv) For Federal fiscal year 2008 and thereafter, hospitals located in counties that are in the same Combined Statistical Area (CSA) or Core-Based Statistical Area (CBSA) (under the MSA definitions announced by the OMB on June 6, 2003) as the urban area to which they seek redesignation qualify as meeting the proximity requirements for reclassification to the urban area to which they seek redesignation. * * * * * 20. Section 412.316 is amended by— a. Revising paragraph (a). b. Revising paragraph (b)(2). c. Adding a new paragraph (b)(3). d. Revising paragraph (c). The revisions and addition read as follows: § 412.316 Geographic adjustment factors. (a) Local cost variation. CMS adjusts for local cost variation based on the hospital wage index value that is applicable to the hospital under subpart D of this part. The adjustment factor equals the hospital wage index value applicable to the hospital raised to the .6848 power and is applied to 100 percent of the Federal rate. E:\FR\FM\25APP2.SGM 25APP2 24144 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules (b) * * * (2) For discharges occurring on or after October 1, 2004, the definition of large urban area under § 412.63(c)(6) continues to be in effect for purposes of the payment adjustment under this section, based on the geographic classification under § 412.64, except as provided for in paragraph (b)(3) of this section. (3) For purposes of this section, the geographic classifications specified under § 412.64 apply, except that, effective for discharges occurring on or after October 1, 2006, for an urban hospital that is reclassified as rural as set forth in § 412.103, the geographic classification is rural. (c) Cost-of-living adjustment. CMS provides an additional payment to a hospital located in Alaska and Hawaii equal to [0.3152 x (the cost-of-living adjustment factor used to determine payments under subpart D of this part¥1)] percent. 21. Section 412.320 is amended by— a. Revising paragraph (a)(1)(ii). b. Adding a new paragraph (a)(1)(iii). The revision and addition read as follows: § 412.320 Disproportionate share adjustment factor. (a) * * * (1) * * * (ii) For discharges occurring on or after October 1, 2004, the payment adjustment under this section is based on the geographic classifications specified under § 412.64, except as provided for in paragraph (a)(1)(iii) of this section. (iii) For purposes of this section, the geographic classifications specified under § 412.64 apply, except that, effective for discharges occurring on or after October 1, 2006, for an urban hospital that is reclassified as rural as set forth in § 412.103, the geographic classification is rural. * * * * * 22. Section 412.505 is amended by revising paragraph (b)(1) to read as follows: § 412.505 Conditions for payment under the prospective payment system for longterm care hospitals. wwhite on PROD1PC61 with PROPOSALS2 * * * * * (b) General requirements. (1) Effective for cost reporting periods beginning on or after October 1, 2002, a long-term care hospital must meet the conditions for payment of this section, § 412.22(e)(3) and (h)(6), if applicable, and § 412.507 through § 412.511 to receive payment under the prospective payment system described in this VerDate Aug<31>2005 17:10 Apr 24, 2006 Jkt 208001 subpart for inpatient hospital services furnished to Medicare beneficiaries. * * * * * § 412.508 [Amended] 23. In paragraph (c)(3) of § 412.508, the cross-reference ‘‘§ 1001.301’’ is removed and the cross-reference ‘‘1001.201’’ is added in its place. 24. Section 412.511 is revised to read as follows: § 412.511 Reporting and recordkeeping requirements. A long-term care hospital participating in the prospective payment system under this subpart must meet the requirement of §§ 412.22(e)(3) and 412.22(h)(6) to report co-located status, if applicable, and the recordkeeping and cost reporting requirements of §§ 413.20 and 413.24 of this subchapter. 25. Section 412.525 is amended by— a. Revising paragraph (a)(3). b. Revising paragraph (a)(4)(ii). c. Revising paragraph (a)(4)(iii). d. Adding a new paragraph (a)(4)(iv). e. Adding a new paragraph (d)(3). f. Adding a new paragraph (d)(4). The revisions and additions read as follows: § 412.525 Adjustments to the Federal prospective payment. (a) * * * (3) The additional payment equals 80 percent of the difference between the estimated cost of the patient’s care (determined by multiplying the hospital-specific cost-to-charge ratio by the Medicare allowable covered charge) and the sum of the adjusted LTCH PPS Federal prospective payment and the fixed-loss amount. (4) * * * (ii) For discharges occurring on or after August 8, 2003, and before October 1, 2006, high-cost outlier payments are subject to the provisions of § 412.84(i)(1), (i)(3), and (i)(4) and (m) for adjustments of cost-to-charge ratios. (iii) For discharges occurring on or after October 1, 2003, and before October 1, 2006, high-cost outlier payments are subject to the provisions of § 412.84(i)(2) for adjustments to costto-charge ratios. (iv) For discharges occurring on or after October 1, 2006, high-cost outlier payments are subject to the following provisions: (A) CMS may specify an alternative to the cost-to-charge ratio otherwise applicable under paragraph (a)(4)(iv)(B) of this section. A hospital may also request that its fiscal intermediary use a different (higher or lower) cost-to-charge ratio based on substantial evidence PO 00000 Frm 00150 Fmt 4701 Sfmt 4702 presented by the hospital. A request must be approved by the CMS Regional Office. (B) The cost-to-charge ratio applied at the time a claim is processed is based on either the most recent settled cost report or the most recent tentatively settled cost report, whichever is from the latest cost reporting period. (C) The fiscal intermediary may use a statewide average cost-to-charge ratio, which CMS establishes annually, if it is unable to determine an accurate cost-tocharge ratio for a hospital in one of the following circumstances: (1) A new hospital that has not yet submitted its first Medicare cost report. (For this purpose, a new hospital is defined as an entity that has not accepted assignment of an existing hospital’s provider agreement in accordance with § 489.18 of this chapter.) (2) A hospital whose cost-to-charge ratio is in excess of 3 standard deviations above the corresponding national geometric mean cost to charge ratio. CMS establishes and publishes this mean annually. (3) Any other hospital for which data to calculate a cost-to-charge ratio are not available. (D) Any reconciliation of outlier payments is based on the cost-to-charge ratio calculated based on a ratio of costs to charges computed from the relevant cost report and charge data determined at the time the cost report coinciding with the discharge is settled. (E) At the time of any reconciliation under paragraph (a)(4)(iv)(D) of this section, outlier payments may be adjusted to account for the time value of any underpayments or overpayments. Any adjustment is based upon a widely available index to be established in advance by the Secretary, and is applied from the midpoint of the cost reporting period to the date of reconciliation. * * * * * (d) * * * (3) Patients who are transferred to onsite providers and readmitted to a long-term care hospital, as provided for in § 412.532. (4) Long-term care hospitals-withinhospitals and satellites of long-term care hospitals as provided in § 412.534. 26. Section 412.529 is amended by revising paragraph (c)(5) to read as follows: § 412.529 Special payment provision for short-stay outliers. * * * * * (c) * * * (5)(i) For discharges occurring on or after October 1, 2002, and before August 8, 2003, no reconciliations are made to E:\FR\FM\25APP2.SGM 25APP2 wwhite on PROD1PC61 with PROPOSALS2 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules short-stay outlier payments upon cost report settlement to account for differences between cost-to-charge ratio and the actual cost-to-charge ratio of the case. (ii) For discharges occurring on or after August 8, 2003, and before October 1, 2006, short-stay outlier payments are subject to the provisions of § 412.84(i)(1), (i)(3), and (i)(4) and (m) for adjustments of cost-to-charge ratios. (iii) For discharges occurring on or after October 1, 2003, and before October 1, 2006, short-stay outlier payments are subject to the provisions of § 412.84(i)(2) for adjustments to costto-charge ratios. (iv) For discharges occurring on or after October 1, 2006, short-stay outlier payments are subject to the following provisions: (A) CMS may specify an alternative to the cost-to-charge ratio otherwise applicable under paragraph (c)(5)(iv)(B) of this section. A hospital may also request that its fiscal intermediary use a different (higher or lower) cost-to-charge ratio based on substantial evidence presented by the hospital. This request must be approved by the CMS Regional Office. (B) The cost-to-charge ratio applied at the time a claim is processed is based on either the most recent settled cost report or the most recent tentatively settled cost report, whichever is from the latest cost reporting period. (C) The fiscal intermediary may use a statewide average cost-to-charge ratio, which CMS establishes annually, if it is unable to determine an accurate cost-tocharge ratio for a hospital in one of the following circumstances: (1) A new hospital that has not yet submitted its first Medicare cost report. (For this purpose, a new hospital is defined as an entity that has not accepted assignment of an existing hospital’s provider agreement in accordance with § 489.18 of this chapter.) (2) A hospital whose cost-to-charge ratio is in excess of 3 standard deviations above the corresponding national geometric mean. CMS establishes and publishes this mean annually. (3) Any other hospital for which data to calculate a cost-to-charge ratio are not available. (D) Any reconciliation of outlier payments is based on the cost-to-charge ratio calculated based on a ratio of costs to charges computed from the relevant cost report and charge data determined at the time the cost report coinciding with the discharge is settled. (E) At the time of any reconciliation under paragraph (c)(5)(iv)(D) of this VerDate Aug<31>2005 17:10 Apr 24, 2006 Jkt 208001 section, outlier payments may be adjusted to account for the time value of any underpayments or overpayments. Any adjustment is based upon a widely available index to be established in advance by the Secretary, and is applied from the midpoint of the cost reporting period to the date of reconciliation. 27. Section 412.532 is amended by— a. Revising paragraph (a)(2). b. Revising paragraph (b). The revisions read as follows: § 412.532 Special payment provisions for patients who are transferred to onsite providers and readmitted to a long-term care hospital. (a) * * * (2) A satellite facility, as defined in § 412.22(h), that is co-located with the long-term care hospital. * * * * * (b) As used in this section, ‘‘colocated’’ or ‘‘onsite’’ facility means a hospital, satellite facility, unit, or SNF that occupies space in a building also used by another hospital or unit or in one or more buildings on the same campus, as defined in § 413.65(a)(2) of this subchapter, as buildings used by another hospital or unit. * * * * * § 412.541 [Amended] 28. In § 412.541, paragraph (b)(2)(i), remove the cross-reference ‘‘§ 412.533(b)’’ and add in its place ‘‘§ 412.533(a)(5) and § 412.533(c)’’. PART 413—PRINCIPLES OF REASONABLE COST REIMBURSEMENT; PAYMENT FOR END-STAGE RENAL DISEASE SERVICES; PROSPECTIVELY DETERMINED PAYMENT RATES FOR SKILLED NURSING FACILITIES 29. The authority citation for part 413 is revised to read as follows: Authority: Secs. 1102, 1812(d), 1814(b), 1815, 1833(a), (i), and (n), 1861(v), 1871, 1881, 1883, and 1886 of the Social Security Act (42 U.S.C. 1302, 1395d(d), 1395f(b), 1395g, 1395l(a), (i), and (n), 1395x(v), 1395hh, 1395rr, 1395tt, and 1395ww); and sec. 124 of Pub. L. 106–133 (113 Stat. 1501A– 332). 30. Section 413.74 is amended by revising paragraph (a) to read as follows: § 413.74 Payment to a foreign hospital. (a) Principle. Section 1814(f) of the Act provides for the payment of emergency and nonemergency inpatient hospitals services furnished by foreign hospitals to Medicare beneficiaries. Subpart H of part 424 of this chapter, together with this section, specifies the conditions for payment. * * * * * PO 00000 Frm 00151 Fmt 4701 Sfmt 4702 24145 31. Section 413.75 is amended by— a. In paragraph (b), revising paragraph (1) under the definition of ‘‘Medicare GME affiliated group’’. b. In paragraph (b), removing the cross-reference ‘‘§ 413.79(g)(2)’’ under paragraph (2) of the definition of ‘‘Medicare GME affiliated group’’ and adding the cross-reference ‘‘§ 413.79(f)(2)’’ in its place. c. In paragraph (b), removing the cross-reference ‘‘§ 413.79(g)(2)’’ under paragraph (3) of the definition of ‘‘Medicare GME affiliated group’’ and adding the cross-reference ‘‘§ 413.79(f)(2)’’ in its place. The revision reads as follows: § 413.75 Direct GME payments: General requirements. * * * * * (b) * * * Medicare GME affiliated group means— (1) Two or more hospitals that are located in the same urban or rural area (as those terms are defined in subpart D of Part 412 of this subchapter) or in a contiguous area and meet the rotation requirements in § 413.79(f)(2). * * * * * 32. Section 413.77 is amended by revising paragraphs (e)(1) introductory text and (e)(1)(i) to read as follows: § 413.77 Direct GME payments: Determination of per resident amounts. * * * * * (e) Exceptions—(1) Base period for certain hospitals. If a hospital did not have any approved medical residency training programs or did not participate in Medicare during the base period, but either condition changes in a cost reporting period beginning on or after July 1, 1985, the fiscal intermediary establishes a per resident amount for the hospital using the information from the first cost reporting period during which the hospital participates in Medicare and the residents are on duty during the first month of that period. Effective for cost reporting periods beginning on or after October 1, 2006, if a hospital did not have any approved medical residency training programs or did not participate in Medicare during the base period, but either condition changes in a cost reporting period beginning on or after October 1, 2006, and the residents are not on duty during the first month of that period, the fiscal intermediary establishes a per resident amount for the hospital using the information from the first cost reporting period immediately following the cost reporting period during which the hospital participates in Medicare and residents began training at the hospital. The per resident E:\FR\FM\25APP2.SGM 25APP2 24146 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules amount is based on the lower of the amount specified in paragraph (e)(1)(i) or paragraph (e)(1)(ii) of this section, subject to the provisions of paragraph (e)(1)(iii) of this section. Any GME costs incurred by the hospital during the cost reporting period prior to the base period used for calculating the PRA are reimbursed on a reasonable cost basis. (i) The hospital’s actual cost per resident incurred in connection with the GME program(s) based on the cost and resident data from the hospital’s base year cost reporting period as established in paragraph (e)(1) of this section. * * * * * 33. Section 413.79 is amended by— a. Revising paragraph (e)(1)(iv). b. In the introductory text of paragraph (f), removing the crossreference ‘‘paragraph (e)(3) of this section’’ and adding the cross-reference ‘‘paragraph (d) of this section’’ in its place. The revision reads as follows: § 413.79 Direct GME payments: Determination of the weighted number of FTE residents. * * * * * (e) * * * (1) * * * (iv) Effective for affiliation agreements entered into on or after October 1, 2005, an urban hospital that qualifies for an adjustment to its FTE cap under paragraph (e)(1) of this section is permitted to be part of a Medicare GME affiliated group for purposes of establishing an aggregate FTE cap only if the adjustment that results from the affiliation is an increase to the urban hospital’s FTE cap. * * * * * 34. Section 413.85 is amended by revising paragraph (h)(3) to read as follows: § 413.85 Costs of approved nursing and allied health education activities. wwhite on PROD1PC61 with PROPOSALS2 * * * * * (h) * * * (3) Educational seminars, workshops, and continuing education programs in which the employees or trainees participate that enhance the quality of medical care or operating efficiency of the provider and, effective October 1, 2003, do not lead to the ability to practice and begin employment in a nursing or allied health specialty. * * * * * 35. Section 413.89 is amended by— a. Revising paragraph (a). b. Revising paragraph (h). The revisions read as follows: VerDate Aug<31>2005 17:10 Apr 24, 2006 Jkt 208001 § 413.89 Bad debts, charity, and courtesy allowances. (a) Principle. Bad debts, charity, and courtesy allowances are deductions from revenue and are not to be included in allowable cost. However, subject to the limitations described under paragraph (h) of this section and the exception for anesthetists’ services described under paragraph (i) of this section, bad debts attributable to the deductibles and coinsurance amounts are reimbursable under the program. * * * * * (h) Limitations on bad debts. (1) Hospitals. In determining reasonable costs for hospitals, the amount of bad debt otherwise treated as allowable costs (as defined in paragraph (e) of this section) is reduced by— (i) For cost reporting periods beginning during fiscal year 1998, by 25 percent; (ii) For cost reporting periods beginning during fiscal year 1999, by 40 percent; (iii) For cost reporting periods beginning during fiscal year 2000, by 45 percent; and (iv) For cost reporting periods beginning during a subsequent fiscal year, by 30 percent. (2) Skilled nursing facilities. For cost reporting periods beginning during fiscal year 2006 or during a subsequent fiscal year, the amount of skilled nursing facility bad debts for coinsurance otherwise treated as allowable costs (as defined in paragraph (e) of this section) for services furnished to a patient who is not a full-benefit dual eligible individual (as defined in § 423.772) is reduced by 30 percent. * * * * * PART 424—CONDITIONS FOR MEDICARE PAYMENT 36. The authority citation for part 424 continues to read as follows: Authority: Secs. 1102 and 1871 of the Social Security Act (42 U.S.C. 1302 and 1395hh). § 424.32 [Amended] 38. In § 424.121, paragraph (c) is amended by removing the cross- PO 00000 Frm 00152 Fmt 4701 § 424.123 Conditions for payment for nonemergency inpatient hospital services furnished by a hospital closer to the individual’s residence. * * * * * (c) * * * (2) Accredited by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) or accredited or approved by a program of the country where it is located under standards the CMS finds to be essentially equivalent to those of the JCAHO. * * * * * PART 485—CONDITIONS OF PARTICIPATION: SPECIALIZED PROVIDERS 40. The authority citation for part 485 continues to read as follows: Authority: Secs. 1102 and 1871 of the Social Security Act (42 U.S.C. 1302 and 1395hh). § 485.610 [Amended] 41. In paragraph (c) of § 485.610, the phrase ‘‘as of October 1, 2006’’ is removed and the phrase ‘‘on or before December 31, 2005’’ is added in its place. PART 489—PROVIDER AGREEMENTS AND SUPPLIER APPROVAL 42. The authority citation for part 489 continues to read as follows: Authority: Secs. 1102, 1819, 1861, 1864(m), 1866, 1869, and 187l of the Social Security Act (42 U.S.C. 1302, 1395i-3, 1395x, 1395aa(m), 1395cc, 1395ff, and 1395hh). 43. Section 489.24 is amended by— a. Revising the definition of ‘‘Labor’’ under paragraph (b). b. Revising paragraph (f). The revisions read as follows: § 489.24 Special responsibilities of Medicare hospitals in emergency cases. * [Amended] 37. In § 424.32, in paragraph (b), the phrase ‘‘CMS–1490U–Request for Medicare Payment by Organization. (For use by an organization requesting payment for medical services.)’’ is removed and the phrase ‘‘CMS–1491– Request for Medicare PaymentAmbulance. (For use by an organization requesting payment for ambulance services.)’’ is removed. § 424.121 reference ‘‘§ 405.313’’ and adding the cross-reference ‘‘§ 411.9’’ in its place. 39. Section 424.123 is amended by revising paragraph (c)(2) to read as follows: Sfmt 4702 * * * * (b) * * * Labor means the process of childbirth beginning with the latent or early phase of labor and continuing through the delivery of the placenta. A woman experiencing contractions is in true labor unless a physician, certified nursemidwife, or other qualified medical person acting within his or her scope of practice as defined in hospital medical staff bylaws and State law, certifies that, after a reasonable time of observation, the woman is in false labor. * * * * * E:\FR\FM\25APP2.SGM 25APP2 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules (f) Recipient hospital responsibilities. A participating hospital that has specialized capabilities or facilities (including, but not limited to, facilities such as burn units, shock-trauma units, neonatal intensive care units, or (with respect to rural areas) regional referral centers, which, for purposes of this subpart, means hospitals meeting the requirements of referral centers found at § 412.96 of this chapter) may not refuse to accept from a referring hospital within the boundaries of the United States an appropriate transfer of an individual who requires such specialized capabilities or facilities if the receiving hospital has the capacity to treat the individual. This requirement applies to any participating hospital with specialized capabilities, regardless of whether the hospital has a dedicated emergency department. * * * * * (Catalog of Federal Domestic Assistance Program No. 93.773, Medicare—Hospital Insurance; and Program No. 93.774, Medicare—Supplementary Medical Insurance Program) Dated: March 30, 2006. Mark B. McClellan, Administrator, Centers for Medicare & Medicaid Services. Dated: April 10, 2006. Michael O. Leavitt, Secretary. [Editorial Note: The following Addendum and appendices will not appear in the Code of Federal Regulations.] Addendum—Proposed Schedule of Standardized Amounts Effective With Discharges Occurring On or After October 1, 2006 and Update Factors and Rate-of-Increase Percentages Effective With Cost Reporting Periods Beginning On or After October 1, 2006 (If you choose to comment on issues in this section, please include the caption ‘‘Operating Payment Rates’’ at the beginning of your comment.) wwhite on PROD1PC61 with PROPOSALS2 I. Summary and Background In this Addendum, we are setting forth the proposed amounts and factors for determining prospective payment rates for Medicare hospital inpatient operating costs and Medicare hospital inpatient capitalrelated costs. We are also setting forth the proposed rate-of-increase percentages for updating the target amounts for hospitals and hospital units excluded from the IPPS. For discharges occurring on or after October 1, 2006, except for SCHs, MDHs, and hospitals located in Puerto Rico, each hospital’s payment per discharge under the IPPS has been based on 100 percent of the Federal national rate, which has been based on the national adjusted standardized amount. This amount reflects the national VerDate Aug<31>2005 17:10 Apr 24, 2006 Jkt 208001 24147 average hospital cost per case from a base year, updated for inflation. SCHs are paid based on whichever of the following rates yields the greatest aggregate payment: the Federal national rate; the updated hospital-specific rate based on FY 1982 costs per discharge; the updated hospital-specific rate based on FY 1987 costs per discharge; or the updated hospitalspecific rate based on FY 1996 costs per discharge. Under section 1886(d)(5)(G) of the Act, MDHs were paid for FY 2006 based on the Federal national rate or, if higher, the Federal national rate plus 50 percent of the difference between the Federal national rate and the updated hospital-specific rate based on FY 1982 or FY 1987 costs per discharge, whichever is higher. (MDHs do not have the option to use their FY 1996 hospital-specific rate.) Section 5003(a)(1) of Pub. L. 109–171 extended and modified the MDH special payment provision which was previously set to expire on October 1, 2006, to discharges occurring on or after October 1, 2006, but before October 1, 2011. Under section 5003(b) of Pub. L. 109–171, if the change results in an increase to its target amount, MDHs must rebase their hospital-specific rates to their FY 2002 cost reports. In addition, under section 5003(c) of Pub. L. 109–171, MDHs will now be paid based on the Federal national rate or, if higher, the Federal national rate plus 75 percent of the difference between the Federal national rate and the updated hospital-specific rate. Further, based upon section 5003(d) of Pub. L. 109–171, MDHs will no longer be subject to the 12-percent cap on their DSH payment adjustment factor. For hospitals in Puerto Rico, the payment per discharge is based on the sum of 25 percent of a Puerto Rico rate that reflects base year average costs per case of Puerto Rico hospitals and 75 percent of the Federal national rate. (See section II.D.3. of this Addendum for a complete description.) As discussed below in section II. of this Addendum, we are proposing to make changes in the determination of the prospective payment rates for Medicare inpatient operating costs for FY 2007. The proposed changes, to be applied effective with discharges occurring on or after October 1, 2006, affect the calculation of the Federal rates. In section III. of this Addendum, we discuss our proposed changes for determining the prospective payment rates for Medicare inpatient capital-related costs for FY 2007. Section IV. of this Addendum sets forth our proposed changes for determining the rate-of-increase limits for hospitals excluded from the IPPS for FY 2007. Section V. of this Addendum sets forth proposed policies on payment for blood clotting factors administered to hemophilia inpatients. The tables to which we refer in the preamble of this proposed rule are presented in section VI. of this Addendum. subsequent fiscal years is set forth at § 412.64. The basic methodology for determining the prospective payment rates for hospital inpatient operating costs for hospitals located in Puerto Rico for FY 2005 and subsequent fiscal years is set forth at §§ 412.211 and 412.212. Below we discuss the factors used for determining the prospective payment rates. In summary, the proposed standardized amounts set forth in Tables 1A, 1B, 1C, and 1D of section VI. of this Addendum reflect— • Equalization of the standardized amounts for urban and other areas at the level computed for large urban hospitals during FY 2004 and onward, as provided for under section 1886(d)(3)(A)(iv) of the Act, updated by the applicable percentage increase required under sections 1886(b)(3)(B)(i)(XX) and 1886(b)(3)(B)(viii) of the Act. • The two labor-related shares that are applicable to the standardized amounts and Puerto Rico-specific standardized amounts, depending on whether the hospital’s payments would be higher with a lower (in the case of a wage index less than or equal to 1.0000) or higher (in the case of a wage index above 1.0000) labor share, as provided for under sections 1886(d)(3)(E), and 1886(d)(9)(C)(iv) of the Act. • Proposed updates of 3.4 percent for all areas (that is, the full market basket percentage increase of 3.4 percent), as required by section 1886(b)(3)(B)(i)(XX) of the Act, as amended by section 5001 of Pub. L. 109–171, and reflecting the requirements of section 1886(b)(3)(B)(viii) of the Act, as added by section 5001(a)(3) of Pub. L. 109– 171, to reduce the applicable percentage increase by 2.0 percentage points for a hospital that fails to submit data, in a form and manner specified by the Secretary, relating to the quality of inpatient care furnished by the hospital; • An adjustment to ensure the proposed DRG recalibration and wage index update and changes are budget neutral, as provided for under sections 1886(d)(4)(C)(iii) and 1886(d)(3)(E) of the Act, by applying new budget neutrality adjustment factors to the standardized amount; • An adjustment to ensure the effects of the special transition measures adopted in relation to the implementation of new labor market areas are budget neutral; • An adjustment to ensure the effects of geographic reclassification are budget neutral, as provided for in section 1886(d)(8)(D) of the Act, by removing the FY 2006 budget neutrality factor and applying a revised factor; • An adjustment to apply the new outlier offset by removing the FY 2006 outlier offset and applying a new offset; • An adjustment to ensure the effects of the rural community hospital demonstration required under section 410A of Pub. L. 108– 173 are budget neutral, as required under section 410A(c)(2) of Pub. L. 108–173. II. Proposed Changes to Prospective Payment Rates for Hospital Inpatient Operating Costs for FY 2007 The basic methodology for determining prospective payment rates for hospital inpatient operating costs for FY 2005 and A. Calculation of the Adjusted Standardized Amount 1. Standardization of Base-Year Costs or Target Amounts The national standardized amount is based on per discharge averages of adjusted PO 00000 Frm 00153 Fmt 4701 Sfmt 4702 E:\FR\FM\25APP2.SGM 25APP2 wwhite on PROD1PC61 with PROPOSALS2 24148 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules hospital costs from a base period (section 1886(d)(2)(A) of the Act) or, for Puerto Rico, adjusted target amounts from a base period (section 1886(d)(9)(B)(i) of the Act), updated and otherwise adjusted in accordance with the provisions of section 1886(d) of the Act. The September 1, 1983 interim final rule (48 FR 39763) contained a detailed explanation of how base-year cost data (from cost reporting periods ending during FY 1981) were established in the initial development of standardized amounts for the IPPS. The September 1, 1987 final rule (52 FR 33043 and 33066) contains a detailed explanation of how the target amounts were determined, and how they are used in computing the Puerto Rico rates. Sections 1886(d)(2)(B) and (d)(2)(C) of the Act require us to update base-year per discharge costs for FY 1984 and then standardize the cost data in order to remove the effects of certain sources of cost variations among hospitals. These effects include case-mix, differences in area wage levels, cost-of-living adjustments for Alaska and Hawaii, indirect medical education costs, and costs to hospitals serving a disproportionate share of low-income patients. In accordance with section 1886(d)(3)(E) of the Act, the Secretary estimates, from timeto-time, the proportion of hospitals’ costs that are attributable to wages and wage-related costs. The standardized amount is divided into labor-related and nonlabor-related amounts; only the proportion considered the labor-related amount is adjusted by the wage index. Section 1886(d)(3)(E) of the Act requires that 62 percent of the standardized amount be adjusted by the wage index, unless doing so would result in lower payments to a hospital than would otherwise be made. (Section 1886(d)(9)(C)(iv)(II) of the Act extends this provision to the laborrelated share for hospitals located in Puerto Rico.) For FY 2007, we are proposing not to adjust the national and Puerto Rico-specific labor-related and nonlabor-related share from the percentages established in FY 2006. Accordingly, we are proposing to adjust 62 percent of the national standardized amount for all hospitals whose wage indexes are less than or equal to 1.0000. For all hospitals whose wage values are greater than 1.0000, we are proposing to adjust 69.7 percent of the national standardized amount by the hospitals’ wage indexes. For hospitals in Puerto Rico, we are proposing to adjust 58.7 percent of the Puerto Rico-specific standardized amount for all hospitals whose Puerto Rico-specific wage indexes are less than or equal to 1.0000. For Puerto Rico hospitals whose Puerto Rico-specific wage index values are greater than 1.0000, we are proposing to adjust 62 percent of the Puerto Rico-specific standardized amount. The proposed standardized amounts appear in Table 1A, 1B, and 1C of the Addendum to this proposed rule. 2. Computing the Average Standardized Amount Section 1886(d)(3)(A)(iv) of the Act requires that, beginning with FY 2004 and thereafter, an equal standardized amount is to be computed for all hospitals at the level VerDate Aug<31>2005 17:10 Apr 24, 2006 Jkt 208001 computed for large urban hospitals during FY 2003, updated by the applicable percentage update. Section 1886(d)(9)(A) of the Act equalizes the Puerto Rico-specific urban and rural area rates. Accordingly, we are using this proposed rule to provide for a single national standardized amount and a single Puerto Rico standardized amount for FY 2007. 3. Updating the Average Standardized Amount In accordance with section 1886(d)(3)(A)(iv)(II) of the Act, we are proposing to update the equalized standardized amount for FY 2007 by the full estimated market basket percentage increase for hospitals in all areas, as specified in section 1886(b)(3)(B)(i)(XX) of the Act, as amended by section 5001(a)(1) of Pub. L. 109–171. The percentage change in the market basket reflects the average change in the price of goods and services purchased by hospitals to furnish inpatient care. The most recent forecast of the hospital market basket increase for FY 2007 is 3.4 percent. Thus, for FY 2007, the proposed update to the average standardized amount is 3.4 percent for hospitals in all areas. Section 1886(b)(3)(B) of the Act specifies the mechanism used to update the standardized amount for payment for inpatient hospital operating costs. Section 1886(b)(3)(B)(viii) of the Act, as added by section 5001(a)(3) of Pub. L. 109–171, provides for a reduction of 2.0 percentage points to the update percentage increase (also known as the market basket update) for FY 2007 and each subsequent fiscal year for any ‘‘subsection (d) hospital’’ that does not submit quality data as discussed in section IV.A. of the preamble of this proposed rule. The proposed standardized amounts in Tables 1A through 1C of section VI. of this Addendum reflect these differential amounts. Although the update factors for FY 2007 are set by law, we are required by section 1886(e)(4) of the Act to recommend, taking into account MedPAC’s recommendations, appropriate update factors for FY 2007 for both IPPS hospitals and hospitals and hospital units excluded from the IPPS. Our recommendation on the update factors (which is required by sections 1886(e)(4)(A) and (e)(5)(A) of the Act) is set forth in Appendix B of this proposed rule. 4. Other Adjustments to the Average Standardized Amount As in the past, we are proposing to adjust the FY 2007 standardized amount to remove the effects of the FY 2006 geographic reclassifications and outlier payments before applying the proposed FY 2007 updates. We then apply the new offsets for outliers and geographic reclassifications to the proposed standardized amount for FY 2007. We do not remove the prior year’s budget neutrality adjustments for reclassification and recalibration of the DRG weights and for updated wage data because, in accordance with sections 1886(d)(4)(C)(iii) and 1886(d)(3)(E) of the Act, estimated aggregate payments after the changes in the DRG relative weights and wage index should equal estimated aggregate payments prior to the changes. If we removed the prior year PO 00000 Frm 00154 Fmt 4701 Sfmt 4702 adjustment, we would not satisfy these conditions. Budget neutrality is determined by comparing aggregate IPPS payments before and after making the changes that are required to be budget neutral (for example, reclassifying and recalibrating the DRGs, updating the wage data, and geographic reclassifications). We include outlier payments in the payment simulations because outliers may be affected by changes in these payment parameters. We are also proposing to adjust the standardized amount this year by an amount estimated to ensure that aggregate IPPS payments do not exceed the amount of payments that would have been made in the absence of the rural community hospital demonstration required under section 410A of Pub. L. 108–173. This demonstration is required to be budget neutral under section 410A(c)(2) of Pub. L. 108–173. a. Recalibration of DRG Weights and Updated Wage Index—Budget Neutrality Adjustment Section 1886(d)(4)(C)(iii) of the Act specifies that, beginning in FY 1991, the annual DRG reclassification and recalibration of the relative weights must be made in a manner that ensures that aggregate payments to hospitals are not affected. As discussed in section II. of the preamble, we normalized the recalibrated DRG weights by an adjustment factor, so that the average case weight after recalibration is equal to the average case weight prior to recalibration. However, equating the average case weight after recalibration to the average case weight before recalibration does not necessarily achieve budget neutrality with respect to aggregate payments to hospitals because payments to hospitals are affected by factors other than average case weight. Therefore, as we have done in past years, we are proposing to make a budget neutrality adjustment to ensure that the requirement of section 1886(d)(4)(C)(iii) of the Act is met. Section 1886(d)(3)(E) of the Act requires us to update the hospital wage index on an annual basis beginning October 1, 1993. This provision also requires us to make any updates or adjustments to the wage index in a manner that ensures that aggregate payments to hospitals are not affected by the change in the wage index. For FY 2007, we are proposing to continue to adjust 10 percent of the wage index factor for occupational mix. We describe the proposed occupational mix adjustment in section III.C. of the preamble to this proposed rule. Because section 1886(d)(3)(E) of the Act requires us to update the wage index on a budget neutral basis, we are including the effects of this proposed occupational mix adjustment on the wage index in our budget neutrality calculations. In FY 2005, those urban hospitals that became rural under the new labor market area definitions were assigned the wage index of the urban area in which they were located under the previous labor market definitions for a 3-year period of FY 2005, FY 2006, and FY 2007. Because we are in the third year of this 3-year transition, we are proposing to adjust the standardized amounts for FY 2007 to ensure budget neutrality for this policy. We discuss this proposed E:\FR\FM\25APP2.SGM 25APP2 wwhite on PROD1PC61 with PROPOSALS2 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules adjustment in section III.B. of the preamble to this proposed rule. Section 4410 of Pub. L. 105–33 provides that, for discharges on or after October 1, 1997, the area wage index applicable to any hospital that is not located in a rural area may not be less than the area wage index applicable to hospitals located in rural areas in that State. This provision is required by section 4410(b) of Pub. L. 105–33 to be budget neutral. Therefore, we include the effects of this provision in our calculation of the proposed wage update budget neutrality factor. As discussed in the FY 2006 IPPS final rule (70 FR 47493), FY 2007 is the third and final year of the 3-year provision that uses an imputed wage index floor for States that have no rural areas and States that have geographic rural areas, but that have no hospitals actually classified as rural. We are also proposing to adjust for the effects of this provision in our calculation of the wage update budget neutrality factor. To comply with the requirement that DRG reclassification and recalibration of the relative weights be budget neutral, and the requirement that the updated wage index be budget neutral, we used FY 2005 discharge data to simulate payments and compared aggregate payments using the FY 2006 relative weights and wage indexes to aggregate payments using the proposed FY 2007 relative weights and wage indexes. The same methodology was used for the FY 2006 budget neutrality adjustment. Based on this comparison, we computed a proposed budget neutrality adjustment factor equal to 0.998363. We also are proposing to adjust the Puerto Rico-specific standardized amount for the effect of DRG reclassification and recalibration. We computed a proposed budget neutrality adjustment factor for the Puerto Rico-specific standardized amount equal to 0.998963. These proposed budget neutrality adjustment factors are applied to the standardized amounts without removing the effects of the FY 2006 budget neutrality adjustments. In addition, as discussed in section IV.E. of the preamble to this proposed rule, we are applying the same proposed DRG reclassification and recalibration budget neutrality factor of 0.998963 to the hospitalspecific rates that are to be effective for cost reporting periods beginning on or after October 1, 2006. Using the same data, we calculated a proposed transition budget neutrality adjustment to account for the ‘‘hold harmless’’ policy under which urban hospitals that became rural under the new labor market area definitions were assigned the wage index of the urban area in which they were located under the previous labor market area definitions for a 3-year period of FY 2005, FY 2006, and FY 2007 (see Table 2 in section VI. of this Addendum). Using the pre-reclassified wage index, we simulated payments under the new labor market area definitions and compared them to simulated payments under the ‘‘hold harmless’’ policy. Based on this comparison, we computed a proposed transition budget neutrality adjustment of 0.999591. VerDate Aug<31>2005 17:10 Apr 24, 2006 Jkt 208001 b. Reclassified Hospitals—Budget Neutrality Adjustment Section 1886(d)(8)(B) of the Act provides that, effective with discharges occurring on or after October 1, 1988, certain rural hospitals are deemed urban. In addition, section 1886(d)(10) of the Act provides for the reclassification of hospitals based on determinations by the MGCRB. Under section 1886(d)(10) of the Act, a hospital may be reclassified for purposes of the wage index. Under section 1886(d)(8)(D) of the Act, the Secretary is required to adjust the standardized amount to ensure that aggregate payments under the IPPS after implementation of the provisions of sections 1886(d)(8)(B) and (C) and 1886(d)(10) of the Act are equal to the aggregate prospective payments that would have been made absent these provisions. We note that neither the wage index reclassifications provided under section 508 of Pub. L. 108–173 nor the wage index adjustments provided under section 1886(d)(13) of the Act are budget neutral. Section 508(b) of Pub. L. 108–173 provides that the wage index reclassifications approved under section 508(a) of Pub. L. 108–173 ‘‘shall not be effected in a budget neutral manner.’’ Section 1886(d)(13)(H) of the Act similarly provides that any increase in a wage index under section 1886(d)(13) shall not be taken into account ‘‘in applying any budget neutrality adjustment with respect to such index’’ under section 1886(d)(8)(D) of the Act. To calculate this proposed budget neutrality factor, we used FY 2005 discharge data to simulate payments, and compared total IPPS payments prior to any reclassifications under sections 1886(d)(8)(B) and (C) and 1886(d)(10) of the Act to total IPPS payments after such reclassifications. Based on these simulations, we are proposing to apply an adjustment factor of 0.991727 to ensure that the effects of this reclassification are budget neutral. The proposed adjustment factor is applied to the standardized amount after removing the effects of the FY 2006 budget neutrality adjustment factor. We note that the proposed FY 2007 adjustment reflects FY 2007 wage index reclassifications approved by the MGCRB or the Administrator, and the effects of MGCRB reclassifications approved in FY 2005 and FY 2006 (section 1886(d)(10)(D)(v) of the Act makes wage index reclassifications effective for 3 years). c. Outliers Section 1886(d)(5)(A) of the Act provides for payments in addition to the basic prospective payments for ‘‘outlier’’ cases involving extraordinarily high costs. To qualify for outlier payments, a case must have costs greater than the sum of the prospective payment rate for the DRG, any IME and DSH payments, any new technology add-on payments, and the ‘‘outlier threshold’’ or ‘‘fixed loss’’ amount (a dollar amount by which the costs of a case must exceed payments in order to qualify for an outlier payment). We refer to the sum of the prospective payment rate for the DRG, any IME and DSH payments, any new technology add-on payments, and the outlier threshold as the outlier ‘‘fixed-loss cost threshold.’’ To PO 00000 Frm 00155 Fmt 4701 Sfmt 4702 24149 determine whether the costs of a case exceed the fixed-loss cost threshold, a hospital’s cost-to-charge ratio is applied to the total covered charges for the case to convert the charges to costs. Payments for eligible cases are then made based on a marginal cost factor, which is a percentage of the costs above the fixed-loss cost threshold. The marginal cost factor for FY 2007 is 80 percent—the same marginal cost factor we have used since FY 1995 (59 FR 45367). In accordance with section 1886(d)(5)(A)(iv) of the Act, outlier payments for any year are projected to be not less than 5 percent nor more than 6 percent of total operating DRG payments plus outlier payments. Section 1886(d)(3)(B) of the Act requires the Secretary to reduce the average standardized amount by a factor to account for the estimated proportion of total DRG payments made to outlier cases. Similarly, section 1886(d)(9)(B)(iv) of the Act requires the Secretary to reduce the average standardized amount applicable to hospitals in Puerto Rico to account for the estimated proportion of total DRG payments made to outlier cases. More information on outlier payments may be found on the CMS Web site at https://www.cms.hhs.gov/ AcuteInpatientPPS/04_outlier.asp# TopOfPage. i. Proposed FY 2007 Outlier Fixed-Loss Cost Threshold For FY 2007, we are proposing to use the same methodology used for FY 2006 (70 FR 47493) to calculate the outlier threshold. As we have done in the past, to calculate the proposed FY 2007 outlier threshold, we simulated payments by applying proposed FY 2007 rates and policies using cases from the FY 2005 MedPAR files. Therefore, in order to determine the proposed FY 2007 outlier threshold, we are proposing to inflate the charges on the MedPAR claims by 2 years, from FY 2005 to FY 2007. In certain years in the past, we have inflated MedPAR claims by calculating a 2year average annual rate-of-change in charges-per-case using the charge data for the two most recent years for which we had relatively complete MedPAR data. As discussed in the FY 2006 IPPS final rule (70 FR 47494), however, we believe that charge data from FY 2003 may be distorted due to the atypically high rate of hospital charge inflation during FY 2003. Therefore, we are not proposing to inflate charges using a 2year average annual rate-of-change from FY 2003 to FY 2004 and FY 2004 to FY 2005. Instead, we are proposing to continue to use a refined methodology that takes into account the lower inflation in hospital charges that is occurring as a result of the outlier final rule (68 FR 34494), which changed our methodology for determining outlier payments by implementing the use of more current and accurate CCRs. Our refined methodology uses more recent data that reflects the rate-of-change in hospital charges under the new outlier policy. Specifically, we are proposing to establish the proposed FY 2007 outlier threshold as follows: Using the latest data available, we propose to calculate the 1-year average annualized rateof-change in charges-per-case from the last quarter of FY 2004 in combination with the E:\FR\FM\25APP2.SGM 25APP2 24150 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules first quarter of FY 2005 (July 1, 2004 through December 31, 2004) to the last quarter of FY 2005 in combination with the first quarter of FY 2006 (July 1, 2005 through December 31, 2005). This rate of change was 7.57 percent (1.0757) or 15.15 percent (1.1515) over 2 years. As we have done in the past, we are proposing to establish the proposed FY 2007 outlier threshold using hospital cost-tocharge ratios from the December 2005 update to the Provider-Specific File—the most recent available at the time of this proposed rule. This file includes cost-to-charge ratios that reflect implementation of the changes to the policy for determining the applicable cost-tocharge ratios that became effective August 8, 2003 (68 FR 34494). Using this methodology, we are proposing to establish an outlier fixed-loss cost threshold for FY 2007 equal to the prospective payment rate for the DRG, plus any IME and DSH payments, and any addon payments for new technology, plus $25,530. We note that the case-weighted national average cost-to-charge ratio declined by approximately 1 percent from the March 2005 to the December 2005 update of the Provider-Specific File. Hospital charges continue to increase at a steady rate of growth between 7 and 8 percent over each of the last 2 years, resulting in a decline to the cost-to-charge ratios that are used to compute the outlier threshold. Using lower cost-tocharge ratios from the December 2005 Provider-Specific File, in combination with the FY 2005 MedPAR claims and inflated charges, contributes to a higher proposed outlier threshold for FY 2007 compared to FY 2006. As we did in establishing the FY 2006 outlier threshold (70 FR 47494), in our projection of FY 2007 outlier payments, we are not making an adjustment for the possibility that hospitals’ cost-to-charge ratios and outlier payments may be reconciled upon cost report settlement. We continue to believe that, due to the policy implemented in the June 9, 2003 outlier final rule, cost-to-charge ratios will no longer fluctuate significantly and, therefore, few hospitals will actually have these ratios reconciled upon cost report settlement. In addition, it is difficult to predict which specific hospitals will have cost-to-charge ratios and outlier payments reconciled in their cost reports in any given year. We also note that reconciliation occurs because hospitals’ actual cost-to-charge ratios for the cost reporting period are different than the interim cost-to-charge ratios used to calculate outlier payments when a bill is processed. Our simulations assume that cost-to-charge ratios accurately measure hospital costs and, therefore, are more indicative of post- reconciliation than pre-reconciliation outlier payments. As a result, we are proposing to continue to omit any assumptions about the effects of reconciliation from the outlier threshold calculation. ii. Other Changes Concerning Outliers As stated in the FY 1994 IPPS final rule (58 FR 46348, September 1, 1993), we establish outlier thresholds that are applicable to both hospital inpatient operating costs and hospital inpatient capital-related costs. When we modeled the combined operating and capital outlier payments, we found that using a common set of thresholds resulted in a lower percentage of outlier payments for capital-related costs than for operating costs. We project that the thresholds for FY 2007 will result in outlier payments equal to 5.1 percent of operating DRG payments and 4.87 percent of capital payments based on the Federal rate. In accordance with section 1886(d)(3)(B) of the Act, we are proposing to reduce the proposed FY 2007 standardized amount by the same percentage to account for the projected proportion of payments paid to outliers. The proposed outlier adjustment factors that would be applied to the standardized amount for FY 2007 are as follows: Operating standardized amounts wwhite on PROD1PC61 with PROPOSALS2 National ........................................................................................................................................................ Puerto Rico .................................................................................................................................................. We are proposing to apply the outlier adjustment factors to the FY 2007 rates after removing the effects of the FY 2006 outlier adjustment factors on the standardized amount. To determine whether a case qualifies for outlier payments, we apply hospital-specific cost-to-charge ratios to the total covered charges for the case. Operating and capital costs for the case are calculated separately by applying separate operating and capital costto-charge ratios. These costs are then combined and compared with the outlier fixed-loss cost threshold. The outlier final rule (68 FR 34494) eliminated the application of the statewide average cost-to-charge ratios for hospitals whose cost-to-charge ratios fall below 3 standard deviations from the national mean cost-to-charge ratio. However, for those hospitals for which the fiscal intermediary computes operating cost-to-charge ratios greater than 1.25 or capital cost-to-charge ratios greater than 0.158, or hospitals for whom the fiscal intermediary is unable to calculate a cost-to-charge ratio (as described at § 412.84(i)(3) of our regulations), we are still using statewide average cost-to-charge ratios to determine whether a hospital qualifies for outlier payments.22 Table 8A in section VI. of this Addendum contains the 22 These figures represent 3.0 standard deviations from the mean of the log distribution of cost-tocharge ratios for all hospitals. VerDate Aug<31>2005 17:10 Apr 24, 2006 Jkt 208001 proposed statewide average operating cost-tocharge ratios for urban hospitals and for rural hospitals for which the fiscal intermediary is unable to compute a hospital-specific cost-tocharge ratio within the above range. Effective for discharges occurring on or after October 1, 2006, these proposed statewide average ratios would replace the ratios published in the IPPS final rule for FY 2006 (70 FR 47672). Table 8B in section VI. of this Addendum contains the proposed comparable statewide average capital cost-to-charge ratios. Again, the proposed cost-to-charge ratios in Tables 8A and 8B would be used during FY 2007 when hospital-specific cost-to-charge ratios based on the latest settled cost report are either not available or are outside the range noted above. For an explanation of Table 8C, please see section VI. of this Addendum. We finally note that we published a manual update (Change Request 3966) to outliers on October 12, 2005. The manual update covered an array of topics, including cost-to-charge ratios, reconciliation, and the time value of money. To download and view the manual update, please visit https://www. cms.hhs.gov/transmittals/downloads/ R707CP.pdf. iii. FY 2005 and FY 2006 Outlier Payments In the FY 2006 IPPS final rule (70 FR 47496), we stated that, based on available data, we estimated that actual FY 2005 outlier payments would be approximately 4.1 percent of actual total DRG payments. This estimate was computed based on simulations PO 00000 Frm 00156 Fmt 4701 Sfmt 4702 0.948984 0.970984 Capital Federal rate 0.951305 0.968473 using the FY 2004 MedPAR file (discharge data for FY 2004 bills). That is, the estimate of actual outlier payments did not reflect actual FY 2005 bills, but instead reflected the application of FY 2005 rates and policies to available FY 2004 bills. Our current estimate, using available FY 2005 bills, is that actual outlier payments for FY 2005 were approximately 4.10 percent of actual total DRG payments. Thus, the data indicate that, for FY 2005, the percentage of actual outlier payments relative to actual total payments is lower than we projected before FY 2005 (and, thus, is less than the percentage by which we reduced the standardized amounts for FY 2005). We note that, for FY 2006, the outlier threshold was lowered to $23,600 compared to $25,800 for FY 2005. The outlier threshold was lower in FY 2006 than FY 2005 as a result of slower growth in hospital charge inflation following implementation of the outlier final rule that went into effect on August 9, 2003. Nevertheless, consistent with the policy and statutory interpretation we have maintained since the inception of the IPPS, we do not plan to make retroactive adjustments to outlier payments to ensure that total outlier payments for FY 2005 are equal to 5.1 percent of total DRG payments. We currently estimate that actual outlier payments for FY 2006 will be approximately 4.71 percent of actual total DRG payments, 0.39 percentage point lower than the 5.1 percent we projected in setting the outlier E:\FR\FM\25APP2.SGM 25APP2 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules policies for FY 2006. This estimate is based on simulations using the FY 2005 MedPAR file (discharge data for FY 2005 bills). We used these data to calculate an estimate of the actual outlier percentage for FY 2006 by applying FY 2006 rates and policies, including an outlier threshold of $23,600 to available FY 2005 bills. Even though we are estimating payments below the 5.1 percent threshold for FY 2006, our simulations using FY 2005 Medicare data show consistent levels of charge inflation and a need to increase the threshold for FY 2007 to ensure that 5.1 percent of total IPPS payments are paid as outliers. However, our current estimate of the outlier threshold for FY 2007 may change in the final rule based on updated data. iv. Technical Changes Subpart F of Part 412 of the existing regulations discusses payment for outlier cases and special payment for new technology. We have become aware of an inadvertent mistake in § 412.84(m). Currently, § 412.84(m) discusses the application of the time value of money when a hospital’s outlier payments are reconciled. When referencing reconciliation, the section by mistake references paragraph (h)(3) instead of paragraph (i)(4). We are proposing to revise § 412.84(m) to reference the current policy under paragraph (i)(4). d. Rural Community Hospital Demonstration Program Adjustment (Section 410A of Pub. L. 108–173) Section 410A of Pub. L. 108–173 requires the Secretary to establish a demonstration that will modify reimbursement for inpatient services for up to 15 small rural hospitals. Section 410A(c)(2) of Pub. L. 108–173 requires that ‘‘in conducting the demonstration program under this section, the Secretary shall ensure that the aggregate payments made by the Secretary do not exceed the amount which the Secretary would have paid if the demonstration program under this section was not implemented.’’ As discussed in section IV.M. of the preamble to this proposed rule, we are proposing to satisfy this requirement by adjusting national IPPS rates by a factor that is sufficient to account for the added costs of this demonstration. We estimate that the average additional annual payment that will be made to each participating hospital under the demonstration will be approximately $1,021,985. We based this estimate on the recent historical experience of the difference between inpatient cost and payment for hospitals that are participating in the demonstration. For 9 participating hospitals, the total annual impact of the demonstration program is estimated to be $9,197,870. The required adjustment to the Federal rate used in calculating Medicare inpatient prospective payments as a result of the demonstration is 0.999905. In order to achieve budget neutrality, we are proposing to adjust national IPPS rates by an amount sufficient to account for the added costs of this demonstration. In other words, we are proposing to apply budget neutrality across the payment system as a whole rather than merely across the participants of this demonstration. We believe that the language of the statutory budget neutrality requirement permits the agency to implement the budget neutrality provision in this manner. This is because the statutory language requires that ‘‘aggregate payments made by the Secretary do not exceed the amount which the Secretary would have paid if the demonstration * * * was not implemented,’’ but does not identify the range across which aggregate payments must be held equal. 5. Proposed FY 2007 Standardized Amount The adjusted standardized amount is divided into labor-related and nonlaborrelated portions. Tables 1A and 1B in section VI. of this Addendum contain the national standardized amount that we are proposing to apply to all hospitals, except hospitals in Puerto Rico. The Puerto Rico-specific amounts are shown in Table 1C. The amounts shown in Tables 1A and 1B differ only in that the labor-related share applied to the standardized amounts in Table 1A is 69.7 24151 percent, and the labor-related share applied to the standardized amounts in Table 1B is 62 percent. In accordance with sections 1886(d)(3)(E) and 1886(d)(9)(C)(iv) of the Act, we are applying the labor-related share of 62 percent, unless the application of that percentage would result in lower payments to a hospital than would otherwise be made. The effect of this application is that the laborrelated share of the standardized amount is 62 percent for all hospitals (other than those in Puerto Rico) whose wage indexes are less than or equal to 1.0000. In addition, Tables 1A and 1B include proposed standardized amounts reflecting the full 3.4 percent proposed update for FY 2007, and proposed standardized amounts reflecting the 2.0 percentage point reduction to the proposed update (a 1.4 percent update) applicable for hospitals that fail to submit quality data consistent with section 1886(b)(3)(B)(viii) of the Act. The following table illustrates the proposed changes from the FY 2006 national average standardized amount. The first column shows the proposed changes from the FY 2006 standardized amounts for hospitals that satisfy the quality data submission requirement for receiving the full update (3.4 percent). The second column shows the proposed changes for hospitals receiving the reduced update (1.4 percent). The first row of the table shows the proposed updated (through FY 2006) average standardized amount after restoring the FY 2006 offsets for outlier payments, demonstration budget neutrality, the wage index transition budget neutrality and geographic reclassification budget neutrality. The DRG reclassification and recalibration and wage index budget neutrality factor is cumulative. Therefore, we did not remove the FY 2006 budget neutrality factors for DRG reclassification and recalibration from the amounts in the table. We have added separate rows to this table to reflect the different labor-related shares that apply to hospitals. COMPARISON OF FY 2006 STANDARDIZED AMOUNTS TO PROPOSED FY 2007 SINGLE STANDARDIZED AMOUNT WITH FULL UPDATE AND REDUCED UPDATE Full update (3.4 percent) wwhite on PROD1PC61 with PROPOSALS2 FY 2006 Base Rate, after removing reclassification budget neutrality, demonstration budget neutrality, wage index transition budget neutrality factors and outlier offset (based on the proposed labor and nonlabor market share percentage for FY 2007). Proposed FY 2007 Update Factor ............................................................................................... Proposed FY 2007 DRG Recalibrations and Wage Index Budget Neutrality Factor .................. Proposed FY 2007 Reclassification Budget Neutrality Factor ..................................................... Adjusted for Blend of FY 2006 DRG Recalibration and Wage Index Budget Neutrality Factors Proposed FY 2007 Outlier Factor ................................................................................................ Proposed FY 2007 Labor Market Wage Index Transition Budget Neutrality Factor ................... Proposed Rural Demonstration Budget Neutrality Factor ............................................................ Proposed Rate for FY 2007 (after multiplying FY 2006 base rate by above factors) where the wage index is less than or equal to 1.0000. Proposed Rate for FY 2007 (after multiplying FY 2006 base rate by above factors) where the wage index is greater than 1.0000. Under section 1886(d)(9)(A)(ii) of the Act, the Federal portion of the Puerto Rico VerDate Aug<31>2005 17:10 Apr 24, 2006 Jkt 208001 payment rate is based on the dischargeweighted average of the national large urban PO 00000 Frm 00157 Fmt 4701 Sfmt 4702 Reduced update (1.4 percent) Labor: $3,505.76 ......... Nonlabor: $1,524.03 ... Labor: $3,505.76. Nonlabor: $1,524.03. 1.034 ........................... 0.998363 ..................... 0.991727 ..................... Labor: $3,589.08 ......... Nonlabor: $1,560.25 ... 0.948984 ..................... 0.999591 ..................... 0.999905 ..................... Labor: $3,028.19 ......... Nonlabor: $1,855.98 ... Labor: $3,404.27 ......... Nonlabor: $1,479.90 ... 1.014. 0.998363. 0.991727. Labor: $3,519.67. Nonlabor: $1,530.07. 0.948984. 0.999591. 0.999905. Labor: $2,969.62. Nonlabor: $1,820.08. Labor: $3,338.42. Nonlabor: $1,451.28. standardized amount (as set forth in Table 1A). The proposed labor-related and E:\FR\FM\25APP2.SGM 25APP2 24152 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules nonlabor-related portions of the national average standardized amounts for Puerto Rico hospitals for FY 2007 are set forth in Table 1C of section VI. of this Addendum. This table also includes the Puerto Rico standardized amounts. The labor-related share applied to the Puerto Rico specific standardized amount is 58.7 percent, or 62 percent, depending on which is more advantageous to the hospital. (Section 1886(d)(9)(C)(iv) of the Act, as amended by section 403(b) of Pub. L. 108–173, provides that the labor-related share for hospitals in Puerto Rico will be 62 percent, unless the application of that percentage would result in lower payments to the hospital.) B. Adjustments for Area Wage Levels and Cost-of-Living Tables 1A through 1C, as set forth in section VI. of this Addendum, contain the labor-related and nonlabor-related shares that we are proposing to use to calculate the prospective payment rates for hospitals located in the 50 States, the District of Columbia, and Puerto Rico for FY 2007. This section addresses two types of adjustments to the standardized amounts that are made in determining the proposed prospective payment rates as described in this Addendum. 1. Adjustment for Area Wage Levels Sections 1886(d)(3)(E) and 1886(d)(9)(C)(iv) of the Act require that we make an adjustment to the labor-related portion of the national and Puerto Rico prospective payment rates, respectively, to account for area differences in hospital wage levels. This adjustment is made by multiplying the labor-related portion of the adjusted standardized amounts by the appropriate wage index for the area in which the hospital is located. In section III. of the preamble to this proposed rule, we discuss the data and methodology for the proposed FY 2007 wage index. The proposed FY 2007 wage indexes are set forth in Tables 4A–1, 4A–2, 4B, 4C–1, 4C–2, and 4F of section VI. of this Addendum. wwhite on PROD1PC61 with PROPOSALS2 2. Adjustment for Cost-of-Living in Alaska and Hawaii Section 1886(d)(5)(H) of the Act authorizes an adjustment to take into account the unique circumstances of hospitals in Alaska and Hawaii. Higher labor-related costs for these two States are taken into account in the adjustment for area wages described above. For FY 2007, we are proposing to adjust the payments for hospitals in Alaska and Hawaii by multiplying the nonlabor-related portion of the standardized amount by the appropriate adjustment factor contained in the table below. If the Office of Personnel Management releases revised cost-of-living adjustment factors before July 1, 2006, we will publish them in the final rule and use them in determining FY 2007 payments. VerDate Aug<31>2005 17:10 Apr 24, 2006 Jkt 208001 TABLE OF COST-OF-LIVING ADJUSTMENT FACTORS: ALASKA AND HAWAII HOSPITALS Cost of living adjustment factor Area Alaska-All areas ...................... Hawaii: County of Honolulu ............. Hawaii ................................. County of Kauai .................. County of Maui .................... County of Kalawao .............. 1.25 1.25 1.165 1.2325 1.2375 1.2375 (The above factors are based on data obtained from the U.S. Office of Personnel Management.) C. DRG Relative Weights As discussed in section II. of the preamble of this proposed rule, we have developed a classification system for all hospital discharges, assigning them into DRGs, and have developed relative weights for each DRG that reflect the resource utilization of cases in each DRG relative to Medicare cases in other DRGs. Table 5 of section VI. of this Addendum contains the relative weights that we are proposing to use for discharges occurring in FY 2007. These factors have been recalibrated as explained in section II. of the preamble of this proposed rule. D. Calculation of the Proposed Prospective Payment Rates for FY 2007 General Formula for Calculation of Prospective Payment Rates for FY 2007 The proposed operating prospective payment rate for all hospitals paid under the IPPS located outside of Puerto Rico, except SCHs and MDHs, for FY 2007 equals the Federal rate based on the corresponding amounts in Table 1A or Table 1B in section VI. of this Addendum. The proposed prospective payment rate for SCHs for FY 2007 equals the higher of the applicable Federal rate (from Table 1A or Table 1B) or the hospital-specific rate as described below. The proposed prospective payment rate for MDHs for FY 2007 equals the higher of the Federal rate, or the Federal rate plus 75 percent of the difference between the Federal rate and the hospital-specific rate as described below. The proposed prospective payment rate for Puerto Rico for FY 2007 equals 25 percent of the Puerto Rico rate from Table 1C in section VI. of this Addendum plus 75 percent of the applicable national rate from Table 1A or Table 1B in section VI. of this Addendum. 1. Federal Rate For discharges occurring on or after October 1, 2006 and before October 1, 2007, except for SCHs, MDHs, and hospitals in Puerto Rico, payment under the IPPS is based exclusively on the Federal rate. The Federal rate is determined as follows: Step 1—Select the appropriate average standardized amount considering the applicable wage index (Table 1A for wage indexes greater than 1.0000 and Table 1B for wage indexes less than or equal to 1.0000) and whether the hospital has submitted PO 00000 Frm 00158 Fmt 4701 Sfmt 4702 qualifying quality data (full update for qualifying hospitals, update minus 2.0 percentage points for nonqualifying hospitals). Step 2—Multiply the labor-related portion of the standardized amount by the applicable wage index for the geographic area in which the hospital is located or the area to which the hospital is reclassified (see Tables 4A–1, 4A–2, 4B, 4C–1, and 4C–2 of section VI. of this Addendum). Step 3—For hospitals in Alaska and Hawaii, multiply the nonlabor-related portion of the standardized amount by the appropriate cost-of-living adjustment factor. Step 4—Add the amount from Step 2 and the nonlabor-related portion of the standardized amount (adjusted, if appropriate, under Step 3). Step 5—Multiply the final amount from Step 4 by the relative weight corresponding to the appropriate DRG (see Table 5 of section VI. of this Addendum). The Federal rate as determined in Step 5 may then be further adjusted if the hospital qualifies for either the IME or DSH adjustment. In addition, for hospitals that qualify for a low-volume payment adjustment under section 1886(d)(12) of the Act, the payment in Step 5 would be increased by 25 percent. 2. Hospital-Specific Rate (Applicable Only to SCHs and MDHs) a. Calculation of Hospital-Specific Rate Section 1886(b)(3)(C) of the Act provides that SCHs are paid based on whichever of the following rates yields the greatest aggregate payment: the Federal rate; the updated hospital-specific rate based on FY 1982 costs per discharge; the updated hospital-specific rate based on FY 1987 costs per discharge; or the updated hospital-specific rate based on FY 1996 costs per discharge. As discussed above, MDHs must rebase their hospital-specific rates to their FY 2002 cost reports if doing so results in higher payments. In addition, effective for discharges occurring on or after October 1, 2006, MDHs are paid based on the Federal national rate or, if higher, the Federal national rate plus 75 percent of the difference between the Federal national rate and the greater of the updated hospital-specific rates based on either FY 1982, FY 1987 or FY 2002 costs per discharge. Further, MDHs will no longer be subject to the 12-percent cap on their DSH payment adjustment factor. Hospital-specific rates have been determined for each of these hospitals based on the FY 1982 costs per discharge, the FY 1987 costs per discharge, or, for SCHs, the FY 1996 costs per discharge or for MDHs the FY 2002 cost per discharge. For a more detailed discussion of the calculation of the hospitalspecific rates, we refer the reader to the FY 1984 IPPS interim final rule (September 1, 1983, 48 FR 39772); the April 20, 1990 final rule with comment (55 FR 15150); the FY 1991 IPPS final rule (September 4, 1990, 55 FR 35994); and the FY 2001 IPPS final rule (August 1, 2000, 65 FR 47082). In addition, for both SCHs and MDHs, the hospitalspecific rate is adjusted by the budget neutrality adjustment factor (that is, by the proposed recalibration budget neutrality E:\FR\FM\25APP2.SGM 25APP2 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules factor of 0.998963) as discussed in section IV.C. of the preamble to this proposed rule. The resulting rate would be used in determining the payment rate an SCH or MDH would receive for its discharges beginning on or after October 1, 2006. b. Updating the FY 1982, FY 1987, FY 1996, and FY 2002 Hospital-Specific Rates for FY 2007 We are proposing to increase the hospitalspecific rates by 3.4 percent (the hospital market basket percentage increase) for SCHs and MDHs for FY 2007. Section 1886(b)(3)(C)(iv) of the Act provides that the update factor applicable to the hospitalspecific rates for SCHs is equal to the update factor provided under section 1886(b)(3)(B)(iv) of the Act, which, for SCHs in FY 2007, is the market basket rate-ofincrease. Section 1886(b)(3)(D) of the Act provides that the update factor applicable to the hospital-specific rates for MDHs also equals the update factor provided under section 1886(b)(3)(B)(iv) of the Act, which, for FY 2007, is the market basket rate-ofincrease. 3. General Formula for Calculation of Proposed Prospective Payment Rates for Hospitals Located in Puerto Rico Beginning On or After October 1, 2006 and Before October 1, 2007 Section 1886(d)(9)(E)(iv) of the Act provides that, effective for discharges occurring on or after October 1, 2004, hospitals located in Puerto Rico are paid based on a blend of 75 percent of the national prospective payment rate and 25 percent of the Puerto Rico-specific rate. a. Puerto Rico Rate The Puerto Rico prospective payment rate is determined as follows: Step 1—Select the appropriate average standardized amount considering the applicable wage index (see Table 1C). Step 2—Multiply the labor-related portion of the standardized amount by the appropriate Puerto Rico-specific wage index (see Table 4F of section VI. of the Addendum). Step 3—Add the amount from Step 2 and the nonlabor-related portion of the standardized amount. Step 4—Multiply the amount from Step 3 by the appropriate DRG relative weight. (see Table 5 of section IV. of the Addendum). Step 5—Multiply the result in Step 4 by 25 percent. wwhite on PROD1PC61 with PROPOSALS2 b. National Rate The national prospective payment rate is determined as follows: Step 1—Select the appropriate average standardized amount considering the applicable wage index (see Table 1C). Step 2—Multiply the labor-related portion of the standardized amount by the applicable wage index for the geographic area in which the hospital is located or the area to which the hospital is reclassified (see Table 4F of section VI. of this Addendum). Step 3—Add the amount from Step 2 and the nonlabor-related portion of the national average standardized amount. VerDate Aug<31>2005 17:10 Apr 24, 2006 Jkt 208001 Step 4—Multiply the amount from Step 3 by the appropriate DRG relative weight (see Table 5 of section VI. of the Addendum). Step 5—Multiply the result in Step 4 by 75 percent. The sum of the Puerto Rico rate and the national rate computed above equals the prospective payment for a given discharge for a hospital located in Puerto Rico. This rate may then be further adjusted if the hospital qualifies for either the IME or DSH adjustment. III. Proposed Changes to Payment Rates for Acute Care Hospital Inpatient CapitalRelated Costs for FY 2007 (If you choose to comment on issues in this section, please include the caption ‘‘Capital Payment Rate’’ at the beginning of your comment.) The PPS for acute care hospital inpatient capital-related costs was implemented for cost reporting periods beginning on or after October 1, 1991. Effective with that cost reporting period, hospitals were paid during a 10-year transition period (which extended through FY 2001) to change the payment methodology for Medicare acute care hospital inpatient capital-related costs from a reasonable cost-based methodology to a prospective methodology (based fully on the Federal rate). The basic methodology for determining Federal capital prospective rates is set forth in regulations at §§ 412.308 through 412.352. Below we discuss the factors that we are proposing to use to determine the capital Federal rate for FY 2007, which would be effective for discharges occurring on or after October 1, 2006. The 10-year transition period ended with hospital cost reporting periods beginning on or after October 1, 2001 (FY 2002). Therefore, for cost reporting periods beginning in FY 2002, all hospitals (except ‘‘new’’ hospitals under § 412.304(c)(2)) are paid based on 100 percent of the capital Federal rate. For FY 1992, we computed the standard Federal payment rate for capital-related costs under the IPPS by updating the FY 1989 Medicare inpatient capital cost per case by an actuarial estimate of the increase in Medicare inpatient capital costs per case. Each year after FY 1992, we update the capital standard Federal rate, as provided at § 412.308(c)(1), to account for capital input price increases and other factors. The regulations at § 412.308(c)(2) provide that the capital Federal rate is adjusted annually by a factor equal to the estimated proportion of outlier payments under the capital Federal rate to total capital payments under the capital Federal rate. In addition, § 412.308(c)(3) requires that the capital Federal rate be reduced by an adjustment factor equal to the estimated proportion of payments for (regular and special) exceptions under § 412.348. Section 412.308(c)(4)(ii) requires that the capital standard Federal rate be adjusted so that the effects of the annual DRG reclassification and the recalibration of DRG weights and changes in the geographic adjustment factor are budget neutral. For FYs 1992 through 1995, § 412.352 required that the capital Federal rate also be adjusted by a budget neutrality factor so that PO 00000 Frm 00159 Fmt 4701 Sfmt 4702 24153 aggregate payments for inpatient hospital capital costs were projected to equal 90 percent of the payments that would have been made for capital-related costs on a reasonable cost basis during the fiscal year. That provision expired in FY 1996. Section 412.308(b)(2) describes the 7.4 percent reduction to the capital rate that was made in FY 1994, and § 412.308(b)(3) describes the 0.28 percent reduction to the capital rate made in FY 1996 as a result of the revised policy of paying for transfers. In FY 1998, we implemented section 4402 of Pub. L. 105–33, which required that, for discharges occurring on or after October 1, 1997, and before October 1, 2002, the unadjusted capital standard Federal rate is reduced by 17.78 percent. As we discussed in the FY 2003 IPPS final rule (67 FR 50102) and implemented in § 412.308(b)(6), a small part of that reduction was restored effective October 1, 2002. To determine the appropriate budget neutrality adjustment factor and the regular exceptions payment adjustment during the 10-year transition period, we developed a dynamic model of Medicare inpatient capital-related costs; that is, a model that projected changes in Medicare inpatient capital-related costs over time. With the expiration of the budget neutrality provision, the capital cost model was only used to estimate the regular exceptions payment adjustment and other factors during the transition period. As we explained in the FY 2002 IPPS final rule (66 FR 39911), beginning in FY 2002, an adjustment for regular exception payments is no longer necessary because regular exception payments were only made for cost reporting periods beginning on or after October 1, 1991, and before October 1, 2001 (see § 412.348(b)). Because payments are no longer being made under the regular exception policy effective with cost reporting periods beginning in FY 2002, we no longer use the capital cost model. The capital cost model and its application during the transition period are described in Appendix B of the FY 2002 IPPS final rule (66 FR 40099). Section 412.374 provides for the use of a blended payment system for payments to Puerto Rico hospitals under the PPS for acute care hospital inpatient capital-related costs. Accordingly, under the capital PPS, we compute a separate payment rate specific to Puerto Rico hospitals using the same methodology used to compute the national Federal rate for capital-related costs. In accordance with section 1886(d)(9)(A) of the Act, under the PPS for acute care hospital operating costs, hospitals located in Puerto Rico are paid for operating costs under a special payment formula. Prior to FY 1998, hospitals in Puerto Rico were paid a blended operating rate that consisted of 75 percent of the applicable standardized amount specific to Puerto Rico hospitals and 25 percent of the applicable national average standardized amount. Similarly, prior to FY 1998, hospitals in Puerto Rico were paid a blended capital rate that consisted of 75 percent of the applicable capital Puerto Rico-specific rate and 25 percent of the applicable capital Federal rate. However, effective October 1, 1997, in accordance with section 4406 of E:\FR\FM\25APP2.SGM 25APP2 24154 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules wwhite on PROD1PC61 with PROPOSALS2 Pub. L. 105–33, operating payments to hospitals in Puerto Rico were revised to be based on a blend of 50 percent of the applicable standardized amount specific to Puerto Rico hospitals and 50 percent of the applicable national average standardized amount. In conjunction with this change to the operating blend percentage, effective with discharges occurring on or after October 1, 1997, we also revised the methodology for computing capital payments to hospitals in Puerto Rico to be based on a blend of 50 percent of the Puerto Rico capital rate and 50 percent of the capital Federal rate. As we discussed in the FY 2005 IPPS final rule (69 FR 49185), section 504 of Pub. L. 108–173 increased the national portion of the operating IPPS payments for Puerto Rico hospitals from 50 percent to 62.5 percent and decreased the Puerto Rico portion of the operating IPPS payments from 50 percent to 37.5 percent for discharges occurring on or after April 1, 2004 through September 30, 2004 (see the March 26, 2004 One-Time Notification (Change Request 3158)). In addition, section 504 of Pub. L. 108–173 provided that the national portion of operating IPPS payments for Puerto Rico hospitals is equal to 75 percent and the Puerto Rico portion of operating IPPS payments is equal to 25 percent for discharges occurring on or after October 1, 2004. Consistent with that change in operating IPPS payments to hospitals in Puerto Rico, for FY 2005 (as we discussed in the FY 2005 IPPS final rule), we revised the methodology for computing capital payments to hospitals located in Puerto Rico to be based on a blend of 25 percent of the Puerto Rico capital rate and 75 percent of the capital Federal rate for discharges occurring on or after October 1, 2004. A. Determination of Proposed Federal Hospital Inpatient Capital-Related Prospective Payment Rate Update In the FY 2006 IPPS final rule (70 FR 47503), we established a capital Federal rate of $420.65 for FY 2006. In the discussion that follows, we explain the factors that we are proposing to use to determine the FY 2007 capital Federal rate. In particular, we explain why the proposed FY 2007 capital Federal rate would increase approximately 0.9 percent compared to the FY 2006 capital Federal rate. However, we estimate aggregate capital payments would decrease by 0.4 percent during this same period. This decrease is due to a decrease in the estimated total number of Medicare fee-for-service discharges for FY 2007 as compared to the estimated total number of Medicare fee-forservice discharges in FY 2006. We are estimating a decrease in Medicare fee-forservice discharges in FY 2007 as compared to FY 2006, in part because we are projecting an increase in beneficiary Medicare managed care enrollment as a result of the implementation of several provisions of Pub. L. 108–173. Therefore, although we are projecting that capital PPS payments per discharge would increase slightly from FY 2006 to FY 2007, we project that aggregate capital PPS payments would decrease for the same period. Total payments to hospitals under the IPPS are relatively unaffected by changes in the VerDate Aug<31>2005 17:10 Apr 24, 2006 Jkt 208001 capital prospective payments. Since capital payments constitute about 10 percent of hospital payments, a 1-percent change in the capital Federal rate yields only about 0.1 percent change in actual payments to hospitals. As noted above, aggregate payments under the capital IPPS are estimated to decrease slightly in FY 2007 compared to FY 2006. 1. Projected Capital Standard Federal Rate Update a. Description of the Update Framework Under § 412.308(c)(1), the capital standard Federal rate is updated on the basis of an analytical framework that takes into account changes in a capital input price index (CIPI) and several other policy adjustment factors. Specifically, we have adjusted the projected CIPI rate-of-increase as appropriate each year for case-mix index-related changes, for intensity, and for errors in previous CIPI forecasts. The proposed update factor for FY 2007 under that framework is 0.8 percent based on the best data available at this time. The proposed update factor is based on a projected 0.8 percent increase in the CIPI, a 0.0 percent adjustment for intensity, a 0.0 percent adjustment for case-mix, a 0.0 percent adjustment for the FY 2005 DRG reclassification and recalibration, and a forecast error correction of 0.0 percent. As discussed below in section III.C. of this Addendum, we believe that the CIPI is the most appropriate input price index for capital costs to measure capital price changes in a given year. We also explain the basis for the FY 2007 CIPI projection in that same section of this Addendum. Below we describe the proposed policy adjustments that have been applied. The case-mix index is the measure of the average DRG weight for cases paid under the IPPS. Because the DRG weight determines the prospective payment for each case, any percentage increase in the case-mix index corresponds to an equal percentage increase in hospital payments. The case-mix index can change for any of several reasons: • The average resource use of Medicare patients changes (‘‘real’’ case-mix change); • Changes in hospital coding of patient records result in higher weight DRG assignments (‘‘coding effects’’); and • The annual DRG reclassification and recalibration changes may not be budget neutral (‘‘reclassification effect’’). We define real case-mix change as actual changes in the mix (and resource requirements) of Medicare patients as opposed to changes in coding behavior that result in assignment of cases to higher weighted DRGs but do not reflect higher resource requirements. The capital update framework includes the same case-mix index adjustment used in the former operating IPPS update framework (as discussed in the May 18, 2005 IPPS proposed rule for FY 2005 (69 FR 28816)). (We are no longer using an update framework in making a recommendation for updating the operating IPPS standardized amounts as discussed in section II, of Appendix B in the FY 2006 IPPS final rule (70 FR 47707).) For FY 2007, we are projecting a 1.0 percent total increase in the case-mix index. PO 00000 Frm 00160 Fmt 4701 Sfmt 4702 We estimate that the real case-mix increase would also equal 1.0 percent in FY 2007. The net adjustment for change in case-mix is the difference between the projected increase in case-mix and the projected total increase in case-mix. Therefore, the proposed net adjustment for case-mix change in FY 2007 is 0.0 percentage points. The capital update framework also contains an adjustment for the effects of DRG reclassification and recalibration. This adjustment is intended to remove the effect on total payments of prior year changes to the DRG classifications and relative weights, in order to retain budget neutrality for all casemix index-related changes other than those due to patient severity. Due to the lag time in the availability of data, there is a 2-year lag in data used to determine the adjustment for the effects of DRG reclassification and recalibration. For example, we are adjusting for the effects of the FY 2005 DRG reclassification and recalibration as part of our proposed update for FY 2007. We estimate that FY 2005 DRG reclassification and recalibration would result in a 0.0 percent change in the case-mix when compared with the case-mix index that would have resulted if we had not made the reclassification and recalibration changes to the DRGs. Therefore, we are proposing to make a 0.0 percent adjustment for DRG reclassification and recalibration in the update for FY 2007 to maintain budget neutrality. The capital update framework also contains an adjustment for forecast error. The input price index forecast is based on historical trends and relationships ascertainable at the time the update factor is established for the upcoming year. In any given year, there may be unanticipated price fluctuations that may result in differences between the actual increase in prices and the forecast used in calculating the update factors. In setting a prospective payment rate under the framework, we make an adjustment for forecast error only if our estimate of the change in the capital input price index for any year is off by 0.25 percentage points or more. There is a 2-year lag between the forecast and the measurement of the forecast error. A forecast error of ¥0.1 percentage point was calculated for the FY 2005 update. That is, current historical data indicate that the forecasted FY 2005 CIPI used in calculating the FY 2005 update factor (0.7 percent) slightly overstated the actual realized price increases (0.6 percent) by 0.1 percentage point. This slight overprediction was mostly due to an underestimation in the deceleration of the average yield of the long-term municipal bonds. The forecast correctly anticipated the deceleration of the municipal bond rates; however, it underestimated the magnitude of the deceleration resulting from the relatively looser Federal monetary policy (that is, delaying interest rate hikes). However, because this estimation of the change in the CIPI is less than 0.25 percentage points, it is not reflected in the update recommended under this framework. Therefore, we are proposing to make a 0.0 percent adjustment for forecast error in the update for FY 2007. E:\FR\FM\25APP2.SGM 25APP2 wwhite on PROD1PC61 with PROPOSALS2 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules Under the capital IPPS update framework, we also make an adjustment for changes in intensity. We calculate this adjustment using the same methodology and data that were used in the framework used in the past under the operating IPPS. The intensity factor for the operating update framework reflects how hospital services are utilized to produce the final product, that is, the discharge. This component accounts for changes in the use of quality-enhancing services, for changes in within-DRG severity, and for expected modification of practice patterns to remove noncost-effective services. We calculate case-mix constant intensity as the change in total charges per admission, adjusted for price level changes (the CPI for hospital and related services) and changes in real case-mix. The use of total charges in the calculation of the intensity factor makes it a total intensity factor; that is, charges for capital services are already built into the calculation of the factor. Therefore, we have incorporated the intensity adjustment from the operating update framework into the capital update framework. Without reliable estimates of the proportions of the overall annual intensity increases that are due, respectively, to ineffective practice patterns and to the combination of quality-enhancing new technologies and within-DRG complexity, we assume, as in the operating update framework, that one-half of the annual increase is due to each of these factors. The capital update framework thus provides an add-on to the input price index rate of increase of one-half of the estimated annual increase in intensity, to allow for within-DRG severity increases and the adoption of quality-enhancing technology. We have developed a Medicare-specific intensity measure based on a 5-year average. Past studies of case-mix change by the RAND Corporation (‘‘Has DRG Creep Crept Up? Decomposing the Case Mix Index Change Between 1987 and 1988’’ by G. M. Carter, J. P. Newhouse, and D. A. Relles, R–4098– HCFA/ProPAC (1991)) suggest that real casemix change was not dependent on total change, but was usually a fairly steady 1.0 to 1.4 percent per year. We use 1.4 percent as the upper bound because the RAND study did not take into account that hospitals may have induced doctors to document medical records more completely in order to improve payment. We calculate case-mix constant intensity as the change in total charges per admission, adjusted for price level changes (the CPI for hospital and related services), and changes in real case-mix. As we noted above, in accordance with § 412.308(c)(1)(ii), we began updating the capital standard Federal rate in FY 1996 using an update framework that takes into account, among other things, allowable changes in the intensity of hospital services. For FYs 1996 through 2001, we found that case-mix constant intensity was declining and we established a 0.0 percent adjustment for intensity in each of those years. For FYs 2002 and 2003, we found that case-mix constant intensity was increasing and we established a 0.3 percent adjustment and 1.0 percent adjustment for intensity, respectively. For FYs 2004 and 2005, we found that the charge data appeared to be VerDate Aug<31>2005 17:10 Apr 24, 2006 Jkt 208001 skewed (as discussed in greater detail below) and we established a 0.0 percent adjustment in each of those years. Furthermore, we stated that we would continue to apply a 0.0 percent adjustment for intensity until any increase in charges can be tied to intensity rather than attempts to maximize outlier payments. As noted above, our intensity measure is based on a 5-year average, and therefore, the proposed intensity adjustment for FY 2007 is based on data from the 5-year period FY 2001 through FY 2005. We found a dramatic increase in hospital charges for each of those 5 years without a corresponding increase in the hospital case-mix index. These findings are similar to the considerable increase in hospitals’ charges, which we found when we were determining the intensity factor in the FY 2004, FY 2005 and FY 2006 update recommendations as discussed in the FY 2004 IPPS final rule (68 FR 45482), the FY 2005 IPPS final rule (69 FR 49285) and the FY 2006 IPPS final rule (70 FR 47500), respectively. If hospitals were treating new or different types of cases, which would result in an appropriate increase in charges per discharge, then we would expect hospitals’ case-mix to increase proportionally. As we discussed in the FY 2006 IPPS final rule (70 FR 47500), because our intensity calculation relies heavily upon charge data and we believe that these charge data may be inappropriately skewed, we established a 0.0 percent adjustment for intensity for FY 2006. On June 9, 2003, we published revisions to our outlier policy for determining the additional payment for extraordinarily highcost cases (68 FR 34494 through 34515). These revised policies were effective on August 8, 2003, and October 1, 2003. While it does appear that a response to these policy changes is beginning to occur, that is, the change in charges for FYs 2004 and 2005 are somewhat less than the previous 4 years, they still show a significant annual increase in charges without a corresponding increase in hospital case-mix. The increase in charges in FY 2004, for example, is approximately 12 percent, which, while less than the increase in the previous 3 years, is still much higher than increases in years prior to FY 2001. In addition, this approximate 12-percent increase in charges for FY 2004 significantly exceeds the case-mix increase for the same period. Based on the approximate 12-percent increase in charges for FY 2004, we believe residual effects of hospitals’ charge practices prior to the implementation of the outlier policy revisions established in the June 9, 2003 final rule continue to appear in the data because hospitals may not have had enough time to adopt changes in their behavior in response to the new outlier policy. Thus, we believe that the FY 2004 and FY 2005 charge data may still be skewed. Because the intensity adjustment is based on a 5-year average, and although the new outlier policy was generally effective in FY 2004, we believe it still will be several years before all the effects of hospitals attempting to maximize outlier payments are removed from the intensity calculation. Therefore, we are proposing a 0.0 percent adjustment for intensity for FY 2007. In the past (FYs 1996 through 2001) when we found intensity to be PO 00000 Frm 00161 Fmt 4701 Sfmt 4702 24155 declining, we believed a zero (rather than negative) intensity adjustment was appropriate. Similarly, we believe that it is appropriate to apply a zero intensity adjustment for FY 2007 until any increase in charges can be tied to intensity rather than to attempts to maximize outlier payments. Above, we described the basis of the components used to develop the proposed 0.8 percent capital update factor for FY 2007 as shown in the table below. CMS PROPOSED FY 2007 UPDATE FACTOR TO THE CAPITAL FEDERAL RATE Capital Input Price Index .............. Intensity ........................................ Case-Mix Adjustment Factors: Real Across DRG Change ........ Projected Case-Mix Change ..... 0.8 0.0 1.0 ¥1.0 Subtotal ................................. Effect of FY 2005 Reclassification and Recalibration ...................... Forecast Error Correction ............. 0.0 Total Proposed Update ......... 0.8 0.0 0.0 b. Comparison of CMS and MedPAC Update Recommendation In the past, MedPAC has included update recommendations for capital PPS in a Report to Congress. In its March 2006 Report to Congress, MedPAC did not make an update recommendation for capital PPS payments for FY 2007. However, in that same report, MedPAC made an update recommendation for hospital inpatient and outpatient services (page 46). MedPAC reviews inpatient and outpatient services together because they are so closely interrelated. For FY 2007, MedPAC recommended an increase in the payment rate for the operating IPPS by the projected increase in the hospital market basket index, less half of MedPAC’s expectation for productivity growth (or 0.45 percent, based on its assessment of beneficiaries’ access to care and changes in hospital capacity, volume of services, access to capital, quality of care, and the relationship of Medicare payments and hospitals’ costs. In addition, MedPAC recommended combining the annual rate update with an incentive payment policy for quality. (MedPAC’s Report to the Congress: Medicare Payment Policy, March 2006, Section 2A.) 2. Proposed Outlier Payment Adjustment Factor Section 412.312(c) establishes a unified outlier methodology for inpatient operating and inpatient capital-related costs. A single set of thresholds is used to identify outlier cases for both inpatient operating and inpatient capital-related payments. Section 412.308(c)(2) provides that the standard Federal rate for inpatient capital-related costs be reduced by an adjustment factor equal to the estimated proportion of capital-related outlier payments to total inpatient capitalrelated PPS payments. The outlier thresholds are set so that operating outlier payments are projected to be 5.1 percent of total operating DRG payments. E:\FR\FM\25APP2.SGM 25APP2 24156 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules wwhite on PROD1PC61 with PROPOSALS2 In the FY 2006 IPPS final rule (70 FR 47501), we estimated that outlier payments for capital would equal 4.85 percent of inpatient capital-related payments based on the capital Federal rate in FY 2006. Based on the thresholds as set forth in section II.A.4.c. of this Addendum, we estimate that outlier payments for capital-related costs would equal 4.87 percent for inpatient capitalrelated payments based on the Federal rate in FY 2007. Therefore, we are proposing to apply an outlier adjustment factor of 0.9513 to the capital Federal rate. Thus, the percentage of capital outlier payments to total capital standard payments for FY 2007 would be slightly higher than the percentages for FY 2006. The outlier reduction factors are not built permanently into the capital rates; that is, they are not applied cumulatively in determining the capital Federal rate. The proposed FY 2007 outlier adjustment of 0.9513 is a ¥0.02 percent change from the FY 2006 outlier adjustment of 0.9515. Therefore, the net change in the outlier adjustment to the proposed capital Federal rate for FY 2007 is 0.9998 (0.9513/0.9915). Thus, the proposed outlier adjustment decreases the proposed FY 2007 capital Federal rate by 0.02 percent compared with the FY 2006 outlier adjustment. 3. Proposed Budget Neutrality Adjustment Factor for Changes in DRG Classifications and Weights and the GAF Section 412.308(c)(4)(ii) requires that the capital Federal rate be adjusted so that aggregate payments for the fiscal year based on the capital Federal rate after any changes resulting from the annual DRG reclassification and recalibration and changes in the GAF are projected to equal aggregate VerDate Aug<31>2005 17:10 Apr 24, 2006 Jkt 208001 payments that would have been made on the basis of the capital Federal rate without such changes. Because we implemented a separate GAF for Puerto Rico, we apply separate budget neutrality adjustments for the national GAF and the Puerto Rico GAF. We apply the same budget neutrality factor for DRG reclassifications and recalibration nationally and for Puerto Rico. Separate adjustments were unnecessary for FY 1998 and earlier because the GAF for Puerto Rico was implemented in FY 1998. In the past, we used the actuarial capital cost model (described in Appendix B of the FY 2002 IPPS final rule (66 FR 40099)) to estimate the aggregate payments that would have been made on the basis of the capital Federal rate with and without changes in the DRG classifications and weights and in the GAF to compute the adjustment required to maintain budget neutrality for changes in DRG weights and in the GAF. During the transition period, the capital cost model was also used to estimate the regular exception payment adjustment factor. As we explain in section III.A.4. of this Addendum, beginning in FY 2002, an adjustment for regular exception payments is no longer necessary. Therefore, we are no longer using the capital cost model. Instead, we are using historical data based on hospitals’ actual cost experiences to determine the exceptions payment adjustment factor for special exceptions payments. To determine the proposed factors for FY 2007, we compared (separately for the national capital rate and the Puerto Rico capital rate) estimated aggregate capital Federal rate payments based on the FY 2006 DRG relative weights and the FY 2006 GAF to estimated aggregate capital Federal rate payments based on the proposed FY 2007 PO 00000 Frm 00162 Fmt 4701 Sfmt 4702 relative weights and the proposed FY 2007 GAF. As we established in the FY 2006 IPPS final rule (70 FR 47503), the budget neutrality factors were 0.9920 for the national capital rate and 0.9959 for the Puerto Rico capital rate. In making the comparison, we set the exceptions reduction factor to 1.00. To achieve budget neutrality for the changes in the national GAF, based on calculations using updated data, we are proposing to apply an incremental budget neutrality adjustment of 1.0003 for FY 2007 to the previous cumulative FY 2006 adjustments of 0.9920, yielding an adjustment of 0.9922, through FY 2007 (calculations done on unrounded numbers). For the Puerto Rico GAF, we are proposing to apply an incremental budget neutrality adjustment of 1.0017 for FY 2007 to the previous cumulative FY 2006 adjustment of 0.9959, yielding a cumulative adjustment of 0.9986 through FY 2007. We then compared estimated aggregate capital Federal rate payments based on the FY 2006 DRG relative weights and the FY 2006 GAF to estimated aggregate capital Federal rate payments based on the proposed FY 2007 DRG relative weights and the proposed FY 2007 GAF. The proposed incremental adjustment for DRG classifications and changes in relative weights is 1.0009 both nationally and for Puerto Rico. The proposed cumulative adjustments for DRG classifications and changes in relative weights and for changes in the GAF through FY 2007 are 0.9932 nationally and 0.9986 for Puerto Rico. The following table summarizes the adjustment factors for each fiscal year: BILLING CODE 4120–01–P E:\FR\FM\25APP2.SGM 25APP2 wwhite on PROD1PC61 with PROPOSALS2 BILLING CODE 4120–01–C The methodology used to determine the proposed recalibration and geographic (DRG/ GAF) budget neutrality adjustment factor for FY 2007 is similar to that used in establishing budget neutrality adjustments under the PPS for operating costs. One difference is that, under the operating PPS, the budget neutrality adjustments for the effect of geographic reclassifications are determined separately from the effects of other changes in the hospital wage index and VerDate Aug<31>2005 17:10 Apr 24, 2006 Jkt 208001 the DRG relative weights. Under the capital PPS, there is a single DRG/GAF budget neutrality adjustment factor (the national capital rate and the Puerto Rico capital rate are determined separately) for changes in the GAF (including geographic reclassification) and the DRG relative weights. In addition, there is no adjustment for the effects that geographic reclassification has on the other payment parameters, such as the payments for serving low-income patients, indirect PO 00000 Frm 00163 Fmt 4701 Sfmt 4702 24157 medical education payments, or the large urban add-on payments. In the FY 2006 IPPS final rule (70 FR 47503), we calculated a GAF/DRG budget neutrality factor of 1.0008 for FY 2006. For FY 2007, we are proposing to establish a GAF/DRG budget neutrality factor of 1.0012. The GAF/DRG budget neutrality factors are built permanently into the capital rates; that is, they are applied cumulatively in determining the capital Federal rate. This follows from the requirement that estimated E:\FR\FM\25APP2.SGM 25APP2 EP25AP06.021</GPH> Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules 24158 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules wwhite on PROD1PC61 with PROPOSALS2 aggregate payments each year be no more or less than they would have been in the absence of the annual DRG reclassification and recalibration and changes in the GAF. The incremental change in the proposed adjustment from FY 2006 to FY 2007 is 1.0012. The cumulative change in the proposed capital Federal rate due to this proposed adjustment is 0.9932 (the product of the incremental factors for FYs 1993 though 2006 and the proposed incremental factor of 1.0012 for FY 2007). (We note that averages of the incremental factors that were in effect during FYs 2005 and 2006, respectively, were used in the calculation of the proposed cumulative adjustment of 1.0012 for FY 2007.) This proposed factor accounts for DRG reclassifications and recalibration and for changes in the GAF. It also incorporates the effects on the proposed GAF of FY 2007 geographic reclassification decisions made by the MGCRB compared to FY 2006 decisions. However, it does not account for changes in payments due to changes in the DSH and IME adjustment factors or in the large urban add-on. 4. Proposed Exceptions Payment Adjustment Factor Section 412.308(c)(3) requires that the capital standard Federal rate be reduced by an adjustment factor equal to the estimated proportion of additional payments for both regular exceptions and special exceptions under § 412.348 relative to total capital PPS payments. In estimating the proportion of regular exception payments to total capital PPS payments during the transition period, we used the actuarial capital cost model originally developed for determining budget neutrality (described in Appendix B of the FY 2002 IPPS final rule (66 FR 40099)) to determine the exceptions payment adjustment factor, which was applied to both the Federal and hospital-specific capital rates. An adjustment for regular exception payments is no longer necessary in determining the proposed FY 2007 capital Federal rate because, in accordance with § 412.348(b), regular exception payments were only made for cost reporting periods beginning on or after October 1, 1991 and before October 1, 2001. Accordingly, as we explained in the FY 2002 IPPS final rule (66 FR 39949), in FY 2002 and subsequent fiscal years, no payments will be made under the regular exceptions provision. However, in accordance with § 412.308(c), we still need to compute a budget neutrality adjustment for special exception payments under § 412.348(g). We describe our methodology for determining the exceptions adjustment used in calculating the proposed FY 2007 capital Federal rate below. Under the special exceptions provision specified at § 412.348(g)(1), eligible hospitals include SCHs, urban hospitals with at least 100 beds that have a disproportionate share percentage of at least 20.2 percent or qualify for DSH payments under § 412.106(c)(2), and hospitals with a combined Medicare and Medicaid inpatient utilization of at least 70 percent. An eligible hospital may receive special exceptions payments if it meets: (1) A project need requirement as described at § 412.348(g)(2), which, in the case of certain urban hospitals, includes an excess capacity test as described at § 412.348(g)(4); (2) an age of assets test as described at § 412.348(g)(3); and (3) a project size requirement as described at § 412.348(g)(5). Based on information compiled from our fiscal intermediaries, six hospitals have qualified for special exceptions payments under § 412.348(g). Since we have cost reports ending in FY 2005 for all of these hospitals, we calculated the adjustment based on actual cost experience. Using data from cost reports ending in FY 2005 from the December 2005 update of the HCRIS data, we divided the capital special exceptions payment amounts for the six hospitals that qualified for special exceptions by the total capital PPS payment amounts (including special exception payments) for all hospitals. Based on the data from cost reports ending in FY 2005, this ratio is rounded to 0.0003. Because we have not received all cost reports ending in FY 2005, we also divided the FY 2005 special exceptions payments by the total capital PPS payment amounts for all hospitals with cost reports ending in FY 2004. This ratio also rounds to 0.0003. Because special exceptions are budget neutral, we are proposing to offset the capital Federal rate by 0.03 percent for special exceptions payments for FY 2007. Therefore, the proposed exceptions adjustment factor is equal to 0.9997 (1—0.0003) to account for special exceptions payments in FY 2007. In the FY 2006 IPPS final rule (70 FR 47503), we estimated that total (special) exceptions payments for FY 2006 would equal 0.03 percent of aggregate payments based on the capital Federal rate. Therefore, we applied an exceptions adjustment factor of 0.9997 (1—0.0003) in determining the FY 2006 capital Federal rate. As we stated above, we estimate that exceptions payments in FY 2007 will equal 0.03 percent of aggregate payments based on the proposed FY 2007 capital Federal rate. Therefore, we are proposing to apply an exceptions payment adjustment factor of 0.9997 to the capital Federal rate for FY 2007. The proposed exceptions adjustment factor for FY 2007 is the same as the factor used in determining the FY 2006 capital Federal rate in the FY 2006 IPPS final rule (70 FR 47503). The exceptions reduction factors are not built permanently into the capital rates; that is, the factors are not applied cumulatively in determining the capital Federal rate. Therefore, the net change in the exceptions adjustment factor used in determining the proposed FY 2007 capital Federal rate is 1.0000 (0.9997/0.9997). 5. Proposed Capital Standard Federal Rate for FY 2007 In the FY 2006 IPPS final rule (70 FR 47503), we established a capital Federal rate of $420.65 for FY 2006. In this proposed rule, we are proposing to establish a capital Federal rate of $424.42 for FY 2007. The proposed capital Federal rate for FY 2007 was calculated as follows: • The proposed FY 2007 update factor is 1.0080; that is, the proposed update is 0.8 percent. • The proposed FY 2007 budget neutrality adjustment factor that is applied to the capital standard Federal payment rate for proposed changes in the DRG relative weights and in the GAF is 1.0012. • The proposed FY 2007 outlier adjustment factor is 0.9513. • The proposed FY 2007 (special) exceptions payment adjustment factor is 0.9997. Because the proposed capital Federal rate has already been adjusted for differences in case-mix, wages, cost-of-living, indirect medical education costs, and payments to hospitals serving a disproportionate share of low-income patients, we are not proposing to make additional adjustments in the capital standard Federal rate for these factors, other than the budget neutrality factor for changes in the DRG relative weights and the GAF. We are providing a chart that shows how each of the proposed factors and adjustments for FY 2007 affected the computation of the proposed FY 2007 capital Federal rate in comparison to the average FY 2006 capital Federal rate. The proposed FY 2007 update factor has the effect of increasing the proposed capital Federal rate by 0.80 percent compared to the average FY 2006 Federal rate. The proposed GAF/DRG budget neutrality factor has the effect of increasing the proposed capital Federal rate by 0.12 percent. The proposed FY 2007 outlier adjustment factor has the effect of decreasing the proposed capital Federal rate by 0.02 percent compared to the average FY 2006 capital Federal rate. The proposed FY 2007 exceptions payment adjustment factor remains unchanged from the FY 2006 exceptions payment adjustment factor, and therefore, has a 0.0 percent net effect on the proposed FY 2007 capital Federal rate. The combined effect of all the proposed changes is to increase the proposed capital Federal rate by 0.90 percent compared to the average FY 2006 capital Federal rate. COMPARISON OF FACTORS AND ADJUSTMENTS [FY 2006 Capital Federal Rate and Proposed FY 2007 Capital Federal Rate] FY 2006 Update Factor 1 ................................................................................................................ GAF/DRG Adjustment Factor 1 ........................................................................................ VerDate Aug<31>2005 17:10 Apr 24, 2006 Jkt 208001 PO 00000 Frm 00164 Fmt 4701 Sfmt 4702 1.0080 1.0008 E:\FR\FM\25APP2.SGM Proposed FY 2007 1.0080 1.0012 25APP2 Change 1.0080 1.0012 Percent change 0.80 0.12 24159 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules COMPARISON OF FACTORS AND ADJUSTMENTS—Continued [FY 2006 Capital Federal Rate and Proposed FY 2007 Capital Federal Rate] FY 2006 Outlier Adjustment Factor 2 .............................................................................................. Exceptions Adjustment Factor 2 ....................................................................................... Capital Federal Rate ........................................................................................................ Outlier Adjustment Factor 2 .............................................................................................. 0.9515 0.9997 $420.65 0.9515 Proposed FY 2007 0.9513 0.9997 $424.42 0.9513 Change 0.9998 0.0000 1.0090 0.9998 Percent change ¥0.02 0.00 0.90 ¥0.02 wwhite on PROD1PC61 with PROPOSALS2 1 The proposed update factor and the GAF/DRG budget neutrality factors are built permanently into the capital rates. Thus, for example, the incremental change from FY 2006 to FY 2007 resulting from the application of the proposed 1.0012 GAF/DRG budget neutrality factor for FY 2007 is 1.0012. 2 The proposed outlier reduction factor and the proposed exceptions adjustment factor are not built permanently into the capital rates; that is, these factors are not applied cumulatively in determining the capital rates. Thus, for example, the net change resulting from the application of the proposed FY 2007 outlier adjustment factor would be 0.9513/0.9515, or 0.9998. 6. Proposed Special Capital Rate for Puerto Rico Hospitals Section 412.374 provides for the use of a blended payment system for payments to Puerto Rico hospitals under the PPS for acute care hospital inpatient capital-related costs. Accordingly, under the capital PPS, we compute a separate payment rate specific to Puerto Rico hospitals using the same methodology used to compute the national Federal rate for capital-related costs. Under the broad authority of section 1886(g) of the Act, as discussed in section VI. of the preamble of this proposed rule, beginning with discharges occurring on or after October 1, 2004, capital payments to hospitals in Puerto Rico are based on a blend of 25 percent of the Puerto Rico capital rate and 75 percent of the capital Federal rate. The Puerto Rico capital rate is derived from the costs of Puerto Rico hospitals only, while the capital Federal rate is derived from the costs of all acute care hospitals participating in the IPPS (including Puerto Rico). To adjust hospitals’ capital payments for geographic variations in capital costs, we apply a GAF to both portions of the blended capital rate. The GAF is calculated using the operating IPPS wage index and varies, depending on the labor market area or rural area in which the hospital is located. We use the Puerto Rico wage index to determine the GAF for the Puerto Rico part of the capitalblended rate and the national wage index to determine the GAF for the national part of the blended capital rate. Because we implemented a separate GAF for Puerto Rico in FY 1998, we also apply separate budget neutrality adjustments for the national GAF and for the Puerto Rico GAF. However, we apply the same budget neutrality factor for DRG reclassifications and recalibration nationally and for Puerto Rico. As we stated above in section III.A.4. of this Addendum, for Puerto Rico, the proposed GAF budget neutrality factor is 1.0017, while the proposed DRG adjustment is 1.0009, for a combined proposed cumulative adjustment of 0.9986. In computing the payment for a particular Puerto Rico hospital, the Puerto Rico portion of the capital rate (25 percent) is multiplied by the Puerto Rico-specific GAF for the labor market area in which the hospital is located, and the national portion of the capital rate (75 percent) is multiplied by the national GAF for the labor market area in which the VerDate Aug<31>2005 17:10 Apr 24, 2006 Jkt 208001 hospital is located (which is computed from national data for all hospitals in the United States and Puerto Rico). In FY 1998, we implemented a 17.78 percent reduction to the Puerto Rico capital rate as a result of Pub. L. 105–33. In FY 2003, a small part of that reduction was restored. For FY 2006, before application of the GAF, the special capital rate for Puerto Rico hospitals was $201.93 for discharges occurring on or after October 1, 2005 through September 30, 2006. With the changes we are proposing to make to the factors used to determine the capital rate, the proposed FY 2007 special capital rate for Puerto Rico is $202.98. B. Calculation of the Proposed Inpatient Capital-Related Prospective Payments for FY 2007 Because the 10-year capital PPS transition period ended in FY 2001, all hospitals (except ‘‘new’’ hospitals under § 412.324(b) and under § 412.304(c)(2)) are paid based on 100 percent of the capital Federal rate in FY 2006. The applicable capital Federal rate was determined by making adjustments as follows: • For outliers, by dividing the capital standard Federal rate by the outlier reduction factor for that fiscal year; and • For the payment adjustments applicable to the hospital, by multiplying the hospital’s GAF, disproportionate share adjustment factor, and IME adjustment factor, when appropriate. For purposes of calculating payments for each discharge during FY 2007, the capital standard Federal rate is adjusted as follows: (Standard Federal Rate) × (DRG weight) × (GAF) × (Large Urban Add-on, if applicable) × (COLA for hospitals located in Alaska and Hawaii) × (1 + Disproportionate Share Adjustment Factor + IME Adjustment Factor, if applicable). The result is the adjusted capital Federal rate. Hospitals also may receive outlier payments for those cases that qualify under the thresholds established for each fiscal year. Section 412.312(c) provides for a single set of thresholds to identify outlier cases for both inpatient operating and inpatient capital-related payments. The proposed outlier thresholds for FY 2007 are in section II.A.4.c. of this Addendum. For FY 2007, a case qualifies as a cost outlier if the cost for the case plus the IME and DSH payments is PO 00000 Frm 00165 Fmt 4701 Sfmt 4702 greater than the prospective payment rate for the DRG plus $25,530. An eligible hospital may also qualify for a special exceptions payment under § 412.348(g) for up through the 10th year beyond the end of the capital transition period if it meets: (1) A project need requirement described at § 412.348(g)(2), which in the case of certain urban hospitals includes an excess capacity test as described at § 412.348(g)(4); and (2) a project size requirement as described at § 412.348(g)(5). Eligible hospitals include SCHs, urban hospitals with at least 100 beds that have a DSH patient percentage of at least 20.2 percent or qualify for DSH payments under § 412.106(c)(2), and hospitals that have a combined Medicare and Medicaid inpatient utilization of at least 70 percent. Under § 412.348(g)(8), the amount of a special exceptions payment is determined by comparing the cumulative payments made to the hospital under the capital PPS to the cumulative minimum payment level. This amount is offset by: (1) Any amount by which a hospital’s cumulative capital payments exceed its cumulative minimum payment levels applicable under the regular exceptions process for cost reporting periods beginning during which the hospital has been subject to the capital PPS; and (2) any amount by which a hospital’s current year operating and capital payments (excluding 75 percent of operating DSH payments) exceed its operating and capital costs. Under § 412.348(g)(6), the minimum payment level is 70 percent for all eligible hospitals. During the transition period, new hospitals (as defined under § 412.300) were exempt from the capital PPS for their first 2 years of operation and were paid 85 percent of their reasonable costs during that period. Effective with the third year of operation through the remainder of the transition period, under § 412.324(b), we paid the hospitals under the appropriate transition methodology (if the hold-harmless methodology were applicable, the hold-harmless payment for assets in use during the base period would extend for 8 years, even if the hold-harmless payments extend beyond the normal transition period). Under § 412.304(c)(2), for cost reporting periods beginning on or after October 1, 2002, we pay a new hospital 85 percent of its reasonable costs during the first 2 years of operation unless it elects to receive payment based on 100 percent of the capital Federal rate. Effective with the third year of E:\FR\FM\25APP2.SGM 25APP2 24160 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules operation, we pay the hospital based on 100 percent of the capital Federal rate (that is, the same methodology used to pay all other hospitals subject to the capital PPS). C. Capital Input Price Index 1. Background Like the operating input price index, the capital input price index (CIPI) is a fixedweight price index that measures the price changes associated with capital costs during a given year. The CIPI differs from the operating input price index in one important aspect—the CIPI reflects the vintage nature of capital, which is the acquisition and use of capital over time. Capital expenses in any given year are determined by the stock of capital in that year (that is, capital that remains on hand from all current and prior capital acquisitions). An index measuring capital price changes needs to reflect this vintage nature of capital. Therefore, the CIPI was developed to capture the vintage nature of capital by using a weighted-average of past capital purchase prices up to and including the current year. We periodically update the base year for the operating and capital input prices to reflect the changing composition of inputs for operating and capital expenses. The CIPI was last rebased to FY 2002 in the FY 2006 IPPS final rule (70 FR 47387). 2. Forecast of the CIPI for FY 2007 Based on the latest forecast by Global Insight, Inc. (first quarter of 2006), we are forecasting the CIPI to increase 0.8 percent in FY 2007. This reflects a projected 1.4 percent increase in vintage-weighted depreciation prices (building and fixed equipment, and movable equipment) and a 3.0 percent increase in other capital expense prices in FY 2007, partially offset by a 2.3 percent decline in vintage-weighted interest expenses in FY 2007. The weighted average of these three factors produces the 0.8 percent increase for the CIPI as a whole in FY 2007. wwhite on PROD1PC61 with PROPOSALS2 IV. Payment Rates for Excluded Hospitals and Hospital Units: Proposed Rate-ofIncrease Percentages (If you choose to comment on issues in this section, please include the caption ‘‘Excluded Hospitals Rate of Increase’’ at the beginning of your comment.) A. Payments to Existing Excluded Hospitals and Units As discussed in section VI. of the preamble of this proposed rule, the inpatient operating costs of children’s hospitals and cancer hospitals that are excluded from the IPPS are paid on the basis of reasonable cost subject to the rate-of-increase ceiling established under the authority of sections 1886(b)(3)(A)(i) and (ii) of the Act and § 413.40 of the regulations. The ceiling is based on a target amount per discharge under TEFRA. In addition, in accordance with § 403.752(a) of the regulations, RNHCIs also are paid under § 413.40 which uses section 1886(b)(3)(B)(ii) of the Act to update the percentage increase in the rate of increase limits. The most recent proposed projected forecast of the market basket percentage increase for FY 2007 for children’s hospitals, cancer hospitals, and RNHCIs using the IPPS VerDate Aug<31>2005 17:10 Apr 24, 2006 Jkt 208001 market basket (70 FR 47396 through 47405) is 3.4 percent. LTCHs, rehabilitation hospitals and units, and psychiatric hospitals and units, historically, were excluded from the IPPS and subject to the rate-of-increase limits under § 413.40, as well. However, prospective payment systems have been developed for each of the three types of hospitals, and each kind of hospital is currently paid under its own PPS, either at 100 percent of the Federal rate or according to a transition period methodology, if applicable. (For more detailed discussion of these payment methodologies, see 69 FR 49190; 69 FR 66922; 68 FR 45674; and 67 FR 55954.) For cost reporting periods beginning on or after October 1, 2002, to the extent a LTCH or a psychiatric hospital or unit has all or a portion of its payment determined under reasonable cost principles, the target amounts for the reasonable cost-based portion of the blended payment are determined in accordance with sections 1886(b)(3)(A)(i) and 1886(b)(3)(B)(ii) of the Act and the regulations at § 413.40(c)(4)(ii). Section 413.40(c)(4)(ii) states, ‘‘Subject to the provisions of [§ 413.40], paragraph (c)(4)(iii) of this section, for subsequent cost reporting periods, the target amount equals the hospital’s target amount for the previous cost reporting period increased by the update factor for the subject cost reporting period, unless the provisions of [§ 413.40] paragraph (c)(5)(ii) of this section apply.’’ Thus, because § 413.40(c)(4)(ii) indicates that the provisions of that paragraph are subject to the provisions of § 413.40(c)(4)(iii), which are applicable only for cost reporting periods beginning on or after October 1, 1997 through September 30, 2002, the target amount for FY 2003 is determined by updating the target amount for FY 2002 by the applicable update factor. For example, if a provider was paid the cap amount for FY 2002 (§ 413.40(c)(4)(iii)), the target amount for FY 2003 would be the amount paid in FY 2002, updated to FY 2003 (that is, the target amount from the previous year increased by the applicable update factor). Effective for cost reporting periods beginning on or after October 1, 2002, IRFs are paid 100 percent of the adjusted Federal prospective payment rate under the IRP PPS. Effective for cost reporting periods beginning on or after October 1, 2002, LTCHs also are no longer paid on a reasonable cost basis, but are paid under a LTCH DRG-based PPS. In implementing the LTCH PPS, an existing LTCH (that is, not defined as new under § 412.23(e)(4)) could have elected to be paid based on 100 percent of the standard Federal prospective payment rate during the transition period. However, we also established a 5-year transition period from reasonable cost-based payments (subject to the TEFRA limit) to fully Federal prospective payment amounts during which an existing LTCH could receive a PPS-blended payment consisting of two payment components—one based on reasonable cost under the TEFRA payment system, and the other based on the standard Federal prospective payment rate. Effective for cost reporting periods that will begin on or after October 1, 2006, the PO 00000 Frm 00166 Fmt 4701 Sfmt 4702 LTCHs that receive payment based on a blended payment amount will no longer receive a portion of their payment that is based, in part, on reasonable cost subject to the rate-of-ceiling under § 413.40. This is because, in accordance with § 412.533, LTCHs are paid 100 percent of the adjusted Federal prospective payment amount and zero percent of the amount calculated under reasonable cost principles for cost reporting periods beginning on or after October 1, 2006. As part of the PPS for existing IPFs, we have established a 3-year transition period during which existing IPFs will be paid based on a blend of reasonable cost-based payment (subject to the TEFRA limit) and the prospective per diem payment rate. IPFs that are paid under a blended methodology will have the reasonable cost-based portion of their payment subject to a hospital target amount. The most recent proposed projected forecast of the market basket percentage increase for FY 2007 for the reasonable costbased portion of an IPF’s payment using the excluded hospital market basket (70 FR 47396 through 47405) is 3.6 percent. For cost reporting periods beginning on or after January 1, 2008, IPFs will be paid 100 percent of the Federal prospective per diem amount. The proposed market basket percentage increases for FY 2007 are made by CMS’ Office of the Actuary and reflect the average change in the price of goods and services purchased by hospitals to furnish inpatient hospital care. As discussed in section IV. of the preamble in the FY 2006 IPPS final rule, we use the IPPS market basket for children’s hospitals, cancer hospitals, and RNHCIs, and the excluded hospital market basket for LTCHs, and IPFs for the reasonable cost portion of its payment to the extent a portion of its PPS payment is based on reasonable costs. We are not proposing any changes to our method of calculating the hospital market basket for IPPS or for excluded hospitals. As we indicated above, the proposed IPPS market basket is 3.4 percent and the proposed excluded hospital market basket is 3.6 percent. B. New Excluded Hospitals and Units Section 1886(b)(7) of the Act established a payment methodology for new (cost reporting periods beginning on or after October 1, 1997) rehabilitation hospitals and units, psychiatric hospitals and units, and LTCHs. For the first two 12-month cost reporting periods, payment was based on the lower of the hospital’s net inpatient operating costs or 110 percent of the national median of target amounts for the particular class of hospital for FY 1996, updated to the applicable cost reporting period, and adjusted for differences in area wage levels. Consequently, beginning with the FY 1998 IPPS final rule, we published annually in the Federal Register, the updated 110 percent median of the wageneutral national target amounts, divided into the labor and nonlabor-related share, for each of the three classes of providers affected by the payment limitation. As explained in the FY 2006 IPPS final rule (70 FR 47466 through 47467), the charts containing the updated 110 percent median payment amount E:\FR\FM\25APP2.SGM 25APP2 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules information are no longer needed and are discontinued. wwhite on PROD1PC61 with PROPOSALS2 V. Proposed Payment for Blood Clotting Factor Administered to Inpatient With Hemophilia (If you choose to comment on issues in this section, please include the caption ‘‘Blood Clotting Factor Payment Rate’’ at the beginning of your comment.) As discussed in section VIII. of the preamble to this proposed rule, in the FY 2006 IPPS final rule (70 FR 47473), we amended our regulations at §§ 412.2(f)(8) and 412.115(b) to state that, for discharges occurring on or after October 1, 2005, we make payment for blood clotting factor administered to hospital inpatients using the VerDate Aug<31>2005 17:10 Apr 24, 2006 Jkt 208001 Medicare Part B payment amounts for blood clotting factor as determined under Subpart K of 48 CFR Part 414 and for the furnished fee as determined under § 410.63. In accordance with § 410.63(c)(2) and our November 21, 2005 regulations (70 FR 70225), the furnishing fee for blood clotting factor for CY 2006 was determined to be $0.146 per individual unit (I.U.). Although the furnishing fee payment rate is calculated at 3 digits, the actual amount paid to providers and suppliers is rounded to 2 digits. In section VIII of the preamble to this proposed rule, we are proposing that the fiscal intermediaries continue to make payment amounts for blood clotting factor administered to hemophilia inpatients using the Medicare Part B payment amounts PO 00000 Frm 00167 Fmt 4701 Sfmt 4702 24161 determined under Subpart K of 42 CFR Part 414 and that payment amounts for the furnishing fee for the blood clotting factor be calculated at 3 digits, currently at $0.146 per I.U. of blood clotting factor. The fiscal intermediaries continue to use the Medicare Part B Drug Pricing File to make payments for blood clotting factors. The furnishing fee is included in the ASP price per unit sent with the Medicare Part B Drug Pricing File that is updated quarterly. By using the Medicare Part B Drug Pricing File, Medicare will be making consistent payments for blood clotting factor provided to inpatients and outpatients. For further updates on pricing, we refer reader to the Medicare Part B drug pricing regulations. E:\FR\FM\25APP2.SGM 25APP2 24162 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules VI. Tables This section contains the tables referred to throughout the preamble to this proposed rule and in this Addendum. Tables 1A, 1B, 1C, 1D, 2, 3A, 3B, 4A–1, 4A–2, 4B, 4C–1, 4C– 2, 4F, 4J, 5, 6A, 6B, 6C, 6D, 6E, 6F, 6G, 6H, 7A, 7B, 8A, 8B, 8C, 9A, 9B, 9C, 10, and 11 are presented below. The tables presented below are as follows: Table 1A—National Adjusted Operating Standardized Amounts, Labor/Nonlabor (69.7 Percent Labor Share/30.3 Percent Nonlabor Share If Wage Index Is Greater Than 1) Table 1B—National Adjusted Operating Standardized Amounts, Labor/Nonlabor (62 Percent Labor Share/38 Percent Nonlabor Share If Wage Index Is Less Than or Equal To 1) Table 1C—Adjusted Operating Standardized Amounts for Puerto Rico, Labor/ Nonlabor Table 1D—Capital Standard Federal Payment Rate Table 2—Hospital Case-Mix Indexes for Discharges Occurring in Federal Fiscal Year 2005; Hospital Wage Indexes for Federal Fiscal Year 2007; Hospital Average Hourly Wage for Federal Fiscal Years 2005 (2001 Wage Data), 2006 (2002 Wage Data), and 2007 (2003 Wage Data); Wage Indexes and 3-Year Average of Hospital Average Hourly Wages Table 3A—FY 2007 and 3-Year Average Hourly Wage for Urban Areas by CBSA Table 3B—FY 2007 and 3-Year Average Hourly Wage for Rural Areas by CBSA Table 4A–1—Wage Index and Capital Geographic Adjustment Factor (GAF) for Urban Areas by CBSA—FY 2007 Table 4A–2—Wage Index and Capital Geographic Adjustment Factor (GAF) for Certain Urban Areas by CBSA for the Period April 1 through September 30, 2007 Table 4B—Wage Index and Capital Geographic Adjustment Factor (GAF) for Rural Areas by CBSA—FY 2007 Table 4C–1—Wage Index and Capital Geographic Adjustment Factor (GAF) for Hospitals That Are Reclassified by CBSA—FY 2007 Table 4C–2—Wage Index and Capital Geographic Adjustment Factor (GAF) for Certain Hospitals That Are Reclassified by CBSA for the Period April 1 through September 30, 2007 Table 4F—Puerto Rico Wage Index and Capital Geographic Adjustment Factor (GAF) by CBSA—FY 2007 Table 4J—Out-Migration Adjustment—FY 2007 Table 5—List of Diagnosis-Related Groups (DRGs), Relative Weighting Factors, and Geometric and Arithmetic Mean Length of Stay (LOS) Table 6A—New Diagnosis Codes Table 6B—New Procedure Codes Table 6C—Invalid Diagnosis Codes Table 6D—Invalid Procedure Codes Table 6E—Revised Diagnosis Code Titles Table 6F—Revised Procedure Code Titles Table 6G—Additions to the CC Exclusions List Table 6H—Deletions from the CC Exclusions List Table 7A—Medicare Prospective Payment System Selected Percentile Lengths of Stay: FY 2005 MedPAR Update December 2005 GROUPER V23.0 Table 7B—Medicare Prospective Payment System Selected Percentile Lengths of Stay: FY 2005 MedPAR Update December 2005 GROUPER V24.0 Table 8A—Statewide Average Operating Cost-to-Charge Ratios—March 2006 Table 8B—Statewide Average Capital Cost-toCharge Ratios—March 2006 Table 8C—Statewide Average Total Cost-toCharge Ratios for LTCHs—March 2006 Table 9A—Hospital Reclassifications and Redesignations by Individual Hospital and CBSA—FY 2007 Table 9B—Hospital Reclassifications and Redesignations by Individual Hospital Under Section 508 of Pub. L. 108–173— FY 2007 Table 9C—Hospitals Redesignated as Rural under Section 1886(d)(8)(E) of the Act— FY 2007 Table 10—Geometric Mean Plus the Lesser of .75 of the National Adjusted Operating Standardized Payment Amount (Increased to Reflect the Difference Between Costs and Charges) or .75 of One Standard Deviation of Mean Charges by Diagnosis-Related Group (DRG)— March 2006 Table 11—Proposed FY 2007 LTC–DRGs, Relative Weights, Geometric Average Length of Stay, and 5/6ths of the Geometric Average Length of Stay TABLE 1A.—NATIONAL ADJUSTED OPERATING STANDARDIZED AMOUNTS, LABOR/NONLABOR [69.7 Percent Labor Share/30.3 Percent Nonlabor Share If Wage Index Greater Than 1] Full update (3.4 percent) Reduced update (1.4 percent) Labor-related Nonlabor-related Labor-related Nonlabor-related $3,404.27 $1,479.90 $3,338.42 $1,451.28 TABLE 1B.—NATIONAL ADJUSTED OPERATING STANDARDIZED AMOUNTS, LABOR/NONLABOR [62 Percent Labor Share/38 Percent Nonlabor Share If Wage Index Less Than or Equal to 1] Full update (3.4 percent) Reduced update (1.4 percent) Labor-related Nonlabor-related Labor-related Nonlabor-related $3,028.19 $1,855.98 $2,969.62 $1,820.08 TABLE 1C.—ADJUSTED OPERATING STANDARDIZED AMOUNTS FOR PUERTO RICO, LABOR/NONLABOR Rates if wage index greater than 1 wwhite on PROD1PC61 with PROPOSALS2 Labor National ............................................................................................................................ Puerto Rico ...................................................................................................................... VerDate Aug<31>2005 17:10 Apr 24, 2006 Jkt 208001 PO 00000 Frm 00168 Fmt 4701 Sfmt 4702 $3,404.27 1,442.78 E:\FR\FM\25APP2.SGM Nonlabor $1,479.90 884.28 25APP2 Rates if wage index less than or equal to 1 Labor $3,028.19 1,365.99 Nonlabor $1,855.98 961.07 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules 24163 TABLE 1D.—CAPITAL STANDARD FEDERAL PAYMENT RATE Rate National .................................................................................................................................................................................................... Puerto Rico .............................................................................................................................................................................................. $424.42 202.98 TABLE 2.—HOSPITAL CASE-MIX INDEXES FOR DISCHARGES OCCURRING IN FEDERAL FISCAL YEAR 2005; HOSPITAL WAGE INDEXES FOR FEDERAL FISCAL YEAR 2007; HOSPITAL AVERAGE HOURLY WAGES FOR FEDERAL FISCAL YEARS 2005 (2001 WAGE DATA), 2006 (2002 WAGE DATA), AND 2007 (2003 WAGE DATA); WAGE INDEXES AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY WAGES Case-mix index 3 wwhite on PROD1PC61 with PROPOSALS2 Provider No. 010001 ..................................................... 010004 ..................................................... 010005 h ................................................... 010006 ..................................................... 010007 ..................................................... 010008 ..................................................... 010009 ..................................................... 010010 h ................................................... 010011 ..................................................... 010012 ..................................................... 010015 ..................................................... 010016 ..................................................... 010018 ..................................................... 010019 ..................................................... 010021 h ................................................... 010022 ..................................................... 010023 ..................................................... 010024 ..................................................... 010025 ..................................................... 010027 ..................................................... 010029 ..................................................... 010031 ..................................................... 010032 ..................................................... 010033 ..................................................... 010034 ..................................................... 010035 ..................................................... 010036 ..................................................... 010038 ..................................................... 010039 ..................................................... 010040 ..................................................... 010043 ..................................................... 010044 ..................................................... 010045 ..................................................... 010046 ..................................................... 010047 ..................................................... 010049 ..................................................... 010050 ..................................................... 010051 ..................................................... 010052 ..................................................... 010053 ..................................................... 010054 ..................................................... 010055 ..................................................... 010056 ..................................................... 010058 ..................................................... 010059 ..................................................... 010061 ..................................................... 010062 ..................................................... 010064 ..................................................... 010065 ..................................................... 010066 ..................................................... 010068 ..................................................... 010069 ..................................................... 010072 ..................................................... 010073 ..................................................... 010078 ..................................................... 010079 ..................................................... 010083 h ................................................... 010084 ..................................................... VerDate Aug<31>2005 17:10 Apr 24, 2006 Jkt 208001 FY 2007 wage index (10/1/2006– 3/31/2007) FY 2007 wage index (4/1/2007– 9/30/2007) Average hourly wage FY 2005 1 Average hourly wage FY 2006 1 Average hourly wage FY 2007 1 0.7670 * 0.8919 0.8008 0.7670 0.8035 0.8829 0.9286 0.8919 0.8841 0.7670 0.8919 0.8919 0.8008 0.7670 0.9307 0.8035 0.8035 0.8256 0.7670 0.8256 * 0.7670 0.8919 0.8035 0.8919 0.7670 0.8040 0.9027 0.8107 0.8919 0.8919 0.8919 0.8107 0.7825 0.7670 0.8919 0.8644 0.7791 * 0.8829 0.7670 0.8919 0.8919 0.8829 0.8176 0.7670 0.8919 0.8035 0.7670 * 0.7670 * 0.7670 0.8040 0.9027 0.7999 0.8919 0.7670 * 0.8919 0.8008 0.7670 0.8035 0.8829 0.9286 0.8919 0.8841 0.7670 0.8919 0.8919 0.8008 0.7670 0.9307 0.8035 0.8035 0.8256 0.7670 0.8256 * 0.7670 0.8919 0.8035 0.8919 0.7670 0.8040 0.9027 0.8107 0.8919 0.8919 0.8919 0.8107 0.7825 0.7670 0.8919 0.8644 0.7791 * 0.8829 0.7670 0.8919 0.8919 0.8829 0.8176 0.7670 0.8919 0.8035 0.7670 * 0.7670 * 0.7670 0.8040 0.9027 0.7999 0.8919 20.6563 22.7585 20.4937 21.0241 16.8811 23.8333 21.6422 22.3021 24.8166 21.7622 20.4732 23.0414 20.5888 20.1336 20.7108 25.8797 23.7791 20.0067 19.8561 14.9585 21.6724 20.9463 18.5073 25.5165 17.1625 23.1319 20.5125 20.3935 23.4151 21.6708 19.5422 23.0220 20.5658 20.8935 19.5937 17.7801 21.5625 14.7053 21.3673 17.4160 23.1894 19.1847 22.7183 20.3182 23.6963 20.5683 18.1323 25.4345 20.0108 17.0935 17.5690 19.6317 21.5419 16.4043 21.0633 20.4254 20.2166 22.5219 21.6546 * 22.4906 23.4823 18.2430 20.4591 23.2229 21.4974 27.4850 22.7020 21.5111 25.1502 22.2990 22.0906 18.6785 24.5670 27.6174 20.7265 21.2674 15.3704 22.6976 * 19.1555 26.3784 16.9686 22.2870 22.9747 21.4509 25.8820 22.8851 22.5945 21.4036 19.8803 21.6965 21.0604 20.2413 22.1584 15.2208 16.4959 19.0108 22.5554 22.3800 23.7144 18.5537 21.3237 21.9370 18.3435 26.1110 21.3785 17.6152 19.0789 21.3608 21.8169 16.4168 21.6857 21.8199 22.3041 24.7127 22.0902 * 23.8467 23.8950 19.0895 17.3246 23.6476 26.9296 28.1598 24.7514 22.2383 25.3918 23.4042 22.7718 19.2877 26.0470 25.9797 21.9289 22.9338 16.1874 24.0249 * 17.6770 27.2283 16.8532 24.4137 21.3352 23.8325 26.9189 25.2353 22.3782 23.4140 21.3661 22.5938 24.7497 21.7057 23.7598 16.2672 35.3506 * 23.2781 22.4711 23.9525 18.7069 22.9583 26.4117 20.1842 25.8259 23.3126 19.9192 22.7410 22.9841 24.5806 17.2624 23.2584 22.9204 22.2041 26.7869 1.4947 *** 1.1314 1.4662 1.0715 0.9849 0.9669 1.0466 1.6004 1.2403 1.0209 1.5262 1.4713 1.2326 1.2234 0.9812 1.9126 1.6759 1.2800 0.7764 1.5817 *** 0.8957 2.0838 0.9964 1.2688 1.1331 1.3544 1.6215 1.6072 1.0549 1.0631 1.1631 1.5002 0.8900 1.1465 1.0283 0.8413 0.8875 1.0530 1.0888 1.5338 1.5870 0.9554 1.0321 1.0134 1.0729 1.7037 1.4924 0.8390 *** 1.0208 *** 0.9714 1.5197 1.1653 1.1662 1.4968 PO 00000 Frm 00169 Fmt 4701 Sfmt 4702 E:\FR\FM\25APP2.SGM 25APP2 Average hourly wage** (3 years) 21.4932 22.7585 22.3126 22.7642 18.0746 20.3331 22.8732 23.3707 26.8482 23.0667 21.4475 24.5277 22.0807 21.6962 19.5086 25.5065 25.7195 20.8398 21.3262 15.4627 22.8346 20.9463 18.4274 26.3825 16.9851 23.2651 21.6253 21.9490 25.4404 23.2539 21.5638 22.5922 20.5979 21.7035 21.7929 19.9626 22.4501 15.4065 23.1645 18.2193 23.0051 21.3064 23.4706 19.3775 22.7109 23.1046 18.8535 25.7663 21.5967 18.2254 19.7954 21.2452 22.6157 16.6999 22.0108 21.7330 21.5896 24.6686 24164 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules TABLE 2.—HOSPITAL CASE-MIX INDEXES FOR DISCHARGES OCCURRING IN FEDERAL FISCAL YEAR 2005; HOSPITAL WAGE INDEXES FOR FEDERAL FISCAL YEAR 2007; HOSPITAL AVERAGE HOURLY WAGES FOR FEDERAL FISCAL YEARS 2005 (2001 WAGE DATA), 2006 (2002 WAGE DATA), AND 2007 (2003 WAGE DATA); WAGE INDEXES AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY WAGES—Continued Case-mix index 3 wwhite on PROD1PC61 with PROPOSALS2 Provider No. 010085 ..................................................... 010086 ..................................................... 010087 ..................................................... 010089 ..................................................... 010090 ..................................................... 010091 ..................................................... 010092 ..................................................... 010095 ..................................................... 010097 ..................................................... 010098 ..................................................... 010099 ..................................................... 010100 h ................................................... 010101 ..................................................... 010102 ..................................................... 010103 ..................................................... 010104 ..................................................... 010108 ..................................................... 010109 ..................................................... 010110 ..................................................... 010112 ..................................................... 010113 ..................................................... 010114 ..................................................... 010115 ..................................................... 010118 ..................................................... 010119 ..................................................... 010120 ..................................................... 010121 ..................................................... 010125 ..................................................... 010126 ..................................................... 010128 ..................................................... 010129 h ................................................... 010130 ..................................................... 010131 ..................................................... 010137 ..................................................... 010138 ..................................................... 010139 ..................................................... 010143 ..................................................... 010144 ..................................................... 010145 ..................................................... 010146 ..................................................... 010148 ..................................................... 010149 ..................................................... 010150 ..................................................... 010152 ..................................................... 010157 ..................................................... 010158 ..................................................... 010161 ..................................................... 010162 ..................................................... 010164 ..................................................... 010165 ..................................................... 010166 ..................................................... 020001 ..................................................... 020004 ..................................................... 020006 ..................................................... 020008 ..................................................... 020012 ..................................................... 020014 ..................................................... 020017 ..................................................... 020018 ..................................................... 020019 ..................................................... 020020 ..................................................... 020024 ..................................................... 020026 ..................................................... 020027 ..................................................... 030001 ..................................................... 030002 ..................................................... VerDate Aug<31>2005 17:10 Apr 24, 2006 Jkt 208001 FY 2007 wage index (10/1/2006– 3/31/2007) FY 2007 wage index (4/1/2007– 9/30/2007) Average hourly wage FY 2005 1 Average hourly wage FY 2006 1 Average hourly wage FY 2007 1 0.8829 0.7670 0.7955 0.8919 0.7955 0.7670 0.8644 0.8644 0.8035 0.7670 0.7670 0.7999 0.7978 0.7670 0.8919 0.8919 0.8035 0.8121 0.7670 0.7670 0.7955 0.8919 * 0.7785 * 0.7670 * 0.7670 0.8035 0.7670 0.8076 0.8919 0.9027 0.8919 0.7670 0.8919 0.8919 0.7955 0.8644 0.8040 0.7670 0.8035 0.8035 0.7955 0.8008 0.8220 * * 0.7978 0.9027 * 1.2062 1.0669 1.2062 1.2062 1.1063 1.0669 1.2062 1.9343 1.9343 * 1.0669 1.9343 1.9343 1.0307 1.0307 0.8829 0.7670 0.7955 0.8919 0.7955 0.7670 0.8644 0.8644 0.8035 0.7670 0.7670 0.7999 0.7978 0.7670 0.8919 0.8919 0.8035 0.8121 0.7670 0.7670 0.7955 0.8919 * 0.7785 * 0.7670 * 0.7670 0.8035 0.7670 0.8076 0.8919 0.9027 0.8919 0.7670 0.8919 0.8919 0.7955 0.8644 0.8040 0.7670 0.8035 0.8035 0.7955 0.8008 0.8220 * * 0.7978 0.9027 * 1.2062 1.0669 1.2062 1.2062 1.1063 1.0669 1.2062 1.9343 1.9343 * 1.0669 1.9343 1.9343 1.0307 1.0307 23.7007 19.4332 21.6226 22.2508 21.4322 19.4222 22.0709 13.4426 17.1735 19.6717 18.1849 20.0027 21.0085 19.9196 24.2201 24.1929 23.7803 21.7128 19.2706 17.2963 20.4181 21.5319 17.5985 18.8560 21.8215 20.5855 17.0329 16.8419 23.1856 17.9354 18.7821 18.4944 24.2197 29.7665 13.5082 24.9410 22.1312 20.6425 23.1976 19.9944 18.5309 23.1593 20.6738 22.1626 21.3574 22.4440 27.5119 * * * * 31.6091 29.9926 33.4210 34.5856 29.3419 32.1233 32.9281 * * * 27.9799 * * 27.7572 27.9628 24.4710 18.6081 22.5225 22.8448 23.6948 18.6912 24.4592 13.9326 16.7548 14.3076 18.7909 21.2915 21.6593 21.0903 26.1163 24.7394 28.4624 21.6194 17.5957 16.8902 21.4121 22.3752 21.7478 19.7673 * 20.9450 24.0867 18.4114 23.1381 21.4201 21.3555 23.2488 25.7837 24.7366 13.8475 25.3014 22.0215 20.8209 24.9531 20.8917 20.5589 26.5854 21.6377 22.6202 24.3560 24.3531 * * * * * 32.8120 32.0966 36.0540 35.9236 31.8995 32.0893 33.5852 * * * 33.0644 * * 29.9840 29.0519 24.9367 22.6793 23.2584 25.7005 26.3719 21.7995 26.0211 14.2458 19.7546 19.7314 20.5469 23.6080 24.1741 24.0016 27.4955 27.7171 25.2790 17.8168 22.8948 16.6350 22.5051 24.9211 * 21.4598 * 21.0977 * 21.5078 23.4829 22.0056 22.7075 24.8205 27.7993 26.6554 14.4665 26.7377 26.1276 22.3801 25.7002 22.8918 23.1208 25.2688 23.5727 23.0833 24.4951 24.3408 * 30.6197 * * * 35.3482 31.4487 35.6547 36.2733 32.7496 30.0133 36.7983 * * * 29.0436 * * 33.2450 30.2114 1.3213 1.0963 1.9768 1.2732 1.7279 0.9676 1.6101 0.8483 0.7214 1.0614 1.0007 1.6896 1.1300 0.9498 1.9055 1.8131 1.1587 0.9898 0.7972 1.0411 1.6585 1.3874 0.8657 1.2164 *** 0.9951 *** 1.0529 1.1487 0.8668 1.0141 0.9442 1.3884 1.2455 0.6116 1.5878 1.1706 1.5785 1.3931 1.1068 0.8957 1.2762 1.0607 1.1816 1.1543 1.1432 *** *** 1.1708 1.5089 1.7090 1.6912 1.1433 1.2733 1.2806 1.3394 1.1853 1.9918 0.9347 0.9039 0.8722 1.1284 1.6273 0.8979 1.4328 2.0991 PO 00000 Frm 00170 Fmt 4701 Sfmt 4702 E:\FR\FM\25APP2.SGM 25APP2 Average hourly wage** (3 years) 24.3634 20.2158 22.4539 23.6155 23.7551 19.8855 24.1412 13.8767 17.8691 17.4056 19.1587 21.6931 22.2531 21.7005 25.9641 25.5564 25.7731 20.3493 19.6997 16.9597 21.4462 22.9538 19.2200 20.1886 21.8215 20.8812 19.3686 18.8306 23.2663 20.5563 21.0365 21.9717 26.0170 26.9261 13.9564 25.6921 23.4216 21.3097 24.6568 21.2823 20.7425 24.9404 21.9452 22.6354 23.3774 23.6867 27.5119 30.6197 * * * 33.3208 31.1921 35.1161 35.6184 31.3425 31.3617 34.4089 * * * 30.0116 * * 30.4046 29.0057 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules 24165 TABLE 2.—HOSPITAL CASE-MIX INDEXES FOR DISCHARGES OCCURRING IN FEDERAL FISCAL YEAR 2005; HOSPITAL WAGE INDEXES FOR FEDERAL FISCAL YEAR 2007; HOSPITAL AVERAGE HOURLY WAGES FOR FEDERAL FISCAL YEARS 2005 (2001 WAGE DATA), 2006 (2002 WAGE DATA), AND 2007 (2003 WAGE DATA); WAGE INDEXES AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY WAGES—Continued Case-mix index 3 wwhite on PROD1PC61 with PROPOSALS2 Provider No. 030006 ..................................................... 030007 ..................................................... 030009 ..................................................... 030010 ..................................................... 030011 ..................................................... 030012 ..................................................... 030013 ..................................................... 030014 ..................................................... 030016 ..................................................... 030017 ..................................................... 030018 ..................................................... 030019 ..................................................... 030022 ..................................................... 030023 ..................................................... 030024 ..................................................... 030027 ..................................................... 030030 ..................................................... 030033 ..................................................... 030036 ..................................................... 030037 ..................................................... 030038 ..................................................... 030040 ..................................................... 030043 ..................................................... 030044 ..................................................... 030055 h ................................................... 030059 ..................................................... 030060 ..................................................... 030061 ..................................................... 030062 ..................................................... 030064 ..................................................... 030065 ..................................................... 030067 ..................................................... 030068 ..................................................... 030069 h ................................................... 030071 ..................................................... 030073 ..................................................... 030074 ..................................................... 030077 ..................................................... 030078 ..................................................... 030080 ..................................................... 030083 ..................................................... 030084 ..................................................... 030085 ..................................................... 030087 ..................................................... 030088 ..................................................... 030089 ..................................................... 030092 ..................................................... 030093 ..................................................... 030094 ..................................................... 030099 ..................................................... 030100 ..................................................... 030101 h ................................................... 030102 ..................................................... 030103 ..................................................... 030105 ..................................................... 030106 ..................................................... 030107 ..................................................... 030108 ..................................................... 030109 ..................................................... 030110 ..................................................... 030111 ..................................................... 030112 ..................................................... 030113 ..................................................... 030114 ..................................................... 030115 ..................................................... 040001 ..................................................... VerDate Aug<31>2005 17:10 Apr 24, 2006 Jkt 208001 FY 2007 wage index (10/1/2006– 3/31/2007) FY 2007 wage index (4/1/2007– 9/30/2007) Average hourly wage FY 2005 1 Average hourly wage FY 2006 1 Average hourly wage FY 2007 1 0.9239 1.1121 * 0.9239 0.9239 0.9858 0.9179 1.0307 1.0307 1.0307 1.0307 1.0307 1.0307 1.1611 1.0307 * 1.0307 1.1121 1.0307 1.0307 1.0307 0.9158 0.9158 * 1.1417 * 0.9158 1.0307 0.9158 0.9239 1.0307 0.9158 0.9158 1.1417 1.4448 1.4448 1.4448 1.4448 1.4448 0.9239 1.0307 1.4448 0.9239 1.0307 1.0307 1.0307 1.0307 1.0307 1.0307 0.9158 0.9239 1.1417 1.0307 1.0307 1.0307 1.0307 1.0307 1.0307 1.0307 1.0307 0.9239 1.0307 * * * 0.8779 0.9239 1.1121 * 0.9239 0.9239 0.9858 0.9179 1.0307 1.0307 1.0307 1.0307 1.0307 1.0307 1.1611 1.0307 * 1.0307 1.1121 1.0307 1.0307 1.0307 0.9158 0.9158 * 1.1417 * 0.9158 1.0307 0.9158 0.9239 1.0307 0.9158 0.9158 1.1417 1.4448 1.4448 1.4448 1.4448 1.4448 0.9239 1.0307 1.4448 0.9239 1.0307 1.0307 1.0307 1.0307 1.0307 1.0307 0.9158 0.9239 1.1417 1.0307 1.0307 1.0307 1.0307 1.0307 1.0307 1.0307 1.0307 0.9239 1.0307 * * * 0.8779 24.0169 26.9442 21.4065 22.8647 22.8422 25.5205 23.5229 25.1189 27.1583 24.4055 24.4308 28.4917 25.1461 28.4112 28.3470 21.0527 24.6005 26.6009 26.5708 30.3907 26.5178 22.5130 26.0825 19.5714 23.1837 24.7676 22.3551 23.4722 21.9849 24.6732 25.6738 19.1332 19.7030 25.6243 * * * * * 24.3573 24.9269 * 23.2070 26.3878 23.2478 26.2166 25.4127 23.5623 26.9985 26.7996 * 25.0077 * 28.2832 27.6900 30.4791 * * * * * * * * * 23.1475 25.8872 29.6174 22.3992 24.8275 25.1361 26.3859 25.7050 25.6259 26.7003 26.2452 28.9476 27.3156 26.4404 33.8333 31.6658 20.4031 30.2712 26.6531 30.3521 28.6453 29.5509 24.8145 24.7932 * 24.5202 * 24.3523 25.5529 23.8068 25.4922 27.1646 20.4376 20.8846 26.3518 * * * * * 25.2077 27.5353 * 24.5792 26.6594 26.6796 27.1835 27.3203 25.8955 29.5948 26.3236 29.0691 26.1927 29.0942 30.1994 31.3094 34.7222 * * * * * * * * * 23.7718 26.2503 31.2754 26.0201 28.0899 27.5948 27.7968 27.1721 28.4109 28.5953 31.2902 30.0034 30.4092 30.9356 34.3731 33.8834 * 32.7083 28.3920 31.8947 32.1766 30.7744 27.0303 24.7174 * 27.1476 * 25.0412 28.9415 26.5482 28.3696 29.2736 20.6472 22.1437 30.5875 * * * * * 26.8022 28.0562 * 26.3130 30.1137 28.0619 28.3816 30.6136 27.5072 32.6317 25.9313 29.5931 27.6535 29.6919 32.9960 31.9342 34.0269 34.7976 * 16.7958 33.6019 * * * * * 21.8122 1.6331 1.4120 *** 1.3771 1.4547 1.3826 1.4350 1.4890 1.2235 2.0967 1.2445 1.3225 1.5620 1.6994 2.0605 0.9510 1.5508 1.2744 1.4226 2.2721 1.6855 0.9044 1.2719 0.8466 1.4275 *** 1.1831 1.6392 1.2655 1.9610 1.6072 1.0836 1.1530 1.3792 0.9063 0.8491 0.9153 0.8067 0.9638 1.4675 1.3724 0.8694 1.5851 1.6022 1.3772 1.5203 1.4300 1.2279 1.3717 0.8328 2.0714 1.4542 2.6166 1.6786 2.3179 1.6852 1.9370 2.1298 2.6413 1.4204 1.0628 1.9419 0.9339 1.3901 1.3316 1.0958 PO 00000 Frm 00171 Fmt 4701 Sfmt 4702 E:\FR\FM\25APP2.SGM 25APP2 Average hourly wage** (3 years) 25.4671 29.3738 22.5654 25.2470 25.3205 26.6212 25.5234 26.3536 27.4983 27.3461 27.5160 28.8240 27.5456 32.2119 31.3965 20.7264 29.0268 27.2450 29.8589 30.5501 29.0959 24.8110 25.1254 19.5714 25.0481 24.7676 23.8848 26.0923 24.1628 26.2797 27.4560 20.0627 20.9244 27.3999 * * * * * 25.4224 26.8708 * 24.7847 27.8776 26.0537 27.3548 27.9388 25.9035 29.7783 26.3941 29.3347 26.3284 29.4041 30.4822 30.6375 32.6905 34.7976 * 16.7958 33.6019 * * * * * 22.8805 24166 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules TABLE 2.—HOSPITAL CASE-MIX INDEXES FOR DISCHARGES OCCURRING IN FEDERAL FISCAL YEAR 2005; HOSPITAL WAGE INDEXES FOR FEDERAL FISCAL YEAR 2007; HOSPITAL AVERAGE HOURLY WAGES FOR FEDERAL FISCAL YEARS 2005 (2001 WAGE DATA), 2006 (2002 WAGE DATA), AND 2007 (2003 WAGE DATA); WAGE INDEXES AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY WAGES—Continued Case-mix index 3 wwhite on PROD1PC61 with PROPOSALS2 Provider No. 040002 040003 040004 040007 040010 040011 040014 040015 040016 040017 040018 040019 040020 040021 040022 040024 040026 040027 040029 040032 040035 040036 040039 040041 040042 040045 040047 040050 040051 040053 040054 040055 040062 040066 040067 040069 040071 040072 040074 040075 040076 040077 040078 040080 040081 040084 040085 040088 040091 040100 040105 040109 040114 040118 040119 040126 040132 040134 040137 040138 040140 040141 040142 040143 040144 040145 ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... VerDate Aug<31>2005 17:10 Apr 24, 2006 Jkt 208001 FY 2007 wage index (10/1/2006– 3/31/2007) FY 2007 wage index (4/1/2007– 9/30/2007) Average hourly wage FY 2005 1 Average hourly wage FY 2006 1 Average hourly wage FY 2007 1 0.7366 * 0.8779 0.8918 0.8779 0.7366 0.8667 0.7366 0.8918 0.8599 0.7761 0.9032 0.9032 0.8918 0.8779 * 0.8812 0.8345 0.8918 * * 0.8918 0.8206 0.8667 0.9367 * 0.8206 0.7366 0.7366 * 0.7366 0.7761 0.7761 * 0.7366 0.9032 0.8667 0.7366 0.8918 * 0.8667 * 0.8812 0.7952 0.7366 0.8918 0.7366 0.8715 0.8133 0.8667 * * 0.8918 0.7952 0.8667 * * 0.8918 0.8918 0.8779 * 0.8779 0.8812 * * 0.7952 0.7366 * 0.8779 0.8918 0.8779 0.7366 0.8667 0.7366 0.8918 0.8599 0.7761 0.9032 0.9032 0.8918 0.8779 * 0.8812 0.8345 0.8918 * * 0.8918 0.8206 0.8667 0.9367 * 0.8206 0.7366 0.7366 * 0.7366 0.7761 0.7761 * 0.7366 0.9032 0.8667 0.7366 0.8918 * 0.8667 * 0.8812 0.7952 0.7366 0.8918 0.7366 0.8715 0.8133 0.8667 * * 0.8918 0.7952 0.8667 * * 0.8918 0.8918 0.8779 * 0.8779 0.8812 * * 0.7952 19.3429 18.5000 23.3504 23.4565 22.0984 19.0319 24.0846 18.0793 22.7219 19.4365 23.8515 21.5316 20.9136 24.7771 23.7462 20.1101 24.3053 19.9348 22.8770 18.5171 13.4265 24.2851 17.7976 22.0188 18.9550 18.7952 21.5334 15.4782 18.8943 20.8153 16.7370 22.2237 21.6403 23.4616 15.1441 21.7607 22.9350 20.8269 22.6147 16.2583 21.0442 18.3261 24.4589 21.3483 13.7148 22.6441 18.0756 21.2974 23.0252 19.3560 15.8171 18.8624 23.5628 24.2547 20.1631 12.5944 36.5525 * 23.4672 23.3615 25.1224 * * * * * 20.1384 * 25.0286 25.7142 23.0274 20.3970 25.3451 19.2831 22.1228 21.9875 23.6044 23.7328 21.6603 25.6917 25.4052 * 25.4072 21.1412 24.0704 * * 26.3226 19.5998 22.1531 19.9627 17.2280 21.9163 16.3930 19.1401 20.7824 18.2684 23.3156 23.3083 * 16.8799 24.4662 24.3824 19.9009 25.2423 18.3254 20.6272 18.2082 24.5378 22.3392 15.1081 24.7225 29.8444 22.6183 23.1320 20.0460 18.2182 22.8801 24.8992 24.7363 21.0103 14.0701 28.1390 27.3412 25.2907 25.7513 * 24.0901 27.9695 * * * 20.4562 * 26.2802 27.2033 24.1107 20.3176 26.0281 20.1555 25.7321 21.3748 24.3463 24.6250 21.9802 25.3027 27.5251 * 27.5446 21.3991 24.4352 * * 26.7026 20.6232 22.7230 20.6357 * 22.7571 17.6674 * * 17.8810 22.5541 23.6394 * 18.6028 24.3733 24.5703 21.6484 24.6178 * 23.0707 * 23.6641 23.4566 15.4211 27.5794 22.6181 23.0136 24.5553 20.9265 * * 26.3883 25.7793 23.4451 15.4020 * 30.4316 26.4443 28.5258 * 26.4956 22.2893 35.7717 21.0608 * 1.2276 1.2375 1.6200 1.7125 1.3944 1.0404 1.4709 1.0464 1.6831 1.1298 1.0715 1.1033 1.5722 1.2758 1.5344 0.6960 1.5365 1.4625 1.5492 *** *** 1.6193 1.2931 1.1459 1.3639 0.9944 1.1045 1.1711 0.9556 1.0141 1.1450 1.6026 1.7081 *** 1.0279 1.0422 1.4755 1.0619 1.1734 0.9567 1.0182 0.9726 1.6359 1.0378 0.8376 1.1802 1.0444 1.3259 1.2045 1.3571 1.0217 1.1287 1.7651 1.4456 1.4191 0.8957 *** 2.4406 1.3274 1.3548 *** 0.8243 1.4333 *** *** 1.7845 PO 00000 Frm 00172 Fmt 4701 Sfmt 4702 E:\FR\FM\25APP2.SGM 25APP2 Average hourly wage** (3 years) 20.0058 18.5000 24.9024 25.4311 23.1027 19.9412 25.1431 19.1800 23.5240 20.9608 23.9210 23.3182 21.5335 25.2694 25.5185 20.1101 25.8166 20.8293 23.8327 18.5171 13.4265 25.8362 19.3622 22.3095 19.8706 17.9500 22.0400 16.5402 19.0196 20.7984 17.6265 22.7083 22.8746 23.4616 16.7821 23.5051 23.9588 20.7448 24.0892 17.2857 21.5644 18.2646 24.2102 22.4402 14.7485 25.0806 22.5790 22.3299 23.5683 20.1488 16.9121 20.7540 24.9878 24.8977 21.5482 13.9828 32.3748 28.9159 25.0310 26.2151 25.1224 25.3872 24.7923 35.7717 21.0608 * Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules 24167 TABLE 2.—HOSPITAL CASE-MIX INDEXES FOR DISCHARGES OCCURRING IN FEDERAL FISCAL YEAR 2005; HOSPITAL WAGE INDEXES FOR FEDERAL FISCAL YEAR 2007; HOSPITAL AVERAGE HOURLY WAGES FOR FEDERAL FISCAL YEARS 2005 (2001 WAGE DATA), 2006 (2002 WAGE DATA), AND 2007 (2003 WAGE DATA); WAGE INDEXES AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY WAGES—Continued Case-mix index 3 wwhite on PROD1PC61 with PROPOSALS2 Provider No. 040147 040302 040323 040324 050002 050006 050007 050008 050009 050013 050014 050015 050016 050017 050018 050022 050024 050025 050026 050028 050029 050030 050036 050038 050039 050040 050042 050043 050045 050046 050047 050054 050055 050056 050057 050058 050060 050061 050063 050065 050067 050069 050070 050071 050072 050073 050075 050076 050077 050078 050079 050082 050084 050088 050089 050090 050091 050093 050096 050097 050099 050100 050101 050102 050103 050104 ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... VerDate Aug<31>2005 17:10 Apr 24, 2006 Jkt 208001 FY 2007 wage index (10/1/2006– 3/31/2007) FY 2007 wage index (4/1/2007– 9/30/2007) Average hourly wage FY 2005 1 Average hourly wage FY 2006 1 Average hourly wage FY 2007 1 * * * * 1.5669 1.2884 1.5049 1.5075 1.4527 1.4527 1.3350 1.1291 1.1719 1.3350 1.1762 1.1291 1.1371 1.1371 1.1371 1.1291 * 1.1291 1.1291 1.5281 1.1291 1.1762 1.2884 1.5669 1.1291 1.1739 1.5075 1.1291 1.5075 1.1762 1.1291 1.1762 1.1291 * 1.1762 1.1600 1.1731 1.1600 1.5049 1.5669 1.5669 1.5669 1.5669 1.5669 1.1371 1.1762 1.5669 1.1739 1.2038 * 1.1600 1.5049 1.1762 1.1291 1.1762 * 1.1600 1.1371 1.5669 1.1291 1.1762 1.1762 * * * * 1.5669 1.2884 1.5049 1.5075 1.4527 1.4527 1.3350 1.1291 1.1719 1.3350 1.1762 1.1291 1.1371 1.1371 1.1371 1.1291 * 1.1291 1.1291 1.5281 1.1291 1.1762 1.2884 1.5669 1.1291 1.1603 1.5075 1.1291 1.5075 1.1762 1.1291 1.1762 1.1291 * 1.1762 1.1603 1.1731 1.1603 1.5049 1.5669 1.5669 1.5669 1.5669 1.5669 1.1371 1.1762 1.5669 1.1603 1.2038 * 1.1603 1.5049 1.1762 1.1291 1.1762 * 1.1603 1.1371 1.5669 1.1291 1.1762 1.1762 * * * * 31.9709 27.6176 37.5804 36.9371 35.5384 31.7637 29.5726 30.1398 25.5735 30.5863 20.3179 28.2773 26.9378 31.7242 26.6406 21.5448 34.3934 22.9148 27.4915 35.0441 29.8179 31.8983 29.8062 39.6054 22.7051 25.2786 39.3993 27.1437 36.9386 29.4829 26.2099 27.3584 26.5515 * 32.0515 33.8223 29.6982 28.6752 40.5645 41.1036 40.8108 41.3430 43.7101 43.0845 29.6264 25.6814 42.7385 28.9139 28.2664 26.4093 29.4884 31.1774 30.1534 31.1083 24.2277 26.6788 28.7711 28.0303 35.4655 24.9381 28.7375 29.1240 * * * * 34.1948 30.5373 38.7033 39.1539 39.6393 31.9837 33.0373 30.7940 26.2162 36.6593 22.3472 29.8632 27.5587 36.1622 28.3027 26.6160 * 24.9707 32.7929 38.7527 31.6734 34.3279 33.9415 43.1589 23.8408 25.6875 40.9874 24.1262 37.5879 27.9330 29.4351 33.8215 27.3282 32.2172 33.3039 34.0280 31.9597 31.2172 45.3382 44.9464 44.2651 45.9765 47.2356 46.4990 32.0245 31.1425 47.8597 37.7783 33.0179 25.7385 33.5323 32.9584 30.8560 33.4119 24.6680 * 31.0437 29.6949 40.3195 29.1364 34.2529 29.7326 * * * * 36.4919 34.9121 43.7992 44.3345 44.6602 36.6624 34.2931 32.9364 25.0655 41.3084 23.5749 32.3919 29.6260 34.1382 32.1634 27.9303 * 27.3246 33.9665 42.3234 35.2640 35.1377 39.2888 46.8909 25.5028 27.3051 45.6968 21.5112 44.0022 30.8781 29.9720 34.2823 29.5772 * 35.3038 35.1370 34.7752 34.9317 49.7618 51.5757 50.8845 51.3203 55.9906 53.7174 34.5870 32.6611 49.6550 40.5118 35.8900 * 35.0765 34.1010 32.2866 36.3766 29.0265 * 34.0709 32.1909 42.6624 32.5557 34.1636 33.2730 1.6530 0.7642 0.6969 0.8299 1.3835 1.6033 1.4652 1.3291 1.7796 1.9303 1.1619 1.2530 1.3081 2.0744 1.1775 1.5578 1.1455 1.9363 1.5437 1.2579 *** 1.2571 1.6518 1.5557 1.6694 1.3231 1.4842 1.6420 1.2924 1.1753 1.7513 1.2085 1.2513 1.3372 1.6796 1.5522 1.5248 *** 1.3301 1.8339 1.1518 1.6789 1.3261 1.2702 1.2617 1.2713 1.1620 1.6785 1.5579 1.2213 1.5002 1.6455 1.5694 *** 1.3345 1.2940 1.1259 1.5086 1.2678 *** 1.5000 1.8497 1.3351 1.3060 1.5640 1.3813 PO 00000 Frm 00173 Fmt 4701 Sfmt 4702 E:\FR\FM\25APP2.SGM 25APP2 Average hourly wage** (3 years) * * * * 34.3441 30.7219 40.0756 40.2397 40.0554 33.4866 32.4016 31.3257 25.5928 36.1871 22.0407 30.2730 28.0641 34.0294 29.1587 24.9072 34.3934 25.0300 31.5046 38.7342 32.1617 33.7788 34.3247 43.1599 24.0609 26.1065 42.1673 24.0692 39.3279 29.4498 28.5742 31.7862 27.8373 32.2172 33.4928 34.3436 32.3897 31.6324 45.6981 46.4017 45.8517 46.7321 49.6104 48.3873 32.2078 29.5911 46.8148 36.0157 32.2531 26.0862 32.7927 32.7532 31.1304 33.6827 26.0314 26.6788 31.4119 30.0363 39.6163 28.7040 32.4158 30.7456 24168 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules TABLE 2.—HOSPITAL CASE-MIX INDEXES FOR DISCHARGES OCCURRING IN FEDERAL FISCAL YEAR 2005; HOSPITAL WAGE INDEXES FOR FEDERAL FISCAL YEAR 2007; HOSPITAL AVERAGE HOURLY WAGES FOR FEDERAL FISCAL YEARS 2005 (2001 WAGE DATA), 2006 (2002 WAGE DATA), AND 2007 (2003 WAGE DATA); WAGE INDEXES AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY WAGES—Continued Case-mix index 3 wwhite on PROD1PC61 with PROPOSALS2 Provider No. 050107 050108 050110 050111 050112 050113 050114 050115 050116 050117 050118 050121 050122 050124 050125 050126 050127 050128 050129 050131 050132 050133 050135 050136 050137 050138 050139 050140 050144 050145 050148 050149 050150 050152 050153 050155 050158 050159 050167 050168 050169 050172 050173 050174 050175 050177 050179 050180 050188 050189 050191 050192 050193 050194 050195 050196 050197 050204 050205 050207 050211 050214 050215 050217 050219 050222 ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... VerDate Aug<31>2005 17:10 Apr 24, 2006 Jkt 208001 FY 2007 wage index (10/1/2006– 3/31/2007) FY 2007 wage index (4/1/2007– 9/30/2007) Average hourly wage FY 2005 1 Average hourly wage FY 2006 1 Average hourly wage FY 2007 1 1.1291 1.3350 1.1291 1.1762 1.1762 1.5049 1.1762 1.1371 1.1762 1.1884 1.1731 1.1291 1.2038 1.1762 1.5281 1.1762 1.3350 1.1371 1.1600 1.5082 1.1762 1.1461 1.1762 1.5049 1.1762 1.1762 1.1762 1.1600 1.1762 1.4457 1.1291 1.1762 1.3350 1.5075 1.5281 * 1.1762 1.1739 1.2038 1.1600 1.1762 1.1291 1.1600 1.5049 1.1762 * 1.1731 1.5669 1.5281 1.4457 1.1762 1.1291 1.1600 1.5509 1.5669 1.1291 1.5669 1.1762 1.1762 1.1291 1.5669 * 1.5281 * 1.1762 1.1371 1.1291 1.3350 1.1291 1.1762 1.1762 1.5049 1.1762 1.1371 1.1762 1.1884 1.1731 1.1291 1.2038 1.1762 1.5281 1.1762 1.3350 1.1371 1.1603 1.5082 1.1762 1.1461 1.1762 1.5049 1.1762 1.1762 1.1762 1.1603 1.1762 1.4457 1.1291 1.1762 1.3350 1.5075 1.5281 * 1.1762 1.1603 1.2038 1.1603 1.1762 1.1291 1.1603 1.5049 1.1762 * 1.1731 1.5669 1.5281 1.4457 1.1762 1.1291 1.1603 1.5509 1.5669 1.1291 1.5669 1.1762 1.1762 1.1291 1.5669 * 1.5281 * 1.1762 1.1371 27.6002 31.4271 20.0769 26.6345 34.0258 34.2851 29.2858 27.5207 28.8193 28.2227 33.0650 25.5962 29.7629 26.7065 40.9218 29.6203 23.6208 28.3278 27.8488 38.6834 29.4317 27.6030 24.9415 35.2834 36.5409 43.8671 35.1013 37.5473 32.4042 39.5676 24.7063 30.1596 31.5333 40.3464 40.4446 21.8829 33.6400 30.8069 25.9850 30.8036 26.2864 27.1497 27.6097 36.3117 31.5615 24.7531 25.8072 40.8101 39.3507 20.0709 * 21.2448 30.7341 38.6750 43.9696 25.2168 40.8832 25.2512 28.0504 27.0216 38.3319 24.4785 41.6886 23.6286 22.9226 26.3882 33.1358 35.5711 26.1453 28.1588 36.8026 33.8064 31.1294 30.9288 34.5110 32.4414 35.4044 27.9537 34.2416 28.0288 41.7020 29.3360 26.1222 31.0662 32.2680 40.5321 35.1544 31.3530 24.3927 37.4560 38.4827 46.9557 37.6217 39.6269 33.5109 42.3134 27.3005 33.2270 31.7560 43.6487 43.3190 21.8550 35.1326 31.3199 28.5179 33.2506 27.4644 28.5604 30.3582 40.1747 30.5733 25.1442 27.1155 40.2504 39.5110 29.1280 34.2091 27.0424 29.6421 40.9096 48.4358 32.1933 48.9052 28.6423 27.8611 29.5215 41.2166 23.9972 43.7985 * 22.4065 29.1094 32.9560 40.0597 27.0752 27.7673 37.1212 38.7793 33.7817 29.7825 37.0771 34.3628 40.0173 30.3495 33.7869 29.6897 40.7957 32.5210 33.3619 32.3557 36.3489 46.3164 37.0147 32.6669 22.8053 43.2698 40.4779 47.6585 39.0103 42.1233 34.0982 48.1345 28.8900 37.1830 33.9978 46.4718 43.6382 16.9856 35.7746 32.3724 30.6646 36.3166 30.0990 25.7654 29.5083 43.9133 33.4885 24.8662 30.1673 38.1691 41.5956 29.5245 38.9681 27.1667 34.2248 45.2123 50.0403 33.9150 51.0016 32.1731 29.2978 30.5777 37.1447 25.6142 43.1523 * 26.6745 32.9502 1.4706 1.9403 1.2736 1.3212 1.5308 1.3140 1.4334 1.4811 1.6951 2.3561 1.1866 1.2724 1.5554 1.3010 1.3922 1.4204 1.3341 1.5385 1.7922 1.3140 1.3868 1.4974 1.0165 1.2848 1.2925 2.1552 1.3295 1.4309 1.3888 1.3655 1.0959 1.4738 1.2309 1.4829 1.5515 *** 1.3045 1.2085 1.2968 1.6582 1.4331 1.2604 1.2462 1.6356 1.2512 *** 1.2173 1.5914 1.4277 1.0446 1.5168 1.0079 1.2523 1.3621 1.5019 1.0951 2.0347 1.4560 1.4361 1.2589 1.2871 *** 1.8301 1.2241 1.1942 1.6433 PO 00000 Frm 00174 Fmt 4701 Sfmt 4702 E:\FR\FM\25APP2.SGM 25APP2 Average hourly wage** (3 years) 31.1819 35.9841 24.1400 27.5460 36.0398 35.6638 31.4992 29.4457 33.5192 31.0394 36.1567 28.0779 32.6896 28.1843 41.1327 30.5081 26.9264 30.6445 32.4090 41.7664 33.9609 30.5790 23.8553 38.6465 38.6009 46.1884 37.2783 39.8915 33.3800 43.3982 27.0245 33.9364 32.4639 43.5222 42.5499 19.9780 34.9077 31.5413 28.3647 33.5327 28.0689 27.0886 29.1194 40.1381 31.8687 24.9253 27.9651 39.6057 40.1682 26.1888 36.4880 25.1695 31.5406 41.6588 47.5753 30.7046 46.9043 28.6226 28.4343 28.9980 38.8162 24.6874 42.9010 23.6286 24.0446 29.6111 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules 24169 TABLE 2.—HOSPITAL CASE-MIX INDEXES FOR DISCHARGES OCCURRING IN FEDERAL FISCAL YEAR 2005; HOSPITAL WAGE INDEXES FOR FEDERAL FISCAL YEAR 2007; HOSPITAL AVERAGE HOURLY WAGES FOR FEDERAL FISCAL YEARS 2005 (2001 WAGE DATA), 2006 (2002 WAGE DATA), AND 2007 (2003 WAGE DATA); WAGE INDEXES AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY WAGES—Continued Case-mix index 3 wwhite on PROD1PC61 with PROPOSALS2 Provider No. 050224 050225 050226 050228 050230 050231 050232 050234 050235 050236 050238 050239 050240 050242 050243 050245 050248 050251 050253 050254 050256 050257 050261 050262 050264 050267 050270 050272 050276 050277 050278 050279 050280 050281 050283 050286 050289 050290 050291 050292 050295 050296 050298 050299 050300 050301 050305 050308 050309 050312 050313 050315 050320 050324 050325 050327 050329 050331 050333 050334 050335 050336 050342 050348 050349 050350 ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... VerDate Aug<31>2005 17:10 Apr 24, 2006 Jkt 208001 FY 2007 wage index (10/1/2006– 3/31/2007) FY 2007 wage index (4/1/2007– 9/30/2007) Average hourly wage FY 2005 1 Average hourly wage FY 2006 1 Average hourly wage FY 2007 1 1.1600 1.1291 1.1600 1.5669 1.1600 1.1762 1.1719 1.1371 1.1762 1.1739 1.1762 1.1762 1.1762 1.5509 1.1291 1.1600 1.4457 1.1524 * 1.3350 1.1762 1.1291 1.1291 1.1762 1.5669 * 1.1371 1.1600 1.5669 1.1762 1.1762 1.1600 1.3205 1.1762 1.5669 * 1.5049 1.1762 1.5049 1.1291 1.1291 1.5281 1.1600 1.1762 1.1600 1.1291 1.5669 1.5281 1.3350 * 1.2038 1.1291 1.5669 1.1371 1.1467 1.1600 1.1291 * 1.1291 1.4457 1.1467 1.2038 1.1291 1.1600 1.1291 1.1762 1.1603 1.1291 1.1603 1.5669 1.1603 1.1762 1.1719 1.1371 1.1762 1.1603 1.1762 1.1762 1.1762 1.5509 1.1291 1.1603 1.4457 1.1524 * 1.3350 1.1762 1.1291 1.1291 1.1762 1.5669 * 1.1371 1.1603 1.5669 1.1762 1.1762 1.1603 1.3205 1.1762 1.5669 * 1.5049 1.1762 1.5049 1.1291 1.1291 1.5281 1.1603 1.1762 1.1603 1.1291 1.5669 1.5281 1.3350 * 1.2038 1.1291 1.5669 1.1371 1.1467 1.1603 1.1291 * 1.1291 1.4457 1.1467 1.2038 1.1291 1.1603 1.1291 1.1762 26.7916 29.5184 29.2259 40.1362 34.1417 30.1298 24.4383 29.2421 27.8965 28.1969 29.1481 28.2327 35.2284 39.7629 31.8153 27.0949 31.6240 26.5021 22.2450 24.1512 28.4728 20.8367 25.3005 36.1162 41.3478 26.7060 30.0540 25.9103 41.2251 35.8246 28.0351 25.5299 30.6723 26.2623 38.5600 19.4973 38.6875 32.6388 29.6162 27.0775 31.5960 34.9952 25.8232 27.7535 28.3862 28.5769 40.9978 38.0564 28.9181 32.6846 27.5321 26.1224 36.3252 30.9958 30.2280 29.8327 26.8021 20.9847 15.3119 38.7635 27.4046 25.3062 24.7654 33.2676 16.9251 29.4262 29.3143 29.9656 30.5867 42.4226 32.9555 30.9607 27.4099 29.6560 29.2979 32.1647 31.1764 31.0963 35.5735 44.3130 31.4883 28.6527 35.3864 27.2675 24.0044 27.0041 29.8194 21.3216 27.3234 44.0256 41.1211 * 32.4812 27.1989 39.3778 32.5213 29.9244 27.6573 35.2030 27.3824 43.0638 * 41.1774 34.5482 35.3653 26.8879 36.1950 39.0061 27.7416 31.5435 30.7148 31.9995 44.8630 43.0691 34.4145 33.9022 31.8003 28.5933 40.2352 32.9792 30.6117 33.0087 26.2120 20.2692 23.4009 40.7467 28.9403 28.5659 26.8507 37.7898 17.4791 31.1833 28.8640 34.0444 33.2724 42.9194 35.0745 32.4202 27.6649 32.7366 32.4385 34.3346 32.8459 34.5993 36.3640 47.8288 33.3571 26.3353 32.9444 28.5383 23.7595 30.9210 30.3954 18.4749 28.7777 39.3464 46.2652 * 34.4844 29.5863 41.0210 35.8637 32.1019 29.7339 40.9920 28.5186 44.5318 * 42.7353 38.0526 39.7762 25.7186 35.7270 42.1606 29.5427 35.3234 30.9822 33.4929 47.4120 45.3244 39.0822 39.2083 36.4300 32.5499 44.1674 35.1320 30.2526 35.2380 23.5644 0.0000 19.6469 44.4184 33.3349 30.4356 29.5020 31.6594 17.5811 31.8456 1.6708 1.4668 1.5929 1.3599 1.4695 1.6381 1.6137 1.2181 1.5375 1.3795 1.4857 1.5990 1.6409 1.3786 1.5396 1.3396 1.0135 1.0330 *** 1.2518 1.6462 0.9608 1.3115 2.0841 1.3655 *** 0.8638 1.3545 1.2458 1.0130 1.5373 1.1861 1.6912 1.4270 1.4222 *** 1.6421 1.5832 1.8467 1.0868 1.4657 1.1664 1.1617 1.3599 1.4966 1.3290 1.4188 1.4727 1.4190 *** 1.2280 1.3061 1.2485 1.8751 1.1433 1.7507 1.2606 1.2324 1.1135 1.6725 1.4631 1.2386 1.2404 1.7064 0.9631 1.3701 PO 00000 Frm 00175 Fmt 4701 Sfmt 4702 E:\FR\FM\25APP2.SGM 25APP2 Average hourly wage** (3 years) 28.3306 31.2944 31.0874 41.8170 34.0630 31.1914 26.4468 30.5308 29.8741 31.5469 31.1416 31.3400 35.7323 44.0747 32.2620 27.3622 33.3125 27.5142 23.2530 27.4105 29.5443 20.0450 27.2755 39.8642 42.9907 26.7060 32.3873 27.5860 40.5582 34.5741 30.1313 27.6818 35.5779 27.3907 42.1410 19.4973 40.9116 35.1131 34.7389 26.5226 34.7452 38.8925 27.7148 31.7208 30.1038 31.4366 44.4443 42.1179 34.4798 34.8872 32.2898 29.2160 40.1172 33.2026 30.3712 32.7821 25.4937 20.6171 18.9090 41.3547 29.9569 28.1945 27.1298 34.1821 17.3402 30.8831 24170 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules TABLE 2.—HOSPITAL CASE-MIX INDEXES FOR DISCHARGES OCCURRING IN FEDERAL FISCAL YEAR 2005; HOSPITAL WAGE INDEXES FOR FEDERAL FISCAL YEAR 2007; HOSPITAL AVERAGE HOURLY WAGES FOR FEDERAL FISCAL YEARS 2005 (2001 WAGE DATA), 2006 (2002 WAGE DATA), AND 2007 (2003 WAGE DATA); WAGE INDEXES AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY WAGES—Continued Case-mix index 3 wwhite on PROD1PC61 with PROPOSALS2 Provider No. 050351 050352 050353 050355 050357 050359 050360 050366 050367 050369 050373 050376 050377 050378 050379 050380 050382 050385 050390 050391 050392 050393 050394 050396 050397 050407 050410 050411 050414 050417 050419 050420 050423 050424 050425 050426 050430 050432 050433 050434 050435 050438 050441 050444 050447 050448 050454 050455 050456 050457 050464 050468 050469 050470 050471 050476 050477 050478 050481 050485 050488 050491 050492 050494 050496 050497 ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... VerDate Aug<31>2005 17:10 Apr 24, 2006 Jkt 208001 FY 2007 wage index (10/1/2006– 3/31/2007) FY 2007 wage index (4/1/2007– 9/30/2007) Average hourly wage FY 2005 1 Average hourly wage FY 2006 1 Average hourly wage FY 2007 1 1.1762 1.3350 1.1762 * 1.1291 1.1291 1.5082 1.1291 1.5669 1.1762 1.1762 1.1762 * 1.1762 * 1.5281 1.1762 1.5049 1.1291 * * 1.1762 1.1739 1.1291 1.1291 1.5075 * 1.1762 1.3350 1.1291 * 1.1762 1.1291 1.1371 1.3350 1.1600 1.1524 1.1762 1.1291 1.1291 1.1371 1.1762 1.5281 1.1884 1.1371 1.1291 1.5075 1.1291 1.1762 1.5075 1.1731 1.1762 1.1291 1.1291 1.1762 1.1548 1.1762 1.1291 1.1762 1.1762 1.5669 * 1.1291 1.4294 1.5669 * 1.1762 1.3350 1.1762 * 1.1291 1.1291 1.5082 1.1291 1.5669 1.1762 1.1762 1.1762 * 1.1762 * 1.5281 1.1762 1.5049 1.1291 * * 1.1762 1.1603 1.1291 1.1291 1.5075 * 1.1762 1.3350 1.1291 * 1.1762 1.1291 1.1371 1.3350 1.1603 1.1524 1.1762 1.1291 1.1291 1.1371 1.1762 1.5281 1.1884 1.1371 1.1291 1.5075 1.1291 1.1762 1.5075 1.1731 1.1762 1.1291 1.1291 1.1762 1.1548 1.1762 1.1291 1.1762 1.1762 1.5669 * 1.1291 1.1607 1.5669 * 29.3082 24.2931 26.6332 11.2498 26.7265 23.6030 38.8658 25.7692 34.4959 27.1327 32.2315 30.7562 20.2484 33.9087 31.7645 39.1098 26.0927 25.5735 28.7761 21.3012 22.7209 28.2369 26.0074 30.5470 27.4716 35.6035 19.4995 37.3817 28.8561 25.2930 28.4471 26.1838 28.5944 29.9133 38.5317 30.0077 24.6684 30.3547 20.7565 25.9506 32.2183 26.4668 38.2823 27.6971 21.8552 25.0983 36.8383 24.5314 22.1675 40.2725 37.1342 29.4280 27.3281 18.4689 34.5484 30.9974 34.6400 30.9865 31.9177 28.8459 40.5313 30.6461 27.4933 35.1457 38.2871 15.9501 30.8661 33.9362 31.8291 * 32.3095 25.7739 37.0769 31.1854 38.7727 29.5697 31.9271 32.9393 * 34.2417 32.9575 42.0782 29.4323 34.5184 26.0066 18.1004 * 30.0661 27.5061 33.5699 28.1640 37.9066 21.3814 37.8064 34.6672 29.5031 33.3125 24.9401 30.6416 31.0730 42.4177 30.6899 25.0607 30.8030 23.0806 26.1621 28.0306 27.2662 42.9765 30.5504 25.2573 27.9759 43.5311 22.7235 22.5630 45.5829 37.3692 29.5448 28.9079 24.6755 34.5211 34.6585 34.6995 33.3998 33.7446 31.4233 42.9904 32.1379 27.1540 35.9909 42.2672 * 30.9044 36.5470 29.8341 * 33.8000 28.7656 48.6833 34.7036 39.7345 31.1003 33.6616 33.4664 * 34.9267 * 47.6500 30.3595 37.1708 28.4859 17.3151 * 33.7433 28.6006 33.2548 26.3981 41.8534 * 39.9558 40.1702 35.5015 * 35.6349 27.2663 34.8883 49.8051 33.7075 24.1967 33.3848 21.8447 31.5749 30.8458 35.3830 45.2125 34.8554 27.5371 29.4935 39.2067 27.9979 21.7036 47.8507 39.4867 28.0800 30.0283 27.9194 36.7915 36.3598 38.0704 35.2408 37.8839 36.5912 44.2163 34.6829 28.5116 39.9419 43.6264 * 1.5271 1.3579 1.5360 *** 1.4425 1.2211 1.5358 1.2149 1.4299 1.4248 1.3683 1.5389 *** 0.9845 *** 1.6161 1.3883 1.3188 1.1686 *** 1.2184 1.4363 1.5925 1.5970 0.8840 1.1776 *** 1.4503 1.2989 1.2539 1.3384 1.1790 0.9624 2.0096 1.3417 1.3805 0.9578 1.6517 0.9334 1.1118 1.1492 1.5756 1.9802 1.3356 0.9565 1.2766 1.8575 1.5997 1.1131 1.6072 1.6871 1.4951 1.1606 1.0676 1.7588 1.4381 1.3548 1.0037 1.4293 1.6324 1.3306 *** 1.5281 1.4219 1.7826 *** PO 00000 Frm 00176 Fmt 4701 Sfmt 4702 E:\FR\FM\25APP2.SGM 25APP2 Average hourly wage** (3 years) 30.3838 31.4422 29.3493 11.2498 30.4700 26.1226 41.5316 30.3816 38.0017 29.2945 32.6188 32.3997 20.2484 34.3818 32.3515 42.7763 28.6792 32.3860 27.6662 18.6962 22.7209 30.5690 27.4286 32.4895 27.3054 38.5688 20.4290 38.4595 34.4823 30.1379 30.8677 28.5400 28.9029 32.0453 44.1546 31.4665 24.5819 31.5269 21.8898 28.1756 30.2661 29.8308 42.1714 31.2912 24.9581 27.5949 39.9010 25.1532 22.0233 44.5817 37.9820 28.9842 28.7511 24.0596 35.2853 33.8764 35.8949 33.2560 34.5090 32.2964 42.6485 32.1991 27.7452 37.0297 41.5275 15.9501 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules 24171 TABLE 2.—HOSPITAL CASE-MIX INDEXES FOR DISCHARGES OCCURRING IN FEDERAL FISCAL YEAR 2005; HOSPITAL WAGE INDEXES FOR FEDERAL FISCAL YEAR 2007; HOSPITAL AVERAGE HOURLY WAGES FOR FEDERAL FISCAL YEARS 2005 (2001 WAGE DATA), 2006 (2002 WAGE DATA), AND 2007 (2003 WAGE DATA); WAGE INDEXES AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY WAGES—Continued Case-mix index 3 wwhite on PROD1PC61 with PROPOSALS2 Provider No. 050498 050502 050503 050506 050510 050512 050515 050516 050517 050523 050526 050528 050531 050534 050535 050537 050539 050541 050543 050545 050546 050547 050548 050549 050550 050551 050552 050557 050559 050561 050567 050568 050569 050570 050571 050573 050575 050577 050578 050579 050580 050581 050583 050584 050585 050586 050588 050589 050590 050591 050592 050594 050597 050599 050601 050603 050604 050608 050609 050613 050615 050616 050618 050623 050624 050625 ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... VerDate Aug<31>2005 17:10 Apr 24, 2006 Jkt 208001 FY 2007 wage index (10/1/2006– 3/31/2007) FY 2007 wage index (4/1/2007– 9/30/2007) Average hourly wage FY 2005 1 Average hourly wage FY 2006 1 Average hourly wage FY 2007 1 1.3350 1.1762 1.1371 1.1719 1.5669 1.5669 1.1371 1.3350 1.1600 1.5669 1.1600 1.1291 1.1762 1.1291 1.1600 1.3350 * 1.5669 1.1600 1.1762 1.1291 1.5049 1.1600 1.4294 1.1600 1.1600 1.1762 1.1731 * 1.1762 1.1600 1.1353 1.4294 1.1600 1.1762 1.1291 1.1762 * 1.1762 * 1.1600 1.1762 1.1371 1.1600 1.1600 1.1600 1.1762 1.1600 1.3350 1.1762 1.1600 1.1600 1.1762 1.3350 1.1762 1.1600 1.5281 1.1291 1.1600 1.5049 1.1762 1.1739 1.1291 * 1.1762 1.1762 1.3350 1.1762 1.1371 1.1719 1.5669 1.5669 1.1371 1.3350 1.1603 1.5669 1.1603 1.1291 1.1762 1.1291 1.1603 1.3350 * 1.5669 1.1603 1.1762 1.1291 1.5049 1.1603 1.1603 1.1603 1.1603 1.1762 1.1731 * 1.1762 1.1603 1.1353 1.4294 1.1603 1.1762 1.1291 1.1762 * 1.1762 * 1.1603 1.1762 1.1371 1.1603 1.1603 1.1603 1.1762 1.1603 1.3350 1.1762 1.1603 1.1603 1.1762 1.3350 1.1762 1.1603 1.5281 1.1291 1.1603 1.5049 1.1762 1.1603 1.1291 * 1.1762 1.1762 28.2667 28.7200 29.2001 32.4509 44.3883 41.8921 37.4251 29.4936 23.6034 34.7491 29.9495 28.6273 25.0157 29.7546 32.3646 27.4196 28.0586 43.7765 25.7161 42.9451 52.7180 45.1842 37.1314 33.8288 31.1918 31.6782 26.8274 28.3111 26.9662 37.5863 30.1167 22.5008 30.4874 32.6896 32.1656 30.5249 23.2447 28.7060 31.5953 40.2740 29.4337 32.0823 33.5209 24.5757 27.2982 25.3551 32.3603 30.6273 31.5987 28.5915 32.5000 34.6747 25.4868 30.8420 35.0325 28.6982 45.4433 22.1999 38.4561 * 32.8786 28.5636 25.4500 29.6550 28.1941 33.5137 33.0298 29.5615 31.6418 36.0164 47.5510 46.9233 38.9978 36.2772 23.9007 35.5452 31.3744 29.6838 26.9420 29.8603 32.3723 31.3844 29.8242 46.1121 26.1103 30.5554 30.2329 33.2205 30.3775 34.9818 30.2302 31.6165 27.1744 31.8048 * 38.8651 32.9829 24.4061 33.0259 34.0171 33.6156 34.1991 25.2513 30.8841 33.8825 39.4976 31.6256 32.1801 33.3697 24.8180 22.7121 27.4173 32.8212 30.9547 32.2142 28.8549 24.4542 34.7946 27.5691 38.1975 34.7409 30.2464 49.9429 23.3630 41.1797 * 33.2909 36.9017 27.4539 32.0627 32.2907 36.3631 38.4968 29.5347 34.6646 39.2455 53.3925 52.5188 40.9092 41.3786 20.4043 33.8904 28.6212 30.6464 27.4627 33.2952 34.8889 36.4258 * 53.9701 26.9874 31.4513 33.9577 34.4268 33.5332 36.8840 31.3077 34.6310 31.8084 31.8447 * 39.1626 36.4373 24.1895 34.1734 35.5233 34.9236 35.5274 25.2933 32.5645 37.2259 42.9387 33.1490 35.0108 35.7392 28.8553 22.4887 26.3755 33.0991 35.0014 39.4654 30.9334 27.7236 36.8272 29.5797 33.8834 36.6564 34.1227 56.4414 25.9073 43.2731 45.7255 36.1435 39.1701 30.9826 * 34.8735 38.7997 1.3331 1.7102 1.4527 1.6799 1.1963 1.2973 1.3889 1.4805 1.2150 1.3334 1.2525 1.1675 1.0277 1.4487 1.4985 1.4722 1.2551 1.3930 0.7326 0.7166 0.7168 0.9861 0.7147 1.5821 1.3092 1.3263 1.0959 1.5467 *** 1.2629 1.5546 1.1828 1.2260 1.5499 1.2097 1.6925 1.1724 *** 1.4960 *** 1.2568 1.4088 1.6923 1.4362 1.2218 1.2754 1.2773 1.2077 1.3770 1.1729 1.1345 1.9344 1.2248 1.9037 1.5196 1.3875 1.2051 1.3413 1.3376 1.0079 1.1030 1.3862 0.9803 *** 1.2767 1.7608 PO 00000 Frm 00177 Fmt 4701 Sfmt 4702 E:\FR\FM\25APP2.SGM 25APP2 Average hourly wage** (3 years) 33.2353 29.2993 31.9860 36.0522 48.9441 47.8701 39.1963 35.5878 22.4083 34.6993 29.8713 29.7397 26.4967 30.9702 33.3056 31.8666 29.0033 48.2244 26.2597 35.1847 38.6191 37.9709 34.1652 35.2563 30.9052 32.6691 28.6605 30.7712 26.9662 38.5888 33.2519 23.7155 32.6118 34.1290 33.5914 33.4579 24.6933 30.7682 34.1510 40.7876 31.4028 33.1503 34.1719 26.1102 23.8337 26.3132 32.7769 32.2283 34.5389 29.4952 27.9860 35.4259 27.5512 34.3184 35.4896 31.1484 51.0552 23.7863 41.0915 45.7255 34.1052 35.1520 28.0403 30.7447 31.8503 36.2505 24172 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules TABLE 2.—HOSPITAL CASE-MIX INDEXES FOR DISCHARGES OCCURRING IN FEDERAL FISCAL YEAR 2005; HOSPITAL WAGE INDEXES FOR FEDERAL FISCAL YEAR 2007; HOSPITAL AVERAGE HOURLY WAGES FOR FEDERAL FISCAL YEARS 2005 (2001 WAGE DATA), 2006 (2002 WAGE DATA), AND 2007 (2003 WAGE DATA); WAGE INDEXES AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY WAGES—Continued Case-mix index 3 wwhite on PROD1PC61 with PROPOSALS2 Provider No. 050630 050633 050636 050641 050644 050662 050663 050667 050668 050674 050677 050678 050680 050681 050682 050684 050686 050688 050689 050690 050693 050694 050695 050696 050697 050698 050699 050701 050704 050707 050708 050709 050710 050713 050714 050717 050718 050720 050722 050723 050724 050725 050726 050727 050728 050729 050730 050732 050733 050735 050736 050737 050738 050739 050740 050741 050742 050743 050744 050745 050746 050747 050749 050750 050751 050752 ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... VerDate Aug<31>2005 17:10 Apr 24, 2006 Jkt 208001 FY 2007 wage index (10/1/2006– 3/31/2007) FY 2007 wage index (4/1/2007– 9/30/2007) Average hourly wage FY 2005 1 Average hourly wage FY 2006 1 Average hourly wage FY 2007 1 * 1.1719 1.1371 1.1762 1.1762 1.5281 1.1762 1.4527 1.5075 1.3350 1.1762 1.1600 1.5669 1.1762 1.1291 1.1291 1.1291 1.5281 1.5669 1.5049 1.1600 1.1291 1.2038 1.1762 1.3205 * * 1.1291 1.1762 1.5049 1.1291 1.1600 1.1291 * 1.5509 1.1762 1.1291 1.1600 1.1371 1.1762 1.1291 1.1762 1.1731 1.1762 1.5049 1.1762 1.1762 1.1291 1.3205 * * * * * * * * * * * * * * * * * * 1.1719 1.1371 1.1762 1.1762 1.5281 1.1762 1.4527 1.5075 1.3350 1.1762 1.1603 1.5669 1.1762 1.1291 1.1291 1.1291 1.5281 1.5669 1.5049 1.1603 1.1291 1.2038 1.1762 1.3205 * * 1.1291 1.1762 1.5049 1.1291 1.1603 1.1291 * 1.5509 1.1762 1.1291 1.1603 1.1371 1.1762 1.1291 1.1762 1.1731 1.1762 1.5049 1.1762 1.1762 1.1291 1.3205 * * * * * * * * * * * * * * * * * 28.0726 33.4771 27.2360 20.4720 25.6614 47.5065 25.1493 25.9250 * 38.4454 37.3389 29.1159 35.6614 * 21.7264 25.2575 38.5595 41.3305 40.3815 43.9228 34.8040 26.7041 30.1226 36.9314 19.2603 * 25.6818 29.6896 24.6609 32.4877 21.2163 21.9079 34.8311 20.7448 32.4491 34.5519 15.4037 24.8117 * 34.9814 * 22.0946 27.0928 23.7179 31.4768 * * * * * * * * * * * * * * * * * * * * * 30.9410 35.3734 30.5156 21.4612 27.6547 32.6362 25.7747 26.3937 31.8065 42.6866 38.7984 30.7220 38.3946 * 21.7791 26.4234 40.9486 41.9325 42.2018 47.2769 35.0621 28.9544 35.6549 35.9220 25.1984 * 26.8210 29.6253 25.3488 34.0550 22.5034 25.6119 39.9858 20.2803 33.6676 38.0796 21.4996 30.0812 * 35.0119 34.4267 21.7816 27.8433 24.3026 36.0820 34.2580 51.5425 * * * * * * * * * * * * * * * * * * * * 38.2742 33.1069 20.4706 29.0068 33.6809 26.8993 27.2269 40.9413 48.7644 39.9638 32.1066 38.9269 * 17.7264 28.9330 42.8975 44.3596 46.1901 52.2448 35.5736 32.3426 39.4080 38.1340 16.9270 * 31.2540 33.5009 28.9925 35.8114 32.9787 26.9167 47.0098 21.3180 32.9341 38.9983 25.9059 29.7498 33.9652 39.8595 29.4969 24.4527 32.0629 30.9146 39.6245 36.8283 37.2860 * * * * * * * * * * * * * * * * * * * *** 1.2327 1.3124 1.1728 0.8979 0.8775 1.1419 0.9036 1.1034 1.3084 1.4769 1.3278 1.2190 1.7997 0.9911 1.1508 1.2563 1.2419 1.5018 1.2765 1.3208 1.0803 1.0920 2.1492 1.1158 1.0543 *** 1.3443 1.0465 1.1989 1.7111 1.4082 1.3359 *** 1.4106 1.6850 1.1405 0.9455 0.9800 1.3104 1.9939 0.9799 1.5792 1.3104 1.3772 1.4087 1.1560 2.4527 1.5564 1.4593 1.2171 1.4960 1.3749 1.6624 1.2695 1.4605 1.4578 1.1704 2.0392 1.2940 1.7795 1.3787 1.2647 2.2585 2.1455 1.3908 PO 00000 Frm 00178 Fmt 4701 Sfmt 4702 E:\FR\FM\25APP2.SGM 25APP2 Average hourly wage** (3 years) 29.5481 35.7436 30.3577 20.7862 27.4716 38.4416 25.9210 26.5042 35.0252 43.7800 38.8140 30.7504 37.8867 * 20.0252 26.8758 40.9700 42.6254 42.9969 48.3299 35.1560 29.3794 35.4440 36.9904 19.9625 * 27.9556 31.4867 26.5384 34.0977 25.2406 24.7734 41.2427 20.6998 33.0470 37.0998 20.4331 28.4890 33.9652 36.7280 31.8092 22.7171 29.3587 26.5349 35.3141 35.5529 43.9757 * * * * * * * * * * * * * * * * * * * Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules 24173 TABLE 2.—HOSPITAL CASE-MIX INDEXES FOR DISCHARGES OCCURRING IN FEDERAL FISCAL YEAR 2005; HOSPITAL WAGE INDEXES FOR FEDERAL FISCAL YEAR 2007; HOSPITAL AVERAGE HOURLY WAGES FOR FEDERAL FISCAL YEARS 2005 (2001 WAGE DATA), 2006 (2002 WAGE DATA), AND 2007 (2003 WAGE DATA); WAGE INDEXES AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY WAGES—Continued Case-mix index 3 wwhite on PROD1PC61 with PROPOSALS2 Provider No. 060001 ..................................................... 060003 ..................................................... 060004 ..................................................... 060006 ..................................................... 060007 ..................................................... 060008 ..................................................... 060009 ..................................................... 060010 ..................................................... 060011 ..................................................... 060012 ..................................................... 060013 ..................................................... 060014 ..................................................... 060015 ..................................................... 060016 ..................................................... 060018 ..................................................... 060020 ..................................................... 060022 ..................................................... 060023 ..................................................... 060024 ..................................................... 060027 ..................................................... 060028 ..................................................... 060030 ..................................................... 060031 ..................................................... 060032 ..................................................... 060034 ..................................................... 060036 ..................................................... 060041 ..................................................... 060043 ..................................................... 060044 ..................................................... 060049 ..................................................... 060050 ..................................................... 060054 ..................................................... 060057 ..................................................... 060064 ..................................................... 060065 ..................................................... 060071 ..................................................... 060075 ..................................................... 060076 ..................................................... 060096 ..................................................... 060100 ..................................................... 060103 ..................................................... 060104 ..................................................... 060107 ..................................................... 060111 ..................................................... 060112 ..................................................... 060113 ..................................................... 060114 ..................................................... 060115 ..................................................... 060116 ..................................................... 060117 ..................................................... 070001 ..................................................... 070002 ..................................................... 070003 ..................................................... 070004 ..................................................... 070005 ..................................................... 070006 2 ................................................... 070007 ..................................................... 070008 ..................................................... 070009 ..................................................... 070010 ..................................................... 070011 ..................................................... 070012 ..................................................... 070015 ..................................................... 070016 ..................................................... 070017 ..................................................... 070018 2 ................................................... VerDate Aug<31>2005 17:10 Apr 24, 2006 Jkt 208001 FY 2007 wage index (10/1/2006– 3/31/2007) FY 2007 wage index (4/1/2007– 9/30/2007) Average hourly wage FY 2005 1 Average hourly wage FY 2006 1 Average hourly wage FY 2007 1 0.9930 1.0805 1.0924 0.9331 * 0.9331 1.0924 0.9689 1.0924 0.9331 0.9331 1.0924 1.0924 0.9331 0.9331 0.9331 0.9697 1.0805 1.0924 1.0805 1.0924 0.9689 0.9697 1.0924 1.0924 0.9331 0.9331 0.9331 1.0805 0.9594 * 1.0037 * 1.0924 1.0924 0.9331 1.0037 0.9331 1.0805 1.0924 1.0805 1.0924 1.0924 * 1.0924 1.0924 1.0924 * * * 1.2701 1.1750 1.1750 1.1750 1.2701 1.3038 1.2020 1.1750 1.1750 1.3038 1.1750 1.1750 1.1750 1.2701 1.2701 1.3038 0.9930 1.0805 1.0924 0.9331 * 0.9331 1.0924 0.9689 1.0924 0.9331 0.9331 1.0924 1.0924 0.9331 0.9331 0.9331 0.9697 1.0805 1.0924 1.0805 1.0924 0.9689 0.9697 1.0924 1.0924 0.9331 0.9331 0.9331 1.0805 0.9594 * 1.0037 * 1.0924 1.0924 0.9331 1.0037 0.9331 1.0805 1.0924 1.0805 1.0924 1.0924 * 1.0924 1.0924 1.0924 * * * 1.2511 1.1750 1.1750 1.1750 1.2511 1.3008 1.2020 1.1750 1.1750 1.3008 1.1750 1.1750 1.1750 1.2511 1.2511 1.3008 24.9410 24.7856 28.0656 22.7493 21.4792 21.8037 27.0511 27.2290 26.1958 24.1557 24.9708 29.6744 30.1158 23.9655 23.6620 22.2052 25.7832 26.7285 28.7231 26.6348 27.9686 26.0011 25.6207 28.2234 28.4604 20.4635 22.7123 20.0939 25.2471 26.8089 21.9108 23.5803 26.9891 30.0963 28.5282 20.2706 30.7835 25.5406 27.4085 29.7690 28.8063 30.8625 26.8267 31.2571 * * * * * * 32.2718 29.0663 31.3716 27.3004 29.3265 33.9310 30.3648 24.9176 28.8649 33.1535 27.5391 40.3337 30.9728 29.6662 30.3951 35.7189 26.8470 24.2224 29.9649 24.5704 * 23.3859 28.7645 28.9850 27.2833 26.2469 24.5994 31.2588 30.4533 25.6527 25.7628 22.6748 26.5238 27.7644 29.0130 28.0909 30.0448 26.6251 26.3650 30.4247 29.8445 20.7131 23.4978 18.7896 25.0360 29.0598 * 22.3490 * 31.3105 31.1987 25.7248 32.7563 26.8236 30.0602 32.1537 30.3002 32.0889 26.1883 * * * * * * * 34.0302 31.1530 32.4197 29.2544 32.1668 36.8469 31.7125 26.4806 30.2706 32.5798 29.9105 44.1424 33.4595 31.0903 31.7223 37.6081 28.5246 30.1449 32.9128 25.5300 * 23.0325 31.2466 28.4315 34.2985 27.9068 27.6808 32.4518 33.5968 26.9441 25.3149 23.5825 28.8935 29.7290 30.3956 30.2413 32.0442 27.6439 28.4559 31.9803 31.4601 20.8128 23.9297 17.2960 26.8821 30.6057 * 24.3711 * 33.4859 33.7362 27.5209 33.9644 26.4669 33.4708 33.3856 33.2964 33.4664 27.1594 * 36.1471 * * * * * 35.1488 32.9351 33.5145 30.2004 33.4862 38.1568 35.6535 27.6747 32.5288 34.7931 31.1602 30.3498 35.2743 31.3403 33.4075 39.4816 1.5478 1.4520 1.3094 1.4136 *** 1.2525 1.4588 1.7178 1.5317 1.4984 1.4281 1.8075 1.6923 1.2587 1.3005 1.5999 1.6231 1.7032 1.8041 1.5798 1.4361 1.3963 1.5545 1.5252 1.6754 1.1583 0.9165 1.0621 1.1635 1.3952 *** 1.4677 *** 1.6788 1.3952 1.1650 1.2838 1.2449 1.5490 1.7275 1.3008 1.3986 1.4001 *** 1.7095 1.2832 1.2889 0.8453 1.2462 1.2872 1.6340 1.8265 1.0862 1.1975 1.3661 1.3682 1.3065 1.2465 1.2280 1.7865 1.4018 1.1831 1.3748 1.3865 1.3862 1.3414 PO 00000 Frm 00179 Fmt 4701 Sfmt 4702 E:\FR\FM\25APP2.SGM 25APP2 Average hourly wage** (3 years) 26.7856 26.4193 30.3597 24.3032 21.4792 22.7676 29.0996 28.2640 29.1788 26.0885 25.7684 31.1092 31.2391 25.5481 24.9213 22.8530 27.0838 28.0786 29.4074 28.4406 30.0599 26.7912 26.8116 30.1845 29.9383 20.6604 23.4036 18.6864 25.7042 28.8870 21.9108 23.4286 26.9891 31.6328 31.1126 24.6844 32.5290 26.2923 30.3136 31.7750 30.8687 32.1175 26.7219 31.2571 36.1471 * * * * * 33.8080 31.0526 32.4479 28.9166 31.7706 36.3107 32.6301 26.3851 30.5697 33.5340 29.5355 37.0108 33.2900 30.7038 31.8732 37.7074 24174 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules TABLE 2.—HOSPITAL CASE-MIX INDEXES FOR DISCHARGES OCCURRING IN FEDERAL FISCAL YEAR 2005; HOSPITAL WAGE INDEXES FOR FEDERAL FISCAL YEAR 2007; HOSPITAL AVERAGE HOURLY WAGES FOR FEDERAL FISCAL YEARS 2005 (2001 WAGE DATA), 2006 (2002 WAGE DATA), AND 2007 (2003 WAGE DATA); WAGE INDEXES AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY WAGES—Continued Case-mix index 3 wwhite on PROD1PC61 with PROPOSALS2 Provider No. 070019 ..................................................... 070020 ..................................................... 070021 ..................................................... 070022 ..................................................... 070024 ..................................................... 070025 ..................................................... 070027 ..................................................... 070028 ..................................................... 070029 ..................................................... 070031 ..................................................... 070033 ..................................................... 070034 2 ................................................... 070035 ..................................................... 070036 ..................................................... 070038 ..................................................... 070039 ..................................................... 080001 ..................................................... 080002 ..................................................... 080003 ..................................................... 080004 ..................................................... 080006 ..................................................... 080007 ..................................................... 090001 ..................................................... 090002 ..................................................... 090003 ..................................................... 090004 ..................................................... 090005 ..................................................... 090006 ..................................................... 090007 ..................................................... 090008 ..................................................... 090011 ..................................................... 100001 ..................................................... 100002 ..................................................... 100004 ..................................................... 100006 ..................................................... 100007 ..................................................... 100008 ..................................................... 100009 ..................................................... 100010 ..................................................... 100012 ..................................................... 100014 ..................................................... 100015 ..................................................... 100017 ..................................................... 100018 ..................................................... 100019 ..................................................... 100020 ..................................................... 100022 ..................................................... 100023 ..................................................... 100024 ..................................................... 100025 ..................................................... 100026 ..................................................... 100027 ..................................................... 100028 ..................................................... 100029 ..................................................... 100030 ..................................................... 100032 ..................................................... 100034 ..................................................... 100035 ..................................................... 100038 ..................................................... 100039 ..................................................... 100040 ..................................................... 100043 ..................................................... 100044 ..................................................... 100045 ..................................................... 100046 ..................................................... 100047 ..................................................... VerDate Aug<31>2005 17:10 Apr 24, 2006 Jkt 208001 FY 2007 wage index (10/1/2006– 3/31/2007) FY 2007 wage index (4/1/2007– 9/30/2007) Average hourly wage FY 2005 1 Average hourly wage FY 2006 1 Average hourly wage FY 2007 1 1.2701 1.1823 1.1750 1.2701 1.2020 1.1750 1.1750 1.3038 1.1750 1.2701 1.3038 1.3038 1.1750 1.2093 1.2093 1.2701 1.0941 * 1.0941 1.0878 0.9843 1.0254 1.1028 * 1.1076 1.1076 1.1076 1.1076 * 1.1076 1.1076 0.9046 0.9642 * 0.9409 0.9409 0.9825 0.9825 * 0.9339 0.9397 0.9249 0.9397 0.9935 0.9440 * 1.0470 0.9409 0.9825 0.8609 0.8609 0.8609 0.9440 0.9825 0.9409 0.9249 0.9825 0.9866 1.0470 1.0470 0.9046 0.9249 0.9857 0.9409 0.9249 0.9453 1.2511 1.1823 1.1750 1.2511 1.2020 1.1750 1.1750 1.3008 1.1750 1.2511 1.3008 1.3008 1.1750 1.2093 1.2511 1.2511 1.0941 * 1.0941 1.0878 0.9843 1.0254 1.1028 * 1.1076 1.1076 1.1076 1.1076 * 1.1076 1.1076 0.9046 0.9642 * 0.9409 0.9409 0.9825 0.9825 * 0.9339 0.9397 0.9249 0.9397 0.9935 0.9440 * 1.0470 0.9409 0.9825 0.8609 0.8609 0.8609 0.9440 0.9825 0.9409 0.9249 0.9825 0.9866 1.0470 1.0470 0.9046 0.9249 0.9857 0.9409 0.9249 0.9453 29.6290 29.9507 31.4397 32.3625 31.0243 29.2540 27.3487 29.5653 26.3871 27.2359 35.5355 35.6831 27.1816 34.0555 31.1133 35.0164 30.2463 26.4192 27.1131 26.0092 24.4204 24.6485 31.3552 29.6780 27.0514 29.9785 30.2504 25.9086 30.1419 29.6744 32.4412 25.2381 22.1269 16.2637 26.2372 25.4333 25.7377 24.4666 26.9486 24.5762 22.3054 22.5781 22.9545 27.8582 25.5566 23.6106 29.0519 21.4015 27.6476 21.1174 21.3533 12.0314 23.7818 26.9307 22.4887 23.0174 24.4064 25.3590 27.4422 26.6016 23.5372 22.8963 26.3208 23.0520 26.6169 24.4212 31.8148 31.0935 33.2357 35.4120 32.0430 30.9938 31.8018 31.5036 27.7213 28.9190 37.1929 36.3899 27.5585 36.1610 25.7516 31.2269 30.0242 27.7932 29.2266 27.4921 25.6160 27.0074 35.0413 * 29.2660 32.2021 30.7728 29.5590 * 29.1059 34.0693 24.4060 25.3389 16.5974 26.3789 26.5378 27.4314 25.9381 * 26.3788 24.5862 24.6038 26.1580 28.1481 27.6179 23.9414 29.9345 23.0074 30.2395 22.1580 21.4703 16.1223 26.8661 27.5844 24.0943 25.2450 25.9415 26.9407 29.8583 28.4627 23.6443 25.2273 28.3596 26.9641 26.3673 25.0404 34.6720 33.3626 36.0196 38.9946 35.2369 31.9792 30.8014 35.1796 30.7435 30.4813 39.7676 38.1857 30.3920 38.8442 25.5738 32.8867 32.7311 29.1393 31.1057 29.3258 27.0472 29.7437 37.9529 * 31.2552 35.6103 32.4581 29.1423 * 32.8342 36.3623 23.8151 26.4462 * 27.9464 28.2465 28.9763 27.1166 * 28.0401 25.3244 25.8553 27.5965 29.5692 28.1170 27.1058 33.2813 24.6790 29.4861 23.3147 22.9234 18.8639 27.4585 28.4463 24.7251 26.3898 27.9305 29.2732 31.0393 29.5742 25.9099 26.5006 29.7123 30.5941 27.4887 26.1017 1.3161 1.3759 1.2443 1.7575 1.3670 1.8013 1.3452 1.6360 1.3189 1.3075 1.3631 1.4079 1.2940 1.6631 1.1294 0.9397 1.6313 *** 1.5848 1.4833 1.2902 1.4550 1.7661 *** 1.2598 1.9157 1.3435 1.4536 *** 1.3953 2.0690 1.5529 1.4122 0.8962 1.6390 1.6725 1.7204 1.4625 *** 1.6806 1.3972 1.3865 1.6159 1.6523 1.6733 *** 1.6879 1.5132 1.2661 1.6860 1.6048 0.9126 1.3425 1.2634 1.3103 1.7935 1.9078 1.5645 1.9590 1.4635 1.7080 1.3536 1.4428 1.3397 1.2924 1.7742 PO 00000 Frm 00180 Fmt 4701 Sfmt 4702 E:\FR\FM\25APP2.SGM 25APP2 Average hourly wage** (3 years) 32.0589 31.4683 33.5900 35.6213 32.7950 30.7563 30.0429 32.0982 28.2936 28.9306 37.5730 36.7733 28.3695 36.4123 26.3181 33.0224 31.0532 27.8103 29.2127 27.6577 25.7475 27.1759 34.8066 29.6780 29.2762 32.6016 31.1497 28.1875 30.1419 30.3957 34.2608 24.4521 24.6809 16.4390 26.8585 26.8017 27.4811 25.8395 26.9486 26.3901 24.0840 24.2886 25.6638 28.5441 27.1634 24.9057 30.8780 23.0038 29.0764 22.2233 21.9413 15.6138 26.0611 27.6559 23.8482 24.9308 25.9959 27.1757 29.4968 28.2437 24.3687 24.9156 28.1591 27.0017 26.8296 25.2191 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules 24175 TABLE 2.—HOSPITAL CASE-MIX INDEXES FOR DISCHARGES OCCURRING IN FEDERAL FISCAL YEAR 2005; HOSPITAL WAGE INDEXES FOR FEDERAL FISCAL YEAR 2007; HOSPITAL AVERAGE HOURLY WAGES FOR FEDERAL FISCAL YEARS 2005 (2001 WAGE DATA), 2006 (2002 WAGE DATA), AND 2007 (2003 WAGE DATA); WAGE INDEXES AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY WAGES—Continued Case-mix index 3 wwhite on PROD1PC61 with PROPOSALS2 Provider No. 100048 100049 100050 100051 100052 100053 100054 100055 100056 100057 100061 100062 100063 100067 100068 100069 100070 100071 100072 100073 100075 100076 100077 100079 100080 100081 100084 100086 100087 100088 100090 100092 100093 100098 100099 100102 100103 100105 100106 100107 100108 100109 100110 100113 100114 100117 100118 100121 100122 100124 100125 100126 100127 100128 100130 100131 100132 100134 100135 100137 100139 100140 100142 100150 100151 100154 ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... VerDate Aug<31>2005 17:10 Apr 24, 2006 Jkt 208001 FY 2007 wage index (10/1/2006– 3/31/2007) FY 2007 wage index (4/1/2007– 9/30/2007) Average hourly wage FY 2005 1 Average hourly wage FY 2006 1 Average hourly wage FY 2007 1 0.8609 0.8908 0.9825 0.9409 0.8908 0.9825 0.8654 0.9249 * 0.9409 0.9825 0.8964 0.9249 0.9249 0.9397 0.9249 0.9866 0.9249 0.9397 1.0470 0.9249 0.9825 0.9453 * 0.9642 0.8609 0.9409 1.0470 0.9866 0.9046 0.9046 0.9440 0.8609 * 0.8908 0.8734 * 0.9604 0.8609 0.9339 0.8609 0.9409 0.9409 0.9299 0.9825 0.9046 0.9046 0.8908 0.8654 0.8609 0.9825 0.9249 0.9249 0.9249 0.9642 0.9825 0.9249 0.8609 0.9316 0.8908 0.9299 0.9046 0.8609 0.9825 0.9046 0.9825 0.8609 0.8908 0.9825 0.9409 0.8908 0.9825 0.8654 0.9249 * 0.9409 0.9825 0.8964 0.9249 0.9249 0.9397 0.9249 0.9866 0.9249 0.9397 1.0470 0.9249 0.9825 0.9453 * 0.9642 0.8609 0.9409 1.0470 0.9866 0.9046 0.9046 0.9440 0.8609 * 0.8908 0.8734 * 0.9604 0.8609 0.9339 0.8609 0.9409 0.9409 0.9299 0.9825 0.9046 0.9046 0.8908 0.8654 0.8609 0.9825 0.9249 0.9249 0.9249 0.9642 0.9825 0.9249 0.8609 0.9316 0.8908 0.9299 0.9046 0.8609 0.9825 0.9046 0.9825 18.3767 22.9532 20.6893 22.3311 20.9078 27.3383 25.7279 22.1051 25.7945 22.6038 26.7673 24.1413 21.5566 23.9333 24.9025 22.4386 23.7746 23.4176 24.2934 25.3685 23.3503 21.0777 24.3478 * 26.3596 16.9168 25.4140 26.4817 25.9909 24.8729 24.0501 26.0856 21.1547 21.2505 20.4328 22.8850 21.7494 24.9503 20.2882 24.4484 16.3757 23.8836 28.3699 25.0067 27.7413 26.0451 23.6669 24.0937 21.2597 21.6483 25.3532 23.2996 21.3223 25.6763 22.8324 25.8316 23.0428 19.5337 22.3071 23.3692 14.5046 24.8165 20.7219 25.7122 26.1848 26.3703 18.8771 22.9810 19.8713 23.1940 22.3920 27.3224 28.0512 23.5332 * 25.3897 29.2565 25.2340 24.7026 26.1213 25.9202 24.7442 24.8883 24.9682 26.0459 30.3358 25.1691 21.9483 26.0347 * 27.0126 15.6662 26.3393 28.2641 27.1531 25.9182 24.2422 28.4789 21.3524 * 21.3036 23.8596 * 26.8091 24.0389 26.1337 22.0750 24.9951 29.1494 26.3806 29.2195 26.4536 28.0569 24.8579 23.4751 22.7023 26.7452 24.4515 24.4485 29.4979 24.2046 29.2462 24.3293 20.9244 24.0024 25.1974 17.5489 26.4720 22.9577 26.1990 28.1322 27.6127 19.7932 23.3622 21.7480 28.0190 23.5420 28.0804 29.1317 25.4970 * 24.9844 31.0039 26.5512 26.0284 26.9257 27.0727 25.9129 27.0935 26.4245 26.3997 30.3162 26.0289 23.4786 29.4683 * 28.4894 16.8158 26.7820 29.9772 30.3527 26.1923 25.0930 27.9279 22.2184 * 24.7212 25.3617 * 29.2659 23.8545 26.1391 21.2176 25.9430 29.4304 27.5595 29.2327 27.5443 28.2361 26.5604 23.9552 25.0550 29.5003 29.0390 26.1506 29.8875 25.2345 28.1549 26.2877 20.4785 28.0900 24.6076 16.6310 26.1383 23.8571 27.5276 30.5977 28.2710 0.9448 1.2016 1.1313 1.3495 1.3169 1.2474 1.2414 1.3622 *** 1.5600 1.5507 1.7063 1.2658 1.4126 1.7656 1.3348 1.7383 1.2411 1.3793 1.7701 1.4953 1.2143 1.3599 1.6395 1.8174 1.0745 1.8081 1.2749 1.8986 1.6439 1.5387 1.5509 1.7611 *** 1.0847 1.1374 0.9737 1.4783 0.9711 1.2031 0.8066 1.3164 1.6056 1.9725 1.3113 1.1967 1.3392 1.1021 1.2277 1.1827 1.2466 1.3389 1.6178 2.1100 1.1732 1.3335 1.2373 0.9129 1.6218 1.2238 0.8408 1.1473 1.2230 1.3097 1.8299 1.5669 PO 00000 Frm 00181 Fmt 4701 Sfmt 4702 E:\FR\FM\25APP2.SGM 25APP2 Average hourly wage** (3 years) 19.0265 23.1049 20.7633 24.4952 22.3120 27.5770 27.5948 23.6039 25.7945 24.3593 29.0171 25.3312 24.1067 25.6361 25.9472 24.3174 25.1963 25.0038 25.6529 28.6546 24.8882 22.0898 26.5871 * 27.3255 16.4460 26.1607 28.2256 27.9094 25.6760 24.4705 27.5045 21.5835 21.2505 22.1811 24.0415 21.7494 27.0006 22.7821 25.5929 19.8907 24.9469 29.0104 26.3652 28.7304 26.7071 27.0580 25.1840 22.8872 23.1604 27.3520 25.6215 24.0288 28.4604 24.0576 27.7421 24.6022 20.3225 24.6354 24.4568 16.2799 25.8508 22.5245 26.4717 28.4241 27.4772 24176 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules TABLE 2.—HOSPITAL CASE-MIX INDEXES FOR DISCHARGES OCCURRING IN FEDERAL FISCAL YEAR 2005; HOSPITAL WAGE INDEXES FOR FEDERAL FISCAL YEAR 2007; HOSPITAL AVERAGE HOURLY WAGES FOR FEDERAL FISCAL YEARS 2005 (2001 WAGE DATA), 2006 (2002 WAGE DATA), AND 2007 (2003 WAGE DATA); WAGE INDEXES AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY WAGES—Continued Case-mix index 3 wwhite on PROD1PC61 with PROPOSALS2 Provider No. 100156 ..................................................... 100157 ..................................................... 100160 ..................................................... 100161 ..................................................... 100166 ..................................................... 100167 ..................................................... 100168 ..................................................... 100172 ..................................................... 100173 ..................................................... 100175 ..................................................... 100176 ..................................................... 100177 ..................................................... 100179 ..................................................... 100180 ..................................................... 100181 ..................................................... 100183 ..................................................... 100187 ..................................................... 100189 ..................................................... 100191 ..................................................... 100200 ..................................................... 100204 ..................................................... 100206 ..................................................... 100208 ..................................................... 100209 ..................................................... 100210 ..................................................... 100211 ..................................................... 100212 ..................................................... 100213 ..................................................... 100217 ..................................................... 100220 ..................................................... 100223 ..................................................... 100224 ..................................................... 100225 ..................................................... 100226 ..................................................... 100228 ..................................................... 100230 ..................................................... 100231 ..................................................... 100232 h ................................................... 100234 ..................................................... 100236 ..................................................... 100237 ..................................................... 100238 ..................................................... 100239 ..................................................... 100240 ..................................................... 100242 ..................................................... 100243 ..................................................... 100244 ..................................................... 100246 ..................................................... 100248 ..................................................... 100249 ..................................................... 100252 ..................................................... 100253 ..................................................... 100254 ..................................................... 100255 ..................................................... 100256 ..................................................... 100258 ..................................................... 100259 ..................................................... 100260 ..................................................... 100262 ..................................................... 100264 ..................................................... 100265 ..................................................... 100266 ..................................................... 100267 ..................................................... 100268 ..................................................... 100269 ..................................................... 100275 ..................................................... VerDate Aug<31>2005 17:10 Apr 24, 2006 Jkt 208001 FY 2007 wage index (10/1/2006– 3/31/2007) FY 2007 wage index (4/1/2007– 9/30/2007) Average hourly wage FY 2005 1 Average hourly wage FY 2006 1 Average hourly wage FY 2007 1 0.8734 0.9249 0.8609 0.9409 0.9866 1.0470 0.9642 0.9825 0.9249 0.8840 0.9857 0.9440 0.9046 0.9249 0.9825 0.9825 0.9825 1.0470 0.9249 1.0470 0.9299 0.9249 * 0.9825 1.0470 0.9249 0.8964 0.9866 0.9857 0.9339 0.8654 1.0470 1.0470 0.9046 1.0470 1.0470 0.8609 0.9046 0.9642 0.9453 1.0470 0.9249 0.9866 0.9825 0.8609 0.9249 0.9339 0.9857 0.9249 0.9249 0.9857 0.9642 0.9316 0.9249 0.9249 1.0470 0.9249 0.9857 * 0.9249 0.9249 0.8609 0.9866 0.9642 0.9642 0.9642 0.8734 0.9249 0.8609 0.9409 0.9866 1.0470 0.9642 0.9825 0.9249 0.8840 0.9857 0.9440 0.9046 0.9249 0.9825 0.9825 0.9825 1.0470 0.9249 1.0470 0.9299 0.9249 * 0.9825 1.0470 0.9249 0.8964 0.9866 0.9857 0.9339 0.8654 1.0470 1.0470 0.9046 1.0470 1.0470 0.8609 0.9046 0.9642 0.9453 1.0470 0.9249 0.9866 0.9825 0.8609 0.9249 0.9339 0.9857 0.9249 0.9249 0.9857 0.9642 0.9316 0.9249 0.9249 1.0470 0.9249 0.9857 * 0.9249 0.9249 0.8609 0.9866 0.9642 0.9642 0.9642 22.2757 25.9133 27.2019 28.3607 24.4251 26.8584 26.0864 18.4651 22.4866 22.0666 29.8326 25.3973 26.6537 26.3299 19.5022 26.7893 26.1394 26.5763 24.3553 28.0926 24.4697 23.0340 24.9854 25.0778 28.6449 * 24.2669 25.1893 25.2635 25.0154 23.4556 23.3593 27.9473 27.8003 27.2873 26.3690 24.6994 23.9405 25.2574 25.9282 25.6112 27.1748 26.9668 23.4830 21.5130 25.2987 24.1515 27.6382 25.9170 23.4021 24.9860 24.4051 25.0192 22.2341 26.0629 31.8772 24.9404 25.2630 26.3954 25.0250 23.4758 22.6614 26.5059 29.8289 25.3228 24.3059 26.7092 27.3851 26.9851 28.8077 27.9618 30.3694 27.1292 18.2735 24.8721 23.5455 31.2694 26.6781 29.5619 27.1804 21.8540 27.4951 27.3653 28.4136 26.6340 29.8963 25.7537 25.2196 * 26.6246 28.9486 24.7095 24.7566 27.1936 25.2907 26.0905 24.7015 24.8077 28.4316 29.3317 29.8952 28.1703 25.5175 24.9322 26.3601 26.6585 31.3543 28.4302 27.7592 25.3265 24.0990 26.1131 25.2584 28.9894 27.7797 23.2084 25.8540 25.7121 25.7338 24.4808 28.8856 31.2482 26.0175 27.5188 * 25.5489 24.1454 23.2340 27.3768 29.2898 26.7450 26.0361 27.4848 28.9595 31.2701 28.6336 29.6865 30.7365 27.9334 20.8673 26.6141 24.0790 31.0778 27.6011 29.6646 29.2623 21.8409 28.1843 28.0710 29.4643 27.8297 29.9888 27.3984 26.6863 * 26.6405 29.7288 23.9827 26.0396 27.3982 25.9973 27.8611 25.6022 26.1308 28.6655 28.7732 28.4669 29.6743 26.3337 27.3158 28.2662 28.1991 32.3006 29.9215 28.4351 25.7112 25.8928 27.1058 26.5235 29.9108 28.7311 24.0596 27.0442 27.9291 26.1147 26.3538 29.7926 31.3505 27.1642 27.0181 * 25.9597 25.9086 23.7655 28.7517 29.9909 27.3632 27.0080 1.1245 1.5980 1.2422 1.5442 1.5055 1.2695 1.4259 1.3322 1.7421 0.9891 1.9676 1.2982 1.7788 1.3332 1.0919 1.2043 1.2393 1.2966 1.2986 1.4276 1.5591 1.3147 *** 1.3796 1.5797 1.2015 1.5477 1.5951 1.2343 1.6552 1.5470 1.2356 1.2202 1.2371 1.3987 1.3410 1.7304 1.2545 1.3964 1.4175 1.9228 1.6275 1.2871 0.9280 1.4467 1.5924 1.3521 1.5959 1.5784 1.3230 1.2232 1.3805 1.5434 1.2809 1.8683 1.5255 1.2692 1.3677 *** 1.2637 1.3089 1.4274 1.2996 1.1892 1.3995 1.3040 PO 00000 Frm 00182 Fmt 4701 Sfmt 4702 E:\FR\FM\25APP2.SGM 25APP2 Average hourly wage** (3 years) 25.5333 27.4711 28.5770 28.6073 27.2716 29.3059 27.0344 19.1957 24.6478 23.2771 30.7413 26.6232 28.6728 27.6555 21.1771 27.5031 27.1892 28.2193 26.3354 29.3614 25.9174 25.0189 24.9854 26.1523 29.1000 24.3359 25.0603 26.6057 25.5366 26.3924 24.5922 24.8045 28.3365 28.6694 28.6149 28.0367 25.5418 25.3587 26.6107 26.9446 29.5164 28.5609 27.7562 24.8537 23.8355 26.2400 25.3682 28.8806 27.5094 23.5536 25.9795 26.0507 25.6499 24.3804 28.2929 31.4813 26.0636 26.6532 26.3954 25.5115 24.5857 23.2568 27.5078 29.7065 26.5403 25.8478 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules 24177 TABLE 2.—HOSPITAL CASE-MIX INDEXES FOR DISCHARGES OCCURRING IN FEDERAL FISCAL YEAR 2005; HOSPITAL WAGE INDEXES FOR FEDERAL FISCAL YEAR 2007; HOSPITAL AVERAGE HOURLY WAGES FOR FEDERAL FISCAL YEARS 2005 (2001 WAGE DATA), 2006 (2002 WAGE DATA), AND 2007 (2003 WAGE DATA); WAGE INDEXES AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY WAGES—Continued Case-mix index 3 wwhite on PROD1PC61 with PROPOSALS2 Provider No. 100276 100277 100279 100281 100284 100285 100286 100287 100288 100289 100290 100291 100292 100293 100294 100295 100296 100298 100299 110001 110002 110003 110004 110005 110006 110007 110008 110010 110011 110015 110016 110018 110020 110023 110024 110025 110026 110027 110028 110029 110030 110031 110032 110033 110034 110035 110036 110038 110039 110040 110041 110042 110043 110044 110045 110046 110049 110050 110051 110054 110056 110059 110063 110064 110069 110071 ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... VerDate Aug<31>2005 17:10 Apr 24, 2006 Jkt 208001 FY 2007 wage index (10/1/2006– 3/31/2007) FY 2007 wage index (4/1/2007– 9/30/2007) Average hourly wage FY 2005 1 Average hourly wage FY 2006 1 Average hourly wage FY 2007 1 1.0470 0.9825 0.9339 1.0470 0.9825 * 0.9935 0.9642 0.9642 1.0470 0.9191 0.9440 0.8609 * * * 0.9825 0.9316 0.9866 0.9644 0.9644 0.9046 0.8965 0.9761 0.9827 0.8969 0.9761 0.9761 0.9761 0.9761 0.7577 0.9761 0.9761 0.9644 0.9089 0.9046 0.7577 0.7964 0.9681 0.9644 0.9761 0.9761 0.7577 0.9761 0.9681 0.9761 0.9089 0.8101 0.9681 0.9644 0.9707 0.9761 0.9089 0.7577 0.9761 0.9761 * 0.9050 0.7577 0.9644 * 0.7577 * 0.8256 0.9176 0.7577 1.0470 0.9825 0.9339 1.0470 0.9825 * 0.9935 0.9642 0.9642 1.0470 0.9191 0.9440 0.8609 * * * 0.9825 0.9316 0.9866 0.9644 0.9644 0.9046 0.8965 0.9761 0.9827 0.8969 0.9761 0.9761 0.9761 0.9761 0.7577 0.9761 0.9761 0.9644 0.9089 0.9046 0.7577 0.7964 0.9681 0.9644 0.9761 0.9761 0.7577 0.9761 0.9681 0.9761 0.9089 0.8101 0.9681 0.9644 0.9707 0.9761 0.9089 0.7577 0.9761 0.9761 * 0.9050 0.7577 0.9644 * 0.7577 * 0.8256 0.9176 0.7577 27.2589 47.3905 25.4909 27.0864 22.5927 * 27.1051 28.2229 37.4785 28.4504 * * * * * * * * * 25.1164 21.8616 20.0968 22.7929 22.3645 25.0719 30.7430 23.4662 28.7690 25.4620 25.5661 18.8376 25.6485 24.8735 25.3746 23.8091 31.5253 20.5740 19.2323 25.1836 25.2335 25.0842 24.1711 20.7211 25.2326 24.4141 25.7562 25.4854 20.5880 19.4032 18.8744 21.5402 26.8321 25.2788 19.6940 21.3922 24.0022 19.8706 25.6020 19.0995 22.2250 23.0080 18.7097 20.3760 23.8739 22.3006 13.3731 30.0576 16.5427 26.8606 28.6660 23.8170 * 29.4284 28.3427 33.8141 29.2915 23.5080 * * * * * * * * 25.3102 25.3897 21.4002 23.9911 22.9000 28.6090 23.8729 27.1711 29.7142 26.0899 26.6610 21.7610 28.2431 26.8501 27.3029 25.7205 26.1311 21.2826 20.2175 28.1619 24.8893 26.4770 24.7874 21.9407 28.3210 26.9986 27.4583 26.8789 21.2138 24.7248 19.7509 23.4074 28.6873 26.6323 20.9654 24.9821 23.8292 * 26.1320 19.4276 25.7085 * 20.5565 * 24.2739 24.1669 18.0224 31.2531 20.7768 28.5951 29.8789 22.3173 * 28.4751 28.2583 29.6965 29.5902 25.1300 28.4799 26.9608 32.7722 30.3556 26.1791 * * * 26.6205 26.3797 22.0049 24.4124 27.9633 28.9119 26.3197 30.1360 31.8635 28.0194 28.7369 20.7638 26.4698 27.1406 30.3424 27.3054 29.9555 21.3621 20.8174 30.5430 26.6096 28.1621 26.3138 22.5419 29.6154 28.0571 28.1179 27.7279 21.7736 25.8629 19.1800 24.7306 34.0887 23.9626 22.6491 23.5532 25.5453 * 28.2504 * 26.5180 * 20.6838 * 23.6909 24.9679 19.7309 1.2587 1.4104 1.3178 1.3391 1.0591 1.2194 1.6325 1.3417 1.5562 1.7571 1.1732 1.3066 1.3038 *** *** *** 1.3555 0.8740 1.3010 1.2775 1.3523 1.2617 1.2789 1.2301 1.4702 1.6002 1.2995 2.1912 1.2378 1.1303 1.1761 1.1832 1.3269 1.3249 1.4064 1.4741 1.1102 1.0741 1.8298 1.7593 1.2303 1.2875 1.1329 1.3719 1.6774 1.6293 1.8177 1.4966 1.4547 1.1223 1.2552 1.0876 1.7925 1.1525 1.1388 1.1557 *** 1.1141 1.1491 1.4092 0.9187 1.1352 *** 1.4874 1.2898 1.0437 PO 00000 Frm 00183 Fmt 4701 Sfmt 4702 E:\FR\FM\25APP2.SGM 25APP2 Average hourly wage** (3 years) 29.5875 22.4551 27.0996 28.6295 22.9046 * 28.3833 28.2764 33.2143 29.1535 24.3178 28.4799 26.9608 32.7722 30.3556 26.1791 * * * 25.6873 24.5871 21.1828 23.7130 24.5295 27.4847 26.5387 26.9747 30.1393 26.5176 27.0953 20.4328 26.7925 26.3040 27.7599 25.5765 28.9712 21.0771 20.0273 27.9386 25.6552 26.6637 25.1188 21.7322 27.8235 26.5634 27.1607 26.7470 21.2085 23.0782 19.2690 23.1719 29.8762 25.2951 21.0788 23.2970 24.4504 19.8706 26.6887 19.2687 24.8264 23.0080 19.8951 20.3760 23.9385 23.8522 16.8213 24178 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules TABLE 2.—HOSPITAL CASE-MIX INDEXES FOR DISCHARGES OCCURRING IN FEDERAL FISCAL YEAR 2005; HOSPITAL WAGE INDEXES FOR FEDERAL FISCAL YEAR 2007; HOSPITAL AVERAGE HOURLY WAGES FOR FEDERAL FISCAL YEARS 2005 (2001 WAGE DATA), 2006 (2002 WAGE DATA), AND 2007 (2003 WAGE DATA); WAGE INDEXES AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY WAGES—Continued Case-mix index 3 wwhite on PROD1PC61 with PROPOSALS2 Provider No. 110073 110074 110075 110076 110078 110079 110080 110082 110083 110086 110087 110089 110091 110092 110095 110096 110100 110101 110104 110105 110107 110109 110111 110112 110113 110115 110121 110122 110124 110125 110128 110129 110130 110132 110135 110136 110142 110143 110146 110149 110150 110153 110161 110163 110164 110165 110166 110168 110172 110177 110179 110183 110184 110186 110187 110189 110190 110191 110192 110193 110194 110198 110200 110201 110203 110205 ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... VerDate Aug<31>2005 17:10 Apr 24, 2006 Jkt 208001 FY 2007 wage index (10/1/2006– 3/31/2007) FY 2007 wage index (4/1/2007– 9/30/2007) Average hourly wage FY 2005 1 Average hourly wage FY 2006 1 Average hourly wage FY 2007 1 0.7577 0.9827 0.8958 0.9761 0.9761 0.9761 0.9761 0.9761 0.9761 0.7577 0.9761 0.7577 0.9761 0.7577 0.8101 * 0.7577 0.7577 0.7577 0.7577 0.9554 0.7577 0.9681 0.7577 0.9681 0.9761 0.7577 0.8982 0.8005 0.9176 0.8958 0.8256 0.7577 0.7577 0.7577 * 0.7577 0.9761 0.8363 * 0.9644 0.9176 0.9761 0.8969 0.9554 0.9761 * 0.9644 0.9761 0.9681 * 0.9761 0.9761 0.8256 0.9644 0.9644 0.7759 0.9761 0.9761 * 0.7577 0.9761 0.8256 0.9554 0.9761 0.9644 0.7577 0.9827 0.8958 0.9761 0.9761 0.9761 0.9761 0.9761 0.9761 0.7577 0.9761 0.7577 0.9761 0.7577 0.8101 * 0.7577 0.7577 0.7577 0.7577 0.9554 0.7577 0.9681 0.7577 0.9681 0.9761 0.7577 0.8982 0.8005 0.9176 0.8958 0.8256 0.7577 0.7577 0.7577 * 0.7577 0.9761 0.8363 * 0.9644 0.9176 0.9761 0.8969 0.9554 0.9761 * 0.9644 0.9761 0.9681 * 0.9761 0.9761 0.8256 0.9644 0.9644 0.7759 0.9761 0.9761 * 0.7577 0.9761 0.8256 0.9554 0.9761 0.9644 16.3610 27.5836 20.9973 25.2424 27.8627 24.5255 21.5482 28.9731 26.2604 20.8557 26.2872 21.2013 26.3857 18.7397 21.8709 19.4498 16.5833 14.4630 19.5575 20.6270 26.0763 20.4726 20.5577 21.0612 16.7641 29.8699 21.2534 22.0210 20.9334 22.1458 23.2576 22.4202 17.6529 18.9927 20.0057 22.7715 17.3328 25.4932 19.9221 24.7686 23.8157 22.8660 27.4435 25.5461 26.4450 24.3897 25.2264 24.6321 27.0240 25.0129 26.1173 27.6020 25.5420 23.2348 22.5730 23.9404 19.1054 25.8409 25.7406 27.8223 16.3148 30.8014 21.2177 27.0388 25.8951 20.6150 18.6336 27.1207 22.0935 26.3506 29.5779 23.1024 22.3213 29.8366 27.8245 21.1509 28.0471 21.9509 26.5523 18.5527 23.4846 * 16.5600 16.4270 18.7951 21.1077 26.2526 21.4280 29.2190 24.2463 19.1753 32.0197 21.6637 23.7589 22.7058 22.4238 24.4596 23.3631 18.7549 19.2307 20.4411 15.8573 18.1980 27.7055 23.9067 27.1477 22.6624 24.5368 29.3201 26.0764 27.0600 26.8378 26.8070 27.0022 29.1703 26.7504 26.0759 29.6133 26.5240 25.0299 24.2933 26.7653 14.2517 26.8277 26.7852 27.3341 18.4776 31.7748 22.3249 28.2232 26.8768 19.7409 17.5422 29.1532 22.7715 28.1355 30.4031 26.4675 18.4242 30.9276 30.3920 21.2115 28.3256 22.3332 28.9885 20.2520 25.7326 * 15.1511 18.1778 19.1452 22.7867 28.0519 21.8210 24.6109 21.7411 18.9512 31.9907 22.0498 24.7846 23.4296 23.3281 25.6176 24.4429 18.4928 20.1060 21.8451 18.5125 19.4290 27.6784 24.7255 28.2647 25.2397 24.4107 31.2120 28.0288 28.5216 27.1472 * 28.7602 30.7555 27.9520 * 29.9753 27.0140 26.1373 24.4380 25.5622 22.4774 27.2171 27.9800 27.8180 18.8136 31.7399 24.7384 30.6525 30.3037 21.5043 1.0751 1.5434 1.2899 1.4276 2.0372 1.4419 1.2829 1.9077 1.9292 1.2886 1.4659 1.1203 1.2844 1.0523 1.4415 0.9724 0.9636 1.0753 1.0503 1.3027 1.9366 1.0020 1.1922 0.9195 1.0319 1.7116 1.0279 1.5567 1.0276 1.3252 1.2532 1.5112 0.9251 1.0227 1.2432 *** 0.9652 1.3959 1.0904 *** 1.2486 1.1463 1.4911 1.3865 1.5927 1.3817 *** 1.8861 1.2080 1.7219 *** 1.2204 1.1779 1.3488 1.2445 1.1035 1.0679 1.2940 1.3492 *** 0.9325 1.3451 1.8335 1.4386 0.9744 1.1502 PO 00000 Frm 00184 Fmt 4701 Sfmt 4702 E:\FR\FM\25APP2.SGM 25APP2 Average hourly wage** (3 years) 17.4505 27.9899 21.9811 26.5899 29.3431 24.6603 20.7532 29.9458 28.2014 21.0747 27.5768 21.8399 27.4113 19.1704 23.7156 19.4498 16.0255 16.2572 19.1709 21.5133 26.8480 21.2959 24.2986 22.2315 18.3153 31.3106 21.6648 23.5480 22.3620 22.6254 24.4945 23.4176 18.3190 19.4424 20.8410 19.1561 18.3479 26.9990 22.8343 26.9026 23.8573 23.9661 29.3628 26.5286 27.3709 26.1300 26.0253 26.8363 29.0077 26.6015 26.0961 29.1744 26.4179 24.8057 23.8234 25.4422 18.1909 26.6346 26.8678 27.6526 17.9305 31.4753 22.6614 28.6696 27.7533 20.6527 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules 24179 TABLE 2.—HOSPITAL CASE-MIX INDEXES FOR DISCHARGES OCCURRING IN FEDERAL FISCAL YEAR 2005; HOSPITAL WAGE INDEXES FOR FEDERAL FISCAL YEAR 2007; HOSPITAL AVERAGE HOURLY WAGES FOR FEDERAL FISCAL YEARS 2005 (2001 WAGE DATA), 2006 (2002 WAGE DATA), AND 2007 (2003 WAGE DATA); WAGE INDEXES AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY WAGES—Continued Case-mix index 3 wwhite on PROD1PC61 with PROPOSALS2 Provider No. 110209 110212 110214 110215 110218 110219 110220 110221 110222 110224 110225 110226 120001 120002 120004 120005 120006 120007 120010 120011 120014 120016 120019 120022 120024 120025 120026 120027 120028 120029 130002 130003 130005 130006 130007 130011 130013 130014 130018 130021 130024 130025 130026 130028 130036 130049 130060 130062 130063 130065 130066 130067 140001 140002 140003 140007 140008 140010 140011 140012 140013 140015 140016 140018 140019 140024 ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... VerDate Aug<31>2005 17:10 Apr 24, 2006 Jkt 208001 FY 2007 wage index (10/1/2006– 3/31/2007) FY 2007 wage index (4/1/2007– 9/30/2007) Average hourly wage FY 2005 1 Average hourly wage FY 2006 1 Average hourly wage FY 2007 1 0.7577 0.8340 * 0.9761 * 0.9761 * * * 0.9554 0.9761 * 1.1066 1.0502 1.1066 1.0502 1.1066 1.1066 1.1066 1.1066 1.0502 * 1.0502 1.1066 * * 1.1066 1.1066 1.1066 1.1066 0.8674 1.0033 * 0.9404 0.9404 * 0.9404 0.9404 0.9400 * 0.8949 0.8674 * 0.9400 * 1.0284 * * 0.9404 0.9300 0.9696 0.9300 0.8334 0.9017 * 1.0742 1.0742 1.0742 0.8334 1.0596 0.8973 0.8902 * 1.0742 0.8334 * 0.7577 0.8340 * 0.9761 * 0.9761 * * * 0.9554 0.9761 * 1.1066 1.0502 1.1066 1.0502 1.1066 1.1066 1.1066 1.1066 1.0502 * 1.0502 1.1066 * * 1.1066 1.1066 1.1066 1.1066 0.8674 1.0033 * 0.9404 0.9404 * 0.9404 0.9404 0.9400 * 0.8949 0.8674 * 0.9400 * 1.0284 * * 0.9404 0.9300 0.9696 0.9300 0.8334 0.9017 * 1.0742 1.0742 1.0742 0.8334 1.0596 0.8973 0.8902 * 1.0742 0.8334 * 19.1000 20.9365 * 23.9657 26.1073 27.1880 * * * * * * 31.7108 26.9900 28.3569 26.9053 29.6751 28.7964 27.1265 31.7447 28.0786 52.1034 28.9661 24.7875 * 48.7148 28.5048 26.4630 31.3195 * 21.6626 25.4904 25.2550 24.3982 24.8764 22.9336 26.3118 23.4789 23.9798 18.9400 21.7853 19.7066 25.4020 25.2938 16.7907 24.5841 26.7516 16.7951 20.9502 * * * 21.4779 24.4908 22.6230 26.7943 27.2211 31.5774 20.6338 24.3675 22.6022 22.2266 17.1372 27.3334 18.4554 16.9672 19.0450 40.5120 * 25.7886 * 27.0362 * * * * * * 34.7715 29.9913 28.6527 29.3405 31.2285 30.4247 30.1659 34.1643 28.6416 19.6034 30.3809 26.6100 * 30.2358 30.3293 28.6717 30.3794 * 23.6078 27.6345 25.7523 25.3221 24.9562 * 27.9209 24.3884 26.4125 16.1658 23.3347 20.1452 * 26.3443 * 26.9749 * 20.6642 22.5904 * * * 22.3170 24.6954 * 28.3482 28.5297 35.1024 22.4091 28.6564 23.3065 23.0600 18.1242 27.7548 18.9228 17.5249 20.6610 23.5240 38.0916 27.6105 * 28.9963 36.3797 27.9342 35.6600 * * * 36.1455 31.1454 29.8958 30.7655 31.6553 30.8207 29.2456 37.6638 30.9983 * 30.9024 28.3925 * * 32.6726 28.6901 32.2641 * 24.8996 29.1686 * 27.3657 28.8562 * 28.4195 26.4165 27.5137 * 24.5799 21.7093 * 27.8274 * 27.6683 * 25.4820 25.0864 21.5260 * * 22.9464 27.0262 * 30.5555 29.4264 32.1387 23.3923 28.7947 24.3673 24.3516 * 26.2598 20.5469 * 0.5449 1.0965 *** 1.2932 *** 1.3711 *** *** *** 1.2679 1.1623 1.1684 1.7479 1.1953 1.2414 1.2996 1.2506 1.6798 1.8625 1.4183 1.2906 *** 1.1569 1.8414 0.8882 *** 1.3774 1.3041 1.3553 2.0189 1.4037 1.3819 *** 1.7984 1.7777 1.2032 1.3238 1.2962 1.6875 *** 1.0850 1.2211 *** 1.3940 *** 1.5643 *** 0.4992 1.3226 1.8682 2.0225 1.1199 1.0879 1.3285 *** 1.3267 1.4514 1.5134 1.1519 1.1895 1.4139 1.4234 1.0295 1.4130 0.9335 1.0391 PO 00000 Frm 00185 Fmt 4701 Sfmt 4702 E:\FR\FM\25APP2.SGM 25APP2 Average hourly wage** (3 years) 19.6589 28.8400 38.0916 25.8891 26.1073 27.7481 36.3797 27.9342 35.6600 * * * 34.2182 29.4877 28.9336 28.9478 30.8640 30.0248 28.7313 34.6233 29.2759 31.3542 30.1294 26.5859 * 39.4887 30.6338 27.9388 31.3359 * 23.4857 27.4795 25.4954 25.7611 26.2212 22.9336 27.5522 24.7517 26.0217 17.6183 23.2478 20.5485 25.4020 26.7013 16.7907 26.4480 26.7516 20.1910 22.8539 21.5260 * * 22.2483 25.3949 22.6230 28.5893 28.3893 32.9542 22.1495 27.2494 23.3996 23.2245 17.6389 27.1177 19.2999 17.2349 24180 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules TABLE 2.—HOSPITAL CASE-MIX INDEXES FOR DISCHARGES OCCURRING IN FEDERAL FISCAL YEAR 2005; HOSPITAL WAGE INDEXES FOR FEDERAL FISCAL YEAR 2007; HOSPITAL AVERAGE HOURLY WAGES FOR FEDERAL FISCAL YEARS 2005 (2001 WAGE DATA), 2006 (2002 WAGE DATA), AND 2007 (2003 WAGE DATA); WAGE INDEXES AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY WAGES—Continued Case-mix index 3 wwhite on PROD1PC61 with PROPOSALS2 Provider No. 140026 140027 140029 140030 140032 140033 140034 140040 140043 140045 140046 140048 140049 140051 140052 140053 140054 140058 140059 140061 140062 140063 140064 140065 140066 140067 140068 140075 140077 140079 140080 140082 140083 140084 140088 140089 140091 140093 140094 140095 140100 140101 140102 140103 140105 140109 140110 140113 140114 140115 140116 140117 140118 140119 140120 140122 140124 140125 140127 140130 140133 140135 140137 140140 140141 140143 ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... VerDate Aug<31>2005 17:10 Apr 24, 2006 Jkt 208001 FY 2007 wage index (10/1/2006– 3/31/2007) FY 2007 wage index (4/1/2007– 9/30/2007) Average hourly wage FY 2005 1 Average hourly wage FY 2006 1 Average hourly wage FY 2007 1 0.8680 * 1.0742 1.0742 0.8902 1.0596 0.8902 0.8827 0.9773 * 0.8902 1.0742 1.0742 1.0742 0.9017 0.8900 1.0742 0.8902 0.9017 * 1.0742 1.0742 0.8827 1.0742 0.9017 0.8973 1.0742 1.0742 0.9017 * 1.0742 1.0742 1.0742 1.0596 1.0742 0.8334 0.9649 0.9155 1.0742 1.0742 1.0596 1.0742 * 1.0742 1.0742 * 1.0596 0.9649 1.0742 1.0742 1.0742 1.0742 1.0742 1.0742 0.8973 1.0742 1.0742 0.9017 0.8959 1.0596 1.0742 0.8334 0.9017 * * 0.8827 0.8680 * 1.0742 1.0742 0.8902 1.0596 0.8902 0.8827 0.9773 * 0.8902 1.0742 1.0742 1.0742 0.9017 0.8900 1.0742 0.8902 0.9017 * 1.0742 1.0742 0.8827 1.0742 0.9017 0.8973 1.0742 1.0742 0.9017 * 1.0742 1.0742 1.0742 1.0596 1.0742 0.8334 0.9649 0.9155 1.0742 1.0742 1.0596 1.0742 * 1.0742 1.0742 * 1.0596 0.9649 1.0742 1.0742 1.0742 1.0742 1.0742 1.0742 0.8973 1.0742 1.0742 0.9017 0.8959 1.0596 1.0742 0.8334 0.9017 * * 0.8827 21.6847 22.6208 27.7304 28.7623 22.8157 26.1553 22.1003 20.0269 26.0330 21.0042 22.5022 27.0874 26.6533 27.9935 22.2588 23.5477 31.7265 22.1269 22.7121 30.9925 31.2359 26.5584 21.7470 26.1904 20.4353 23.5906 25.8963 26.9257 19.0922 29.3040 26.0109 26.8077 24.6491 27.6819 31.0364 22.1227 26.1075 22.1540 25.3678 29.9746 32.8743 25.4784 21.2278 21.7512 26.3054 17.8103 25.6561 23.5337 25.7968 26.3677 30.5166 25.6314 27.7392 33.6302 22.5795 26.4991 35.2798 20.7189 22.8172 26.3518 26.1599 21.2104 20.5053 21.4710 23.0515 23.8255 23.0470 * 28.6565 29.7771 24.0574 25.6068 23.0034 22.2969 26.7996 20.6548 23.2127 28.2222 27.4009 27.7901 23.5662 24.8455 31.8564 22.8423 22.4651 20.8063 34.7704 27.8306 22.0407 29.4678 21.9771 25.3986 27.3956 27.9325 19.1363 * 23.2575 25.6645 26.2972 29.2515 32.4978 23.3401 26.8518 25.3127 27.9273 27.6799 37.0819 28.5365 * 23.3258 27.4531 19.5675 27.9844 26.7969 28.3014 25.1498 31.9902 26.8802 29.7570 36.1419 22.7375 28.4188 36.1327 20.4014 24.1658 29.5247 28.0339 22.3264 21.4700 * 21.7871 26.2954 25.8658 * 30.4267 30.8539 26.3265 26.6309 24.0132 23.0412 27.2076 * 25.1403 29.4775 29.7853 30.9784 25.9526 27.0098 33.1231 24.5345 22.7978 * 34.9018 28.3171 23.6796 30.5985 21.7172 27.3723 28.3348 27.0069 20.5654 * 28.0751 29.2173 26.7552 30.0397 30.8245 24.5591 27.8742 27.5152 27.9141 26.6424 37.2217 29.2080 * 23.8866 28.4390 * 29.3202 29.9552 28.6458 25.8357 34.3361 27.9774 32.2213 34.7716 24.0981 31.0736 36.4899 22.3436 25.0102 32.9615 30.6892 23.0885 23.4302 * * 26.2579 1.1460 *** 1.5856 1.5703 1.2542 1.2032 1.2202 1.1819 1.2734 1.0786 1.4780 1.2684 1.5191 1.5347 1.2841 1.8913 1.4870 1.2228 1.1165 1.0739 1.2142 1.4093 1.1938 1.3865 1.1297 1.8182 1.1945 1.2767 1.0393 *** 1.4417 1.4773 1.0308 1.2289 1.8500 1.1914 1.8250 1.1831 1.0356 1.2507 1.3030 1.1672 *** 1.1961 1.2788 1.0917 1.0910 1.5788 1.4160 1.0851 1.2978 1.5416 1.6195 1.7729 1.2239 1.4330 1.3392 1.2398 1.6317 1.2469 1.2969 1.4756 1.0253 *** 1.0512 1.2279 PO 00000 Frm 00186 Fmt 4701 Sfmt 4702 E:\FR\FM\25APP2.SGM 25APP2 Average hourly wage** (3 years) 23.4929 22.6208 29.0118 29.8244 24.4078 26.1186 23.0492 21.6957 26.6815 20.8316 23.7433 28.2409 27.9674 28.8784 23.9370 25.1043 32.2061 23.1736 22.6554 25.9797 33.6097 27.6213 22.5242 28.7875 21.3717 25.4762 27.2266 27.3106 19.5779 29.3040 25.6089 27.2244 25.9303 29.0292 31.4341 23.2899 26.9776 24.7343 27.1207 28.1556 35.8092 27.8662 21.2278 22.9977 27.3700 18.6923 27.6755 26.5722 27.6452 25.7964 32.3584 26.8349 29.8836 34.8306 23.1900 28.6341 35.9612 21.1516 23.9945 29.7730 28.1483 22.2454 21.8888 21.4710 22.4305 25.4680 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules 24181 TABLE 2.—HOSPITAL CASE-MIX INDEXES FOR DISCHARGES OCCURRING IN FEDERAL FISCAL YEAR 2005; HOSPITAL WAGE INDEXES FOR FEDERAL FISCAL YEAR 2007; HOSPITAL AVERAGE HOURLY WAGES FOR FEDERAL FISCAL YEARS 2005 (2001 WAGE DATA), 2006 (2002 WAGE DATA), AND 2007 (2003 WAGE DATA); WAGE INDEXES AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY WAGES—Continued Case-mix index 3 wwhite on PROD1PC61 with PROPOSALS2 Provider No. 140144 140145 140147 140148 140150 140151 140152 140155 140158 140160 140161 140162 140164 140165 140166 140167 140168 140170 140172 140174 140176 140177 140179 140180 140181 140182 140184 140185 140186 140187 140189 140190 140191 140193 140197 140199 140200 140202 140203 140205 140206 140207 140208 140209 140210 140211 140213 140215 140217 140223 140224 140228 140231 140233 140234 140239 140240 140242 140245 140250 140251 140252 140258 140271 140275 140276 ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... VerDate Aug<31>2005 17:10 Apr 24, 2006 Jkt 208001 FY 2007 wage index (10/1/2006– 3/31/2007) FY 2007 wage index (4/1/2007– 9/30/2007) Average hourly wage FY 2005 1 Average hourly wage FY 2006 1 Average hourly wage FY 2007 1 * 0.9017 0.8334 0.8900 1.0742 1.0742 1.0742 1.0032 1.0742 0.9773 1.0596 0.8959 0.8902 * 0.8334 0.9728 * * 1.0742 1.0742 1.0742 1.0742 1.0742 1.0742 1.0742 1.0742 0.8334 0.9017 1.0032 0.9017 0.9155 * 1.0742 * 1.0742 * 1.0742 1.0596 * 1.0150 1.0742 1.0742 1.0742 0.8973 0.8334 1.0742 1.0742 * 1.0742 1.0742 1.0742 0.9987 1.0742 1.0596 0.8827 0.9987 1.0742 1.0742 * 1.0742 1.0742 1.0742 1.0742 * 0.8569 1.0742 * 0.9017 0.8334 0.8900 1.0742 1.0742 1.0742 1.0032 1.0742 0.9773 1.0596 0.8959 0.8902 * 0.8334 0.9728 * * 1.0742 1.0742 1.0742 1.0742 1.0742 1.0742 1.0742 1.0742 0.8334 0.9017 1.0032 0.9017 0.9155 * 1.0742 * 1.0742 * 1.0742 1.0596 * 1.0150 1.0742 1.0742 1.0742 0.8973 0.8334 1.0742 1.0742 * 1.0742 1.0742 1.0742 0.9987 1.0742 1.0596 0.8827 0.9987 1.0742 1.0742 * 1.0742 1.0742 1.0742 1.0742 * 0.8569 1.0742 27.8046 21.6168 19.5896 23.0022 33.9013 22.4842 29.6882 27.6610 23.8542 22.7002 24.1071 26.0312 22.0424 15.9312 21.7776 19.7610 20.0225 17.1608 27.1121 24.7011 28.9378 19.3328 26.3200 27.4366 23.6034 28.0337 20.1279 22.0222 28.1977 22.0674 25.6954 18.8530 25.2817 22.9443 21.8060 21.3464 24.9217 27.4336 28.2212 * 27.5481 25.7331 27.6586 23.3886 16.6729 29.5114 29.1649 22.3097 29.3711 29.2540 29.0350 25.0074 28.3545 27.3379 23.2604 24.2112 27.2654 30.4005 16.0772 27.4628 26.7266 30.2656 27.9478 18.8535 25.2824 27.5936 * 23.4608 19.8541 24.7031 35.2711 23.4879 27.6086 28.9724 27.0986 24.5373 23.1647 27.4472 23.7457 16.6304 23.1005 22.8911 * * 29.8568 27.8131 31.3490 22.5610 27.6376 28.3629 25.0100 28.2211 21.1802 23.8531 30.6951 23.2892 23.7198 19.8297 25.8678 * 23.0684 22.0315 26.3379 29.7870 * * 30.6561 24.1048 29.4708 24.5376 19.2639 29.7054 30.2945 * 31.5324 30.4923 28.2177 25.6419 30.6410 28.6305 23.6928 29.0092 28.7310 32.0522 * 28.5971 27.1687 33.3351 30.2639 * 26.1473 29.8325 * 25.4576 21.5005 25.6350 53.4891 25.1381 30.5283 29.8350 27.3765 25.6756 24.6442 28.9571 24.3913 * 26.5696 23.2552 * * 32.0491 30.6391 32.8367 25.4042 29.1623 29.4449 24.7902 30.4042 24.5927 24.9794 29.4859 24.9822 22.2803 * 28.1849 * 24.2236 * 28.3720 32.1701 * * 29.1294 25.1473 29.7525 26.3371 20.5812 30.7546 31.3811 * 32.7581 31.9618 29.8867 27.7259 30.0920 28.3631 24.7645 31.8210 30.1439 34.4226 * 29.9198 28.4384 34.5410 33.6353 * 27.9824 31.3200 *** 1.0954 1.1011 1.7345 1.6237 0.8172 1.0879 1.2917 1.4185 1.2622 1.1501 1.6074 1.7902 1.0595 1.1868 1.1260 *** 0.9621 1.4090 1.4735 1.2059 0.9899 1.3042 1.2048 1.2002 1.5644 1.2402 1.4592 1.5570 1.5360 1.1691 1.0766 1.2997 *** 1.3178 1.0459 1.4752 1.5706 *** 1.7126 1.0867 1.2439 1.6564 1.5833 1.1359 1.2974 1.2144 *** 1.4968 1.4796 1.3603 1.5725 1.4875 1.6248 1.0969 1.5507 1.4058 1.4891 *** 1.1833 1.3420 1.3975 1.5438 0.8939 1.3373 1.8331 PO 00000 Frm 00187 Fmt 4701 Sfmt 4702 E:\FR\FM\25APP2.SGM 25APP2 Average hourly wage** (3 years) 27.8046 23.5453 20.3136 24.3700 41.2967 23.7102 29.2513 28.8823 25.9317 24.3339 23.9715 27.4950 23.3924 16.2816 23.8462 21.9523 20.0225 17.1608 29.9831 27.6903 31.1310 22.6360 27.7184 28.4116 24.4674 28.7014 22.1636 23.6400 29.5088 23.4667 23.9070 19.3398 26.4367 22.9443 22.9343 21.6914 26.5054 29.9764 28.2212 * 29.1455 24.9715 28.9886 24.7775 18.7925 30.0426 30.2935 22.3097 31.1722 30.5734 29.0497 26.1206 29.7474 28.1358 23.9187 28.3245 28.6637 32.3743 16.0772 28.6855 27.4435 32.7890 30.7068 18.8535 26.4533 29.6123 24182 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules TABLE 2.—HOSPITAL CASE-MIX INDEXES FOR DISCHARGES OCCURRING IN FEDERAL FISCAL YEAR 2005; HOSPITAL WAGE INDEXES FOR FEDERAL FISCAL YEAR 2007; HOSPITAL AVERAGE HOURLY WAGES FOR FEDERAL FISCAL YEARS 2005 (2001 WAGE DATA), 2006 (2002 WAGE DATA), AND 2007 (2003 WAGE DATA); WAGE INDEXES AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY WAGES—Continued Case-mix index 3 wwhite on PROD1PC61 with PROPOSALS2 Provider No. 140280 ..................................................... 140281 ..................................................... 140285 ..................................................... 140286 ..................................................... 140288 ..................................................... 140289 ..................................................... 140290 ..................................................... 140291 ..................................................... 140292 ..................................................... 140294 ..................................................... 140300 ..................................................... 140301 ..................................................... 140303 ..................................................... 140344 ..................................................... 150001 ..................................................... 150002 ..................................................... 150003 ..................................................... 150004 ..................................................... 150005 ..................................................... 150006 ..................................................... 150007 ..................................................... 150008 ..................................................... 150009 ..................................................... 150010 ..................................................... 150011 ..................................................... 150012 ..................................................... 150013 ..................................................... 150014 ..................................................... 150015 ..................................................... 150017 ..................................................... 150018 ..................................................... 150021 ..................................................... 150022 ..................................................... 150023 ..................................................... 150024 ..................................................... 150026 ..................................................... 150027 ..................................................... 150029 ..................................................... 150030 ..................................................... 150033 ..................................................... 150034 ..................................................... 150035 ..................................................... 150037 ..................................................... 150038 ..................................................... 150042 ..................................................... 150044 ..................................................... 150045 h ................................................... 150046 ..................................................... 150047 ..................................................... 150048 ..................................................... 150049 ..................................................... 150051 ..................................................... 150052 ..................................................... 150056 ..................................................... 150057 ..................................................... 150058 ..................................................... 150059 ..................................................... 150060 ..................................................... 150061 ..................................................... 150062 ..................................................... 150063 ..................................................... 150064 ..................................................... 150065 ..................................................... 150069 ..................................................... 150070 ..................................................... 150072 ..................................................... VerDate Aug<31>2005 17:10 Apr 24, 2006 Jkt 208001 FY 2007 wage index (10/1/2006– 3/31/2007) FY 2007 wage index (4/1/2007– 9/30/2007) Average hourly wage FY 2005 1 Average hourly wage FY 2006 1 Average hourly wage FY 2007 1 0.8569 1.0742 * 1.0742 1.0742 0.9017 1.0742 1.0596 1.0742 0.8334 1.0742 1.0742 1.0742 * 0.9757 1.0596 0.8957 1.0596 0.9757 0.9543 0.9494 1.0596 0.9137 0.9494 0.9582 0.9677 * * 1.0596 0.9498 0.9421 0.9498 0.8728 0.8663 0.9757 0.9421 * 0.9677 0.9582 0.9757 1.0596 0.9361 0.9757 0.9757 0.8479 0.9137 0.9914 0.8663 0.9498 0.9599 * 0.9582 * 0.9757 0.9757 0.9677 0.9757 * 0.8479 * * 0.8479 0.9582 0.9599 * 0.8479 0.8569 1.0742 * 1.0742 1.0742 0.9017 1.0742 1.0596 1.0742 0.8334 1.0742 1.0742 1.0742 * 0.9757 1.0596 0.8957 1.0596 0.9757 0.9543 0.9494 1.0596 0.9137 0.9494 0.9582 0.9677 * * 1.0596 0.9498 0.9421 0.9498 0.8728 0.8663 0.9757 0.9421 * 0.9677 0.9582 0.9757 1.0596 0.9361 0.9757 0.9757 0.8479 0.9137 0.9914 0.8663 0.9498 0.9599 * 0.9582 * 0.9757 0.9757 0.9677 0.9757 * 0.8479 * * 0.8479 0.9582 0.9599 * 0.8479 21.9302 29.2602 17.7824 28.4378 26.9581 22.3274 28.6926 28.2338 26.1781 22.6123 33.3983 * * * 27.1021 23.3804 23.3196 24.8884 25.4443 24.8976 23.5841 23.6953 20.4993 23.9740 23.2249 22.9314 19.7689 26.5785 24.3015 23.7180 24.7048 27.8168 22.8035 23.1253 24.7879 23.7185 21.2855 23.4103 24.4361 25.8851 23.9388 26.0952 27.7009 24.4188 21.9917 23.1200 24.2899 21.0417 24.5455 24.5864 20.2178 22.6866 19.6073 27.6754 22.7804 26.9753 27.0792 23.2409 21.3640 23.5550 19.0377 21.6370 24.4451 25.3445 22.6260 20.3191 23.4447 30.4838 20.7576 29.1543 29.3988 22.6211 31.7341 29.8958 27.6285 23.4504 34.8568 31.7073 * * 29.6844 25.0063 25.3458 26.8458 27.2369 26.4061 26.6073 26.6928 22.2147 26.8524 24.3490 27.3029 21.8465 * 26.2434 25.2342 26.3289 29.6967 22.6773 23.7159 27.1589 28.1127 17.4862 26.9680 26.9533 27.9995 26.0465 26.6620 28.5451 28.8054 23.0102 23.7065 25.2225 21.9369 25.8349 27.1817 22.3370 23.7061 20.6339 28.2842 24.8605 27.5341 28.5715 24.8544 22.2822 24.6088 * 23.7707 25.9461 25.2655 * 20.5111 22.5604 33.7817 * 31.0563 31.7089 24.5456 31.2636 31.3199 29.2990 24.0181 35.6231 49.7125 29.8654 * 28.3954 26.3713 27.0406 28.0176 29.5025 26.1674 29.4617 27.3400 24.9618 26.1311 25.3748 27.7477 * * 27.7478 27.1394 27.4616 29.5355 22.9027 26.3792 27.5637 28.7334 * 27.8939 28.0417 29.0207 28.1138 27.1031 30.7071 29.0433 22.3848 24.3939 27.1520 24.1694 25.1553 27.4034 * 25.3577 * 29.5718 29.6310 29.3647 32.4123 * 21.7707 * * 25.1734 27.9073 25.9517 * 21.3608 1.4395 1.6866 *** 1.1273 1.5613 1.3194 1.3527 1.5063 1.1567 1.1615 1.1185 1.2721 1.8671 0.7733 1.1131 1.4378 1.6318 1.4953 1.1856 1.3717 1.3603 1.4502 1.3886 1.4176 1.1850 1.5696 1.0122 *** 1.3253 1.7827 1.6614 1.7672 1.1171 1.5443 1.3983 1.3092 1.0215 1.4031 1.1595 1.6558 1.5452 1.5489 1.3067 1.1286 1.4612 1.3885 1.0516 1.4240 1.7598 1.3838 1.2142 1.5992 1.0642 1.9057 2.0352 1.5547 1.5388 1.0871 1.1363 1.0931 *** 1.2156 1.2414 1.2501 *** 1.1595 PO 00000 Frm 00188 Fmt 4701 Sfmt 4702 E:\FR\FM\25APP2.SGM 25APP2 Average hourly wage** (3 years) 22.6515 31.1676 19.1679 29.5696 29.3668 23.1903 30.6196 29.9025 27.7701 23.3722 34.6085 37.1819 29.8654 * 28.4082 24.8884 25.2176 26.5920 27.5016 25.8384 26.6700 25.9807 22.6002 25.6410 24.3343 25.8046 20.8053 26.5785 26.1118 25.3937 26.1770 29.0360 22.7977 24.2243 26.5220 26.9980 19.1736 25.8068 26.5118 27.6412 26.1270 26.6373 28.9916 27.4342 22.4673 23.7747 25.569 22.4186 25.1829 26.3728 21.2543 23.9071 20.1223 28.5127 25.6224 28.0150 29.3673 24.0586 21.8139 24.0884 19.0377 23.5270 26.1176 25.5268 22.6260 20.7440 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules 24183 TABLE 2.—HOSPITAL CASE-MIX INDEXES FOR DISCHARGES OCCURRING IN FEDERAL FISCAL YEAR 2005; HOSPITAL WAGE INDEXES FOR FEDERAL FISCAL YEAR 2007; HOSPITAL AVERAGE HOURLY WAGES FOR FEDERAL FISCAL YEARS 2005 (2001 WAGE DATA), 2006 (2002 WAGE DATA), AND 2007 (2003 WAGE DATA); WAGE INDEXES AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY WAGES—Continued Case-mix index 3 wwhite on PROD1PC61 with PROPOSALS2 Provider No. 150074 ..................................................... 150075 ..................................................... 150076 ..................................................... 150078 ..................................................... 150079 ..................................................... 150082 ..................................................... 150084 ..................................................... 150086 ..................................................... 150088 ..................................................... 150089 ..................................................... 150090 ..................................................... 150091 h ................................................... 150096 ..................................................... 150097 ..................................................... 150100 ..................................................... 150101 ..................................................... 150102 ..................................................... 150104 ..................................................... 150106 h ................................................... 150109 ..................................................... 150112 ..................................................... 150113 ..................................................... 150115 ..................................................... 150122 ..................................................... 150123 ..................................................... 150124 ..................................................... 150125 ..................................................... 150126 ..................................................... 150128 ..................................................... 150129 ..................................................... 150130 ..................................................... 150132 ..................................................... 150133 ..................................................... 150134 ..................................................... 150136 ..................................................... 150146 ..................................................... 150147 ..................................................... 150148 ..................................................... 150149 ..................................................... 150150 ..................................................... 150151 ..................................................... 150152 ..................................................... 150153 ..................................................... 150154 ..................................................... 150155 ..................................................... 150156 ..................................................... 150157 ..................................................... 150158 ..................................................... 150159 ..................................................... 150160 ..................................................... 150323 ..................................................... 150325 ..................................................... 160001 ..................................................... 160003 ..................................................... 160005 ..................................................... 160008 ..................................................... 160013 ..................................................... 160014 ..................................................... 160016 ..................................................... 160020 ..................................................... 160024 ..................................................... 160026 ..................................................... 160028 ..................................................... 160029 ..................................................... 160030 ..................................................... 160031 ..................................................... VerDate Aug<31>2005 17:10 Apr 24, 2006 Jkt 208001 FY 2007 wage index (10/1/2006– 3/31/2007) FY 2007 wage index (4/1/2007– 9/30/2007) Average hourly wage FY 2005 1 Average hourly wage FY 2006 1 Average hourly wage FY 2007 1 0.9757 0.9498 0.9543 * * 0.8844 0.9757 0.9599 0.9582 0.8479 1.0596 1.0071 * 0.9757 0.8844 0.9498 0.9278 0.9757 0.9498 0.8957 0.9582 0.9582 0.8479 0.9582 * * 1.0596 1.0596 0.9757 0.9757 * * 0.9498 0.9137 * 0.9498 1.0596 * 0.8844 0.9498 * * 0.9757 0.9757 * * 0.9757 * * * * * 0.8976 * 0.8696 0.8696 0.8914 * 0.8976 * 0.9136 * 0.9453 0.9726 0.9819 * 0.9757 0.9498 0.9543 * * 0.8844 0.9757 0.9599 0.9582 0.8479 1.0596 1.0071 * 0.9757 0.8844 0.9498 0.9278 0.9757 0.9498 0.8957 0.9582 0.9582 0.8479 0.9582 * * 1.0596 1.0596 0.9757 0.9757 * * 0.9498 0.9137 * 0.9498 1.0596 * 0.8844 0.9498 * * 0.9757 0.9757 * * 0.9757 * * * * * 0.8976 * 0.8696 0.8696 0.8914 * 0.8976 * 0.9136 * 0.9453 0.9726 0.9819 * 24.4374 24.2085 24.1434 21.2476 20.6486 22.2054 28.7722 22.4471 23.0998 22.6545 24.6758 27.8087 21.9091 24.4179 22.2687 27.9745 22.6870 21.8172 20.9955 24.3786 24.7455 23.0450 20.5215 24.2471 15.3050 18.8218 24.3872 25.5585 23.1660 35.4311 21.5678 24.2559 21.8839 22.1085 25.7004 26.1168 32.3336 27.2081 23.8554 26.5138 * * * * * * * * * * * * 23.8657 19.0037 21.1745 19.8066 23.0163 19.2447 21.2785 19.0043 24.2385 24.2045 26.0052 24.9493 24.9920 18.5281 25.2586 24.0745 28.1874 * 21.4067 25.5860 29.3905 23.9404 23.6253 25.0449 26.2899 30.6209 * 25.0367 24.3530 29.1657 24.5923 25.5871 20.9387 23.5865 26.5643 24.8760 19.3411 26.0173 * 21.3933 26.7666 26.9887 26.4976 29.9099 21.7399 25.6257 22.7293 23.8526 26.2703 29.3383 22.8456 * 23.6361 25.5331 38.1446 44.7143 * * * * * * * * * * 25.1220 * 21.8950 20.7200 23.7163 20.5882 23.3619 19.5554 26.2392 24.7424 26.2948 27.9277 26.7068 19.7368 25.6634 25.6197 28.2428 * * 28.1847 29.5244 25.2450 26.2241 24.6068 29.4725 30.7951 * 27.1660 25.0773 29.8966 25.3187 28.5451 19.9273 26.0186 27.6269 26.0356 22.3372 * * * 27.1394 27.7563 28.2773 30.1445 * 27.7474 25.1827 26.1958 * 30.2135 27.0517 * 24.7733 28.4744 * * 32.2301 29.2863 45.0525 25.8304 * * * * * * 25.0365 * 23.7127 22.3526 24.6784 * 24.6900 * 27.4041 * 28.0717 29.7097 28.9474 * 1.4564 1.0933 1.2852 1.0122 1.1145 1.7181 1.7659 1.2036 1.2606 1.5861 1.5494 1.1148 0.9023 1.1238 1.7215 1.0867 1.0400 1.0401 1.0633 1.4441 1.4182 1.2634 1.4534 1.1613 *** 1.1063 1.4997 1.4372 1.4280 1.1690 1.0939 *** 1.2322 1.0669 *** 1.0555 1.2950 *** 1.0182 1.2596 *** *** 2.4953 2.5331 *** *** 1.5402 1.1799 0.9066 1.8672 0.8865 0.8673 1.1633 0.8939 1.1884 1.0864 1.2716 0.9604 1.5629 1.1096 1.6059 1.0140 1.3221 1.6161 1.4263 0.9870 PO 00000 Frm 00189 Fmt 4701 Sfmt 4702 E:\FR\FM\25APP2.SGM 25APP2 Average hourly wage** (3 years) 25.1233 24.6280 26.8000 21.2476 21.0466 25.2933 29.2252 23.9229 24.3172 24.0532 26.7855 29.8811 21.9091 25.5838 23.8670 29.0799 24.2235 25.2739 20.5636 24.6513 26.3492 24.6828 20.6746 25.1559 15.3050 20.1237 26.1113 26.7967 25.9381 31.4914 21.6494 25.8793 23.2488 23.9695 25.9880 28.6444 26.4997 27.2081 24.1065 26.8947 38.1446 44.7143 32.2301 29.2863 45.0525 25.8304 * * * * * * 24.6447 19.0037 22.2743 20.9456 23.7825 19.9190 23.1167 19.2901 25.9650 24.4805 26.9016 27.5319 26.8746 19.1263 24184 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules TABLE 2.—HOSPITAL CASE-MIX INDEXES FOR DISCHARGES OCCURRING IN FEDERAL FISCAL YEAR 2005; HOSPITAL WAGE INDEXES FOR FEDERAL FISCAL YEAR 2007; HOSPITAL AVERAGE HOURLY WAGES FOR FEDERAL FISCAL YEARS 2005 (2001 WAGE DATA), 2006 (2002 WAGE DATA), AND 2007 (2003 WAGE DATA); WAGE INDEXES AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY WAGES—Continued Case-mix index 3 wwhite on PROD1PC61 with PROPOSALS2 Provider No. 160032 160033 160034 160039 160040 160044 160045 160047 160048 160050 160057 160058 160064 160066 160067 160069 160074 160076 160079 160080 160081 160082 160083 160089 160090 160091 160092 160101 160104 160106 160107 160110 160112 160113 160115 160116 160117 160118 160122 160124 160126 160140 160146 160147 160153 160154 160365 160366 170001 170006 170009 170010 170012 170013 170014 170015 170016 170017 170018 170019 170020 170022 170023 170027 170033 170039 ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... VerDate Aug<31>2005 17:10 Apr 24, 2006 Jkt 208001 FY 2007 wage index (10/1/2006– 3/31/2007) FY 2007 wage index (4/1/2007– 9/30/2007) Average hourly wage FY 2005 1 Average hourly wage FY 2006 1 Average hourly wage FY 2007 1 0.8968 0.8696 * * 0.8891 * 0.8891 0.9453 * * 0.9568 0.9726 0.9256 * 0.8891 0.9132 * * 0.8891 0.8696 * 0.9136 0.9136 0.8976 * * * 0.9136 0.8696 * * 0.8891 0.8696 * * * 0.9132 * 0.8696 0.8696 * * 0.9201 0.8976 0.9201 * * * 0.8017 0.8620 0.9501 0.8146 0.8832 0.8832 0.9501 * 0.8738 0.9093 * * 0.8832 * 0.8832 0.8017 0.8832 0.9093 0.8968 0.8696 * * 0.8696 * 0.8891 0.9453 * * 0.9568 0.9726 0.9256 * 0.8696 0.9132 * * 0.8891 0.8696 * 0.9136 0.9136 0.8976 * * * 0.9136 0.8696 * * 0.8696 0.8696 * * * 0.9132 * 0.8696 0.8696 * * 0.9201 0.8976 0.9201 * * * 0.8017 0.8620 0.9501 0.8146 0.8832 0.8832 0.9501 * 0.8738 0.9093 * * 0.8832 * 0.8832 0.8017 0.8832 0.9093 22.3837 23.4148 19.4837 20.9623 21.8187 19.5635 24.4957 24.5000 19.5701 23.8830 22.0472 25.5244 27.6301 21.4631 21.9418 22.7514 20.2418 20.9749 22.5299 23.5721 21.3614 23.8181 25.0617 21.5693 21.2753 18.0630 22.0841 24.2309 24.0075 21.4912 21.3754 24.1762 21.8901 18.6599 19.5764 22.2019 23.4250 18.3322 22.9565 22.7223 20.3748 22.5230 20.9583 26.6577 26.3671 * * * 20.9837 20.6460 29.1979 21.2131 22.6869 23.1159 22.9772 19.1902 24.2336 23.3030 17.9497 20.3243 22.2571 22.9313 23.2690 21.4678 20.0801 20.1983 23.4727 24.6768 19.3503 22.1180 23.9053 * 25.4153 25.2072 19.5832 24.5403 23.0937 27.1646 28.6139 22.7709 23.4060 25.3402 * * 23.7234 23.1837 23.1930 26.4398 28.2193 22.6551 * 17.9862 * 25.1000 24.9134 * * 24.9434 23.0672 * * * 25.0278 19.7764 22.5872 23.1690 19.8323 * 22.9897 26.6438 28.9881 * * * 21.9131 21.9019 29.2588 24.0008 24.7392 25.0419 23.5960 20.2367 25.9482 24.7771 * 22.0251 23.1800 22.2878 23.9808 22.5103 20.7865 21.5203 25.7041 26.5814 * * 25.6843 * 26.9819 25.6964 * * 25.1339 28.6411 28.7718 * 23.7824 27.7295 * * 25.4508 25.9475 * 27.2896 27.3867 23.6643 * * * 23.7690 28.0389 * * 26.9342 25.2434 * * * 25.9502 * 23.9298 23.1591 * * 22.5441 28.6722 30.5992 * * * 23.0583 24.5553 31.2360 24.9889 25.8453 25.9854 24.9156 * 26.3308 26.6342 * * 22.6799 * 24.4018 22.9256 22.0776 25.4845 1.0729 1.7593 0.9775 0.9863 1.2803 1.1510 1.7325 1.4056 1.0401 1.1294 1.2446 1.9653 1.5286 1.0600 1.3137 1.5111 1.0989 *** 1.5393 1.3064 1.1664 1.8161 1.6913 1.2968 0.8236 0.9377 0.9932 1.1187 1.5181 *** *** 1.5282 1.2386 *** 1.0432 1.0175 1.3193 *** 1.1051 1.1607 1.0173 1.0475 1.4589 1.3443 1.6297 0.9033 0.7586 0.8054 1.2262 1.2593 1.0705 1.2077 1.6500 1.5264 1.0386 1.0240 1.6420 1.1104 0.9385 1.1619 1.5720 1.1286 1.4438 1.4472 1.3383 0.9534 PO 00000 Frm 00190 Fmt 4701 Sfmt 4702 E:\FR\FM\25APP2.SGM 25APP2 Average hourly wage** (3 years) 23.9167 24.9317 19.4156 21.5414 23.8388 19.5635 25.6677 25.1382 19.5767 24.2221 23.4637 27.1442 28.4086 22.1300 23.1319 25.2986 20.2418 20.9749 23.9274 24.2696 22.2788 25.8257 26.9189 22.6499 21.2753 18.0240 22.0841 24.3536 25.6671 21.4912 21.3754 25.3634 23.4606 18.6599 19.5764 22.2019 24.8152 19.0436 23.1689 23.0224 20.1046 22.5230 22.1450 27.3688 28.6813 * * * 21.9743 22.4217 29.8767 23.4347 24.4008 24.7349 23.8535 19.7243 25.5277 24.9721 17.9497 21.1885 22.7039 22.6058 23.8806 22.2935 20.9737 22.1744 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules 24185 TABLE 2.—HOSPITAL CASE-MIX INDEXES FOR DISCHARGES OCCURRING IN FEDERAL FISCAL YEAR 2005; HOSPITAL WAGE INDEXES FOR FEDERAL FISCAL YEAR 2007; HOSPITAL AVERAGE HOURLY WAGES FOR FEDERAL FISCAL YEARS 2005 (2001 WAGE DATA), 2006 (2002 WAGE DATA), AND 2007 (2003 WAGE DATA); WAGE INDEXES AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY WAGES—Continued Case-mix index 3 wwhite on PROD1PC61 with PROPOSALS2 Provider No. 170040 170049 170052 170054 170058 170068 170070 170074 170075 170085 170086 170090 170093 170094 170097 170098 170103 170104 170105 170109 170110 170114 170116 170120 170122 170123 170133 170137 170142 170143 170144 170145 170146 170147 170150 170166 170175 170176 170180 170182 170183 170185 170186 170187 170188 170190 170191 170192 170193 170194 170195 170196 170332 170344 170374 170375 180001 180002 180004 180005 180006 180007 180009 180010 180011 180012 ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... VerDate Aug<31>2005 17:10 Apr 24, 2006 Jkt 208001 FY 2007 wage index (10/1/2006– 3/31/2007) FY 2007 wage index (4/1/2007– 9/30/2007) Average hourly wage FY 2005 1 Average hourly wage FY 2006 1 Average hourly wage FY 2007 1 0.9501 0.9501 * * 0.9501 0.9177 * 0.8017 0.8017 * 0.8738 * * 0.8017 * * 0.9093 0.9501 0.8017 0.9501 0.8017 * * 0.8620 0.9093 0.9093 0.9501 0.8017 0.8591 * * 0.8017 0.9501 0.9093 0.8017 0.8017 0.8832 0.9501 * 0.9501 0.9093 0.9501 0.9093 0.8017 0.9501 0.8591 0.8017 0.9093 0.8832 0.9501 0.9501 0.9093 * * * * 0.9599 0.7793 0.7793 0.8759 * 0.9168 0.9009 0.9168 0.8928 0.9137 0.9501 0.9501 * * 0.9501 0.9177 * 0.8017 0.8017 * 0.8738 * * 0.8017 * * 0.9093 0.9501 0.8017 0.9501 0.8017 * * 0.8620 0.9093 0.9093 0.9501 0.8017 0.8591 * * 0.8017 0.9501 0.9093 0.8017 0.8017 0.8832 0.9501 * 0.9501 0.9093 0.9501 0.9093 0.8017 0.9501 0.8591 0.8017 0.9093 0.8832 0.9501 0.9501 0.9093 * * * * 0.9599 0.7793 0.7793 0.8759 * 0.9168 0.9009 0.9168 0.8928 0.9137 27.1771 24.1208 17.3794 17.5500 22.0398 20.8771 16.4767 20.4936 16.2047 18.4867 22.7737 15.9807 16.8710 20.3678 20.3391 20.0078 21.4985 26.1866 19.6687 22.7166 21.8904 18.1610 23.1127 19.8723 24.6532 26.4676 21.7748 22.7676 22.4095 19.7643 24.4259 21.4472 28.1965 23.1610 17.4916 18.5978 23.6262 24.2283 * 24.3820 22.8633 24.8478 30.5157 21.0780 27.2225 22.4865 24.9599 * * * * * * * * * 24.7647 21.6843 19.0834 22.8871 15.7136 21.8724 24.0971 26.4116 22.3183 22.9096 28.2856 24.7895 18.5291 * 23.3398 22.6087 16.0162 21.0565 16.5444 * 24.0812 * 16.5553 21.3887 * 20.1242 22.8707 26.9671 21.4422 23.2626 22.9195 18.9158 * 21.0499 25.3981 27.2239 22.9309 23.8863 22.5778 20.4459 24.6260 21.5756 29.1358 21.4753 18.5744 19.2842 23.9304 26.2366 25.1366 25.7443 24.5539 26.7797 31.7896 23.3702 29.9751 22.8729 21.3069 27.9704 24.7430 27.9904 * * * * * * 25.4217 22.9727 19.5437 24.5561 14.8011 22.7606 25.3837 24.7256 22.7364 24.6642 28.9419 26.3910 * * 23.1208 22.6765 * 23.2439 18.8919 * 25.4693 * * 20.9912 * * 23.7154 27.8829 21.9852 24.1847 22.8693 * * 22.1507 26.6964 28.2363 22.9094 24.7063 23.3910 * * 23.1863 30.3055 22.7160 20.1810 19.8233 25.8196 28.0633 * 28.2886 26.0515 29.1199 33.0190 24.4045 31.8257 22.9911 22.2346 27.0735 18.4870 30.7548 30.6081 * * * * * 27.4380 25.5510 21.2755 24.9313 * 26.4901 26.6728 25.7070 25.6662 25.8098 1.9280 1.4737 1.2142 *** 1.0587 1.2219 0.9818 1.2412 0.8380 0.9089 1.5716 *** 0.8381 0.9782 *** 0.9894 1.2387 1.5107 1.0190 1.0433 0.9597 0.8804 *** 1.3358 1.6367 1.6568 1.0499 1.2403 1.3495 1.2000 *** 1.0697 1.4687 2.0068 1.1923 1.0396 1.3814 1.5073 *** 1.4744 1.9823 1.3263 2.6919 1.4655 2.0410 1.0729 1.6457 2.0073 1.6307 1.3722 2.0069 2.2556 0.7372 0.7933 0.8095 0.7667 1.2904 1.0856 1.0814 1.0940 0.8701 1.4568 1.6569 1.9267 1.3761 1.4709 PO 00000 Frm 00191 Fmt 4701 Sfmt 4702 E:\FR\FM\25APP2.SGM 25APP2 Average hourly wage** (3 years) 28.1702 25.1440 17.9769 17.5500 22.8378 22.0710 16.2556 21.6462 17.1984 18.4867 24.1433 15.9807 16.7116 20.9361 20.3391 20.0657 22.7347 27.0103 21.0428 23.3947 22.5555 18.5532 23.1127 21.0257 25.5707 27.2774 22.5427 23.8048 22.8083 20.1017 24.5144 22.0533 29.2105 22.4146 18.7858 19.2265 24.4660 26.1546 25.1366 26.1597 24.4826 27.2051 31.8475 22.9793 29.7873 22.7762 22.8619 27.4857 21.4458 29.6973 30.6081 * * * * * 25.9006 23.4521 19.9789 24.1526 15.2405 23.7049 25.3971 25.5805 23.5939 24.4828 24186 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules TABLE 2.—HOSPITAL CASE-MIX INDEXES FOR DISCHARGES OCCURRING IN FEDERAL FISCAL YEAR 2005; HOSPITAL WAGE INDEXES FOR FEDERAL FISCAL YEAR 2007; HOSPITAL AVERAGE HOURLY WAGES FOR FEDERAL FISCAL YEARS 2005 (2001 WAGE DATA), 2006 (2002 WAGE DATA), AND 2007 (2003 WAGE DATA); WAGE INDEXES AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY WAGES—Continued Case-mix index 3 wwhite on PROD1PC61 with PROPOSALS2 Provider No. 180013 ..................................................... 180016 ..................................................... 180017 ..................................................... 180018 ..................................................... 180019 ..................................................... 180020 ..................................................... 180021 ..................................................... 180024 ..................................................... 180025 ..................................................... 180026 ..................................................... 180027 ..................................................... 180028 ..................................................... 180029 ..................................................... 180035 ..................................................... 180036 ..................................................... 180037 ..................................................... 180038 ..................................................... 180040 ..................................................... 180041 ..................................................... 180043 ..................................................... 180044 ..................................................... 180045 ..................................................... 180046 ..................................................... 180047 ..................................................... 180048 ..................................................... 180049 h ................................................... 180050 ..................................................... 180051 ..................................................... 180053 ..................................................... 180054 ..................................................... 180055 ..................................................... 180056 ..................................................... 180063 ..................................................... 180064 ..................................................... 180066 ..................................................... 180067 ..................................................... 180069 ..................................................... 180070 ..................................................... 180078 ..................................................... 180079 ..................................................... 180080 ..................................................... 180087 ..................................................... 180088 ..................................................... 180092 ..................................................... 180093 ..................................................... 180095 ..................................................... 180101 ..................................................... 180102 ..................................................... 180103 ..................................................... 180104 ..................................................... 180105 ..................................................... 180106 ..................................................... 180115 ..................................................... 180116 ..................................................... 180117 ..................................................... 180124 ..................................................... 180126 ..................................................... 180127 ..................................................... 180128 ..................................................... 180130 ..................................................... 180132 ..................................................... 180134 ..................................................... 180138 ..................................................... 180139 ..................................................... 180141 ..................................................... 180143 ..................................................... VerDate Aug<31>2005 17:10 Apr 24, 2006 Jkt 208001 FY 2007 wage index (10/1/2006– 3/31/2007) FY 2007 wage index (4/1/2007– 9/30/2007) Average hourly wage FY 2005 1 Average hourly wage FY 2006 1 Average hourly wage FY 2007 1 0.9571 0.9137 0.8207 0.8928 0.9599 0.7793 0.7793 0.9137 0.9137 * 0.8094 0.8759 0.8062 0.9599 0.9009 0.9137 0.8780 0.9137 * 0.7793 0.8759 0.9599 0.9168 * 0.9137 0.9744 0.7793 0.8431 0.7793 * * 0.8844 * 0.7793 0.9571 0.9168 0.8759 0.7793 0.8759 0.7793 0.8278 0.7793 0.9137 0.9168 0.8545 0.7793 0.9168 0.8094 0.9168 0.8094 0.7793 0.7793 0.7793 0.8210 0.7793 0.9571 * 0.9137 0.8075 0.9137 0.8928 * 0.9137 0.8928 0.9137 0.9168 0.9571 0.9137 0.8207 0.8928 0.9599 0.7793 0.7793 0.9137 0.9137 * 0.8094 0.8759 0.8062 0.9599 0.9009 0.9137 0.8780 0.9137 * 0.7793 0.8759 0.9599 0.9168 * 0.9137 0.9744 0.7793 0.8431 0.7793 * * 0.8844 * 0.7793 0.9571 0.9168 0.8759 0.7793 0.8759 0.7793 0.8278 0.7793 0.9137 0.9168 0.8545 0.7793 0.9168 0.8094 0.9168 0.8094 0.7793 0.7793 0.7793 0.8210 0.7793 0.9571 * 0.9137 0.8075 0.9137 0.8928 * 0.9137 0.8928 0.9137 0.9168 21.4728 22.2148 19.0694 18.3314 22.0379 22.3477 17.9346 23.6826 17.4781 15.8431 22.1072 21.4766 21.2110 26.7702 23.1636 24.4451 22.2750 24.5590 18.5483 18.8436 21.6837 24.5856 24.7562 20.4768 22.3601 19.4488 21.7150 19.2100 18.6610 19.0657 21.1989 21.4695 15.9185 15.3819 24.6359 24.0551 20.8797 17.4266 25.4196 19.5783 20.1651 17.7758 24.6053 22.4864 19.2748 17.1354 24.2242 19.1136 25.1577 22.8911 19.5364 15.7851 19.9316 21.8698 20.5952 21.4270 15.1776 21.4633 20.5575 24.8441 22.2101 17.3449 25.1789 21.3797 24.3140 23.9125 22.9512 23.1832 20.8630 19.0992 24.1342 21.9494 18.5966 32.1824 19.1543 18.2120 23.8763 24.7968 23.0536 29.8438 25.1154 25.7361 24.6348 26.2125 * 19.0617 23.0971 25.8349 27.2244 21.8037 21.6571 23.3407 22.6473 21.3312 19.1578 * 20.7237 22.8910 17.9741 16.2638 24.9543 25.4080 22.3674 20.1308 26.2636 19.7791 21.7380 18.4331 27.5767 22.5679 20.5422 17.9677 25.4796 18.4388 26.9407 24.9441 19.7615 17.8020 20.9831 22.7353 21.1854 23.1917 * 23.4765 20.8406 26.0278 23.7652 18.6779 27.3400 23.5363 25.3042 25.1613 23.9232 24.9302 21.9306 20.9508 24.2365 24.3479 19.2640 31.3281 22.8383 * 21.2891 25.4328 25.1372 31.8857 25.8131 26.3742 25.9911 27.7343 * 20.6947 24.6946 27.3369 27.5609 * 23.9768 23.1703 25.5270 23.0986 20.0309 * * 24.9363 * 17.2395 22.6968 27.3195 24.8052 20.6670 27.6613 20.0616 21.3549 19.5444 28.1804 24.2126 21.1607 17.9541 28.3249 21.2737 28.4766 25.9248 19.8581 19.1634 20.2666 23.1396 22.4436 24.9816 * 24.8603 21.9414 27.7053 24.5256 * 28.8157 23.3285 25.3054 28.6078 1.4693 1.3146 1.2778 1.3860 1.1175 1.0710 0.9567 1.1122 1.1108 1.0695 1.1962 0.9346 1.3805 1.6266 1.2029 1.2572 1.4800 2.0538 *** 1.1754 1.6181 1.3355 1.0532 0.9169 1.2720 1.3907 1.1591 1.2771 1.0110 *** 1.1340 1.1090 1.1323 1.2625 1.1353 2.0454 1.0900 1.1763 1.1205 1.1252 1.2929 1.2016 1.6372 1.1833 1.5187 1.0540 1.1164 1.6318 2.1888 1.6266 0.8701 0.9335 0.9382 1.2247 0.9727 1.3041 1.0703 1.3028 0.9146 1.6643 1.4816 1.0218 1.2283 1.0399 1.8300 1.6199 PO 00000 Frm 00192 Fmt 4701 Sfmt 4702 E:\FR\FM\25APP2.SGM 25APP2 Average hourly wage** (3 years) 22.7868 23.4667 20.6221 19.4438 23.4611 22.9113 18.6011 28.9328 19.7600 17.0401 22.3439 23.9001 23.1824 29.5742 24.6472 25.5161 24.2496 26.2542 18.5483 19.5226 23.1584 25.9400 26.5441 21.1276 22.6449 22.0488 23.2474 21.2619 19.3175 19.0657 20.9496 23.0960 17.0063 16.3222 24.0612 25.5822 22.7309 19.4044 26.4740 19.8220 21.0816 18.6024 26.8275 23.0944 20.3257 17.6956 26.0568 19.5783 26.8190 24.6219 19.7194 17.6990 20.3950 22.5915 21.4051 23.2096 15.1776 23.2919 21.1232 26.2114 23.5331 18.0324 27.1346 22.7513 24.9917 26.0627 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules 24187 TABLE 2.—HOSPITAL CASE-MIX INDEXES FOR DISCHARGES OCCURRING IN FEDERAL FISCAL YEAR 2005; HOSPITAL WAGE INDEXES FOR FEDERAL FISCAL YEAR 2007; HOSPITAL AVERAGE HOURLY WAGES FOR FEDERAL FISCAL YEARS 2005 (2001 WAGE DATA), 2006 (2002 WAGE DATA), AND 2007 (2003 WAGE DATA); WAGE INDEXES AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY WAGES—Continued Case-mix index 3 wwhite on PROD1PC61 with PROPOSALS2 Provider No. 180144 ..................................................... 180147 ..................................................... 180148 ..................................................... 180325 ..................................................... 190001 ..................................................... 190002 ..................................................... 190003 ..................................................... 190004 ..................................................... 190005 ..................................................... 190006 ..................................................... 190007 ..................................................... 190008 ..................................................... 190009 ..................................................... 190010 ..................................................... 190011 ..................................................... 190013 ..................................................... 190014 ..................................................... 190015 ..................................................... 190017 h ................................................... 190019 ..................................................... 190020 ..................................................... 190025 ..................................................... 190026 ..................................................... 190027 ..................................................... 190034 ..................................................... 190036 ..................................................... 190037 ..................................................... 190039 ..................................................... 190040 ..................................................... 190041 ..................................................... 190043 ..................................................... 190044 h ................................................... 190045 ..................................................... 190046 ..................................................... 190048 ..................................................... 190049 ..................................................... 190050 ..................................................... 190053 ..................................................... 190054 ..................................................... 190059 ..................................................... 190060 ..................................................... 190064 ..................................................... 190065 ..................................................... 190077 ..................................................... 190078 h ................................................... 190079 ..................................................... 190081 ..................................................... 190083 ..................................................... 190086 ..................................................... 190088 h ................................................... 190089 ..................................................... 190090 ..................................................... 190095 ..................................................... 190098 ..................................................... 190099 ..................................................... 190102 ..................................................... 190106 ..................................................... 190109 ..................................................... 190110 ..................................................... 190111 ..................................................... 190114 ..................................................... 190115 ..................................................... 190116 ..................................................... 190118 ..................................................... 190122 ..................................................... 190124 ..................................................... VerDate Aug<31>2005 17:10 Apr 24, 2006 Jkt 208001 FY 2007 wage index (10/1/2006– 3/31/2007) FY 2007 wage index (4/1/2007– 9/30/2007) Average hourly wage FY 2005 1 Average hourly wage FY 2006 1 Average hourly wage FY 2007 1 * 0.8164 0.7793 * 0.8855 0.8300 0.8300 0.8003 0.8855 0.8300 0.7487 0.8003 0.8028 * 0.8015 0.7934 0.7487 0.8855 0.8535 0.8028 0.8102 0.7487 0.8028 0.7934 0.7487 0.8855 0.7934 0.8855 0.8855 0.8879 * 0.8300 0.8855 0.8855 0.7487 * 0.7487 0.7487 0.7594 * 0.7934 0.8102 0.8102 * 0.8535 0.8855 0.7487 * 0.8015 0.9584 * 0.7487 * 0.8879 0.8102 0.8300 0.8028 0.8003 * 0.8879 0.7487 0.8879 0.7487 0.8879 0.8102 0.8855 * 0.8164 0.7793 * 0.8855 0.8300 0.8300 0.8003 0.8855 0.8300 0.7487 0.8003 0.8028 * 0.8015 0.7934 0.7487 0.8855 0.8535 0.8028 0.8102 0.7487 0.8028 0.7934 0.7487 0.8855 0.7934 0.8855 0.8855 0.8879 * 0.8300 0.8855 0.8855 0.7487 * 0.7487 0.7487 0.7594 * 0.7934 0.8102 0.8102 * 0.8535 0.8855 0.7487 * 0.8015 0.9584 * 0.7487 * 0.8879 0.8102 0.8300 0.8028 0.8003 * 0.8879 0.7487 0.8879 0.7487 0.8879 0.8102 0.8855 * * * * 19.5680 21.7000 21.8156 22.1835 20.7987 19.4573 18.7854 21.4137 18.8295 19.9788 18.1525 19.6346 17.4740 22.1046 18.6962 23.0704 19.8505 20.4651 21.3386 21.2449 17.5002 23.7356 16.7629 23.3105 23.8076 23.9082 16.8944 19.5304 24.0490 22.2884 18.6148 20.1229 18.5287 15.7258 20.3525 19.2396 22.2517 21.5514 23.0523 18.4043 21.5782 21.8158 14.9141 19.2683 18.8306 22.5045 16.2961 20.0745 18.7302 23.0802 21.1657 23.4618 21.5643 17.4842 19.0611 25.2370 14.6258 26.0272 18.6074 19.0200 19.3131 23.4862 * * * * 19.7516 22.0056 23.4977 23.3290 22.3208 22.2467 19.7528 24.0111 19.8404 21.6889 19.7319 20.8626 22.4596 22.8875 21.5033 23.7168 21.6136 20.8950 22.5087 21.2526 19.6943 24.8152 18.6393 25.6665 26.7428 24.6734 17.3477 19.5567 25.3854 24.2128 19.6288 * 19.1076 16.4968 20.1108 * 23.6278 23.3617 23.7450 18.8409 21.3786 21.2546 15.6146 * 19.8823 22.3480 * 20.2045 18.0174 24.6353 20.4597 25.2267 21.7228 18.6524 * 24.4998 15.8031 26.6295 20.3844 19.7025 23.7082 24.6675 30.3286 * * * 21.5505 23.3871 25.1210 24.5339 23.3281 22.8415 21.6654 24.7413 21.1607 * 20.7613 21.8582 22.4213 24.0393 23.9006 24.9325 21.7393 22.7566 23.6452 24.1159 20.1435 26.1501 19.4805 24.8064 29.1926 28.2604 * 19.6876 26.1439 24.4763 24.1444 * 20.2752 17.0974 22.5554 * 23.7228 23.1018 23.2052 * 21.4302 24.5361 17.3888 * 21.7601 23.7776 * 21.9736 * 25.4941 21.4308 26.2644 22.9793 19.7946 * 26.0669 15.8975 27.9894 21.4300 20.6847 21.6887 26.4280 *** 1.6674 1.9111 0.6167 1.1128 1.6807 1.4747 1.3195 1.4444 1.3548 1.1671 1.7539 1.1787 1.0751 1.0542 1.5067 1.2522 1.3280 1.3326 1.7368 1.1669 1.1904 1.5893 1.7130 1.1212 1.7154 1.0152 1.4789 1.3347 1.4817 0.9762 1.2847 1.6052 1.4230 1.0930 *** 1.1065 1.0904 1.3124 0.8305 1.4882 1.5792 1.5196 0.9219 1.0622 1.2803 0.8857 0.8253 1.2411 1.0582 1.0009 1.0399 *** 1.6321 0.9927 1.5637 1.1741 1.1062 0.9270 1.6432 1.0698 1.1109 1.2757 0.9548 1.2678 1.5845 PO 00000 Frm 00193 Fmt 4701 Sfmt 4702 E:\FR\FM\25APP2.SGM 25APP2 Average hourly wage** (3 years) 30.3286 * * * 20.3938 22.3593 23.4734 23.3634 22.1604 21.4705 20.0400 23.4477 19.8729 20.8295 19.5483 20.7874 20.6365 23.0562 21.2079 23.9113 21.0389 21.3808 22.5325 22.1755 19.1254 24.8932 18.2227 24.6160 26.4378 25.5075 17.1195 19.5901 25.2015 23.6621 20.4885 20.1229 19.3127 16.4674 21.0238 19.2396 23.1972 22.6984 23.3343 18.6185 21.4587 22.5734 15.9862 19.2683 20.1681 22.8555 16.2961 20.8003 18.3606 24.4176 21.0206 24.9673 22.1017 18.5909 19.0611 25.2574 15.4576 26.8610 20.1684 19.8213 21.4626 24.8426 24188 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules TABLE 2.—HOSPITAL CASE-MIX INDEXES FOR DISCHARGES OCCURRING IN FEDERAL FISCAL YEAR 2005; HOSPITAL WAGE INDEXES FOR FEDERAL FISCAL YEAR 2007; HOSPITAL AVERAGE HOURLY WAGES FOR FEDERAL FISCAL YEARS 2005 (2001 WAGE DATA), 2006 (2002 WAGE DATA), AND 2007 (2003 WAGE DATA); WAGE INDEXES AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY WAGES—Continued Case-mix index 3 wwhite on PROD1PC61 with PROPOSALS2 Provider No. 190125 ..................................................... 190128 ..................................................... 190130 ..................................................... 190131 ..................................................... 190133 ..................................................... 190135 ..................................................... 190140 ..................................................... 190144 h ................................................... 190145 ..................................................... 190146 ..................................................... 190148 ..................................................... 190149 ..................................................... 190151 ..................................................... 190152 ..................................................... 190156 ..................................................... 190158 ..................................................... 190160 ..................................................... 190161 ..................................................... 190162 ..................................................... 190164 ..................................................... 190167 ..................................................... 190175 ..................................................... 190176 ..................................................... 190177 ..................................................... 190182 ..................................................... 190183 ..................................................... 190184 ..................................................... 190185 ..................................................... 190190 ..................................................... 190191 h ................................................... 190196 ..................................................... 190197 ..................................................... 190199 ..................................................... 190200 ..................................................... 190201 ..................................................... 190202 ..................................................... 190203 ..................................................... 190204 ..................................................... 190205 ..................................................... 190206 ..................................................... 190208 ..................................................... 190218 ..................................................... 190236 ..................................................... 190240 ..................................................... 190241 ..................................................... 190242 ..................................................... 190243 ..................................................... 190245 ..................................................... 190246 ..................................................... 190247 ..................................................... 190248 ..................................................... 190249 ..................................................... 190250 ..................................................... 190251 ..................................................... 190252 ..................................................... 190253 ..................................................... 190254 ..................................................... 190255 ..................................................... 190256 ..................................................... 190257 ..................................................... 190258 ..................................................... 190259 ..................................................... 190260 ..................................................... 190261 ..................................................... 190262 ..................................................... 190263 ..................................................... VerDate Aug<31>2005 17:10 Apr 24, 2006 Jkt 208001 FY 2007 wage index (10/1/2006– 3/31/2007) FY 2007 wage index (4/1/2007– 9/30/2007) Average hourly wage FY 2005 1 Average hourly wage FY 2006 1 Average hourly wage FY 2007 1 0.8015 0.8102 * 0.8855 0.7725 0.8855 0.7487 0.9584 0.7487 0.8855 * * 0.7487 0.8855 * 0.8855 0.8015 0.7934 * 0.8028 0.7487 0.8855 0.8855 0.8855 0.8855 0.8003 0.7648 0.8855 0.7648 0.8102 0.8300 0.8015 0.8102 * 0.7934 0.8102 0.8855 0.8855 0.8300 0.8855 0.7487 0.8715 0.8879 * 0.8003 0.8102 * 0.8015 0.7648 * * 0.8102 0.8855 0.8102 * 0.8855 * 0.8300 0.8855 0.7487 0.8879 0.8300 0.8855 0.8015 0.8855 0.8300 0.8015 0.8102 * 0.8855 0.7725 0.8855 0.7487 0.9584 0.7487 0.8855 * * 0.7487 0.8855 * 0.8855 0.8015 0.7934 * 0.8028 0.7487 0.8855 0.8855 0.8855 0.8855 0.8003 0.7648 0.8855 0.7648 0.8102 0.8300 0.8015 0.8102 * 0.7934 0.8102 0.8855 0.8855 0.8300 0.8855 0.7487 0.8715 0.8879 * 0.8003 0.8102 * 0.8015 0.7648 * * 0.8102 0.8855 0.8102 * 0.8855 * 0.8300 0.8855 0.7487 0.8879 0.8300 0.8855 0.8015 0.8855 0.8300 22.3976 24.7842 16.6910 22.5032 14.3089 26.9920 17.0371 21.1658 17.3361 23.7721 20.8321 17.1671 17.8741 27.4708 18.3702 26.2352 20.0025 17.8794 22.1781 21.4247 17.8604 24.6790 25.8482 25.4769 25.0837 18.3151 21.3191 24.4176 14.0052 22.3755 21.9355 22.9631 18.5317 26.4258 22.5588 21.8900 26.9099 28.8777 21.7696 26.9117 24.8409 23.9182 23.8233 13.9888 28.9620 20.5937 30.6060 * * * * * * * * * * * * * * * * * * * 23.9649 27.9136 * 25.1917 13.6266 26.8238 17.6936 21.7547 18.9678 26.1792 * 18.8819 18.6293 27.6099 * 26.3042 21.6740 19.1022 25.0328 22.8599 24.3185 27.1531 25.6997 27.4621 28.4799 19.8084 23.9609 24.7912 16.1195 23.5734 24.7135 24.3735 14.1410 27.5681 24.5877 24.7944 26.8795 28.3684 24.4540 26.0139 24.2586 25.0356 23.6824 * 23.9700 23.0072 * 27.1786 * * * * * * * * * * * * * * * * * * 25.7211 28.1804 * 27.3959 17.7890 28.2929 18.5731 23.1334 18.4810 27.6317 * * 17.5239 29.4694 * 27.1110 22.7598 22.3359 25.7829 24.0576 25.8153 26.1048 26.8503 27.9703 27.5625 22.0079 22.4219 26.1253 22.9091 23.3481 24.3478 25.2869 18.4387 29.3041 25.3816 26.9337 28.7207 28.9970 25.8360 26.9116 24.8507 26.1218 25.3463 * 24.8072 24.3809 * 26.0610 * 32.6169 22.5610 19.9654 30.7776 22.7409 23.5958 23.2202 32.7951 23.6948 * 23.3563 31.4217 * * * * * 1.6592 1.0106 1.0390 1.1810 0.9292 1.5040 1.0098 1.1524 0.9656 1.5838 *** 0.9370 0.9812 1.3746 0.8864 1.5509 1.5748 1.0826 *** 1.0953 1.1968 1.3812 1.7672 1.7055 1.0531 1.1374 0.9618 1.4457 0.8819 1.3219 0.9313 1.3995 1.1332 *** 1.4773 1.3534 5.8369 1.4705 1.7340 1.5267 0.8148 1.1776 1.4266 *** 1.4098 1.1366 *** 1.6145 1.7005 *** *** 1.6224 2.2982 1.3551 *** 1.0067 *** 0.7132 1.0318 1.6790 1.6850 1.6898 1.4951 0.8481 1.3581 2.3925 PO 00000 Frm 00194 Fmt 4701 Sfmt 4702 E:\FR\FM\25APP2.SGM 25APP2 Average hourly wage** (3 years) 23.9666 26.9928 16.6910 25.0842 15.7239 27.3619 17.7798 22.0403 18.2716 25.7618 20.8321 17.9835 18.0074 28.1681 18.3702 26.5427 21.4114 19.6222 24.2603 22.8477 22.5159 26.0265 26.1394 26.9919 26.9440 19.9316 22.5353 25.1793 18.5382 23.1104 23.6938 24.1817 16.8503 27.5730 24.2106 24.6847 27.4692 28.7443 24.0124 26.6047 24.6578 25.0378 24.2960 13.9888 25.7035 22.7673 30.6060 26.6431 * 32.6169 22.5610 19.9654 30.7776 22.7409 23.5958 23.2202 32.7951 23.6948 * 23.3563 31.4217 * * * * * Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules 24189 TABLE 2.—HOSPITAL CASE-MIX INDEXES FOR DISCHARGES OCCURRING IN FEDERAL FISCAL YEAR 2005; HOSPITAL WAGE INDEXES FOR FEDERAL FISCAL YEAR 2007; HOSPITAL AVERAGE HOURLY WAGES FOR FEDERAL FISCAL YEARS 2005 (2001 WAGE DATA), 2006 (2002 WAGE DATA), AND 2007 (2003 WAGE DATA); WAGE INDEXES AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY WAGES—Continued Case-mix index 3 wwhite on PROD1PC61 with PROPOSALS2 Provider No. 190264 190265 190266 190267 190268 190272 190315 190319 190322 200001 200002 200007 200008 200009 200012 200013 200018 200019 200020 200021 200024 200025 200026 200027 200028 200031 200032 200033 200034 200037 200039 200040 200041 200050 200052 200063 200066 210001 210002 210003 210004 210005 210006 210007 210008 210009 210010 210011 210012 210013 210015 210016 210017 210018 210019 210022 210023 210024 210025 210027 210028 210029 210030 210032 210033 210034 ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... VerDate Aug<31>2005 17:10 Apr 24, 2006 Jkt 208001 FY 2007 wage index (10/1/2006– 3/31/2007) FY 2007 wage index (4/1/2007– 9/30/2007) Average hourly wage FY 2005 1 Average hourly wage FY 2006 1 Average hourly wage FY 2007 1 * * * * * * * * * 0.9702 0.8528 * 0.9916 0.9916 * * 0.8399 0.9916 1.0309 0.9916 0.9487 0.9916 * * * 0.8399 0.8865 0.9702 0.9487 0.8399 0.9487 0.9916 0.8399 0.9702 0.8399 0.9487 * 0.9211 1.0090 1.1076 1.1068 1.1028 1.0090 1.0090 1.0090 1.0090 * 1.0090 1.0090 1.0090 1.0090 1.1068 0.8946 1.1068 0.8958 1.1068 1.0299 1.0090 0.8946 0.8946 0.9458 1.0090 0.8946 1.0878 1.0090 1.0090 * * * * * * * * * 0.9702 0.8528 * 0.9916 0.9916 * * 0.8399 0.9916 1.0309 0.9916 0.9487 0.9916 * * * 0.8399 0.8865 0.9702 0.9487 0.8399 0.9487 0.9916 0.8399 0.9702 0.8399 0.9487 * 0.9211 1.0090 1.1076 1.1068 1.1028 1.0090 1.0090 1.0090 1.0090 * 1.0090 1.0090 1.0090 1.0090 1.1068 0.8946 1.1068 0.8958 1.1068 1.0299 1.0090 0.8946 0.8946 0.9458 1.0090 0.8946 1.0878 1.0090 1.0090 * * * * * * * * * 23.2210 24.1446 22.3920 25.1741 28.1409 24.1243 23.9048 24.3294 24.0926 28.7351 25.1027 24.6484 24.3646 21.9997 23.2912 24.3061 20.6202 24.2221 26.8727 26.1150 23.3490 24.0474 23.6791 23.6797 25.5233 22.7763 24.7235 21.6354 26.3144 25.2859 32.3042 29.4300 27.1276 25.6396 28.4496 26.3008 24.6332 24.5071 24.8373 25.7934 23.9875 25.8532 28.6992 21.3983 27.5431 24.9252 30.1470 29.0844 27.1756 23.8943 23.9255 24.1265 31.2888 27.5507 25.7138 26.6113 26.3896 * * * * * * * * * 25.1145 25.7478 * 27.4412 31.1056 25.7623 24.4131 23.6337 25.1367 31.7083 24.5519 26.0080 26.0573 * 26.3118 24.3271 21.9489 25.5227 28.6479 26.2926 23.2333 25.1196 25.5405 24.5532 26.4992 21.8726 25.0167 * 27.7561 26.4992 29.8684 34.2392 28.7557 25.4081 30.2548 25.2833 26.2360 25.7775 27.5031 27.4103 25.1348 28.2029 32.2081 23.2168 29.1870 26.1824 33.8015 30.4656 29.5579 26.0771 26.0111 25.9221 27.9741 29.5635 26.1829 29.0420 28.4308 * * * * * * * * * 25.2214 25.8372 * 28.1910 30.5597 * * 23.3123 25.9081 33.4438 27.4575 26.9002 27.0379 * * * 21.2055 26.6057 29.5897 27.3852 24.3927 24.9813 26.1019 24.8537 27.7986 22.6132 25.9508 * 27.6008 32.7693 34.2570 33.2835 28.9736 26.5757 32.0607 24.6380 28.7516 * 29.9956 30.3738 28.1586 30.4000 32.9950 24.8570 29.7414 27.6140 35.4174 32.2959 31.0777 26.8894 25.5623 26.5604 31.4973 27.8221 27.3503 29.2098 30.7435 0.8475 1.7577 2.1798 1.1686 1.0792 1.5252 0.6227 0.6636 0.6534 1.3968 1.1618 1.0634 1.3499 1.9130 1.2286 1.0902 1.3112 1.2865 1.2500 1.2371 1.5547 1.1601 *** 1.2078 1.0082 1.2800 1.1803 1.8640 1.3356 1.1709 1.2856 1.2411 1.1777 1.2158 1.1205 1.1573 1.1290 1.4173 1.9843 1.6774 1.4303 1.2792 1.0955 1.9108 1.3721 1.7671 *** 1.4072 1.6687 1.3016 1.3253 1.8484 1.2333 1.2046 1.7934 1.3768 1.4377 1.7307 1.2602 1.4414 1.1079 1.2797 1.3403 1.1400 1.1879 1.3061 PO 00000 Frm 00195 Fmt 4701 Sfmt 4702 E:\FR\FM\25APP2.SGM 25APP2 Average hourly wage** (3 years) * * * * * * * * * 24.5549 25.2072 22.3920 26.9280 29.9288 24.9713 24.1576 23.7070 25.0652 31.3595 25.7589 25.9263 25.8101 21.9997 24.7659 24.3172 21.2587 25.4585 28.3730 26.6073 23.6760 24.7257 25.0872 24.3828 26.6203 22.4260 25.2331 21.6354 27.2238 28.0377 32.1281 32.3122 28.2902 25.8788 30.2720 25.3549 26.5487 25.1483 27.5064 27.9884 25.7366 28.1869 31.2873 23.1911 28.8513 26.2446 33.0730 30.6752 29.2823 25.5852 25.2157 25.5493 30.1510 28.3058 26.4352 28.3156 28.5652 24190 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules TABLE 2.—HOSPITAL CASE-MIX INDEXES FOR DISCHARGES OCCURRING IN FEDERAL FISCAL YEAR 2005; HOSPITAL WAGE INDEXES FOR FEDERAL FISCAL YEAR 2007; HOSPITAL AVERAGE HOURLY WAGES FOR FEDERAL FISCAL YEARS 2005 (2001 WAGE DATA), 2006 (2002 WAGE DATA), AND 2007 (2003 WAGE DATA); WAGE INDEXES AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY WAGES—Continued Case-mix index 3 wwhite on PROD1PC61 with PROPOSALS2 Provider No. 210035 210037 210038 210039 210040 210043 210044 210045 210048 210049 210051 210054 210055 210056 210057 210058 210060 210061 220001 220002 220003 220006 220008 220010 220011 220012 220015 220016 220017 220019 220020 220024 220025 220028 220029 220030 220031 220033 220035 220036 220041 220046 220049 220050 220051 220052 220058 220060 220062 220063 220065 220066 220067 220070 220071 220073 220074 220075 220076 220077 220080 220082 220083 220084 220086 220088 ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... VerDate Aug<31>2005 17:10 Apr 24, 2006 Jkt 208001 FY 2007 wage index (10/1/2006– 3/31/2007) FY 2007 wage index (4/1/2007– 9/30/2007) Average hourly wage FY 2005 1 Average hourly wage FY 2006 1 Average hourly wage FY 2007 1 1.1076 0.8946 1.0090 1.1076 1.0090 1.0299 1.0090 0.8958 1.0377 1.0090 1.1076 1.1076 1.1076 1.0090 1.1068 1.0090 1.1076 0.8946 1.1318 1.1318 * * 1.0791 1.1318 1.1318 1.2553 1.0664 1.0664 1.1687 1.1318 1.0791 1.0664 1.1318 1.1318 1.1318 1.0664 1.1687 1.1318 1.1318 1.1687 * 1.1318 1.1318 1.0664 1.0664 1.1687 1.1318 1.2181 1.1318 1.1318 1.0664 1.0664 1.1687 1.1318 1.1687 1.0791 1.1687 1.1687 * 1.0918 1.1318 1.1318 1.1687 1.1318 1.1687 1.1687 1.1076 0.8946 1.0090 1.1076 1.0090 1.0299 1.0090 0.8958 1.0377 1.0090 1.1076 1.1076 1.1076 1.0090 1.1068 1.0090 1.1076 0.8946 1.1318 1.1318 * * 1.0791 1.1318 1.1318 1.2553 1.0664 1.0664 1.1687 1.1318 1.0791 1.0664 1.1318 1.1318 1.1318 1.0664 1.1687 1.1318 1.1318 1.1687 * 1.0664 1.1318 1.0664 1.0664 1.1687 1.1318 1.2181 1.1318 1.1318 1.0664 1.0664 1.1687 1.1318 1.1687 1.0791 1.1687 1.1687 * 1.0918 1.1318 1.1318 1.1687 1.1318 1.1687 1.1687 24.5198 24.1913 28.3414 25.8415 28.3723 24.3070 24.8083 15.0867 25.0617 25.9342 27.3692 24.6658 28.0014 26.6884 29.2233 24.8576 28.7531 24.1369 27.3238 28.9722 20.5790 29.5946 27.1675 27.4161 32.6624 32.9791 25.5449 26.8798 28.8264 22.2294 24.2279 25.5837 24.5186 31.3592 28.1432 23.6257 32.2660 26.8049 27.5533 29.6296 29.7464 27.7726 27.0464 24.9945 26.5575 28.0925 25.0598 30.8242 21.9489 25.5840 24.8737 26.2561 28.5220 28.9100 31.8322 29.2399 27.5763 27.9503 27.2534 28.0935 27.1578 24.8060 29.9001 29.0505 31.7482 28.5711 26.1082 27.0973 29.5980 27.6940 29.3514 27.5657 28.8700 15.6380 28.4638 26.9656 29.2998 26.2295 29.9708 28.6091 32.2883 29.7841 28.5087 23.6662 29.0014 30.3598 22.0549 30.8599 30.1043 29.7998 34.4064 35.7872 28.3397 28.0609 29.7108 23.2544 26.5305 27.3488 23.0637 32.0980 28.6970 24.4289 34.8183 28.2539 28.6238 31.5184 * 28.1396 27.7517 26.3768 29.8380 29.8577 24.9642 32.3362 24.2779 27.3967 26.5513 27.1317 29.8911 31.9283 32.2936 31.3566 28.4930 29.1588 29.7507 30.2684 28.9835 26.9841 32.9143 32.5711 34.3667 28.5462 28.2974 27.4321 30.2311 30.6411 28.6883 28.0237 30.1590 14.3656 27.3793 26.7764 30.1862 27.6137 30.8388 30.5354 31.9780 31.7032 28.8466 23.0523 31.2085 32.8760 * 30.7330 30.9345 31.4253 32.7733 37.6096 29.7600 30.8663 31.2550 24.9623 27.8385 28.6898 26.0299 31.5587 31.1099 25.9633 37.0251 31.3862 31.2994 33.5361 * 30.3602 30.6379 28.0886 30.6499 32.5961 26.7206 33.0544 24.9938 29.9941 27.5196 27.9943 30.3267 32.8480 35.5338 33.3418 30.0912 30.5079 27.4339 31.1933 29.5970 29.8247 33.7694 31.4451 33.7988 36.0913 1.2634 1.2148 1.1762 1.1341 1.2321 1.3335 1.3586 1.0603 1.3049 1.2098 1.3106 1.3557 1.2007 1.2815 1.4141 1.0867 1.1523 1.3223 1.2596 1.3298 1.0758 *** 1.2830 1.2555 1.1836 1.5060 1.1800 1.1151 1.2644 1.1472 1.1731 1.3169 1.0713 1.5243 1.1194 1.1049 1.6617 1.1670 1.4035 1.5300 *** 1.4404 1.2204 1.1427 1.2556 1.1658 1.0009 1.1942 0.5772 1.2343 1.2426 1.3716 1.1669 1.1708 1.8540 1.2165 1.3020 1.5634 *** 1.7189 1.2116 1.2876 1.1521 1.2315 1.8147 1.8495 PO 00000 Frm 00196 Fmt 4701 Sfmt 4702 E:\FR\FM\25APP2.SGM 25APP2 Average hourly wage** (3 years) 26.3729 26.3569 29.4259 28.0851 28.8196 26.6189 27.9174 15.0218 27.0126 26.5560 28.9788 26.2370 29.6378 28.6855 31.2261 29.0401 28.7138 23.5621 29.1967 30.8268 21.3294 30.4422 29.4497 29.5798 33.3053 35.5395 27.9761 28.6310 29.9361 23.5079 26.2353 27.1876 24.5351 31.6664 29.3471 24.7095 34.7408 28.8106 29.2385 31.6091 29.7464 28.8066 28.5150 26.5235 28.9958 30.0602 25.5650 32.1202 23.7495 27.6386 26.3247 27.1639 29.6132 31.0719 33.2847 31.2658 28.7684 29.2027 28.0834 29.9019 28.6365 27.2457 32.1442 31.0666 33.2870 30.7044 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules 24191 TABLE 2.—HOSPITAL CASE-MIX INDEXES FOR DISCHARGES OCCURRING IN FEDERAL FISCAL YEAR 2005; HOSPITAL WAGE INDEXES FOR FEDERAL FISCAL YEAR 2007; HOSPITAL AVERAGE HOURLY WAGES FOR FEDERAL FISCAL YEARS 2005 (2001 WAGE DATA), 2006 (2002 WAGE DATA), AND 2007 (2003 WAGE DATA); WAGE INDEXES AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY WAGES—Continued Case-mix index 3 wwhite on PROD1PC61 with PROPOSALS2 Provider No. 220089 ..................................................... 220090 ..................................................... 220095 ..................................................... 220098 ..................................................... 220100 ..................................................... 220101 ..................................................... 220105 ..................................................... 220108 ..................................................... 220110 ..................................................... 220111 ..................................................... 220116 ..................................................... 220119 ..................................................... 220126 ..................................................... 220133 ..................................................... 220135 ..................................................... 220153 ..................................................... 220154 ..................................................... 220163 ..................................................... 220171 ..................................................... 220174 ..................................................... 220176 ..................................................... 230001 ..................................................... 230002 ..................................................... 230003 ..................................................... 230004 ..................................................... 230005 h ................................................... 230006 ..................................................... 230013 ..................................................... 230015 ..................................................... 230017 ..................................................... 230019 ..................................................... 230020 ..................................................... 230021 ..................................................... 230022 ..................................................... 230024 ..................................................... 230027 ..................................................... 230029 ..................................................... 230030 ..................................................... 230031 ..................................................... 230034 ..................................................... 230035 ..................................................... 230036 ..................................................... 230037 ..................................................... 230038 ..................................................... 230040 ..................................................... 230041 ..................................................... 230042 ..................................................... 230046 ..................................................... 230047 ..................................................... 230053 ..................................................... 230054 ..................................................... 230055 ..................................................... 230058 ..................................................... 230059 ..................................................... 230060 ..................................................... 230065 ..................................................... 230066 ..................................................... 230069 ..................................................... 230070 ..................................................... 230071 ..................................................... 230072 ..................................................... 230075 ..................................................... 230077 ..................................................... 230078 ..................................................... 230080 ..................................................... 230081 ..................................................... VerDate Aug<31>2005 17:10 Apr 24, 2006 Jkt 208001 FY 2007 wage index (10/1/2006– 3/31/2007) FY 2007 wage index (4/1/2007– 9/30/2007) Average hourly wage FY 2005 1 Average hourly wage FY 2006 1 Average hourly wage FY 2007 1 1.1161 1.1318 1.1318 1.1318 1.1687 1.1318 1.1318 1.1687 1.1687 1.1687 1.1687 1.1687 1.1687 * 1.2553 1.0664 1.1687 1.1318 1.1318 1.1318 * * 1.0235 1.0737 1.0737 1.0853 * 1.0685 0.9414 1.0737 1.0685 1.0630 0.9191 0.9823 1.0630 * 1.0685 0.9055 1.0123 0.9055 0.9469 1.0040 1.0630 1.0737 0.9469 1.0139 * 1.0853 1.0235 1.0630 0.9620 0.9055 0.9055 1.0737 0.9055 * 1.0737 1.0630 0.9055 1.0685 1.0737 0.9871 1.0685 0.9055 0.9055 0.9055 1.1161 1.1318 1.1318 1.1318 1.1687 1.1318 1.1318 1.1687 1.1687 1.1687 1.1687 1.1687 1.1687 * 1.2553 1.0664 1.1687 1.1318 1.1318 1.1318 * * 1.0391 0.9683 0.9961 1.0853 * 1.0235 0.9414 1.0737 1.0235 1.0391 0.9191 0.9823 1.0391 * 1.0235 0.9055 1.0123 0.9055 0.9469 1.0040 1.0391 0.9469 0.9469 1.0139 * 1.0853 1.0235 1.0391 0.9620 0.9055 0.9055 0.9469 0.9055 * 0.9961 1.0391 0.9055 1.0235 0.9683 0.9871 1.0685 0.9055 0.9055 0.9055 32.4409 29.7945 24.9871 26.8538 28.4848 31.0834 30.0892 29.0804 35.4242 28.9092 32.2337 27.8372 26.7660 31.2981 31.3246 18.9267 30.9009 30.5056 28.9733 30.3356 * 24.3660 27.0305 25.2596 25.5573 22.1018 22.7656 22.7014 23.4512 27.3259 27.6563 26.8516 23.4663 22.2528 27.6555 22.5736 27.9012 20.9867 23.2910 20.9195 20.9197 26.5854 24.7875 25.2499 21.9813 25.2518 24.3640 29.2683 26.2447 28.3030 24.0137 23.7671 21.9308 23.1451 24.5073 27.9179 25.8517 27.6815 25.1587 24.7707 24.1560 24.1482 27.3117 21.9200 21.2840 20.6777 31.1708 30.8685 27.4273 28.8314 29.6912 33.1690 31.9421 30.6252 36.6084 31.1850 32.9988 30.1056 28.7805 33.6003 33.9866 * 28.6462 33.6484 30.4036 31.7572 * * 29.1410 26.1278 26.7206 24.1902 23.8835 23.7822 24.6570 29.5178 28.4575 29.2869 24.9551 23.3000 30.0813 23.5511 29.0935 22.3174 25.4678 26.7967 21.2317 28.3622 26.2000 26.3480 24.2349 26.1760 26.2037 30.3591 28.1351 29.8703 24.9905 25.4143 24.0657 25.5350 25.5015 28.4631 27.4928 29.5556 24.2342 26.3907 24.4933 27.6193 27.6157 23.9901 21.2314 23.0788 32.4915 32.9169 28.5030 30.8540 31.4815 35.9902 33.2654 33.0443 39.0322 33.3309 36.5682 30.8989 31.8676 * 36.0887 14.1334 35.5883 33.8384 32.0101 30.7270 * * 28.6090 27.3169 29.1937 26.3043 * 24.5785 27.0741 31.7604 32.0970 29.1241 26.4485 25.0800 31.5988 * 32.7314 23.5494 28.9309 24.7096 24.6410 29.2811 28.6435 27.9064 25.5295 27.4599 * 31.8614 30.7000 32.3593 25.8181 26.6932 26.0394 27.6205 28.8932 32.3190 29.8291 31.3504 25.2886 28.1751 26.3114 28.5212 28.3061 26.2508 24.0443 24.5396 1.3003 1.2011 1.1330 1.1241 1.3422 1.2661 1.2410 1.1449 2.0017 1.1994 1.9564 1.1193 1.1729 *** 1.3405 0.9848 0.9336 1.6470 1.7942 1.1988 1.5414 1.0769 1.2952 1.2115 1.7321 1.2788 1.1218 1.3549 1.0350 1.6823 1.5714 1.7351 1.5640 1.2895 1.5504 1.1269 1.6096 1.2805 1.3726 1.3358 1.3084 1.3873 1.2855 1.7665 1.2170 1.5467 1.2127 1.8770 1.4956 1.6058 2.0040 1.2536 1.1715 1.5561 1.2076 *** 1.3089 1.1416 1.6546 0.8889 1.4215 1.3157 2.0406 1.0339 1.3081 1.2045 PO 00000 Frm 00197 Fmt 4701 Sfmt 4702 E:\FR\FM\25APP2.SGM 25APP2 Average hourly wage** (3 years) 32.0184 31.2935 27.0085 28.8728 29.9431 33.5726 31.8424 30.9170 37.0923 31.2225 33.8543 29.6743 29.1255 32.4924 33.8967 17.1170 31.2859 32.5869 30.5076 30.9243 * 24.3660 28.2640 26.2815 27.2248 24.1338 23.3472 23.6715 25.0665 29.6143 29.3438 28.4427 24.9904 23.5509 29.7774 23.0457 29.8511 22.3170 25.7151 24.1460 22.2545 28.0601 26.5799 26.5323 23.9840 26.3249 25.3026 30.5717 28.4133 30.1185 24.9538 25.2940 24.0162 25.5084 26.2709 29.1033 27.8691 29.5335 24.8787 26.4737 25.0275 26.7496 27.7598 24.1481 22.1966 22.7915 24192 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules TABLE 2.—HOSPITAL CASE-MIX INDEXES FOR DISCHARGES OCCURRING IN FEDERAL FISCAL YEAR 2005; HOSPITAL WAGE INDEXES FOR FEDERAL FISCAL YEAR 2007; HOSPITAL AVERAGE HOURLY WAGES FOR FEDERAL FISCAL YEARS 2005 (2001 WAGE DATA), 2006 (2002 WAGE DATA), AND 2007 (2003 WAGE DATA); WAGE INDEXES AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY WAGES—Continued Case-mix index 3 wwhite on PROD1PC61 with PROPOSALS2 Provider No. 230082 ..................................................... 230085 ..................................................... 230086 ..................................................... 230087 ..................................................... 230089 ..................................................... 230092 ..................................................... 230093 ..................................................... 230095 ..................................................... 230096 ..................................................... 230097 ..................................................... 230099 ..................................................... 230100 ..................................................... 230101 ..................................................... 230103 ..................................................... 230104 ..................................................... 230105 ..................................................... 230106 ..................................................... 230108 ..................................................... 230110 ..................................................... 230117 ..................................................... 230118 ..................................................... 230119 ..................................................... 230120 ..................................................... 230121 ..................................................... 230124 ..................................................... 230130 ..................................................... 230132 ..................................................... 230133 ..................................................... 230135 ..................................................... 230141 ..................................................... 230142 ..................................................... 230143 ..................................................... 230144 ..................................................... 230145 ..................................................... 230146 ..................................................... 230149 ..................................................... 230151 ..................................................... 230153 ..................................................... 230155 ..................................................... 230156 ..................................................... 230165 ..................................................... 230167 ..................................................... 230169 ..................................................... 230171 ..................................................... 230172 ..................................................... 230174 ..................................................... 230176 ..................................................... 230180 ..................................................... 230184 ..................................................... 230186 ..................................................... 230189 ..................................................... 230190 ..................................................... 230193 ..................................................... 230195 ..................................................... 230197 ..................................................... 230204 ..................................................... 230207 ..................................................... 230208 ..................................................... 230212 ..................................................... 230216 ..................................................... 230217 ..................................................... 230222 h ................................................... 230223 ..................................................... 230227 ..................................................... 230230 ..................................................... 230235 ..................................................... VerDate Aug<31>2005 17:10 Apr 24, 2006 Jkt 208001 FY 2007 wage index (10/1/2006– 3/31/2007) FY 2007 wage index (4/1/2007– 9/30/2007) Average hourly wage FY 2005 1 Average hourly wage FY 2006 1 Average hourly wage FY 2007 1 * 1.0737 * * 1.0630 0.9823 0.9469 0.9055 1.0737 0.9469 1.0630 0.9055 0.9055 * 1.0630 1.0040 1.0737 0.9055 0.9055 1.0737 0.9055 1.0630 * 0.9823 * 1.0685 1.0978 0.9055 1.0630 1.0978 1.0235 * 1.0853 * 1.0630 * 1.0685 * * 1.0853 1.0630 1.0096 * * * 1.0737 1.0630 0.9055 * * * 1.0737 1.0123 1.0235 1.0978 1.0235 1.0685 0.9469 1.0853 1.0123 0.9823 0.9283 1.0685 1.0235 1.0096 * * 1.0737 * * 1.0391 0.9823 0.9469 0.9055 1.0737 0.9469 1.0391 0.9055 0.9055 * 1.0391 1.0040 0.9499 0.9055 0.9055 1.0737 0.9055 1.0391 * 0.9823 * 1.0235 1.0978 0.9055 1.0391 1.0978 1.0391 * 1.0853 * 1.0391 * 1.0235 * * 1.0853 1.0391 1.0096 * * * 0.9683 1.0391 0.9055 * * * 1.0737 1.0123 1.0235 1.0978 1.0235 1.0235 0.9469 1.0853 1.0123 0.9823 0.9283 1.0235 1.0235 1.0096 * 23.1240 22.2569 20.8759 * 23.9486 24.3768 24.5055 19.2244 26.7578 25.2104 25.0390 20.4565 23.1349 18.4304 27.8864 24.6853 24.1128 22.4966 22.7621 29.6361 21.4886 29.2509 21.7894 23.4394 23.0508 26.9907 29.9106 21.2273 23.9000 30.4643 25.6044 19.5387 * 17.2181 24.3891 21.4753 26.4669 22.3404 24.0404 29.4855 27.3164 26.6828 27.1172 22.0635 24.0236 26.2770 25.6777 22.5454 21.9346 27.1126 20.8605 28.7365 24.3181 27.1266 28.3439 25.9871 22.2854 20.9420 27.3686 26.1468 26.7929 24.8925 27.1503 28.1105 25.4471 19.6046 22.2165 22.7314 * 16.9168 28.7015 26.3584 26.4967 21.3915 28.7681 26.5773 26.4882 21.8895 24.3772 21.6609 30.5570 27.2705 24.3980 18.4063 28.7704 29.4775 22.3636 30.2441 24.1485 24.5220 * 26.6076 30.5318 24.3175 25.8406 28.6326 26.9433 21.4083 * * 26.3432 * 28.2243 22.8644 * 31.1909 28.9636 27.4562 31.8442 * 25.7402 27.6920 27.3605 24.7358 23.6707 26.2282 23.0099 29.9604 23.3565 28.2892 30.0367 29.1466 24.5201 21.9651 29.7980 27.5230 28.6075 26.9724 29.2853 29.5798 27.9607 21.8777 * 23.3957 * * 30.4100 28.1764 26.0513 22.4323 30.6584 28.5361 28.7593 24.1824 25.3781 * 31.7701 32.8773 25.6113 20.8489 24.6324 32.3796 23.4529 30.5690 * 26.7038 * 30.4881 32.7610 24.1542 26.3160 31.7206 27.7390 * * * 27.0190 * 27.3926 * * 33.3966 29.3983 29.4375 * * * 30.2951 27.8101 26.5277 34.0691 * * 32.4001 25.2992 29.4364 32.8265 29.7273 25.4131 23.1625 32.5361 29.1364 29.7609 30.2084 28.7434 31.2231 30.0898 * 0.9782 1.2286 1.1583 *** 1.3507 1.3484 1.2207 1.3595 1.1658 1.8024 1.2294 1.2303 1.1612 1.0731 1.6312 1.9789 1.0982 1.1275 1.2929 1.8782 1.0705 1.3083 1.1170 1.2749 1.3714 1.7526 1.4085 1.3772 1.1854 1.6360 1.2984 1.2854 1.5305 *** 1.3093 *** 1.3162 0.9954 *** 1.5931 1.7163 1.5889 *** *** 1.2675 1.3287 1.2860 1.0946 *** *** 0.9848 0.9660 1.2369 1.4121 1.6117 1.3256 1.3967 1.1981 1.0156 1.6633 1.3064 1.3442 1.2478 1.5190 1.5144 0.9813 PO 00000 Frm 00198 Fmt 4701 Sfmt 4702 E:\FR\FM\25APP2.SGM 25APP2 Average hourly wage** (3 years) 22.6498 22.8121 20.8759 16.9168 27.6217 26.3309 25.6772 21.0375 28.7161 26.7964 26.7894 22.1932 24.3329 19.9258 30.0214 28.3242 24.7279 20.4585 25.3971 30.4251 22.4396 30.0291 22.9553 24.8835 23.0508 28.0695 31.0442 23.2760 25.3904 30.2602 26.7874 20.4663 * 17.2181 25.9632 21.4753 27.3632 22.6169 24.0404 31.3733 28.5661 27.8699 29.3455 22.0635 24.8835 28.1112 27.1746 24.6245 23.6789 26.7039 21.9754 30.3817 24.3281 28.3509 30.4301 28.2022 24.0831 22.0408 29.8062 27.6226 28.4930 27.4096 28.4016 29.6698 27.8390 20.7318 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules 24193 TABLE 2.—HOSPITAL CASE-MIX INDEXES FOR DISCHARGES OCCURRING IN FEDERAL FISCAL YEAR 2005; HOSPITAL WAGE INDEXES FOR FEDERAL FISCAL YEAR 2007; HOSPITAL AVERAGE HOURLY WAGES FOR FEDERAL FISCAL YEARS 2005 (2001 WAGE DATA), 2006 (2002 WAGE DATA), AND 2007 (2003 WAGE DATA); WAGE INDEXES AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY WAGES—Continued Case-mix index 3 wwhite on PROD1PC61 with PROPOSALS2 Provider No. 230236 230239 230241 230244 230254 230257 230259 230264 230269 230270 230273 230275 230277 230279 230283 230289 230290 230291 230292 230294 230295 230296 230328 240001 240002 240004 240006 240007 240010 240011 240013 240014 240016 240017 240018 240019 240020 240021 240022 240025 240027 240029 240030 240031 240036 240037 240038 240040 240043 240044 240045 240047 240050 240052 240053 240056 240057 240059 240061 240063 240064 240066 240069 240071 240075 240076 ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... VerDate Aug<31>2005 17:10 Apr 24, 2006 Jkt 208001 FY 2007 wage index (10/1/2006– 3/31/2007) FY 2007 wage index (4/1/2007– 9/30/2007) Average hourly wage FY 2005 1 Average hourly wage FY 2006 1 Average hourly wage FY 2007 1 1.0737 0.9055 1.0123 1.0630 1.0685 1.0235 1.0853 1.0235 1.0685 1.0630 1.0630 0.9055 1.0685 1.0630 * * * * * * * 1.0096 * 1.0943 1.0157 1.0943 1.1246 * 1.1246 * * 1.0943 * 0.9256 1.0842 1.0157 1.0943 * 0.9256 * * * 0.9971 * 1.0842 * 1.0943 1.0157 0.9256 1.0124 * 1.0157 1.0943 0.9256 1.0943 1.0943 1.0943 1.0943 1.1246 1.0943 1.0157 1.0943 1.1246 1.1246 0.9971 1.0943 0.9469 0.9055 1.0123 1.0391 1.0235 1.0235 1.0853 1.0235 1.0235 1.0391 1.0391 0.9055 1.0235 1.0391 * * * * * * * 1.0096 * 1.0943 1.0157 1.0943 1.1246 * 1.1246 * * 1.0943 * 0.9256 1.0842 1.0157 1.0943 * 0.9256 * * * 0.9971 * 1.0842 * 1.0943 1.0157 0.9256 1.0124 * 1.0157 1.0943 0.9256 1.0943 1.0943 1.0943 1.0943 1.1246 1.0943 1.0157 1.0943 1.1246 1.1246 0.9971 1.0943 26.3988 21.1643 25.8671 25.3817 26.4431 25.4086 24.3067 19.9992 27.4732 26.1113 30.2209 30.2244 26.9231 23.1636 24.9272 * 29.4792 * * * * * * 29.9123 26.9608 27.8796 30.2330 23.7588 30.4139 22.9561 28.7202 28.3788 24.9211 23.3314 27.9218 27.5441 28.1568 23.7096 23.7368 27.8656 20.2531 24.3017 23.3753 26.7242 27.0821 24.3986 29.8465 26.3177 20.7155 24.3009 26.1743 29.1211 26.6687 24.9870 28.4733 30.8619 29.4870 28.6340 30.0031 29.9603 26.6996 30.2716 27.4990 26.4780 26.6607 28.4519 28.4754 22.1040 27.4890 26.4326 28.1216 27.8197 26.8677 19.2398 28.8187 27.8488 29.9307 23.1095 29.1973 24.7673 26.2622 29.7720 * 30.9655 31.8943 * * * * 31.5753 28.9860 30.8072 30.1950 * 31.3733 * 28.3860 29.8623 26.7814 24.4417 25.6236 28.6723 31.2443 27.1235 25.2066 * 18.2481 25.3568 24.7154 26.7778 28.0812 * 31.0779 27.4895 21.8685 22.0973 * 28.8288 26.4854 26.4256 29.5315 31.6623 30.6258 29.7916 30.6383 32.3487 29.9662 33.4532 28.9496 28.0585 26.1956 29.8562 30.7222 21.2172 27.5447 28.0406 28.9407 30.1026 27.9433 22.3532 30.9490 25.2072 31.5014 23.7882 29.6262 27.1158 33.2824 * * * * 31.3710 27.2229 * * 33.3161 30.9011 32.7422 30.9169 * 33.5850 * * 30.0296 * 24.2138 27.9842 32.3927 32.7931 * 27.4658 * * * 26.4497 * 30.9000 * 33.2288 27.3304 23.2097 25.1529 * 28.4908 26.8525 28.0986 31.4458 33.3453 31.7172 31.6035 32.8216 34.2862 33.2930 36.4650 30.2048 29.9094 27.9350 31.5934 1.4603 1.2296 1.2197 1.4048 1.4614 0.9689 1.2083 2.1504 1.4452 1.3222 1.5273 0.4787 1.3945 0.5318 *** *** *** *** *** *** *** 1.6564 0.6608 1.5162 1.8250 1.5995 1.0882 0.9780 2.0356 *** 1.3325 1.0328 1.2570 1.2425 1.2809 1.0723 1.0716 0.9533 1.1345 *** 0.9013 1.1341 1.3375 0.9645 1.6566 1.0394 1.5532 1.0905 1.1406 1.1339 1.0878 1.5452 1.0908 1.2502 1.4037 1.2278 1.8040 1.0849 1.7796 1.5489 1.2477 1.4590 1.1852 1.1457 1.1523 1.0765 PO 00000 Frm 00199 Fmt 4701 Sfmt 4702 E:\FR\FM\25APP2.SGM 25APP2 Average hourly wage** (3 years) 28.5769 21.5040 26.9859 26.5791 27.8278 27.6619 26.4486 20.5167 29.1589 26.3816 30.5474 25.8693 28.6272 24.8848 26.4188 29.7720 29.4792 30.9655 31.8943 31.3710 27.2229 * * 31.6280 28.9495 30.4106 30.4586 23.7588 31.7910 22.9561 28.5544 29.4562 25.9310 23.9977 27.0238 29.5002 30.6996 25.3021 25.4771 27.8656 19.1090 24.8217 24.8644 26.7517 28.6586 24.3986 31.4072 27.0645 21.9560 23.8283 26.1743 28.7805 26.6732 26.5338 29.8618 31.9671 30.6390 30.0547 31.1991 32.2192 30.5360 33.5054 28.9405 28.1696 26.9347 30.0582 24194 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules TABLE 2.—HOSPITAL CASE-MIX INDEXES FOR DISCHARGES OCCURRING IN FEDERAL FISCAL YEAR 2005; HOSPITAL WAGE INDEXES FOR FEDERAL FISCAL YEAR 2007; HOSPITAL AVERAGE HOURLY WAGES FOR FEDERAL FISCAL YEARS 2005 (2001 WAGE DATA), 2006 (2002 WAGE DATA), AND 2007 (2003 WAGE DATA); WAGE INDEXES AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY WAGES—Continued Case-mix index 3 wwhite on PROD1PC61 with PROPOSALS2 Provider No. 240078 240079 240080 240083 240084 240087 240088 240093 240094 240100 240101 240103 240104 240106 240107 240109 240115 240117 240123 240124 240127 240128 240132 240133 240135 240137 240139 240141 240143 240152 240154 240162 240166 240179 240187 240196 240206 240207 240210 240211 240213 240366 250001 250002 250004 250006 250007 250009 250010 250012 250015 250017 250018 250019 250020 250021 250023 250025 250027 250031 250034 250035 250036 250037 250038 250039 ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... VerDate Aug<31>2005 17:10 Apr 24, 2006 Jkt 208001 FY 2007 wage index (10/1/2006– 3/31/2007) FY 2007 wage index (4/1/2007– 9/30/2007) Average hourly wage FY 2005 1 Average hourly wage FY 2006 1 Average hourly wage FY 2007 1 1.0943 * 1.0943 0.9256 1.0157 * 0.9971 1.0842 * 0.9256 0.9256 * 1.0943 1.0943 * * 1.0943 0.9256 * * * 0.9256 1.0943 * * * * 1.0943 * * * * 0.9256 * 1.0842 1.0943 1.4448 1.0943 1.0943 1.0842 1.0943 * 0.8278 0.8008 0.9032 0.9032 0.8914 0.8640 0.7579 0.9367 0.7579 0.7579 0.7579 0.8914 0.7579 * 0.8607 0.7579 0.7579 0.8278 0.9032 0.7579 0.8229 * 0.8278 * 1.0943 * 1.0943 0.9256 1.0157 * 0.9971 1.0842 * 0.9256 0.9256 * 1.0943 1.0943 * * 1.0943 0.9256 * * * 0.9256 1.0943 * * * * 1.0943 * * * * 0.9256 * 1.0842 1.0943 1.4448 1.0943 1.0943 1.0842 1.0943 * 0.8278 0.8008 0.9032 0.9032 0.8914 0.8640 0.7579 0.9367 0.7579 0.7579 0.7579 0.8914 0.7579 * 0.8607 0.7579 0.7579 0.8278 0.9032 0.7579 0.8229 * 0.8278 * 30.5339 20.9220 29.6274 25.0214 24.7856 24.8479 27.6323 23.7785 27.3974 25.3269 26.6078 22.5416 30.1392 27.5171 25.5199 15.2076 29.0261 22.0463 20.5755 23.9297 24.4824 21.2638 29.5310 26.1836 16.1837 23.8666 23.7898 26.7173 21.1180 27.3445 23.9643 22.3136 23.4265 20.8449 26.5129 28.9380 * 29.2395 29.7227 44.4214 31.3974 * 21.9176 20.1310 20.6828 21.4038 23.6933 20.4329 19.4130 20.0493 20.6931 18.1013 17.0689 22.8358 19.3390 15.1242 16.1820 20.6892 17.3313 22.0850 20.6752 14.6149 17.8313 17.4463 18.0209 15.2939 32.3235 * 31.6828 26.6582 26.8142 * 28.0825 25.5805 * 27.6299 25.5355 22.7078 31.4306 29.3455 * 16.5051 31.3869 23.6230 21.7500 * * 21.5791 31.7139 * * * * 26.4016 21.7416 29.6196 * 22.2721 25.7509 * 27.8811 30.7719 * 31.7665 32.1564 18.8503 32.7532 * 22.7827 23.3845 24.1065 24.0191 25.8710 22.2323 19.4403 20.2921 20.7555 21.3950 16.6294 23.9741 21.4019 20.3559 16.2418 20.5258 17.3481 21.4326 24.3189 17.2045 19.1975 17.4012 18.9050 17.3155 32.6859 * 32.9636 26.9625 27.5846 * 28.0161 26.9860 * 30.4304 26.1979 * 32.5071 30.9325 * * 32.6799 23.7271 * * * 23.2704 32.8272 * * * * 29.8940 * * * * 27.1602 * 28.0014 32.4098 * 32.6617 33.0565 23.5383 34.3377 * 23.7029 23.9358 24.9720 24.9513 25.8218 22.2900 20.8939 20.2685 21.4605 22.0824 16.9042 26.3257 21.3531 * 17.0598 22.4404 23.1213 24.9777 26.4723 19.4498 19.2912 * 21.6995 * 1.6631 *** 1.8436 1.2072 1.1120 1.0241 1.3204 1.3161 1.1989 1.2983 1.1584 1.1155 1.1722 1.5325 0.9182 0.9469 1.6345 1.1572 1.1119 *** *** 1.0253 1.3295 1.1376 *** *** *** 1.1289 0.8821 0.9917 1.0591 1.1507 1.1450 *** 1.2475 0.7780 0.8192 1.1912 1.2761 0.9917 1.3747 0.8163 1.8600 0.9030 1.9070 1.0729 1.2555 1.2768 1.0392 0.9166 1.0413 1.0388 0.8272 1.5866 0.9684 *** 0.8560 1.1161 0.9523 1.3383 1.5646 0.8603 1.0150 0.8531 0.9812 0.9171 PO 00000 Frm 00200 Fmt 4701 Sfmt 4702 E:\FR\FM\25APP2.SGM 25APP2 Average hourly wage** (3 years) 31.8480 20.9220 31.4183 26.2728 26.3984 24.8479 27.9149 25.4182 27.3974 27.7995 26.0918 22.6234 31.4775 29.3230 25.5199 15.8386 31.0904 23.1567 21.1868 23.9297 24.4824 22.0363 31.3936 26.1836 16.1837 23.8666 23.7898 27.9382 21.4375 28.5127 23.9643 22.2926 25.4648 20.8449 27.4824 30.7649 * 31.2871 31.6494 24.9982 32.9080 * 22.8415 22.3598 23.2149 23.4457 25.1582 21.6627 19.9016 20.2019 20.9636 20.6762 16.8758 24.3649 20.6951 16.1481 16.5022 21.2459 19.2559 22.6950 23.8164 17.1103 18.8229 17.4232 19.5148 16.2540 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules 24195 TABLE 2.—HOSPITAL CASE-MIX INDEXES FOR DISCHARGES OCCURRING IN FEDERAL FISCAL YEAR 2005; HOSPITAL WAGE INDEXES FOR FEDERAL FISCAL YEAR 2007; HOSPITAL AVERAGE HOURLY WAGES FOR FEDERAL FISCAL YEARS 2005 (2001 WAGE DATA), 2006 (2002 WAGE DATA), AND 2007 (2003 WAGE DATA); WAGE INDEXES AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY WAGES—Continued Case-mix index 3 wwhite on PROD1PC61 with PROPOSALS2 Provider No. 250040 ..................................................... 250042 ..................................................... 250043 ..................................................... 250044 ..................................................... 250045 ..................................................... 250048 ..................................................... 250049 ..................................................... 250050 ..................................................... 250051 ..................................................... 250057 ..................................................... 250058 ..................................................... 250059 ..................................................... 250060 ..................................................... 250061 ..................................................... 250065 ..................................................... 250067 ..................................................... 250068 ..................................................... 250069 ..................................................... 250071 ..................................................... 250072 ..................................................... 250077 ..................................................... 250078 2 ................................................... 250079 ..................................................... 250081 ..................................................... 250082 ..................................................... 250083 ..................................................... 250084 ..................................................... 250085 ..................................................... 250093 ..................................................... 250094 ..................................................... 250095 ..................................................... 250096 ..................................................... 250097 ..................................................... 250099 ..................................................... 250100 ..................................................... 250101 ..................................................... 250102 ..................................................... 250104 ..................................................... 250105 ..................................................... 250107 ..................................................... 250112 ..................................................... 250117 ..................................................... 250120 ..................................................... 250122 ..................................................... 250123 ..................................................... 250124 ..................................................... 250125 ..................................................... 250126 ..................................................... 250127 ..................................................... 250128 ..................................................... 250134 ..................................................... 250136 ..................................................... 250138 ..................................................... 250141 ..................................................... 250146 ..................................................... 250149 ..................................................... 250151 ..................................................... 250152 ..................................................... 250153 ..................................................... 250155 ..................................................... 250156 ..................................................... 250159 ..................................................... 250300 ..................................................... 250302 ..................................................... 250306 ..................................................... 250311 ..................................................... VerDate Aug<31>2005 17:10 Apr 24, 2006 Jkt 208001 FY 2007 wage index (10/1/2006– 3/31/2007) FY 2007 wage index (4/1/2007– 9/30/2007) Average hourly wage FY 2005 1 Average hourly wage FY 2006 1 Average hourly wage FY 2007 1 0.8607 0.9032 0.7579 0.8008 * 0.8278 0.7579 0.7579 0.7579 0.7579 0.7579 0.7579 0.7579 0.7579 * 0.7579 * 0.7785 * 0.8278 0.7579 0.8607 0.8278 0.7785 0.8224 * 0.7579 0.7579 0.7579 0.8607 0.7579 0.8278 0.8102 0.8278 0.7785 * 0.8278 0.8278 * * 0.7579 0.8607 0.7579 0.8607 0.8914 0.8278 0.8914 0.9367 1.4448 0.7579 0.8278 0.8278 0.8278 0.9367 * 0.7579 0.7579 0.8278 * * 0.7579 * * * * * 0.8607 0.9032 0.7579 0.8008 * 0.8278 0.7579 0.7579 0.7579 0.7579 0.7579 0.7579 0.7579 0.7579 * 0.7579 * 0.7785 * 0.8278 0.7579 0.8914 0.8278 0.7785 0.8224 * 0.7579 0.7579 0.7579 0.8607 0.7579 0.8278 0.8102 0.8278 0.7785 * 0.8278 0.8278 * * 0.7579 0.8607 0.7579 0.7579 0.8914 0.8278 0.8914 0.9367 1.4448 0.7579 0.8278 0.8278 0.8278 0.9367 * 0.7579 0.7579 0.8278 * * 0.7579 * * * * * 21.3451 21.4117 18.3322 21.1198 25.0863 21.6547 17.8154 18.3170 106908 19.6789 17.5160 17.7270 20.8115 15.2515 16.1984 20.1261 16.9585 21.6617 17.7149 22.9316 14.2271 18.6563 27.2549 21.3830 20.5212 19.9484 21.8001 18.7367 18.8001 22.3312 19.9553 22.7458 19.4534 19.0333 22.0328 21.2234 22.5518 21.4431 17.9468 16.5369 19.6172 19.9774 22.7607 23.7230 22.0486 15.4343 26.8379 20.4085 * 15.9344 23.5608 22.5832 22.7902 24.5772 17.2328 15.0367 21.8697 * * * * * * * * * 23.2285 23.4135 19.8098 23.3862 26.3831 22.9765 17.7005 19.1467 106095 20.1900 18.1704 19.2977 16.8247 12.8174 * 21.6911 * 22.8162 * 24.6587 14.7632 20.9354 38.0031 24.7031 19.6966 * 18.5775 19.7007 21.3237 22.7312 21.3511 22.6298 20.1687 19.5797 24.2209 19.3543 24.2868 22.6591 18.1196 17.8999 21.2824 23.3673 23.4277 24.5854 24.5115 17.2181 27.7077 21.7111 * 17.6269 25.8368 23.0637 23.8861 27.6158 18.6486 15.0641 17.2205 25.7837 29.0461 * * * * * * * 24.9604 25.0292 18.5069 24.1915 * 25.5576 16.6336 20.2413 11.7079 22.5761 19.0087 20.6556 25.4246 16.2589 * 23.4774 * 16.1304 * 26.4719 17.4410 21.3612 44.8151 23.9285 23.1859 * 19.4461 21.3859 22.3211 24.5599 20.0315 24.4706 22.0566 20.5324 26.2027 * 24.3828 23.5992 * * 23.2090 22.2965 24.5030 27.7136 25.8310 18.4511 27.9165 24.0142 * 17.8958 23.0509 24.6860 24.8531 29.0066 * 16.5424 19.1595 27.1864 * 22.3917 * * * * * * 1.5081 1.1719 1.0266 1.0422 1.1328 1.6466 0.8984 1.2572 0.8663 1.1351 1.2384 0.9837 0.8378 0.8786 *** 1.0700 *** 1.5415 *** 1.5965 0.9353 1.6824 0.8320 1.2341 1.4493 *** 1.1750 0.9867 1.1742 1.6054 1.0280 1.1310 1.5757 1.2588 1.4755 *** 1.6047 1.4423 0.9397 0.9189 0.9624 1.0940 1.0796 1.0886 1.3078 0.8426 1.3143 0.9024 0.8488 0.8921 0.7992 1.0417 1.3056 1.6112 0.9041 0.8797 0.4842 0.9050 *** *** 1.6598 0.8786 0.6711 0.7681 0.8875 0.6819 PO 00000 Frm 00201 Fmt 4701 Sfmt 4702 E:\FR\FM\25APP2.SGM 25APP2 Average hourly wage** (3 years) 23.2173 23.2557 18.8884 22.8737 25.7497 23.4215 17.2912 19.2614 109990 20.8199 18.2438 19.2080 20.6969 14.6266 16.1984 21.7391 16.9585 19.3701 17.7149 24.7138 15.4299 20.3108 37.9933 23.1846 21.1022 19.9484 19.8188 19.9851 20.8049 23.2045 20.4379 23.2825 20.5452 19.7105 24.1667 20.1785 23.7712 22.6152 18.0323 17.2381 21.4577 21.8104 23.5079 25.3125 24.1586 17.0346 27.4937 21.9434 * 17.1308 24.1129 23.4511 23.8880 27.2108 17.9106 15.5525 18.6189 26.4345 29.0461 22.3917 * * * * * * 24196 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules TABLE 2.—HOSPITAL CASE-MIX INDEXES FOR DISCHARGES OCCURRING IN FEDERAL FISCAL YEAR 2005; HOSPITAL WAGE INDEXES FOR FEDERAL FISCAL YEAR 2007; HOSPITAL AVERAGE HOURLY WAGES FOR FEDERAL FISCAL YEARS 2005 (2001 WAGE DATA), 2006 (2002 WAGE DATA), AND 2007 (2003 WAGE DATA); WAGE INDEXES AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY WAGES—Continued Case-mix index 3 wwhite on PROD1PC61 with PROPOSALS2 Provider No. 250314 250317 250318 250319 250320 260001 260002 260003 260004 260005 260006 260008 260009 260011 260012 260013 260015 260017 260018 260020 260021 260022 260023 260024 260025 260027 260029 260031 260032 260034 260035 260036 260039 260040 260044 260047 260048 260050 260052 260053 260057 260059 260061 260062 260063 260064 260065 260067 260068 260070 260073 260074 260077 260078 260080 260081 260085 260086 260091 260094 260095 260096 260097 260102 260103 260104 ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... VerDate Aug<31>2005 17:10 Apr 24, 2006 Jkt 208001 FY 2007 wage index (10/1/2006– 3/31/2007) FY 2007 wage index (4/1/2007– 9/30/2007) Average hourly wage FY 2005 1 Average hourly wage FY 2006 1 Average hourly wage FY 2007 1 * * * * * 0.8620 * * 0.8206 0.9017 0.8206 * 0.9501 0.8550 * * 0.8206 0.8902 * 0.9017 0.9017 0.8696 0.9017 0.8206 0.8902 0.9501 * * 0.9017 0.9501 * * * 0.8490 * 0.8206 0.9501 0.9993 0.9017 * 0.9501 0.8206 0.8206 0.9501 * 0.8550 0.8490 * 0.8550 0.8206 0.8206 0.8550 0.9017 0.8206 0.8206 0.9017 0.9501 * 0.9017 0.8345 0.9501 0.9501 0.8631 0.9501 * 0.9017 * * * * * 0.8620 * * 0.8206 0.9017 0.8206 * 0.9501 0.8550 * * 0.8206 0.8902 * 0.9017 0.9017 0.8696 0.9017 0.8206 0.8902 0.9501 * * 0.9017 0.9501 * * * 0.8490 * 0.8206 0.9501 0.9993 0.9017 * 0.9501 0.8206 0.8206 0.9501 * 0.8550 0.8490 * 0.8550 0.8206 0.8206 0.8550 0.9017 0.8206 0.8206 0.9017 0.9501 * 0.9017 0.8345 0.9501 0.9501 0.8631 0.9501 * 0.9017 * * * * * 25.3084 27.2329 17.6339 16.7742 24.6142 26.4948 17.6040 21.2729 21.4409 19.3389 19.2065 22.4450 21.1359 14.8425 25.7898 27.8332 21.7707 21.2519 17.5351 20.0901 24.7605 22.2892 24.2877 23.1125 23.3034 16.8502 20.1324 * 21.9452 20.0686 22.6169 25.8089 20.6364 22.5809 20.0051 16.4875 18.6379 19.6674 26.0439 22.0826 19.1587 23.6969 16.5364 23.9340 14.3881 19.2744 23.9301 23.5466 18.4017 11.2817 23.7447 24.6046 17.1202 26.1149 20.6805 23.8671 25.9932 21.5077 22.9283 23.3175 24.0038 * * * * * 25.9250 26.4879 * 16.9421 26.5773 26.7587 18.9522 22.1816 22.7061 20.3061 20.5007 22.5409 22.7022 17.0434 26.0407 27.6330 22.8085 21.2077 18.4829 22.4645 25.3348 * * 23.9478 24.1143 17.8741 22.1912 * 23.3566 * 24.4185 24.3906 23.6849 24.5165 21.6607 19.3335 19.7243 21.5264 26.4539 * 19.0543 23.0015 17.6256 24.9504 18.4779 21.6214 24.8654 25.5782 19.0802 14.7774 26.3969 25.6302 19.1702 27.2407 23.2544 25.5668 27.5592 21.3957 24.2368 * 26.2867 * * * * * 27.1336 * * 17.2699 28.1696 30.1186 * 23.6333 24.4077 * * 23.5052 23.3807 * 27.6200 29.3311 23.1569 23.3349 18.9172 22.2246 26.9815 * * 25.5746 23.7530 * * * 24.0972 * 25.0084 27.9464 25.0389 26.1098 * 20.6191 23.1217 22.7333 27.6932 * 21.6891 26.9359 * 25.8172 22.5048 21.9134 25.3754 26.2056 20.2858 16.6581 28.6641 26.9696 * 28.9307 24.0891 24.5424 29.7166 24.3155 27.3752 * 28.5834 0.8263 0.7015 0.7989 0.7364 0.7176 1.6784 *** *** 0.9693 1.4686 1.4688 *** 1.2265 1.4257 1.1452 1.0553 1.0248 1.3611 1.0484 1.7691 1.3788 1.2315 1.2983 1.1077 1.3739 1.6704 1.1287 *** 1.8631 0.9620 0.9284 0.9601 1.0479 1.6510 0.9223 1.5031 1.2049 1.2142 1.3392 1.1022 1.1001 1.2035 1.1216 1.2337 *** 1.3185 1.7537 0.8877 1.7594 0.9582 0.9941 1.2557 1.6328 1.3444 0.9295 1.5369 1.6015 0.8999 1.5426 1.5689 1.3199 1.4703 1.1816 0.9158 *** 1.4999 PO 00000 Frm 00202 Fmt 4701 Sfmt 4702 E:\FR\FM\25APP2.SGM 25APP2 Average hourly wage** (3 years) * * * * * 26.1147 26.9807 17.6339 17.0026 26.5242 27.9482 18.2612 22.3815 22.8791 19.8719 19.8516 22.8435 22.4549 15.9088 26.5265 28.2357 22.5606 21.8971 18.3027 21.6146 25.6688 22.2892 24.2877 24.2130 23.7269 17.3672 21.0403 * 23.1582 20.0686 24.0413 26.0146 23.2365 24.4028 20.8214 18.7408 20.5682 21.2263 26.7397 22.0826 19.9635 24.5533 17.0827 24.9247 18.8578 20.9434 24.7419 25.0998 19.2623 14.1755 26.2683 25.7362 18.1866 27.4593 22.7688 24.6443 27.8481 22.4793 24.9011 23.3175 26.3843 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules 24197 TABLE 2.—HOSPITAL CASE-MIX INDEXES FOR DISCHARGES OCCURRING IN FEDERAL FISCAL YEAR 2005; HOSPITAL WAGE INDEXES FOR FEDERAL FISCAL YEAR 2007; HOSPITAL AVERAGE HOURLY WAGES FOR FEDERAL FISCAL YEARS 2005 (2001 WAGE DATA), 2006 (2002 WAGE DATA), AND 2007 (2003 WAGE DATA); WAGE INDEXES AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY WAGES—Continued Case-mix index 3 wwhite on PROD1PC61 with PROPOSALS2 Provider No. 260105 ..................................................... 260107 ..................................................... 260108 ..................................................... 260110 ..................................................... 260113 ..................................................... 260115 ..................................................... 260116 ..................................................... 260119 ..................................................... 260122 ..................................................... 260123 ..................................................... 260127 ..................................................... 260134 ..................................................... 260137 ..................................................... 260138 ..................................................... 260141 ..................................................... 260142 ..................................................... 260147 ..................................................... 260159 ..................................................... 260160 ..................................................... 260162 ..................................................... 260163 ..................................................... 260164 ..................................................... 260166 ..................................................... 260172 ..................................................... 260175 ..................................................... 260176 ..................................................... 260177 ..................................................... 260178 ..................................................... 260179 ..................................................... 260180 ..................................................... 260183 ..................................................... 260186 ..................................................... 260189 ..................................................... 260190 ..................................................... 260191 ..................................................... 260193 ..................................................... 260195 ..................................................... 260198 ..................................................... 260200 ..................................................... 260207 ..................................................... 260209 ..................................................... 260210 ..................................................... 260211 ..................................................... 260213 ..................................................... 260214 ..................................................... 260324 ..................................................... 260326 ..................................................... 270002 2 ................................................... 270003 ..................................................... 270004 ..................................................... 270011 ..................................................... 270012 2 ................................................... 270014 ..................................................... 270017 ..................................................... 270021 ..................................................... 270023 ..................................................... 270032 ..................................................... 270036 ..................................................... 270049 ..................................................... 270050 ..................................................... 270051 ..................................................... 270057 ..................................................... 270060 ..................................................... 270074 ..................................................... 270079 ..................................................... 270081 ..................................................... VerDate Aug<31>2005 17:10 Apr 24, 2006 Jkt 208001 FY 2007 wage index (10/1/2006– 3/31/2007) FY 2007 wage index (4/1/2007– 9/30/2007) Average hourly wage FY 2005 1 Average hourly wage FY 2006 1 Average hourly wage FY 2007 1 0.9017 0.9501 0.9017 0.8902 0.8210 0.9017 0.8210 0.8206 * * * * 0.8620 0.9501 0.8550 0.8206 0.8206 * 0.8206 0.9017 0.8206 * 0.9501 * 0.9501 0.9017 0.9501 0.8550 0.9017 0.9017 0.8902 0.8550 * 0.9501 0.9017 0.9501 0.8206 0.9017 0.9017 0.8490 0.8341 0.9017 0.9501 0.9501 * * * 0.8909 0.8781 0.8740 0.8781 0.8909 0.8909 0.8909 * 0.8740 0.8740 * 0.8740 * 0.8909 0.8740 * 1.4448 * 0.8591 0.9017 0.9501 0.9017 0.8902 0.8210 0.9017 0.8210 0.8206 * * * * 0.8620 0.9501 0.8550 0.8206 0.8206 * 0.8206 0.9017 0.8206 * 0.9501 * 0.9501 0.9017 0.9501 0.8550 0.9017 0.9017 0.8902 0.8550 * 0.9501 0.9017 0.9501 0.8206 0.9017 0.9017 0.8490 0.8341 0.9017 0.9501 0.9501 * * * 0.8909 0.8781 0.8740 0.8781 0.8909 0.8909 0.8909 * 0.8909 0.8591 * 0.8740 * 0.8909 0.8591 * 1.4448 * 0.8591 28.4652 24.2001 24.0936 22.2730 19.2467 21.7450 17.2698 22.1588 17.3270 16.1169 22.5328 18.1531 21.3426 27.8229 21.1511 19.6582 17.2291 26.8924 19.4997 24.1246 19.2885 19.5539 25.5151 18.1438 21.1257 29.2184 25.0724 21.4781 24.8541 21.9679 23.3924 23.4317 * 25.1653 22.4369 24.4705 20.1327 27.6116 25.1134 19.2467 21.8396 * * * * * * 20.7620 24.2823 22.9081 22.0710 23.1697 25.0650 24.6186 21.6758 25.5525 18.2377 21.8255 24.6556 22.4195 26.4457 22.6251 16.6592 * 21.6382 17.3174 28.8849 26.7782 24.9880 23.7978 20.9644 21.9859 18.5076 24.9937 20.8015 * 21.8534 * 22.7431 28.5610 22.4886 20.3993 18.5153 23.7427 21.0544 25.1423 20.1949 19.7068 27.0237 * 22.6171 27.4244 26.1178 22.2251 26.1419 26.7461 26.0418 25.3148 * 26.4505 23.3856 26.2979 22.3958 27.5996 24.8624 19.7294 23.2430 25.3782 33.9109 * * * * 22.7322 26.4843 23.5454 22.1394 25.2873 26.2025 27.5483 21.7056 26.7576 19.6212 20.4242 26.3996 * 26.6619 24.2980 17.7564 * * 17.4862 30.1547 26.1120 26.7305 24.6033 20.3219 23.2089 20.2843 25.3857 * * * * 23.9849 30.1909 24.7555 21.1102 19.8920 23.3667 23.2474 27.0428 21.2854 * 29.7395 * 24.1261 28.7405 27.2209 25.8033 26.6483 27.6875 27.4529 26.7114 * 28.2087 24.3589 27.6919 22.3215 28.1088 28.8227 20.9045 24.8878 26.5193 39.2576 * * * * 24.3756 28.4192 25.1806 22.5874 25.5002 26.3179 26.7552 * 26.4505 21.0457 * 26.8611 * 25.1706 26.5171 * * * 18.9628 1.7844 1.3536 1.8031 1.7032 1.1184 1.1842 1.1117 1.3503 1.0867 *** 0.9496 *** 1.6799 1.9860 1.8731 1.0575 0.9163 *** 1.0950 1.3128 1.1375 1.1012 1.2031 *** 1.1223 1.7007 1.2297 1.8231 1.5349 1.5806 1.6192 1.6356 0.5844 1.2092 1.2955 1.1924 1.2645 1.1484 1.2426 1.0751 1.1133 1.2183 1.6548 1.7185 1.1966 0.6926 0.8398 1.2593 1.2545 1.7115 0.9968 1.6196 1.9153 1.3672 1.0409 1.5356 1.0407 0.8297 1.7342 1.1098 1.5813 1.2530 0.9595 0.9013 *** 1.0056 PO 00000 Frm 00203 Fmt 4701 Sfmt 4702 E:\FR\FM\25APP2.SGM 25APP2 Average hourly wage** (3 years) 29.1870 25.6719 25.3112 23.5975 20.1880 22.3429 18.6799 24.1933 19.0424 16.1169 22.1664 18.1531 22.7568 28.8843 22.6828 20.4022 18.5887 25.0036 21.4698 25.5018 20.2047 19.6321 27.4350 18.1438 22.6182 28.4251 26.1484 23.2762 25.8935 25.4223 25.6739 25.2113 * 26.6613 23.4174 26.2018 21.7669 27.7785 26.3660 20.0908 23.3114 26.0224 36.5853 * * * * 22.6537 26.4146 23.8999 22.2704 24.6491 25.8695 26.3154 21.6913 26.2685 19.6054 20.9986 25.9770 22.4195 26.0404 24.5339 17.1813 * 21.6382 17.9008 24198 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules TABLE 2.—HOSPITAL CASE-MIX INDEXES FOR DISCHARGES OCCURRING IN FEDERAL FISCAL YEAR 2005; HOSPITAL WAGE INDEXES FOR FEDERAL FISCAL YEAR 2007; HOSPITAL AVERAGE HOURLY WAGES FOR FEDERAL FISCAL YEARS 2005 (2001 WAGE DATA), 2006 (2002 WAGE DATA), AND 2007 (2003 WAGE DATA); WAGE INDEXES AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY WAGES—Continued Case-mix index 3 wwhite on PROD1PC61 with PROPOSALS2 Provider No. 270082 ..................................................... 270084 2 ................................................... 270086 ..................................................... 270087 ..................................................... 280003 ..................................................... 280009 ..................................................... 280010 ..................................................... 280013 ..................................................... 280020 ..................................................... 280021 ..................................................... 280023 ..................................................... 280030 ..................................................... 280032 ..................................................... 280040 ..................................................... 280054 ..................................................... 280057 ..................................................... 280060 ..................................................... 280061 ..................................................... 280065 ..................................................... 280077 ..................................................... 280081 ..................................................... 280105 ..................................................... 280108 ..................................................... 280111 ..................................................... 280117 ..................................................... 280119 ..................................................... 280123 ..................................................... 280125 ..................................................... 280127 ..................................................... 280128 ..................................................... 280129 ..................................................... 280130 ..................................................... 290001 ..................................................... 290002 ..................................................... 290003 ..................................................... 290005 ..................................................... 290006 ..................................................... 290007 ..................................................... 290008 ..................................................... 290009 ..................................................... 290010 ..................................................... 290012 ..................................................... 290016 ..................................................... 290019 ..................................................... 290020 h ................................................... 290021 ..................................................... 290022 ..................................................... 290027 ..................................................... 290032 ..................................................... 290039 ..................................................... 290041 ..................................................... 290042 ..................................................... 290044 ..................................................... 290045 ..................................................... 290046 ..................................................... 290047 ..................................................... 290049 ..................................................... 290050 ..................................................... 290051 ..................................................... 300001 ..................................................... 300003 ..................................................... 300005 ..................................................... 300006 ..................................................... 300007 ..................................................... 300010 ..................................................... 300011 ..................................................... VerDate Aug<31>2005 17:10 Apr 24, 2006 Jkt 208001 FY 2007 wage index (10/1/2006– 3/31/2007) FY 2007 wage index (4/1/2007– 9/30/2007) Average hourly wage FY 2005 1 Average hourly wage FY 2006 1 Average hourly wage FY 2007 1 * * 0.8781 0.8591 1.0084 0.9746 * 0.9453 1.0084 * 0.9746 0.9453 0.9746 0.9453 * * 0.9453 0.9154 0.9636 0.9453 0.9453 0.9453 * 0.8691 * 1.4448 0.8828 0.8816 1.0084 1.0084 0.9453 0.9453 1.1975 0.9569 1.1417 1.1417 1.1524 1.1417 0.9421 1.1975 * 1.1417 * 1.1524 1.1417 1.1417 1.1417 0.8967 1.1975 1.1417 1.1417 1.1417 * 1.1417 1.1417 1.1417 1.0054 * * 1.1665 1.1665 1.1665 * * * 1.1665 * * 0.8781 0.8591 1.0084 0.9746 * 0.9453 1.0084 * 0.9746 0.9453 0.9746 0.9453 * * 0.9453 0.9154 0.9636 0.9453 0.9453 0.9453 * 0.8691 * 1.4448 0.8828 0.8816 1.0084 1.0084 0.9453 0.9453 1.1975 0.9569 1.1417 1.1417 1.1524 1.1417 0.9421 1.1975 * 1.1417 * 1.1524 1.1417 1.1417 1.1417 0.8967 1.1975 1.1417 1.1417 1.1417 * 1.1417 1.1417 1.1417 1.0054 * * 1.1665 1.1665 1.1665 * * * 1.1665 19.6173 22.2340 * * 27.2844 25.3162 22.6516 24.5214 25.7522 22.2864 22.7207 32.5601 22.6510 25.2965 22.4241 23.6793 25.2288 23.9110 27.9937 24.0516 25.1973 25.0445 22.5584 22.1424 22.0611 * 27.5207 21.8385 * * * * 27.3105 16.8433 27.1099 27.1531 26.3617 35.4193 26.4086 27.6011 23.8733 27.2675 25.1726 27.2484 21.3094 28.3837 29.8144 17.8850 29.4164 29.6801 30.1346 * * 26.9319 * * * * * 29.4130 27.8059 25.1869 20.6787 25.3125 26.9346 27.3325 * * * * 29.3921 26.7678 * 26.1908 26.5068 22.0489 22.3230 30.7481 23.6462 26.9827 23.5665 20.4830 26.2139 24.9482 26.0135 25.5624 26.0541 26.7555 23.2502 23.4770 24.1521 * * 21.7658 * * * * 31.1981 18.3469 28.1625 27.6697 27.9502 37.5559 27.9714 29.8019 23.9654 31.0843 26.1925 28.6158 21.6993 33.2116 29.4422 15.1448 31.7105 31.2941 33.9878 * * 30.9612 * * * * * 27.5032 33.3560 25.6699 23.3200 * 27.5028 28.4044 * * 23.0672 22.8163 30.8267 27.6871 * 27.2546 27.6978 * 26.7240 30.4696 25.0787 28.4619 * * 27.8379 25.9246 28.3954 27.0934 28.7505 28.0693 * 24.5663 * * 12.1758 22.3025 31.8278 28.9234 * * 35.3981 17.0514 30.4639 28.5735 30.0265 38.9568 28.3311 36.2577 * 33.4690 * 29.6855 20.9481 33.9446 30.4581 21.6128 32.0495 33.6718 35.5146 * 38.1320 34.4022 * * * * * 28.8432 34.5310 26.7123 * * * 31.6428 *** 1.0889 1.1747 1.1805 1.7898 1.8271 *** 1.7857 1.7128 1.1344 1.3783 1.9075 1.3256 1.6714 1.2075 0.8525 1.6944 1.4064 1.2249 1.3131 1.5886 1.2640 1.0675 1.1778 1.1313 0.8523 0.9112 1.4971 1.8457 3.0322 1.9223 1.3422 1.8273 0.9183 1.7512 1.4855 1.2047 1.6530 1.1651 1.7714 1.0541 1.3212 1.2257 1.3891 1.0427 1.7971 1.5768 0.9025 1.4163 1.5419 1.3158 0.4555 *** 1.5773 1.2702 1.4129 1.3499 1.1705 1.5597 1.5726 2.0572 1.3969 1.2070 1.2792 1.1835 1.2737 PO 00000 Frm 00204 Fmt 4701 Sfmt 4702 E:\FR\FM\25APP2.SGM 25APP2 Average hourly wage** (3 years) 19.6173 22.2340 23.0672 22.8163 29.2098 26.5956 22.6516 25.9627 26.6945 22.1652 23.8272 31.2643 23.7853 26.9500 23.0039 21.8581 26.5044 24.9668 27.4121 25.5691 26.6763 26.7054 22.8979 23.4937 23.1088 * 18.1112 21.9721 31.8278 28.9234 * * 31.2171 17.4394 28.5720 27.8244 28.0763 37.2981 27.5573 31.1439 23.9192 30.7038 25.6684 28.5533 21.3644 31.8430 29.9084 18.3839 31.1084 31.6289 33.3938 * 38.1320 31.2459 * * * * * 28.5481 31.9387 25.8743 21.9235 25.3125 27.2341 29.1783 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules 24199 TABLE 2.—HOSPITAL CASE-MIX INDEXES FOR DISCHARGES OCCURRING IN FEDERAL FISCAL YEAR 2005; HOSPITAL WAGE INDEXES FOR FEDERAL FISCAL YEAR 2007; HOSPITAL AVERAGE HOURLY WAGES FOR FEDERAL FISCAL YEARS 2005 (2001 WAGE DATA), 2006 (2002 WAGE DATA), AND 2007 (2003 WAGE DATA); WAGE INDEXES AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY WAGES—Continued Case-mix index 3 wwhite on PROD1PC61 with PROPOSALS2 Provider No. 300012 300013 300014 300015 300016 300017 300018 300019 300020 300022 300023 300024 300029 300034 300308 300309 300310 310001 310002 310003 310005 310006 310008 310009 310010 310011 310012 310013 310014 310015 310016 310017 310018 310019 310020 310021 310022 310024 310025 310026 310027 310028 310029 310031 310032 310034 310037 310038 310039 310040 310041 310042 310044 310045 310047 310048 310049 310050 310051 310052 310054 310057 310058 310060 310061 310063 ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... VerDate Aug<31>2005 17:10 Apr 24, 2006 Jkt 208001 FY 2007 wage index (10/1/2006– 3/31/2007) FY 2007 wage index (4/1/2007– 9/30/2007) Average hourly wage FY 2005 1 Average hourly wage FY 2006 1 Average hourly wage FY 2007 1 1.1665 * 1.1665 * * 1.1665 1.1665 1.1665 1.1665 * 1.1665 * 1.1665 1.1665 * * * 1.3215 1.3038 1.3215 1.1886 1.3215 1.3215 1.3038 1.1318 1.1341 1.3215 1.3038 1.1226 1.3038 1.3215 1.3038 1.3038 1.3215 1.3215 1.1886 1.1226 1.1886 1.3215 1.3215 1.1886 1.3038 1.1226 1.1242 1.1226 1.1242 1.3215 1.3038 1.3038 1.3215 1.1242 * 1.1318 1.3215 1.1736 1.1886 * 1.3038 1.3038 1.1242 1.3038 1.1226 1.3215 1.3038 1.1226 1.1886 1.1665 * 1.1665 * * 1.1665 1.1665 1.1665 1.1665 * 1.1665 * 1.1665 1.1665 * * * 1.3215 1.3008 1.3215 1.1886 1.3215 1.3215 1.3008 1.1318 1.1341 1.3215 1.3008 1.1226 1.3008 1.3215 1.3008 1.3008 1.3215 1.3215 1.1886 1.1226 1.1886 1.3215 1.3215 1.1886 1.1886 1.1226 1.1242 1.1226 1.1242 1.3215 1.3008 1.3008 1.3215 1.1242 * 1.1318 1.3215 1.1736 1.1886 * 1.3008 1.1886 1.1242 1.3008 1.1226 1.3215 1.1226 1.1226 1.1886 28.4234 23.1529 25.5059 24.0620 24.5498 28.3959 28.0308 25.3845 26.8402 23.5948 25.4873 23.9205 26.9484 28.5375 * * * 33.9360 35.4567 31.1040 27.5690 27.0436 29.5857 29.7760 25.3139 28.5241 33.1622 28.5016 32.7222 32.4980 28.9788 28.0930 26.9399 31.0524 29.3392 29.6308 26.1914 27.5278 27.7960 25.3970 27.0982 29.1101 29.1439 30.2345 27.8754 27.8517 32.1471 32.1977 27.1054 28.0068 29.7335 29.0207 27.7752 32.6359 28.3415 28.4715 32.7666 27.2276 32.0113 28.1498 30.6905 26.4606 26.4816 23.2146 27.5400 28.3457 30.5198 * 27.5151 * * 29.6957 29.7209 25.9656 28.6723 * 28.6309 * 29.0806 29.7484 * * * 35.3612 37.3461 32.8935 29.0084 27.4545 31.2579 32.7384 28.5852 30.8612 34.6882 30.6248 29.7204 36.4776 33.9862 30.9233 30.3381 29.6592 30.6722 31.3410 28.2024 30.9171 31.1274 27.5171 28.8314 31.3849 30.7707 33.9685 27.5232 29.9162 35.0329 33.4822 28.8292 34.1113 32.8085 30.7358 31.3206 34.1060 32.7880 30.2025 27.8564 27.3033 33.7168 30.8036 34.1860 29.5221 28.0815 25.1575 28.2129 31.4884 30.3374 * 29.2605 * * 30.3051 29.6873 27.2631 30.5485 * 30.9871 * 29.9138 31.5753 * * * 41.8952 38.9875 35.3962 31.6992 28.9780 32.2471 33.9105 33.1613 31.0823 38.1712 31.4496 30.9277 37.1869 34.3751 32.0816 31.1747 30.9463 32.7089 33.1764 28.9633 33.3774 34.3920 29.3348 29.1626 31.8631 33.7099 35.3478 29.1612 31.8300 38.0377 35.8746 31.8657 34.5838 33.3980 34.0717 31.9267 37.3128 35.2527 32.4064 * 29.5929 36.1453 32.8650 35.7990 28.6219 27.3745 27.6986 31.7646 32.1212 1.3755 *** 1.1978 1.0767 *** 1.2321 1.3845 1.2862 1.2090 1.0801 1.3630 1.6816 1.7658 2.0425 0.6393 0.7909 0.6299 1.7499 1.8830 1.2035 1.3045 1.1997 1.3218 1.2680 1.2806 1.2514 1.6373 1.2295 1.9216 1.9678 1.3082 1.3290 1.1885 1.6374 1.5424 1.6517 1.2444 1.3630 1.3032 1.1807 1.3584 1.2686 1.9437 3.0821 1.3129 1.3412 1.3580 2.0170 1.2537 1.3533 1.2800 *** 1.3686 1.7345 1.2988 1.3238 *** 1.2381 1.3966 1.3415 1.2940 1.3251 1.0596 1.2437 1.2606 1.3618 PO 00000 Frm 00205 Fmt 4701 Sfmt 4702 E:\FR\FM\25APP2.SGM 25APP2 Average hourly wage** (3 years) 29.7075 23.1529 27.5032 24.0620 24.5498 29.4733 29.1985 26.2544 28.7305 23.5948 28.5288 23.9205 28.7021 29.9856 * * * 37.1034 37.2295 33.1810 29.4759 27.8274 31.0509 32.0940 29.0668 30.1687 35.4125 30.2036 30.9970 35.4178 32.6794 30.4154 29.5340 30.5778 30.8843 31.3692 27.8379 30.6108 31.3534 27.4955 28.5991 30.8364 31.2185 33.2165 28.2024 29.8876 35.1550 33.9362 29.2627 32.1930 31.9565 31.1859 30.3672 34.7199 32.2796 30.4056 30.6033 28.0821 33.9634 30.5913 33.5435 28.2552 27.2978 25.4776 29.1214 30.6378 24200 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules TABLE 2.—HOSPITAL CASE-MIX INDEXES FOR DISCHARGES OCCURRING IN FEDERAL FISCAL YEAR 2005; HOSPITAL WAGE INDEXES FOR FEDERAL FISCAL YEAR 2007; HOSPITAL AVERAGE HOURLY WAGES FOR FEDERAL FISCAL YEARS 2005 (2001 WAGE DATA), 2006 (2002 WAGE DATA), AND 2007 (2003 WAGE DATA); WAGE INDEXES AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY WAGES—Continued Case-mix index 3 wwhite on PROD1PC61 with PROPOSALS2 Provider No. 310064 310067 310069 310070 310072 310073 310074 310075 310076 310077 310078 310081 310083 310084 310086 310088 310090 310091 310092 310093 310096 310105 310108 310110 310111 310112 310113 310115 310116 310118 310119 310120 310122 310123 310124 310125 320001 320002 320003 320004 320005 320006 320009 320011 320013 320014 320016 320017 320018 320019 320021 320022 320030 320033 320037 320038 320046 320057 320058 320059 320060 320061 320062 320063 320065 320067 ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... VerDate Aug<31>2005 17:10 Apr 24, 2006 Jkt 208001 FY 2007 wage index (10/1/2006– 3/31/2007) FY 2007 wage index (4/1/2007– 9/30/2007) Average hourly wage FY 2005 1 Average hourly wage FY 2006 1 Average hourly wage FY 2007 1 1.1736 * 1.1226 1.3038 * 1.1242 1.3215 1.1242 1.3038 * * 1.1226 1.3038 1.1242 1.1226 1.1736 1.1886 1.1226 1.1318 1.3038 1.3038 1.3215 1.3038 1.1318 1.1242 1.1242 1.1242 1.3038 1.3215 1.3215 1.3038 1.3038 1.1242 1.2237 1.1592 1.1886 0.9477 1.0821 0.8982 0.8353 0.9477 0.9814 0.9477 0.8795 0.9814 0.9270 0.8353 0.9477 0.9333 0.9477 0.9477 0.8353 0.8353 0.9814 0.9477 0.8353 * 1.4448 1.4448 1.4448 1.4448 1.4448 1.4448 0.9737 0.9737 0.8353 1.1736 * 1.1226 1.3008 * 1.1242 1.3215 1.1242 1.3008 * * 1.1226 1.3008 1.1242 1.1226 1.1736 1.1886 1.1226 1.1318 1.3008 1.3008 1.3215 1.3008 1.1318 1.1242 1.1242 1.1242 1.1226 1.3215 1.3215 1.3008 1.1886 1.1242 1.2237 1.1592 1.1886 0.9477 1.0821 0.8982 0.8353 0.9477 0.9814 0.9477 0.8795 0.9814 0.9270 0.8353 0.9477 0.9333 0.9477 0.9477 0.8353 0.8353 0.9814 0.9477 0.8353 * 1.4448 1.4448 1.4448 1.4448 1.4448 1.4448 0.9737 0.9737 0.8353 29.5979 26.8068 27.9656 32.1806 26.3520 29.6611 28.4361 26.2479 34.9428 30.7465 26.9589 26.4259 24.6563 29.9437 27.3601 25.5274 27.1661 27.1115 25.7071 25.8727 30.3675 30.9968 29.1548 27.8707 28.8692 28.9928 27.5203 26.2803 26.6287 28.1238 35.6786 27.2010 * * * * 26.1962 28.6963 22.3911 24.0362 21.2164 22.5615 24.4237 23.1539 27.8671 26.7112 21.7001 23.6861 23.0915 31.2250 28.5620 22.1492 18.0990 24.1185 21.6080 21.2181 22.9114 * * * * * * 24.9141 21.6189 20.4431 33.4440 * 28.1681 33.2310 * 32.0329 29.4834 31.6870 36.4280 32.6644 29.8014 26.6136 28.2392 32.9001 29.3058 26.4966 30.8941 27.7204 29.4999 28.0401 34.4275 31.9769 30.1002 31.2164 30.7475 30.4192 29.6079 29.6020 25.6976 28.8797 37.7876 31.4110 * * * * 26.9434 30.5158 28.1402 24.9481 23.8264 24.2812 22.8293 24.2279 28.9276 24.5310 23.5040 25.0286 23.2360 31.5192 27.2357 23.7160 22.1971 27.6393 23.3999 20.1533 24.3534 * * * * * * 24.4696 26.6603 23.7745 35.3987 * 29.9598 33.7936 * 33.2615 35.6666 31.9433 38.0720 34.0345 30.7927 29.8217 30.0128 34.3249 30.7666 29.0942 33.3364 28.8503 29.3843 29.9026 36.4988 29.9797 33.0791 33.2096 31.9533 30.9671 31.9823 30.6848 29.5404 31.9920 42.6911 29.5849 * * * * 28.3114 32.0322 27.4758 24.7427 25.4686 26.6616 31.2529 25.6322 22.6383 26.0108 24.8595 31.3764 26.8414 29.5311 26.6064 24.3131 20.9229 32.4689 25.1973 21.5104 * * * * * * * 25.1341 26.9856 23.0640 1.5601 *** 1.2815 1.4011 *** 1.8401 1.2542 1.3069 1.6706 *** *** 1.2351 1.2916 1.2146 1.2372 1.1889 1.2738 1.1950 1.4321 1.1892 2.0353 1.2260 1.3646 1.2908 1.2002 1.2755 1.2386 1.2894 1.2313 1.3298 1.8293 1.0683 1.8284 2.4750 1.7405 3.0573 1.5398 1.4251 1.1829 1.3224 1.3413 1.3228 1.5558 1.1211 1.1009 1.1072 1.1409 1.1564 1.4337 1.6146 1.6483 1.1318 1.0412 1.2017 1.1385 1.2203 1.1831 0.8052 0.8101 0.8615 0.9188 0.8690 0.8781 1.2764 1.1554 0.8883 PO 00000 Frm 00206 Fmt 4701 Sfmt 4702 E:\FR\FM\25APP2.SGM 25APP2 Average hourly wage** (3 years) 32.8719 26.8068 28.7705 33.1015 26.3520 31.6839 31.1493 29.9126 36.4875 32.4516 29.2238 27.6431 27.5631 32.2493 29.1619 27.0316 30.3968 27.8956 28.2367 28.0649 33.8387 30.9490 30.7872 31.0583 30.6096 30.1683 29.7520 28.9374 27.2633 29.6477 38.8840 29.3345 * * * * 27.2210 30.4616 25.7749 24.6089 23.5378 24.5380 25.5999 24.4026 25.9594 25.6452 23.3847 26.3396 24.1413 30.6451 27.3101 23.3995 20.3256 27.9429 23.4459 20.9623 23.6315 * * * * * * 24.8572 25.3295 22.5148 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules 24201 TABLE 2.—HOSPITAL CASE-MIX INDEXES FOR DISCHARGES OCCURRING IN FEDERAL FISCAL YEAR 2005; HOSPITAL WAGE INDEXES FOR FEDERAL FISCAL YEAR 2007; HOSPITAL AVERAGE HOURLY WAGES FOR FEDERAL FISCAL YEARS 2005 (2001 WAGE DATA), 2006 (2002 WAGE DATA), AND 2007 (2003 WAGE DATA); WAGE INDEXES AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY WAGES—Continued Case-mix index 3 wwhite on PROD1PC61 with PROPOSALS2 Provider No. 320069 ..................................................... 320070 ..................................................... 320074 ..................................................... 320079 ..................................................... 320083 ..................................................... 320084 ..................................................... 320085 ..................................................... 330001 ..................................................... 330002 ..................................................... 330003 ..................................................... 330004 ..................................................... 330005 ..................................................... 330006 ..................................................... 330008 ..................................................... 330009 ..................................................... 330010 ..................................................... 330011 ..................................................... 330013 ..................................................... 330014 ..................................................... 330016 ..................................................... 330019 ..................................................... 330023 2 ................................................... 330024 ..................................................... 330025 ..................................................... 330027 ..................................................... 330028 ..................................................... 330029 ..................................................... 330030 ..................................................... 330033 ..................................................... 330036 ..................................................... 330037 ..................................................... 330041 ..................................................... 330043 ..................................................... 330044 ..................................................... 330045 ..................................................... 330046 ..................................................... 330047 h ................................................... 330049 ..................................................... 330053 ..................................................... 330055 ..................................................... 330056 ..................................................... 330057 ..................................................... 330058 ..................................................... 330059 ..................................................... 330061 ..................................................... 330062 ..................................................... 330064 ..................................................... 330065 ..................................................... 330066 ..................................................... 330067 2 ................................................... 330072 ..................................................... 330073 ..................................................... 330074 ..................................................... 330075 ..................................................... 330078 ..................................................... 330079 ..................................................... 330080 ..................................................... 330084 ..................................................... 330085 ..................................................... 330086 ..................................................... 330088 ..................................................... 330090 ..................................................... 330091 ..................................................... 330094 ..................................................... 330095 ..................................................... 330096 ..................................................... VerDate Aug<31>2005 17:10 Apr 24, 2006 Jkt 208001 FY 2007 wage index (10/1/2006– 3/31/2007) FY 2007 wage index (4/1/2007– 9/30/2007) Average hourly wage FY 2005 1 Average hourly wage FY 2006 1 Average hourly wage FY 2007 1 0.8353 1.4448 0.9477 0.9477 0.9477 0.8353 0.9333 * 1.3215 0.8753 1.0583 0.9475 1.3215 0.9475 1.3215 * 0.8816 0.8753 1.3215 0.8267 1.3215 1.3038 1.3215 0.9475 1.3038 1.3215 0.9475 0.9007 0.8267 1.3215 0.9007 1.3215 1.2701 0.8422 1.2701 1.3215 0.8753 1.3038 0.9007 1.3215 1.3215 0.8753 0.9007 1.3215 1.3215 * 1.3215 0.9475 0.8753 1.3038 1.3215 0.9007 0.9007 0.9723 0.9475 0.9974 1.3215 0.8267 0.9428 1.3215 1.2701 0.8267 0.9475 0.9058 * 0.8267 0.8353 1.4448 0.9477 0.9477 0.9477 0.8353 0.9333 * 1.3215 0.8753 1.0583 0.9475 1.3215 0.9475 1.3215 * 0.8816 0.8753 1.3215 0.8267 1.3215 1.3215 1.3215 0.9475 1.3008 1.3215 0.9475 0.9007 0.8267 1.3215 0.9007 1.3215 1.2701 0.8422 1.2701 1.3215 0.8753 1.0913 0.9007 1.3215 1.3215 0.8753 0.9007 1.3215 1.3215 * 1.3215 0.9475 0.8753 1.3215 1.3215 0.9007 0.9007 0.9723 0.9475 0.9974 1.3215 0.8267 0.9428 1.3215 1.2701 0.8267 0.9475 0.9058 * 0.8267 19.7296 * 35.5980 23.8092 * * * 31.3735 29.3459 21.6506 23.9959 25.9287 29.7509 21.3269 35.8367 17.9178 20.3641 23.9070 35.4053 18.9388 32.3413 29.2669 36.5648 19.7561 35.1325 33.5312 18.6623 22.4368 21.3762 27.6813 19.6385 36.2481 34.1039 23.1450 34.4956 42.0900 21.1244 25.7022 19.6807 35.1393 32.9295 22.6519 19.5520 38.1019 32.7427 21.4270 38.5719 21.9192 23.0916 34.8416 32.7905 19.0781 20.2874 22.0240 22.7762 22.1064 36.1171 22.6365 23.2927 28.8424 31.2631 22.7721 22.5796 22.1495 28.9914 22.4895 20.9167 * 22.2175 25.2105 28.2114 17.2511 24.8752 33.4718 31.1924 22.9945 26.0445 29.0124 31.5370 21.8198 35.4986 19.6920 21.8008 24.5162 38.8123 28.4392 34.8266 31.6208 37.8398 20.2775 39.0717 34.2709 19.1589 22.9937 22.5681 28.9409 20.6904 36.0286 34.7480 24.1907 36.1893 44.8494 24.0678 29.2904 18.5290 38.4839 37.8444 24.4680 21.3727 39.7386 33.2848 21.0464 36.4276 23.9128 24.7941 26.4243 36.4336 20.1490 21.4274 22.4188 23.3981 22.5237 39.1724 21.5455 23.9568 29.1784 31.3973 23.6174 23.8063 23.0001 31.9872 22.0337 22.2717 * 31.3214 25.7148 24.0257 17.5258 28.5627 * 30.4429 23.8448 27.5850 30.5004 32.4887 23.2197 35.4703 20.6440 24.9644 26.1086 41.9904 21.7319 36.2560 35.2521 42.0169 21.2619 41.6731 36.1977 22.2943 24.1393 24.4951 28.6763 22.5429 36.9040 38.4138 25.2654 38.2951 49.9508 24.2099 29.7258 20.0581 41.2383 35.4120 26.1030 22.2270 41.0950 35.0321 * 37.5279 24.8627 28.5116 27.2479 37.1569 22.3706 22.6971 23.0741 25.5249 24.6828 39.0128 21.8844 24.6752 32.4300 33.6229 25.2379 25.1750 24.7488 46.3616 22.9866 1.1144 0.9190 1.1380 1.0890 2.5979 0.9804 1.6874 *** 1.5005 1.3482 1.2620 1.5873 1.2604 1.1431 1.2062 *** 1.3098 1.9972 1.3121 0.9857 1.2870 1.5742 1.8005 1.0804 1.4373 1.4210 0.4427 1.2380 1.1423 1.1271 1.1107 1.2505 1.3834 1.2969 1.3331 1.4281 1.2132 1.4505 1.0625 1.5596 1.4423 1.7075 1.3449 1.5303 1.2227 1.0487 1.2592 1.0539 1.3403 1.4381 1.3269 1.1317 1.2195 1.1127 1.4671 1.2417 1.1802 1.0859 1.1463 1.3556 1.0121 1.4380 1.3451 1.2611 *** 1.2346 PO 00000 Frm 00207 Fmt 4701 Sfmt 4702 E:\FR\FM\25APP2.SGM 25APP2 Average hourly wage** (3 years) 20.9948 * 29.3022 24.9372 25.7289 17.4008 26.8570 32.4179 30.3409 22.8408 25.9379 28.4063 31.2785 22.1194 35.5997 19.2176 22.3720 24.8688 38.6661 22.2994 34.4888 32.2225 38.6703 20.4337 38.5866 34.6170 19.8291 23.1393 22.7923 28.4126 20.9676 36.3905 35.7957 24.2192 36.3647 45.5451 23.2219 28.2859 19.4166 38.3132 35.3946 24.4281 21.0700 39.6782 33.7280 21.2306 37.4900 23.5400 25.5240 28.9882 35.4529 20.5067 21.4576 22.5194 23.9158 23.1380 38.1206 22.0141 23.9772 30.1863 32.0964 23.8595 23.8763 23.2787 32.4322 22.5018 24202 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules TABLE 2.—HOSPITAL CASE-MIX INDEXES FOR DISCHARGES OCCURRING IN FEDERAL FISCAL YEAR 2005; HOSPITAL WAGE INDEXES FOR FEDERAL FISCAL YEAR 2007; HOSPITAL AVERAGE HOURLY WAGES FOR FEDERAL FISCAL YEARS 2005 (2001 WAGE DATA), 2006 (2002 WAGE DATA), AND 2007 (2003 WAGE DATA); WAGE INDEXES AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY WAGES—Continued Case-mix index 3 wwhite on PROD1PC61 with PROPOSALS2 Provider No. 330097 ..................................................... 330100 ..................................................... 330101 ..................................................... 330102 ..................................................... 330103 ..................................................... 330104 ..................................................... 330106 ..................................................... 330107 ..................................................... 330108 ..................................................... 330111 ..................................................... 330115 ..................................................... 330119 ..................................................... 330121 ..................................................... 330122 ..................................................... 330125 ..................................................... 330126 ..................................................... 330127 ..................................................... 330128 ..................................................... 330132 ..................................................... 330133 ..................................................... 330135 ..................................................... 330136 ..................................................... 330140 ..................................................... 330141 ..................................................... 330144 ..................................................... 330148 ..................................................... 330151 ..................................................... 330152 ..................................................... 330153 ..................................................... 330157 ..................................................... 330158 ..................................................... 330159 ..................................................... 330160 ..................................................... 330162 ..................................................... 330163 ..................................................... 330164 ..................................................... 330166 h ................................................... 330167 ..................................................... 330169 ..................................................... 330171 ..................................................... 330175 ..................................................... 330177 ..................................................... 330180 ..................................................... 330181 ..................................................... 330182 ..................................................... 330184 ..................................................... 330185 ..................................................... 330188 ..................................................... 330189 ..................................................... 330191 ..................................................... 330193 ..................................................... 330194 ..................................................... 330195 ..................................................... 330196 ..................................................... 330197 ..................................................... 330198 ..................................................... 330199 ..................................................... 330201 ..................................................... 330202 ..................................................... 330203 ..................................................... 330204 ..................................................... 330205 ..................................................... 330208 ..................................................... 330209 ..................................................... 330211 ..................................................... 330212 ..................................................... VerDate Aug<31>2005 17:10 Apr 24, 2006 Jkt 208001 FY 2007 wage index (10/1/2006– 3/31/2007) FY 2007 wage index (4/1/2007– 9/30/2007) Average hourly wage FY 2005 1 Average hourly wage FY 2006 1 Average hourly wage FY 2007 1 * 1.3215 1.3215 0.9475 0.8330 1.3215 1.4485 1.2701 0.8267 0.9475 0.9723 1.3215 * * 0.9007 1.3038 1.3215 1.3215 0.8267 1.3215 1.3038 0.9428 0.9723 1.2701 0.8267 * 0.8267 1.3215 0.8753 0.9428 1.3215 0.9723 1.3215 1.3215 0.9475 0.9007 0.8267 1.2838 1.3215 1.3215 0.8267 0.8267 0.8753 1.2838 1.3038 1.3215 1.2701 0.9475 0.8753 0.8753 1.3215 1.3215 1.3215 1.3215 0.8267 1.2838 1.3215 1.3215 1.3215 0.9723 1.3215 1.3038 1.3215 * 0.8267 * * 1.3215 1.3215 0.9475 0.8330 1.3215 1.3008 1.2701 0.8267 0.9475 0.9723 1.3215 * * 0.9007 1.1473 1.3215 1.3215 0.8267 1.3215 1.1473 0.9428 0.9723 1.2701 0.8267 * 0.8267 1.3215 0.8753 0.9428 1.3215 0.9723 1.3215 1.3215 0.9475 0.9007 0.8267 1.3008 1.3215 1.3215 0.8267 0.8267 0.8753 1.3008 1.3008 1.3215 1.2701 0.9475 0.8753 0.8753 1.3215 1.3215 1.3215 1.3215 0.8267 1.3008 1.3215 1.3215 1.3215 0.9723 1.3215 1.1473 1.3215 * 0.8267 * 19.2233 32.8406 39.2601 23.6141 18.8763 33.7556 39.8554 31.8528 21.4680 17.6185 20.5101 36.5873 19.7388 26.3849 24.6945 28.8299 43.7479 34.5289 16.3088 44.0704 26.9969 22.5447 23.5774 30.6616 20.1805 18.5443 17.6782 32.0616 21.9935 23.6939 33.0067 24.1916 34.0373 31.3812 22.4644 24.4306 18.8777 33.7365 38.3498 27.7810 21.1944 20.1850 21.9641 35.9334 36.3831 33.2843 31.0179 22.6803 19.2538 22.3719 36.9866 39.9177 38.6867 32.5883 22.3117 29.5359 32.7870 33.3215 34.3545 26.2459 30.3273 30.0101 28.2667 28.7213 21.1094 27.0585 20.3189 34.4621 38.7503 24.8184 21.1452 32.8818 41.4561 31.3888 22.2607 20.9387 23.3043 39.1114 * * 26.7118 31.6370 44.6103 37.7166 17.4946 36.6962 29.0837 24.2010 25.7573 34.8902 20.9935 * 19.1841 36.5136 24.5219 25.2312 32.2990 28.9094 34.1960 32.1783 24.0200 28.8481 19.4360 34.4748 39.3361 30.0122 22.2067 19.6100 22.1920 38.5351 39.6038 34.4044 32.3466 23.9210 21.6229 24.0232 37.1807 43.9910 40.0206 33.2171 23.4291 30.5485 35.0059 39.3682 38.0129 26.5882 37.6849 32.1617 29.6282 29.7988 22.9966 27.2232 * 37.3387 40.4612 25.2287 22.5242 33.1903 42.8789 34.1234 22.7058 19.9803 25.2327 38.4828 * * 26.7047 35.1728 44.4572 39.5738 20.2593 40.0269 28.2828 25.7642 27.0648 37.7577 22.9269 * 21.5978 36.5762 26.2638 26.7341 37.6639 28.5063 35.8958 34.4443 27.0659 27.2894 20.4318 36.1041 44.3462 30.0593 23.7714 19.9735 23.7235 40.9623 40.0238 35.1901 34.2430 25.5586 22.9867 24.7436 38.7230 44.2515 39.5538 35.7930 26.7687 32.7085 38.2030 37.4511 36.6670 31.9331 38.9990 32.4144 31.4344 30.1376 24.3905 * 1.1683 0.9820 1.9087 1.3915 1.0850 1.3440 1.7400 1.2734 1.1383 1.0558 1.1814 1.7645 0.9476 *** 1.7528 1.2994 1.3343 1.2870 1.0988 1.3735 1.1836 1.4932 1.7494 1.3524 1.0534 1.0140 1.1572 1.2920 1.7108 1.3554 1.5438 1.4177 1.5992 1.3033 1.1712 1.4565 1.0648 1.7599 1.4208 1.1942 1.1464 1.0045 1.2313 1.3007 2.3224 1.4427 1.2291 1.2590 1.0679 1.2924 1.2808 1.8228 1.7332 1.3705 1.0633 1.3856 1.1511 1.6395 1.2806 1.4512 1.3265 1.2915 1.1799 *** 1.1264 *** PO 00000 Frm 00208 Fmt 4701 Sfmt 4702 E:\FR\FM\25APP2.SGM 25APP2 Average hourly wage** (3 years) 19.7495 34.9547 39.5161 24.5563 20.8126 33.2697 41.4391 32.4908 22.1280 19.4680 23.0156 38.0489 19.7388 26.3849 26.0770 33.1208 44.2717 37.2581 18.3351 40.0358 28.1734 24.2296 25.4535 34.5697 21.3429 18.5443 19.3648 35.0673 24.3225 25.2451 34.3802 27.1433 34.7339 32.6472 24.5702 26.8505 19.5757 34.7272 40.5303 29.2106 22.4153 19.9338 22.6242 38.5235 38.7114 34.3420 32.5908 24.0883 21.2142 23.7211 37.6472 42.7636 39.5038 33.8609 24.1549 30.9857 35.2594 36.6531 36.3901 28.1724 35.5345 31.6042 29.9593 29.5534 22.8006 27.1435 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules 24203 TABLE 2.—HOSPITAL CASE-MIX INDEXES FOR DISCHARGES OCCURRING IN FEDERAL FISCAL YEAR 2005; HOSPITAL WAGE INDEXES FOR FEDERAL FISCAL YEAR 2007; HOSPITAL AVERAGE HOURLY WAGES FOR FEDERAL FISCAL YEARS 2005 (2001 WAGE DATA), 2006 (2002 WAGE DATA), AND 2007 (2003 WAGE DATA); WAGE INDEXES AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY WAGES—Continued Case-mix index 3 wwhite on PROD1PC61 with PROPOSALS2 Provider No. 330213 ..................................................... 330214 ..................................................... 330215 ..................................................... 330218 ..................................................... 330219 ..................................................... 330221 ..................................................... 330222 ..................................................... 330223 ..................................................... 330224 ..................................................... 330225 ..................................................... 330226 ..................................................... 330229 h ................................................... 330230 ..................................................... 330231 ..................................................... 330232 ..................................................... 330233 ..................................................... 330234 ..................................................... 330235 ..................................................... 330236 ..................................................... 330238 ..................................................... 330239 h ................................................... 330240 ..................................................... 330241 ..................................................... 330242 ..................................................... 330245 ..................................................... 330246 ..................................................... 330247 ..................................................... 330249 ..................................................... 330250 ..................................................... 330259 ..................................................... 330261 ..................................................... 330263 ..................................................... 330264 ..................................................... 330265 ..................................................... 330267 ..................................................... 330268 ..................................................... 330270 ..................................................... 330273 ..................................................... 330276 ..................................................... 330277 ..................................................... 330279 ..................................................... 330285 ..................................................... 330286 ..................................................... 330290 ..................................................... 330293 ..................................................... 330304 ..................................................... 330306 ..................................................... 330307 ..................................................... 330314 ..................................................... 330316 ..................................................... 330331 ..................................................... 330332 ..................................................... 330333 ..................................................... 330338 ..................................................... 330339 ..................................................... 330340 ..................................................... 330350 ..................................................... 330353 ..................................................... 330357 ..................................................... 330372 ..................................................... 330385 ..................................................... 330386 ..................................................... 330389 ..................................................... 330390 ..................................................... 330393 ..................................................... 330394 ..................................................... VerDate Aug<31>2005 17:10 Apr 24, 2006 Jkt 208001 FY 2007 wage index (10/1/2006– 3/31/2007) FY 2007 wage index (4/1/2007– 9/30/2007) Average hourly wage FY 2005 1 Average hourly wage FY 2006 1 Average hourly wage FY 2007 1 0.8267 1.3215 0.8422 0.9723 0.9475 1.3215 0.8753 0.8267 1.0583 1.2838 0.9007 0.8360 1.3215 1.3215 0.8753 1.3215 1.3215 0.9428 1.3215 0.9007 0.8360 1.3215 0.9723 1.3215 0.8422 1.2701 1.3215 0.9723 0.9355 1.2838 1.3215 0.8267 1.2701 0.9007 1.3215 0.8267 1.3215 1.3215 0.8330 0.9439 0.9475 0.9007 1.2701 1.3215 * 1.3215 1.3215 0.9883 1.2701 1.3215 1.2838 1.2838 * * 0.8753 1.2701 1.3215 1.3215 1.3215 1.2838 1.3215 1.0583 1.3215 1.3215 1.2701 0.8816 0.8267 1.3215 0.8422 0.9723 0.9475 1.3215 0.8753 0.8267 1.0583 1.3008 0.9007 0.8360 1.3215 1.3215 0.8753 1.3215 1.3215 0.9428 1.3215 0.9007 0.8360 1.3215 0.9723 1.3215 0.8422 1.2701 1.3215 0.9723 0.9355 1.3008 1.3215 0.8267 1.1473 0.9007 1.3215 0.8267 1.3215 1.3215 0.8330 0.9439 0.9475 0.9007 1.2701 1.3215 * 1.3215 1.3215 0.9883 1.2701 1.3215 1.3008 1.3008 * * 0.8753 1.2701 1.3215 1.3215 1.3215 1.3008 1.3215 1.0583 1.3215 1.3215 1.2701 0.8816 21.7208 33.7670 20.6343 21.4095 27.7400 34.7033 25.9825 18.4291 23.9379 28.9952 23.4783 19.5670 32.1101 33.9324 21.4765 41.9968 36.8500 22.1217 32.9391 19.2407 20.4936 40.7478 27.7213 32.2178 21.6857 31.6763 32.1733 21.4345 23.0641 30.0488 30.9356 20.8456 28.1501 19.9414 30.3709 18.9142 38.2605 29.5106 21.7826 25.1438 23.4816 27.1260 32.3244 36.3764 19.0290 33.4431 30.7551 25.4128 26.0150 33.1512 34.7052 31.8389 33.7637 27.3859 22.2812 31.4322 39.3541 38.6962 34.3965 30.1505 42.6671 25.9228 34.7552 33.2628 34.8213 23.3505 22.5191 37.8500 22.6744 24.1106 29.3644 36.5539 23.9746 19.4229 25.7850 29.2719 21.8977 20.6095 33.3175 36.9619 24.4531 45.5132 40.6314 23.3866 35.6347 20.8639 21.5397 39.9450 29.0882 33.6926 22.8003 34.6329 32.2300 22.9834 25.1664 31.9152 30.7942 22.4675 30.0139 20.4635 31.5478 20.9720 42.2111 30.4720 22.2353 25.3582 25.2130 27.9018 33.3552 36.9981 * 34.5761 35.6640 27.5699 25.5597 34.8623 36.1630 33.3050 26.1917 31.3761 22.6569 33.9358 36.6250 37.6549 35.5975 32.6721 46.3221 27.9943 34.7669 36.0573 34.8095 25.2229 24.9647 42.1291 23.3466 26.2793 29.8772 39.1877 25.6286 23.6690 28.0293 31.9981 24.1599 21.8375 35.7536 39.1585 26.2367 46.4011 48.6802 25.6714 38.6055 21.8941 22.3783 42.8856 30.2601 36.2068 25.2401 36.8581 35.2706 24.5819 26.8227 33.2686 33.5583 23.6060 31.0746 21.6198 33.1643 25.6319 53.8973 36.3643 23.8846 26.5151 26.7728 29.9511 34.4498 40.0375 * 36.2311 36.3448 29.2568 25.8968 35.1243 38.8882 34.7704 * 37.2825 24.0829 36.7304 43.5699 43.9114 37.5781 34.7591 47.0402 28.7592 36.9478 34.5945 37.6074 26.6945 1.0844 1.9477 1.2755 1.0776 1.7056 1.3793 1.2774 1.0219 1.3174 1.1580 1.3178 1.2036 0.9991 1.0210 1.1885 1.4774 2.2633 1.1768 1.5550 1.1812 1.2433 1.2427 1.8668 1.3276 1.8252 1.3306 0.7996 1.2670 1.3135 1.4044 1.3009 1.0260 1.2873 1.1926 1.4008 0.9452 2.0124 1.3585 1.1335 1.1855 1.4992 2.0268 1.3541 1.7641 *** 1.3150 1.4598 1.2821 1.2414 1.2614 1.2609 1.2980 *** *** 0.9158 1.2406 1.4882 1.1878 1.2787 1.2829 1.1485 1.2241 1.8452 1.2447 1.7531 1.6481 PO 00000 Frm 00209 Fmt 4701 Sfmt 4702 E:\FR\FM\25APP2.SGM 25APP2 Average hourly wage** (3 years) 23.1508 37.8343 22.2273 23.9406 28.9747 36.8432 25.1525 20.4211 25.9885 30.1465 23.1859 20.6728 33.6689 36.5993 24.0703 44.6873 41.8211 23.6691 35.7449 20.6562 21.4691 41.1747 29.0836 34.0089 23.2687 34.3345 33.1804 23.0385 25.0299 31.7934 31.7945 22.3341 29.7061 20.6587 31.7213 21.7316 44.3875 32.1579 22.6430 25.7061 25.2467 28.3309 33.4062 37.7918 19.0290 34.7931 34.3198 27.4840 25.8297 34.3638 36.6631 33.3802 29.6102 32.0071 23.0041 34.0134 39.8450 40.1352 35.8277 32.6538 45.3358 27.5994 35.4956 34.5746 35.7608 25.0944 24204 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules TABLE 2.—HOSPITAL CASE-MIX INDEXES FOR DISCHARGES OCCURRING IN FEDERAL FISCAL YEAR 2005; HOSPITAL WAGE INDEXES FOR FEDERAL FISCAL YEAR 2007; HOSPITAL AVERAGE HOURLY WAGES FOR FEDERAL FISCAL YEARS 2005 (2001 WAGE DATA), 2006 (2002 WAGE DATA), AND 2007 (2003 WAGE DATA); WAGE INDEXES AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY WAGES—Continued Case-mix index 3 wwhite on PROD1PC61 with PROPOSALS2 Provider No. 330395 ..................................................... 330396 ..................................................... 330397 ..................................................... 330399 ..................................................... 330401 ..................................................... 330402 ..................................................... 330403 ..................................................... 330404 ..................................................... 330405 ..................................................... 330406 ..................................................... 340001 ..................................................... 340002 ..................................................... 340003 ..................................................... 340004 ..................................................... 340005 ..................................................... 340007 ..................................................... 340008 ..................................................... 340010 ..................................................... 340011 ..................................................... 340012 ..................................................... 340013 ..................................................... 340014 ..................................................... 340015 h ................................................... 340016 ..................................................... 340017 ..................................................... 340018 ..................................................... 340019 ..................................................... 340020 ..................................................... 340021 ..................................................... 340023 ..................................................... 340024 ..................................................... 340025 ..................................................... 340027 ..................................................... 340028 ..................................................... 340030 ..................................................... 340032 ..................................................... 340035 ..................................................... 340036 ..................................................... 340037 ..................................................... 340038 ..................................................... 340039 ..................................................... 340040 ..................................................... 340041 ..................................................... 340042 ..................................................... 340044 ..................................................... 340045 ..................................................... 340047 ..................................................... 340049 ..................................................... 340050 ..................................................... 340051 ..................................................... 340053 ..................................................... 340055 ..................................................... 340060 ..................................................... 340061 ..................................................... 340064 ..................................................... 340065 ..................................................... 340068 ..................................................... 340069 ..................................................... 340070 ..................................................... 340071 ..................................................... 340072 ..................................................... 340073 ..................................................... 340075 ..................................................... 340084 ..................................................... 340085 h ................................................... 340087 ..................................................... VerDate Aug<31>2005 17:10 Apr 24, 2006 Jkt 208001 FY 2007 wage index (10/1/2006– 3/31/2007) FY 2007 wage index (4/1/2007– 9/30/2007) Average hourly wage FY 2005 1 Average hourly wage FY 2006 1 Average hourly wage FY 2007 1 1.3215 1.3215 1.3215 1.3215 1.2701 * * * * * 0.9520 0.9520 0.8607 0.9129 * * 0.9520 0.9570 0.8607 0.8607 0.9286 0.8992 0.9787 0.8607 0.9110 * * 0.8814 0.9520 0.9286 0.8607 0.9110 0.9300 0.8962 0.9805 0.9520 0.8607 0.9855 0.8823 0.8607 0.9520 0.9427 0.9029 0.8607 * * 0.8992 0.9805 0.8962 0.8901 0.9520 0.9029 0.8992 0.9805 0.8607 * 0.9516 0.9805 0.8992 0.9570 0.8607 0.9805 0.9029 0.9520 0.9369 0.8607 1.3215 1.3215 1.3215 1.3215 1.2701 * * * * * 0.9520 0.9110 0.8607 0.9129 * * 0.9520 0.9570 0.8607 0.8607 0.9286 0.8992 0.9787 0.8607 0.9110 * * 0.8814 0.9520 0.9286 0.8607 0.9110 0.9300 0.8962 0.9805 0.9520 0.8607 0.9855 0.8823 0.8607 0.9520 0.9427 0.9029 0.8607 * * 0.8992 0.9805 0.8962 0.8901 0.9520 0.9029 0.8992 0.9805 0.8607 * 0.9516 0.9805 0.8992 0.9570 0.8607 0.9805 0.9029 0.9520 0.9369 0.8607 35.4619 32.5345 34.5110 33.6753 35.7435 21.3302 * * * * 23.2436 25.1099 21.5562 24.2055 22.9830 21.1519 24.2089 23.1349 18.1843 22.0583 22.4787 24.4831 24.3870 22.7574 22.8879 20.3840 17.8768 24.1955 23.6884 23.2844 21.2671 20.9915 22.6107 24.6836 27.4664 24.8031 21.2407 22.2089 22.5089 14.0203 25.6605 24.1523 23.0497 22.1107 21.7089 14.5004 25.3727 22.3082 21.4511 21.9069 26.9361 24.3728 22.4303 26.6657 22.3631 20.8413 20.8600 27.5045 23.6045 22.1854 21.3320 29.4189 24.1297 21.3227 23.0890 18.4202 37.3096 35.0297 38.4741 32.3688 40.6249 * 23.1887 * * * 25.0041 27.3349 23.3066 25.4474 22.3814 * 26.6314 24.5666 19.9484 22.7189 23.0261 25.1872 26.2276 23.0359 23.8229 23.7243 * 23.7995 26.0995 24.4897 22.2521 21.2276 23.6326 26.3298 29.0122 26.7475 23.5476 25.2077 21.6411 14.0713 27.1275 26.3325 23.6600 23.0236 * 23.1918 25.0605 30.4827 24.2533 23.4091 27.7261 24.1057 22.8657 27.5594 22.9143 * 21.8830 27.4473 24.9033 25.4537 23.1163 30.2061 26.0225 21.2580 23.9793 22.0070 35.7217 36.8429 36.7459 34.5604 37.3189 * 25.2042 * * * 27.2111 28.4571 24.1238 26.6506 * * 26.2698 27.1894 20.0476 23.2312 24.3059 27.1685 28.1772 23.7376 22.7039 * * 26.1419 29.3286 26.2541 23.8742 23.1272 25.2357 26.5301 30.0506 27.7578 24.5596 26.3904 25.2974 23.1194 27.9102 27.9072 24.3510 24.3666 * * 27.8038 31.2630 25.6210 24.0706 28.5758 26.4405 22.3770 27.2893 23.9195 * 22.4484 29.8633 25.6875 26.0452 24.8367 31.2882 25.4646 21.3338 25.8265 22.5608 1.3957 1.3725 1.3754 1.1594 1.3754 *** *** 0.8753 0.8833 0.8810 1.5157 1.7808 1.1318 1.4174 1.0032 *** 1.1135 1.3600 1.0750 1.3275 1.2343 1.5855 1.3320 1.2923 1.3200 1.2060 *** 1.2238 1.2885 1.3674 1.1513 1.2791 1.1485 1.5457 2.0383 1.4184 1.0842 1.3160 1.0334 1.2308 1.2931 1.9365 1.2470 1.1867 1.0102 0.9486 1.8343 1.8974 1.0680 1.2225 1.5721 1.2438 1.1227 1.7759 1.0805 *** 1.1865 1.8892 1.2950 1.0908 1.1732 1.4358 1.2096 1.1470 1.2078 1.2104 PO 00000 Frm 00210 Fmt 4701 Sfmt 4702 E:\FR\FM\25APP2.SGM 25APP2 Average hourly wage** (3 years) 36.1690 34.7966 36.5053 33.5258 37.8874 21.3302 24.1429 * * * 25.1005 27.0078 22.9768 25.4397 22.6704 21.1519 25.7197 24.9795 19.3757 22.6747 23.2775 25.6433 26.2865 23.1810 23.1314 21.9193 17.8768 24.7053 26.4057 24.6946 22.4843 21.8404 23.8877 25.8563 28.8550 26.5096 23.1461 24.6981 23.1980 16.2732 26.9345 26.1644 23.7190 23.1693 21.7089 18.3297 26.1074 28.1162 23.7875 23.1553 27.7590 24.9504 22.5569 27.1830 23.0608 20.8413 21.7271 28.2974 24.7454 24.6143 23.0580 30.3321 25.1678 21.3047 24.2485 20.8741 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules 24205 TABLE 2.—HOSPITAL CASE-MIX INDEXES FOR DISCHARGES OCCURRING IN FEDERAL FISCAL YEAR 2005; HOSPITAL WAGE INDEXES FOR FEDERAL FISCAL YEAR 2007; HOSPITAL AVERAGE HOURLY WAGES FOR FEDERAL FISCAL YEARS 2005 (2001 WAGE DATA), 2006 (2002 WAGE DATA), AND 2007 (2003 WAGE DATA); WAGE INDEXES AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY WAGES—Continued Case-mix index 3 wwhite on PROD1PC61 with PROPOSALS2 Provider No. 340088 ..................................................... 340090 ..................................................... 340091 ..................................................... 340096 h ................................................... 340097 ..................................................... 340098 ..................................................... 340099 ..................................................... 340104 ..................................................... 340106 ..................................................... 340107 ..................................................... 340109 ..................................................... 340113 ..................................................... 340114 ..................................................... 340115 ..................................................... 340116 ..................................................... 340119 ..................................................... 340120 ..................................................... 340121 ..................................................... 340123 ..................................................... 340124 ..................................................... 340126 h ................................................... 340127 ..................................................... 340129 ..................................................... 340130 ..................................................... 340131 ..................................................... 340132 ..................................................... 340133 ..................................................... 340137 ..................................................... 340138 ..................................................... 340141 ..................................................... 340142 ..................................................... 340143 ..................................................... 340144 ..................................................... 340145 ..................................................... 340146 ..................................................... 340147 ..................................................... 340148 ..................................................... 340151 ..................................................... 340153 ..................................................... 340155 ..................................................... 340156 ..................................................... 340158 ..................................................... 340159 ..................................................... 340160 ..................................................... 340166 ..................................................... 340168 ..................................................... 340171 ..................................................... 340173 ..................................................... 340177 ..................................................... 340178 ..................................................... 340179 ..................................................... 340182 ..................................................... 340183 ..................................................... 340322 ..................................................... 350002 ..................................................... 350003 ..................................................... 350004 ..................................................... 350006 ..................................................... 350009 ..................................................... 350010 ..................................................... 350011 ..................................................... 350014 ..................................................... 350015 ..................................................... 350017 ..................................................... 350019 2 ................................................... 350027 ..................................................... VerDate Aug<31>2005 17:10 Apr 24, 2006 Jkt 208001 FY 2007 wage index (10/1/2006– 3/31/2007) FY 2007 wage index (4/1/2007– 9/30/2007) Average hourly wage FY 2005 1 Average hourly wage FY 2006 1 Average hourly wage FY 2007 1 * 0.9855 0.9129 0.9369 0.8607 0.9520 0.8607 0.8823 0.8607 0.8869 0.8840 0.9520 0.9805 0.9805 0.9029 0.9520 0.8607 0.9840 0.8992 0.9570 0.9570 0.9805 0.9520 0.9520 0.9300 0.8607 0.8915 0.9029 0.9805 0.9840 0.8607 0.9029 0.9520 0.9520 * 0.9570 0.8992 0.8607 0.9520 0.9805 1.4448 0.9840 0.9805 0.8607 0.9520 0.9840 0.9520 0.9805 0.8607 * * * * * 0.8485 0.7255 * 0.7255 0.8485 0.8485 0.8485 0.8485 0.8485 0.8485 0.8485 * * 0.9855 0.9129 0.9369 0.8607 0.9520 0.8607 0.8823 0.8607 0.8869 0.8840 0.9520 0.9805 0.9805 0.9029 0.9520 0.8607 0.9840 0.8992 0.9570 0.9570 0.9805 0.9520 0.9520 0.9300 0.8607 0.8915 0.9029 0.9805 0.9840 0.8607 0.9029 0.9520 0.9520 * 0.9570 0.8992 0.8607 0.9520 0.9805 1.4448 0.9840 0.9805 0.8607 0.9520 0.9840 0.9520 0.9805 0.8607 * * * * * 0.7255 0.7255 * 0.7255 0.8485 0.7237 0.8485 0.7237 0.7255 0.7237 0.9256 * 24.3299 21.7173 24.9411 23.6345 22.5775 25.4823 20.0178 14.3252 22.6979 22.5583 22.3826 26.0776 25.4533 25.1907 26.1641 22.4821 21.8548 20.3701 23.1879 18.3866 23.5405 24.6096 24.1356 23.0937 25.2989 20.4222 22.1588 29.9903 27.4767 24.8132 22.1298 24.8904 25.6538 23.7028 18.8354 23.9998 22.4205 22.2613 25.7078 28.8758 * 23.4724 22.1872 19.1330 25.7398 16.8076 27.2074 26.6128 * * * * * * 20.6474 25.3076 27.5891 19.5870 20.7014 18.5682 22.3896 18.5360 18.6381 20.1943 24.2382 14.2262 * 23.4542 25.8266 25.2169 24.2127 27.3308 20.3683 15.7521 22.4894 22.9698 23.4419 28.2568 26.6813 25.0212 25.3213 24.2287 23.0916 21.7576 26.1083 20.8018 25.0189 25.7831 25.4902 25.2941 27.9358 21.3521 22.5558 21.0642 21.3670 27.3355 22.9907 25.3633 27.2686 23.7131 * 25.4534 23.5880 22.0052 26.4896 30.4940 * 26.4849 23.2991 20.7525 26.0557 17.3249 28.2734 27.5072 24.7471 28.7219 * * * * 22.0283 21.8061 * 19.4985 23.0873 19.1965 23.1947 17.7565 20.1161 21.0243 22.1960 * * 25.8788 26.0698 25.0546 25.6227 28.7253 21.6077 16.5594 25.2139 24.4751 25.4826 28.6890 28.7016 27.0359 27.1898 24.9657 24.7598 22.6663 25.6790 22.2436 26.8953 26.6726 26.3540 26.6451 27.8063 22.9792 22.8049 22.2880 * 29.5610 24.4531 28.6528 26.6107 25.4851 * 26.6789 25.8143 22.6662 28.2013 30.5341 * 28.1593 24.4603 21.8503 27.8366 * 29.1675 29.0996 26.9929 * 34.2396 28.2372 * * 22.4948 23.7797 * 20.7196 23.8524 20.2900 23.9046 17.9617 20.4658 21.8203 23.6479 * *** 1.3172 1.5502 1.2065 1.1989 1.4802 1.2462 0.8626 1.1004 1.1924 1.2610 1.8335 1.6228 1.6156 1.7312 1.2061 1.0248 1.0763 1.2907 1.0333 1.2954 1.1826 1.2866 1.3338 1.5363 1.1937 1.0422 0.9094 0.8891 1.6287 1.2086 1.5034 1.2673 1.3036 *** 1.3166 1.5957 1.0985 1.8446 1.4243 0.8336 1.1327 1.1318 1.3065 1.3370 0.3885 1.1788 1.2716 1.1493 *** *** *** 1.1100 0.7923 1.7713 1.2047 *** 1.6121 1.1099 1.1294 2.0043 0.9021 1.6873 1.3520 1.6973 *** PO 00000 Frm 00211 Fmt 4701 Sfmt 4702 E:\FR\FM\25APP2.SGM 25APP2 Average hourly wage** (3 years) 24.3299 23.8260 25.6286 24.6415 24.1152 27.1943 20.6547 15.5520 23.4325 23.3459 23.8242 27.7109 26.9713 25.7751 26.2312 23.9376 23.2664 21.6117 24.9990 20.3584 25.1845 25.7092 25.4160 25.1555 27.0592 21.6047 22.5184 25.0275 24.4228 27.3178 23.2199 26.2974 26.5141 24.3247 18.8354 25.4056 23.9131 22.3143 26.7972 30.0011 * 25.9520 23.3300 20.6086 26.5981 17.0785 28.2636 27.8382 25.8488 28.7219 34.2396 28.2372 * * 21.7317 23.5084 27.5891 19.9754 22.5660 19.3694 23.2095 18.0556 19.8222 21.0001 23.3102 14.2262 24206 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules TABLE 2.—HOSPITAL CASE-MIX INDEXES FOR DISCHARGES OCCURRING IN FEDERAL FISCAL YEAR 2005; HOSPITAL WAGE INDEXES FOR FEDERAL FISCAL YEAR 2007; HOSPITAL AVERAGE HOURLY WAGES FOR FEDERAL FISCAL YEARS 2005 (2001 WAGE DATA), 2006 (2002 WAGE DATA), AND 2007 (2003 WAGE DATA); WAGE INDEXES AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY WAGES—Continued Case-mix index 3 wwhite on PROD1PC61 with PROPOSALS2 Provider No. 350030 ..................................................... 350043 ..................................................... 350061 ..................................................... 350063 ..................................................... 350064 ..................................................... 350070 ..................................................... 360001 ..................................................... 360002 ..................................................... 360003 ..................................................... 360006 ..................................................... 360008 ..................................................... 360009 ..................................................... 360010 ..................................................... 360011 ..................................................... 360012 ..................................................... 360013 ..................................................... 360014 ..................................................... 360016 ..................................................... 360017 ..................................................... 360019 ..................................................... 360020 ..................................................... 360024 ..................................................... 360025 ..................................................... 360026 ..................................................... 360027 ..................................................... 360029 ..................................................... 360031 ..................................................... 360032 h ................................................... 360034 ..................................................... 360035 ..................................................... 360036 ..................................................... 360037 ..................................................... 360038 ..................................................... 360039 ..................................................... 360040 ..................................................... 360041 ..................................................... 360044 ..................................................... 360046 ..................................................... 360047 ..................................................... 360048 ..................................................... 360049 ..................................................... 360051 ..................................................... 360052 ..................................................... 360054 ..................................................... 360055 ..................................................... 360056 ..................................................... 360058 ..................................................... 360059 ..................................................... 360062 ..................................................... 360064 ..................................................... 360065 ..................................................... 360066 ..................................................... 360068 ..................................................... 360069 ..................................................... 360070 ..................................................... 360071 h ................................................... 360072 ..................................................... 360074 ..................................................... 360075 ..................................................... 360076 ..................................................... 360077 ..................................................... 360078 ..................................................... 360079 ..................................................... 360080 ..................................................... 360081 ..................................................... 360082 ..................................................... VerDate Aug<31>2005 17:10 Apr 24, 2006 Jkt 208001 FY 2007 wage index (10/1/2006– 3/31/2007) FY 2007 wage index (4/1/2007– 9/30/2007) Average hourly wage FY 2005 1 Average hourly wage FY 2006 1 Average hourly wage FY 2007 1 0.8485 * * 1.4448 1.4448 0.8485 0.9599 0.8673 0.9599 1.0119 0.8759 0.9060 0.8737 0.9919 1.0119 0.9060 0.9919 0.9599 1.0119 0.9212 0.9212 * 0.9212 0.9049 0.9212 0.9588 * 0.9060 * 1.0119 0.9212 0.9378 0.9599 0.9919 0.8673 0.9378 0.8673 0.9599 * 0.9588 * 0.9049 0.9049 0.8759 0.8815 0.9599 0.8673 0.9378 1.0119 0.8815 0.9212 0.9060 0.9588 * 0.9088 0.9060 1.0119 0.9588 0.9378 0.9599 0.9378 0.9212 0.9599 0.8673 0.9588 0.9378 0.7237 * * 1.4448 1.4448 0.8485 0.9599 0.8673 0.9599 1.0119 0.8759 0.9060 0.8737 0.9919 1.0119 0.9060 0.9919 0.9599 1.0119 0.9212 0.9212 * 0.9212 0.9049 0.9212 0.9588 * 0.9060 * 1.0119 0.9212 0.9378 0.9599 0.9919 0.8673 0.9378 0.8673 0.9599 * 0.9588 * 0.9049 0.9049 0.8759 0.8815 0.9599 0.8673 0.9378 1.0119 0.8815 0.9212 0.9060 0.9588 * 0.9088 0.9060 1.0119 0.9588 0.9378 0.9599 0.9378 0.9212 0.9599 0.8673 0.9588 0.9378 19.2282 20.9732 18.6546 * * 24.4464 23.7750 22.6923 26.3180 25.7041 23.2545 23.2659 22.0262 22.4482 25.5913 25.1588 23.8305 24.6587 25.4969 24.1105 22.3795 24.0612 23.6574 22.3303 24.7093 20.8778 24.4324 22.9759 25.1366 25.6895 25.0910 25.1615 24.8294 22.5921 22.8729 23.2625 20.4724 23.8918 17.1973 27.2274 24.2605 25.1785 23.3285 20.3176 25.1475 23.4638 22.7943 25.5222 26.8091 22.8729 24.0868 25.2316 23.7895 25.7032 23.1687 21.6176 23.0464 23.6172 24.7610 22.5943 24.7086 24.6821 25.8762 19.5436 25.1439 27.4264 18.9978 * 22.0515 * * 25.2836 23.9101 24.5789 27.5029 28.1698 24.5714 23.1012 23.1178 25.5340 27.5470 26.8129 25.3861 26.1283 27.2910 25.5926 24.4343 23.5793 25.5633 23.5898 25.4894 22.7785 * 23.2638 * 27.5220 27.6094 24.3982 22.8009 24.0218 24.0942 24.1080 21.8411 25.0775 21.7248 28.8107 25.8367 25.7556 24.5405 23.0376 26.3112 23.1024 23.4429 25.3516 28.6518 22.2393 26.3036 27.3362 25.8414 24.2444 24.8863 22.0786 24.4332 24.9055 26.8453 25.9369 25.6505 26.1313 26.0935 20.8309 27.5695 27.1197 20.0738 * * * * 25.9959 26.5234 25.2297 28.8816 30.8441 25.7859 24.8430 23.6797 27.0031 29.9512 27.2317 26.8524 27.7608 29.9598 26.9051 23.8636 * 27.6127 25.4053 27.1811 24.6599 * 25.2551 * 29.8683 28.4712 28.3912 23.6986 24.2491 25.2894 25.5889 21.8857 25.7145 * 29.1376 26.2059 27.0097 25.8613 23.1854 27.3781 27.1657 24.6591 28.8091 31.8334 25.2315 28.1088 27.8899 26.5008 * 26.4994 22.9101 25.5498 26.1751 27.1558 27.3636 29.2165 26.1568 26.1253 21.0795 30.4888 29.4729 0.9937 *** 1.0456 0.8764 0.8725 2.0130 1.4368 1.2119 1.8456 1.9839 1.3028 1.6056 1.2454 1.3176 1.3422 1.1193 1.1293 1.4722 1.8024 1.3228 1.6244 *** 1.4743 1.3027 1.6825 1.1410 *** 1.1695 *** 1.7700 1.2134 1.4154 1.5182 1.4811 1.1486 1.4912 1.1134 1.2112 1.0125 1.8468 *** 1.7024 1.6267 1.3415 1.4208 1.6221 1.0757 1.5786 1.4901 1.6168 1.2521 1.5217 1.8902 1.2137 1.6590 1.1279 1.4686 1.2447 1.1859 1.4726 1.5136 1.3049 1.8031 1.1259 1.3277 1.3704 PO 00000 Frm 00212 Fmt 4701 Sfmt 4702 E:\FR\FM\25APP2.SGM 25APP2 Average hourly wage** (3 years) 19.4364 20.9732 20.3874 * * 25.2624 24.7144 24.2006 27.5641 28.2373 24.5599 23.7552 22.9911 24.9499 27.8791 26.4104 25.3890 26.1961 27.6052 25.5454 23.5858 23.9138 25.8025 23.7441 25.7999 22.7997 24.4324 23.8405 25.1366 27.7932 27.1094 25.9007 23.7742 23.6541 24.0903 24.3654 21.4070 24.9194 19.5322 28.3862 25.4083 26.0022 24.5908 22.1915 26.2760 24.5328 23.6483 26.6068 29.2317 23.4351 26.2426 26.8407 25.3817 24.9438 24.8533 22.1868 24.3891 24.8987 26.3365 25.2933 26.5561 25.6598 26.0376 20.5175 27.5972 28.0495 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules 24207 TABLE 2.—HOSPITAL CASE-MIX INDEXES FOR DISCHARGES OCCURRING IN FEDERAL FISCAL YEAR 2005; HOSPITAL WAGE INDEXES FOR FEDERAL FISCAL YEAR 2007; HOSPITAL AVERAGE HOURLY WAGES FOR FEDERAL FISCAL YEARS 2005 (2001 WAGE DATA), 2006 (2002 WAGE DATA), AND 2007 (2003 WAGE DATA); WAGE INDEXES AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY WAGES—Continued Case-mix index 3 wwhite on PROD1PC61 with PROPOSALS2 Provider No. 360084 360085 360086 360087 360089 360090 360091 360092 360093 360094 360095 360096 360098 360100 360101 360106 360107 360109 360112 360113 360115 360116 360118 360121 360123 360125 360128 360129 360130 360131 360132 360133 360134 360137 360141 360142 360143 360144 360145 360147 360148 360150 360151 360152 360153 360154 360155 360156 360159 360161 360163 360170 360172 360174 360175 360177 360179 360180 360185 360187 360189 360192 360194 360195 360197 360203 ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... VerDate Aug<31>2005 17:10 Apr 24, 2006 Jkt 208001 FY 2007 wage index (10/1/2006– 3/31/2007) FY 2007 wage index (4/1/2007– 9/30/2007) Average hourly wage FY 2005 1 Average hourly wage FY 2006 1 Average hourly wage FY 2007 1 0.8737 1.0119 0.9049 0.9378 0.8673 0.9588 0.9378 1.0119 * * 0.9588 0.8815 0.9378 0.9088 0.9378 * 0.9588 0.8673 0.9588 0.9599 0.9378 0.9599 0.9298 1.0630 0.9378 0.9212 * * 0.9378 0.9088 0.9599 0.9049 0.9599 0.9378 0.8815 * 0.9378 0.9378 0.9378 0.8673 0.8673 0.9212 0.9088 1.0119 0.8673 * 0.9378 0.8886 0.9919 0.8815 0.9599 1.0119 0.9378 0.9049 0.9919 * 0.9599 0.9378 0.8815 0.9049 1.0119 0.9378 * 0.9378 0.9919 0.8673 0.8737 1.0119 0.9049 0.9378 0.8673 0.9588 0.9378 1.0119 * * 0.9588 0.8815 0.9378 0.9088 0.9378 * 0.9588 0.8673 0.9588 0.9599 0.9378 0.9599 0.9298 1.0391 0.9378 0.9212 * * 0.9378 0.9088 0.9599 0.9049 0.9599 0.9378 0.8815 * 0.9378 0.9378 0.9378 0.8673 0.8673 0.9212 0.9088 1.0119 0.8673 * 0.9378 0.8886 0.9919 0.8815 0.9599 1.0119 0.9378 0.9049 0.9919 * 0.9599 0.9378 0.8815 0.9049 1.0119 0.9378 * 0.9378 0.9919 0.8673 25.2059 27.5792 22.3005 25.9131 21.0253 24.4291 26.0541 23.5100 24.1238 27.1864 24.6984 22.2333 23.6413 19.0616 27.7584 21.6450 24.5365 24.3236 26.7880 23.5138 24.0232 23.4049 24.2526 25.2037 24.1761 22.6871 18.5954 19.5336 21.7015 23.1730 25.7991 23.9457 25.3013 25.7647 31.0127 21.2084 23.8938 26.7160 23.4743 22.7172 24.4873 25.8703 22.2179 24.9894 19.0844 17.1274 23.9466 22.6709 25.7108 22.6005 25.7966 22.9359 23.4727 22.8167 24.6152 23.4256 25.9429 26.8720 21.8641 23.8362 24.2512 26.2976 22.3297 25.8043 24.7539 21.5564 25.8415 29.0081 22.1859 25.4040 22.7951 26.7717 27.5067 25.6618 * 26.6348 26.1275 24.6317 24.8447 23.0561 26.6208 24.1588 25.9697 25.4184 28.6784 25.6493 24.0052 18.0655 27.7289 24.5592 22.6523 22.1096 21.0066 * 22.9762 24.0495 25.9453 24.6208 29.2975 26.9522 27.7085 22.1610 24.6306 25.7079 25.8268 24.1953 26.1946 24.7667 24.8629 27.9147 19.0226 * 25.3909 24.0510 33.1613 24.3792 26.9728 24.3620 26.3501 24.9990 26.5949 24.4712 28.8645 26.1514 23.7173 24.8173 24.2136 26.7577 * 26.1280 27.0896 22.1414 27.7366 31.6756 24.8676 29.6489 25.4796 28.6236 26.2518 25.6879 * * 26.3654 25.6497 25.7314 25.3775 28.7561 * 25.0899 26.4649 31.4146 26.8972 25.4614 25.1390 27.5254 27.5575 27.1080 23.6342 * * 25.4768 25.7134 27.4285 28.9439 28.4609 25.1870 30.1241 * 28.4811 28.7129 26.3634 25.2136 26.3049 25.2592 26.0020 30.0354 19.1349 * 26.8044 25.3478 28.6988 25.7944 29.1497 27.3245 27.9941 26.5821 27.7409 * 30.2960 29.5742 24.8364 25.1844 26.6418 26.6802 * 25.5865 28.6572 23.2702 1.5807 2.1063 1.5487 1.3826 1.0966 1.5300 1.3038 1.2227 1.0458 *** 1.3013 1.1174 1.3974 1.2146 1.3459 1.1149 1.0901 1.0676 1.9284 1.2716 1.2507 1.2486 1.5454 1.2601 1.4622 1.2312 0.9991 0.8850 1.4172 1.2611 1.3086 1.6046 1.7646 1.6613 1.5955 1.0183 1.3785 1.2995 1.7603 1.4037 1.0686 1.2404 1.6537 1.5944 1.0121 *** 1.5025 1.1867 1.2285 1.3481 1.8980 1.2814 1.4157 1.2911 1.2853 1.1829 1.6031 2.2529 1.2223 1.6071 1.1205 1.3080 1.4943 1.1127 1.1514 1.1904 PO 00000 Frm 00213 Fmt 4701 Sfmt 4702 E:\FR\FM\25APP2.SGM 25APP2 Average hourly wage** (3 years) 26.2609 29.4421 23.1200 27.0082 23.0814 26.5744 26.6013 24.9879 24.1238 26.9890 25.7726 24.1705 24.7628 22.1813 27.7335 22.9406 25.1975 25.4240 28.9038 25.2973 24.5372 22.2554 26.5502 25.7699 24.5618 22.8051 19.7451 19.5336 23.6048 24.3448 26.3954 25.8164 27.6989 25.9473 29.6138 21.6897 25.7432 27.0896 25.2160 24.0757 25.7083 25.2945 24.3233 27.4637 19.0821 17.1274 25.3987 24.0344 28.9897 24.2437 27.2933 25.1144 25.9423 24.8252 26.3745 23.9572 28.4358 27.5212 23.4838 24.6459 25.0335 26.5811 22.3297 25.8335 26.8812 22.3580 24208 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules TABLE 2.—HOSPITAL CASE-MIX INDEXES FOR DISCHARGES OCCURRING IN FEDERAL FISCAL YEAR 2005; HOSPITAL WAGE INDEXES FOR FEDERAL FISCAL YEAR 2007; HOSPITAL AVERAGE HOURLY WAGES FOR FEDERAL FISCAL YEARS 2005 (2001 WAGE DATA), 2006 (2002 WAGE DATA), AND 2007 (2003 WAGE DATA); WAGE INDEXES AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY WAGES—Continued Case-mix index 3 wwhite on PROD1PC61 with PROPOSALS2 Provider No. 360210 ..................................................... 360211 ..................................................... 360212 ..................................................... 360218 ..................................................... 360230 ..................................................... 360234 ..................................................... 360236 ..................................................... 360239 ..................................................... 360241 ..................................................... 360245 ..................................................... 360247 ..................................................... 360253 ..................................................... 360257 ..................................................... 360258 ..................................................... 360259 ..................................................... 360260 ..................................................... 360261 ..................................................... 360262 ..................................................... 360263 ..................................................... 360264 ..................................................... 360265 ..................................................... 360266 ..................................................... 360268 ..................................................... 360269 ..................................................... 360270 ..................................................... 360271 ..................................................... 360272 ..................................................... 360319 ..................................................... 360325 ..................................................... 360327 ..................................................... 360328 ..................................................... 360330 ..................................................... 370001 ..................................................... 370002 ..................................................... 370004 ..................................................... 370006 ..................................................... 370007 ..................................................... 370008 ..................................................... 370011 ..................................................... 370013 ..................................................... 370014 ..................................................... 370015 ..................................................... 370016 h ................................................... 370018 ..................................................... 370019 ..................................................... 370020 ..................................................... 370022 ..................................................... 370023 ..................................................... 370025 ..................................................... 370026 h ................................................... 370028 ..................................................... 370029 ..................................................... 370030 ..................................................... 370032 ..................................................... 370034 ..................................................... 370036 ..................................................... 370037 ..................................................... 370039 ..................................................... 370040 ..................................................... 370041 ..................................................... 370042 ..................................................... 370043 ..................................................... 370045 ..................................................... 370047 ..................................................... 370048 ..................................................... 370049 ..................................................... VerDate Aug<31>2005 17:10 Apr 24, 2006 Jkt 208001 FY 2007 wage index (10/1/2006– 3/31/2007) FY 2007 wage index (4/1/2007– 9/30/2007) Average hourly wage FY 2005 1 Average hourly wage FY 2006 1 Average hourly wage FY 2007 1 1.0119 0.8673 0.9378 1.0119 0.9378 0.9599 0.9599 0.9049 * 0.9212 1.0119 0.9599 * * 0.9588 * 0.9009 0.9588 0.9060 * * 1.0119 0.9049 * * * * * * * * * 0.8146 0.7663 0.8620 0.8017 0.7663 0.8857 0.8857 0.8857 0.8376 0.8146 0.8857 0.8146 0.7663 0.7663 0.8116 0.7747 0.8146 0.8857 0.8857 0.7663 0.7663 0.8857 0.7663 0.7663 0.8857 0.8146 0.7761 0.8146 * * * 0.8376 0.7663 0.8857 1.0119 0.8673 0.9378 1.0119 0.9378 0.9599 0.9599 0.9049 * 0.9212 1.0119 0.9599 * * 0.9588 * 0.9009 0.9588 0.9060 * * 1.0119 0.9049 * * * * * * * * * 0.8146 0.7663 0.8620 0.8017 0.7663 0.8857 0.8857 0.8857 0.8376 0.8146 0.8857 0.8146 0.7663 0.7663 0.8116 0.7747 0.8146 0.8857 0.8857 0.7663 0.7663 0.8857 0.7663 0.7663 0.8857 0.8146 0.7761 0.8146 * * * 0.8376 0.7663 0.8857 26.5665 23.0884 24.5310 24.4720 26.6444 23.3325 21.3795 24.4398 24.8089 18.7966 25.1083 28.2555 17.9652 * * * * * * * * * * * * * * * * * * * 26.2391 19.7718 24.7694 16.9469 17.2084 22.7419 19.2266 22.6451 24.8138 21.1833 24.2737 23.4286 19.6761 17.4835 18.4217 20.6002 22.0287 22.5734 24.8661 22.1163 20.3315 21.6029 17.6247 16.9222 23.1256 21.0793 21.1061 22.0082 15.3613 21.5588 14.6370 19.7112 17.7273 21.6878 27.8415 22.5449 25.2756 27.4288 27.0223 24.3625 35.8144 25.2474 24.7001 19.1885 19.8892 30.4276 * * 25.1338 27.3903 22.5431 27.1680 20.8884 * * * * * * * * * * * * * 27.7245 20.1479 25.3919 20.1063 17.6547 24.2978 19.7821 24.9295 25.3576 23.6693 25.4062 23.5336 21.4474 18.5046 19.6495 21.5762 23.5659 23.0848 26.6153 23.9956 23.3037 23.4843 18.2341 17.7576 23.9685 21.8220 22.4048 22.3496 * * * 20.4657 19.2464 23.2171 28.7970 25.6367 26.3396 29.1835 29.3334 26.6945 25.7297 25.9671 23.4843 20.0683 19.3874 31.4677 * * 26.3472 * 23.2578 29.8320 22.6737 36.4427 36.5621 * * * * * * * * * * * 24.5650 21.1078 26.9577 22.7149 18.3587 25.3440 21.7538 26.7257 25.6283 24.1384 26.2547 25.0566 21.8628 19.0473 23.6102 23.0397 24.0174 25.8863 27.3471 26.2124 23.5362 24.9755 18.7092 18.8545 25.2235 23.1526 22.4840 21.1950 * * * 23.1490 20.7363 23.8712 1.1799 1.5528 1.3402 1.1646 1.5362 1.3735 1.2075 1.3163 *** 0.5410 0.3827 2.3855 *** 1.4162 1.2048 *** 1.7902 1.3180 1.6984 *** *** 2.0048 2.3692 1.8533 1.0574 1.2708 1.3839 0.7559 0.8727 0.8846 0.6787 0.7444 1.7930 1.1799 1.0870 1.2934 1.0616 1.4174 0.9999 1.5053 1.0129 0.9407 1.5363 1.4528 1.2391 1.3420 1.2433 1.2712 1.2655 1.5216 1.8296 1.0748 1.0261 1.4505 1.2289 1.0525 1.6593 1.1293 1.0032 0.8640 0.8638 *** *** 1.4165 1.1155 1.3251 PO 00000 Frm 00214 Fmt 4701 Sfmt 4702 E:\FR\FM\25APP2.SGM 25APP2 Average hourly wage** (3 years) 27.7707 23.6870 25.4049 27.0945 27.7442 24.6936 25.5205 25.2853 24.1955 19.3751 21.2446 30.0805 17.9652 * 25.7673 27.3903 22.9224 28.5152 21.7835 36.4427 36.5621 * * * * * * * * * * * 26.1351 20.3588 25.6751 19.9948 17.7447 24.2102 20.1606 24.7559 25.2744 22.9965 25.3515 24.0042 20.9956 18.3584 20.4747 21.7646 23.2102 23.8389 26.2811 24.0953 22.4100 23.3829 18.1945 17.8650 24.1678 22.0252 21.9813 21.8627 15.3613 21.5588 14.6370 21.1519 19.2180 22.9296 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules 24209 TABLE 2.—HOSPITAL CASE-MIX INDEXES FOR DISCHARGES OCCURRING IN FEDERAL FISCAL YEAR 2005; HOSPITAL WAGE INDEXES FOR FEDERAL FISCAL YEAR 2007; HOSPITAL AVERAGE HOURLY WAGES FOR FEDERAL FISCAL YEARS 2005 (2001 WAGE DATA), 2006 (2002 WAGE DATA), AND 2007 (2003 WAGE DATA); WAGE INDEXES AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY WAGES—Continued Case-mix index 3 wwhite on PROD1PC61 with PROPOSALS2 Provider No. 370051 ..................................................... 370054 ..................................................... 370056 ..................................................... 370057 ..................................................... 370060 ..................................................... 370064 ..................................................... 370065 ..................................................... 370072 ..................................................... 370076 ..................................................... 370078 ..................................................... 370080 ..................................................... 370083 ..................................................... 370084 ..................................................... 370089 ..................................................... 370091 ..................................................... 370093 ..................................................... 370094 ..................................................... 370095 ..................................................... 370097 ..................................................... 370099 ..................................................... 370100 ..................................................... 370103 ..................................................... 370105 ..................................................... 370106 ..................................................... 370112 ..................................................... 370113 ..................................................... 370114 ..................................................... 370123 ..................................................... 370125 ..................................................... 370138 ..................................................... 370139 ..................................................... 370148 ..................................................... 370149 h ................................................... 370153 ..................................................... 370156 ..................................................... 370158 ..................................................... 370166 ..................................................... 370169 ..................................................... 370170 ..................................................... 370171 ..................................................... 370172 ..................................................... 370173 ..................................................... 370174 ..................................................... 370176 ..................................................... 370177 ..................................................... 370178 ..................................................... 370179 ..................................................... 370180 ..................................................... 370183 ..................................................... 370190 ..................................................... 370192 ..................................................... 370196 ..................................................... 370199 ..................................................... 370200 ..................................................... 370201 ..................................................... 370202 ..................................................... 370203 ..................................................... 370206 ..................................................... 370209 ..................................................... 370210 ..................................................... 370211 ..................................................... 370212 ..................................................... 370213 ..................................................... 370214 ..................................................... 370215 ..................................................... 370216 ..................................................... VerDate Aug<31>2005 17:10 Apr 24, 2006 Jkt 208001 FY 2007 wage index (10/1/2006– 3/31/2007) FY 2007 wage index (4/1/2007– 9/30/2007) Average hourly wage FY 2005 1 Average hourly wage FY 2006 1 Average hourly wage FY 2007 1 0.7663 0.7663 0.8116 0.8146 0.8146 * 0.7784 0.7663 * 0.8146 0.7663 0.7663 0.7663 0.7663 0.8146 0.8857 0.8857 * 0.8116 0.8146 0.7663 0.8003 0.8857 0.8857 0.7761 0.8599 0.8146 * * 0.7663 0.7663 0.8857 0.9213 0.7663 0.7663 0.8857 0.8146 0.7663 1.4448 1.4448 1.4448 1.4448 1.4448 0.8146 * 0.7663 * 1.4448 0.8146 0.8146 0.8857 0.8857 0.8857 0.7663 0.8857 0.8146 0.8857 0.8857 * 0.8146 0.8857 0.8857 * 0.7663 0.8857 0.8146 0.7663 0.7663 0.8116 0.8146 0.8146 * 0.7784 0.7663 * 0.8146 0.7663 0.7663 0.7663 0.7663 0.8146 0.8857 0.8857 * 0.8116 0.8146 0.7663 0.8003 0.8857 0.8857 0.7761 0.8599 0.8146 * * 0.7663 0.7663 0.8857 0.9213 0.7663 0.7663 0.8857 0.8146 0.7663 1.4448 1.4448 1.4448 1.4448 1.4448 0.8146 * 0.7663 * 1.4448 0.8146 0.8146 0.8857 0.8857 0.8857 0.7663 0.8857 0.8146 0.8857 0.8857 * 0.8146 0.8857 0.8857 * 0.7663 0.8857 0.8146 14.6254 21.5521 21.7647 18.0426 23.8007 14.1879 20.6537 14.6387 21.5461 23.9507 17.4857 15.3447 17.2735 19.9021 22.9893 25.7296 22.0591 16.5310 21.7150 20.5217 14.1883 16.1408 22.1584 24.2393 15.4941 23.3011 21.0603 22.8174 17.2013 19.8308 17.8900 24.6194 21.0608 18.5417 16.6572 17.3161 21.9070 15.7686 * * * * * 23.0324 15.6723 14.9767 22.8322 * 20.5025 24.9455 26.1338 29.4383 23.7340 18.1008 23.1240 24.4920 21.2426 27.4495 32.8278 20.0360 * * * * * * 17.2618 21.5043 22.0312 19.7284 18.7592 14.2053 20.0226 99616 * 25.4068 18.0665 16.8836 16.6514 20.4699 23.3357 26.9774 23.1191 * 22.3267 20.5075 14.7712 17.8018 23.8978 26.5867 15.4471 25.3565 21.7880 25.4733 17.1361 18.3113 18.5225 25.2348 22.3537 19.8349 19.4743 18.5578 23.1681 15.8002 * * * * * 25.0509 14.7193 14.6070 23.5794 * 21.8147 33.1137 31.4930 22.6824 26.0451 17.6317 23.3550 25.1181 23.5190 26.0912 * 21.2682 26.5344 21.0758 29.3777 * 32.3589 * 18.0757 22.3399 23.9116 19.2372 18.0984 * 20.4496 101559 * 26.2455 18.5141 17.8617 17.2101 20.8401 24.0027 26.8853 23.7154 * 24.1980 23.8980 15.5623 17.5353 25.8829 28.0721 16.0671 27.2827 22.5180 * * 19.9220 18.3822 27.4012 23.1753 20.5204 22.3167 19.5733 22.8021 16.3268 * * * * * 25.4392 * 14.9388 * * 24.2286 29.7322 27.7061 22.4776 25.0077 20.2539 25.7424 25.9091 23.1328 26.1889 * 22.8799 27.6884 19.8743 * 19.9843 32.1819 26.6205 1.0947 1.2331 1.8115 0.9668 0.9205 0.9620 1.0168 0.7997 *** 1.5644 0.8779 0.9436 0.9721 1.1406 1.5557 1.5136 1.3850 0.9994 1.2947 1.0477 0.9904 0.9691 1.8529 1.3478 0.9375 1.1592 1.5625 *** 0.8725 1.0856 0.9531 1.5590 1.2268 1.0613 0.9835 1.0107 0.9240 0.9628 0.9292 0.8716 0.8898 0.8800 0.8491 1.1636 0.9561 0.8982 0.9100 1.1306 0.9428 1.3439 1.9008 0.8029 0.8699 1.2036 1.5499 1.5608 1.9071 1.6057 *** 2.0675 1.0016 1.5926 *** 1.0348 2.4607 1.9400 PO 00000 Frm 00215 Fmt 4701 Sfmt 4702 E:\FR\FM\25APP2.SGM 25APP2 Average hourly wage** (3 years) 16.5780 21.8038 22.5937 19.0104 20.1632 14.1969 20.3712 109922 21.5461 25.2147 17.9718 16.5924 17.0695 20.4021 23.4438 26.5217 22.9859 16.5310 22.8129 21.5269 14.8564 17.2277 24.0992 26.3986 15.6827 25.2470 21.8058 24.1041 17.1678 19.3246 18.2581 25.7936 22.3280 19.6637 19.3770 18.4941 22.6015 15.9549 * * * * * 24.5212 15.1880 14.8411 23.1700 * 22.1884 29.3472 28.3751 24.9992 24.9496 18.6878 24.0321 25.2121 22.6893 26.4826 32.8278 21.4986 27.1417 20.4250 29.3777 19.9843 32.2582 26.6205 24210 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules TABLE 2.—HOSPITAL CASE-MIX INDEXES FOR DISCHARGES OCCURRING IN FEDERAL FISCAL YEAR 2005; HOSPITAL WAGE INDEXES FOR FEDERAL FISCAL YEAR 2007; HOSPITAL AVERAGE HOURLY WAGES FOR FEDERAL FISCAL YEARS 2005 (2001 WAGE DATA), 2006 (2002 WAGE DATA), AND 2007 (2003 WAGE DATA); WAGE INDEXES AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY WAGES—Continued Case-mix index 3 wwhite on PROD1PC61 with PROPOSALS2 Provider No. 370217 ..................................................... 370218 ..................................................... 370219 ..................................................... 370220 ..................................................... 370222 ..................................................... 370223 ..................................................... 380001 ..................................................... 380002 ..................................................... 380004 ..................................................... 380005 ..................................................... 380006 ..................................................... 380007 ..................................................... 380008 ..................................................... 380009 ..................................................... 380010 ..................................................... 380014 ..................................................... 380017 ..................................................... 380018 ..................................................... 380020 ..................................................... 380021 ..................................................... 380022 ..................................................... 380023 ..................................................... 380025 ..................................................... 380026 ..................................................... 380027 ..................................................... 380029 ..................................................... 380033 ..................................................... 380035 ..................................................... 380037 ..................................................... 380038 ..................................................... 380039 ..................................................... 380040 ..................................................... 380047 ..................................................... 380050 ..................................................... 380051 ..................................................... 380052 ..................................................... 380056 ..................................................... 380060 ..................................................... 380061 ..................................................... 380066 ..................................................... 380071 ..................................................... 380072 ..................................................... 380075 ..................................................... 380081 ..................................................... 380082 ..................................................... 380089 ..................................................... 380090 ..................................................... 380091 ..................................................... 380100 ..................................................... 390001 ..................................................... 390002 ..................................................... 390003 h ................................................... 390004 ..................................................... 390005 ..................................................... 390006 ..................................................... 390008 h ................................................... 390009 ..................................................... 390010 ..................................................... 390011 ..................................................... 390012 ..................................................... 390013 ..................................................... 390016 h ................................................... 390017 ..................................................... 390019 ..................................................... 390022 ..................................................... 390023 ..................................................... VerDate Aug<31>2005 17:10 Apr 24, 2006 Jkt 208001 FY 2007 wage index (10/1/2006– 3/31/2007) FY 2007 wage index (4/1/2007– 9/30/2007) Average hourly wage FY 2005 1 Average hourly wage FY 2006 1 Average hourly wage FY 2007 1 * 0.8146 * * * * 1.1405 0.9956 1.1405 1.0836 * 1.1405 * 1.1405 * 1.1536 1.1405 1.0836 1.0877 1.1405 1.1175 * 1.1405 * 1.0525 1.0527 1.0877 * 1.1405 1.1405 * 0.9826 1.0749 1.0450 1.0527 0.9826 1.0527 1.1405 1.1405 * 1.1405 * 1.0836 0.9826 1.1405 1.1405 1.0525 1.1405 * 0.9927 0.8671 0.9927 0.9413 * 0.9263 0.8671 0.8705 0.8671 0.8633 1.1009 0.9263 0.8671 * 0.9927 * 1.1009 * 0.8146 * * * * 1.1405 0.9956 1.1405 1.0836 * 1.1405 * 1.1405 * 1.1536 1.1405 1.0836 1.0877 1.1405 1.1175 * 1.1405 * 1.0525 1.0527 1.0877 * 1.1405 1.1405 * 0.9826 1.0749 1.0450 1.0527 0.9826 1.0527 1.1405 1.1405 * 1.1405 * 1.0836 0.9826 1.1405 1.1405 1.0525 1.1405 * 0.8503 0.8671 0.8503 0.9413 * 0.9263 0.8671 0.8705 0.8671 0.8633 1.1009 0.9263 0.8671 * 0.9927 * 1.1009 * * * * * * 27.8554 26.3348 28.2466 28.0682 26.0475 31.5207 25.4494 30.4198 27.5291 27.7255 31.7440 27.8952 25.8320 29.3001 27.8683 23.7073 30.2628 26.5217 23.8758 26.2070 29.7995 26.4784 27.1884 30.5903 30.1544 28.4373 27.8385 24.2416 28.1305 22.6799 25.0068 30.2507 29.5145 27.5412 29.5740 22.5275 27.4795 21.0708 30.2721 30.8396 33.6822 35.7002 * 22.4407 23.0113 21.3182 23.4063 19.0318 23.3960 21.0021 24.2789 21.6273 19.8602 * 23.3180 19.9899 20.6575 21.5137 31.0971 27.1600 * * * * * * 30.0103 27.1861 30.5172 30.2211 * 33.9969 25.8356 31.7042 30.2957 29.9648 32.2447 28.0701 28.3563 29.3295 29.2642 26.5439 33.2105 * 25.5161 26.9966 30.8767 * 30.5818 34.2303 32.3959 32.0103 29.8627 25.6190 29.7219 24.9476 25.1475 30.7041 29.8217 * 30.2304 * 29.0368 21.8850 32.3002 33.4214 34.4536 33.8950 * 22.5309 22.4388 21.6478 24.3249 * 25.1216 22.2680 25.5482 23.5390 21.9279 28.5076 24.0044 21.9549 * 23.4636 29.0710 31.7149 26.0370 * * * * * 30.4600 30.2136 33.6461 31.3173 * 34.7305 * 32.6878 35.0551 34.1502 34.4728 31.2271 30.3555 29.8854 30.8763 * 35.9576 * 26.1995 29.4873 32.8129 * 33.5871 36.0814 38.8009 32.4278 31.7128 26.9246 31.3732 26.0940 27.0740 32.3036 32.7612 * 32.7599 * 33.8954 26.7699 36.3613 35.0697 33.0782 40.6515 * 24.2592 24.6765 23.1149 24.8914 * 26.9964 23.1784 26.4813 24.0078 21.5963 30.8519 24.9820 23.1263 * 24.4718 31.6841 34.4844 *** 2.5671 1.9097 1.8202 1.5520 0.8668 1.3171 1.2551 1.7168 1.3327 *** 1.9152 1.2553 1.9941 *** 1.9349 1.8577 1.9551 1.3797 1.4905 1.2577 1.2202 1.3250 1.1244 1.2795 1.2944 1.7377 *** 1.3326 1.3226 *** 1.2511 1.7738 1.4281 1.5533 1.3106 1.0282 1.4189 1.6466 *** 1.3347 *** 1.3200 1.1954 1.2101 1.3636 1.2605 1.3973 1.7000 1.6581 1.2561 1.1504 1.6415 0.9824 1.8717 1.1526 1.7280 1.1892 1.2880 1.2958 1.2264 1.2685 *** 1.1329 *** 1.2172 PO 00000 Frm 00216 Fmt 4701 Sfmt 4702 E:\FR\FM\25APP2.SGM 25APP2 Average hourly wage** (3 years) 26.0370 * * * * * 29.5050 27.9532 30.8486 29.9539 26.0475 33.4267 25.6457 31.6241 30.7377 30.6441 32.7888 29.1079 28.2037 29.5193 29.3903 25.1052 33.1887 26.5217 25.2490 27.6967 31.1892 26.4784 30.5447 33.6061 33.4979 31.1380 29.8785 25.6371 29.7992 24.5630 25.8845 31.1160 30.7533 27.5412 30.8825 22.5275 30.0591 23.2864 33.0576 33.0748 33.7148 36.7344 * 23.0730 23.3793 22.0126 24.2683 19.0318 25.2038 22.1394 25.4517 23.0255 21.1099 29.6959 24.0935 21.8591 20.6575 23.1613 30.5765 31.2591 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules 24211 TABLE 2.—HOSPITAL CASE-MIX INDEXES FOR DISCHARGES OCCURRING IN FEDERAL FISCAL YEAR 2005; HOSPITAL WAGE INDEXES FOR FEDERAL FISCAL YEAR 2007; HOSPITAL AVERAGE HOURLY WAGES FOR FEDERAL FISCAL YEARS 2005 (2001 WAGE DATA), 2006 (2002 WAGE DATA), AND 2007 (2003 WAGE DATA); WAGE INDEXES AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY WAGES—Continued Case-mix index 3 wwhite on PROD1PC61 with PROPOSALS2 Provider No. 390024 ..................................................... 390025 ..................................................... 390026 ..................................................... 390027 ..................................................... 390028 ..................................................... 390029 ..................................................... 390030 ..................................................... 390031 ..................................................... 390032 ..................................................... 390035 ..................................................... 390036 ..................................................... 390037 ..................................................... 390039 h ................................................... 390040 ..................................................... 390041 ..................................................... 390042 ..................................................... 390043 ..................................................... 390044 ..................................................... 390045 ..................................................... 390046 ..................................................... 390048 ..................................................... 390049 ..................................................... 390050 ..................................................... 390052 ..................................................... 390054 ..................................................... 390055 ..................................................... 390056 ..................................................... 390057 ..................................................... 390058 ..................................................... 390061 ..................................................... 390062 ..................................................... 390063 ..................................................... 390065 ..................................................... 390066 ..................................................... 390067 ..................................................... 390068 ..................................................... 390070 ..................................................... 390071 ..................................................... 390072 h ................................................... 390073 ..................................................... 390074 ..................................................... 390075 ..................................................... 390076 ..................................................... 390079 ..................................................... 390080 ..................................................... 390081 ..................................................... 390084 ..................................................... 390086 ..................................................... 390090 ..................................................... 390091 ..................................................... 390093 ..................................................... 390095 ..................................................... 390096 ..................................................... 390097 ..................................................... 390100 ..................................................... 390101 ..................................................... 390102 ..................................................... 390103 ..................................................... 390104 ..................................................... 390107 ..................................................... 390108 ..................................................... 390109 ..................................................... 390110 ..................................................... 390111 ..................................................... 390112 h ................................................... 390113 ..................................................... VerDate Aug<31>2005 17:10 Apr 24, 2006 Jkt 208001 FY 2007 wage index (10/1/2006– 3/31/2007) FY 2007 wage index (4/1/2007– 9/30/2007) Average hourly wage FY 2005 1 Average hourly wage FY 2006 1 Average hourly wage FY 2007 1 1.1009 1.1009 1.1009 1.1009 0.8671 * 0.9927 0.9534 0.8671 1.1009 0.8671 0.8671 0.8621 * 0.8671 0.8671 0.8330 0.9842 0.8330 0.9768 0.9263 0.9927 0.8671 0.8330 0.9768 * 0.8372 1.1009 0.9413 0.9768 0.8717 0.8705 1.1076 0.9263 0.9413 0.9768 1.1009 0.8330 0.9927 0.8717 0.8671 * 1.1009 0.8499 1.1009 1.0878 0.8330 0.8361 0.8671 0.8671 0.8330 0.9927 0.9842 1.1009 0.9768 0.9514 0.8671 0.8671 0.8330 0.8671 1.1009 * 0.8671 1.1009 0.8621 0.8673 1.1009 1.1009 1.1009 1.1009 0.8671 * 0.9927 0.9534 0.8671 1.1009 0.8671 0.8671 0.8621 * 0.8671 0.8671 0.8330 0.9842 0.8330 0.9768 0.9263 0.9927 0.8671 0.8330 0.8503 * 0.8372 1.1009 0.9413 0.9768 0.8717 0.8705 1.1076 0.9263 0.9413 0.9768 1.1009 0.8330 0.8503 0.8717 0.8671 * 1.1009 0.8499 1.1009 1.0878 0.8330 0.8361 0.8671 0.8671 0.8330 0.8503 0.9842 1.1009 0.9768 0.9514 0.8671 0.8671 0.8330 0.8671 1.1009 * 0.8671 1.1009 0.8621 0.8673 37.4330 15.0282 27.0802 28.9159 23.6616 24.4276 20.9859 21.2949 20.9971 24.7281 23.3858 22.9008 17.8461 23.1807 20.6789 23.9632 20.9835 24.2586 22.2582 25.0825 23.6622 25.4056 24.5424 21.6736 21.4983 25.5675 * 25.1901 25.3415 25.5012 19.0692 23.5469 23.4021 23.0891 25.4576 25.9890 26.9235 20.9443 22.0155 24.8013 21.0941 22.6530 18.1276 21.4323 25.0921 28.7974 20.7799 20.7383 20.7474 20.8243 21.0427 21.0754 24.4145 25.3012 26.7267 20.1694 21.6629 18.6703 19.1803 23.1023 24.7486 18.7558 23.3355 30.6809 16.6113 21.7729 35.3959 17.2977 29.5157 35.8381 25.7246 * 22.1581 22.6828 22.7205 26.2647 24.6032 24.7820 20.3787 * 21.5925 25.6328 22.2549 27.1505 23.0712 27.2630 24.9759 27.1366 26.6931 23.3474 22.8087 25.6945 19.5537 27.9583 27.4799 28.4538 21.4052 24.7614 25.2188 24.2087 26.3287 25.8291 30.9499 21.8366 24.9388 26.3698 22.8545 24.6359 27.9004 23.3053 27.2616 30.3840 19.8605 22.5317 25.2014 21.5586 21.4401 23.6240 27.0763 25.6660 27.7208 21.9418 24.8898 20.6775 19.6428 24.1386 27.2661 19.9156 23.9808 32.6510 19.2126 22.2591 31.7173 18.1275 31.6801 35.9249 27.8863 * 23.3532 25.7851 24.1017 28.4959 22.6528 26.1465 21.9402 * 23.2044 27.9366 23.4652 28.4484 24.0257 29.4366 27.4528 29.2676 27.8306 24.7791 24.6768 * 23.5619 30.2759 26.7884 28.6399 21.7605 25.8275 28.1081 26.3047 28.9773 26.8043 34.2332 25.0434 24.8220 26.1445 23.9206 * 31.8947 22.3152 29.3486 32.2244 21.8951 23.6719 27.8713 22.0398 22.8098 21.9985 28.7966 26.8698 28.9921 22.6003 25.2152 20.7796 19.2769 24.5076 27.2284 * 27.8192 34.1737 20.1316 23.2491 0.9546 0.5440 1.2123 1.5991 1.5682 *** 1.1912 1.2239 1.1807 1.2551 1.4696 1.3125 1.1700 *** 1.3108 1.3745 1.2148 1.6474 1.6290 1.6172 1.1056 1.6272 1.9670 1.1532 1.2022 *** 1.0719 1.3152 1.3058 1.4913 1.1330 1.7744 1.3030 1.2757 1.8178 1.3160 1.4291 0.9947 1.0662 1.6664 1.1018 *** 1.3847 1.8657 1.2658 1.2210 1.1741 1.7187 1.8335 1.1438 1.2262 1.1833 1.5833 1.2509 1.7379 1.2730 1.4104 0.9404 1.0839 1.3848 1.2431 1.0688 1.6421 2.0459 1.1876 1.3210 PO 00000 Frm 00217 Fmt 4701 Sfmt 4702 E:\FR\FM\25APP2.SGM 25APP2 Average hourly wage** (3 years) 34.4317 16.8452 29.4675 33.5685 25.7953 24.4276 22.1863 23.2238 22.5468 26.5693 23.5100 24.6214 20.0570 23.1807 21.7988 25.8129 22.2302 26.6625 23.1327 27.2659 25.4111 27.3436 26.3967 23.2785 22.9563 25.6356 21.4544 27.8737 26.4926 27.5670 20.7628 24.7403 25.5499 24.5398 26.8680 26.1705 30.7526 22.4830 23.8819 25.7871 22.6224 23.6261 25.1241 22.3289 27.3026 30.4889 20.8513 22.3560 24.6921 21.4679 21.7808 22.1929 26.8107 25.9841 27.8855 21.6003 24.0444 20.0065 19.3701 23.9477 26.4403 19.3329 24.9894 32.5475 18.6193 22.4294 24212 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules TABLE 2.—HOSPITAL CASE-MIX INDEXES FOR DISCHARGES OCCURRING IN FEDERAL FISCAL YEAR 2005; HOSPITAL WAGE INDEXES FOR FEDERAL FISCAL YEAR 2007; HOSPITAL AVERAGE HOURLY WAGES FOR FEDERAL FISCAL YEARS 2005 (2001 WAGE DATA), 2006 (2002 WAGE DATA), AND 2007 (2003 WAGE DATA); WAGE INDEXES AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY WAGES—Continued Case-mix index 3 wwhite on PROD1PC61 with PROPOSALS2 Provider No. 390114 390115 390116 390117 390118 390119 390121 390122 390123 390125 390127 390128 390130 390131 390132 390133 390135 390136 390137 390138 390139 390142 390145 390146 390147 390150 390151 390152 390153 390154 390156 390157 390160 390162 390163 390164 390166 390168 390169 390173 390174 390176 390178 390179 390180 390181 390183 390184 390185 390189 390191 390192 390193 390194 390195 390197 390198 390199 390200 390201 390203 390204 390211 390215 390217 390219 ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... VerDate Aug<31>2005 17:10 Apr 24, 2006 Jkt 208001 FY 2007 wage index (10/1/2006– 3/31/2007) FY 2007 wage index (4/1/2007– 9/30/2007) Average hourly wage FY 2005 1 Average hourly wage FY 2006 1 Average hourly wage FY 2007 1 0.8671 1.1009 1.1009 0.8330 0.8330 0.9927 0.8717 0.8330 1.1009 0.8330 1.1009 0.8671 0.8633 0.8671 1.1009 1.1009 * * 0.9927 0.8330 1.1009 1.1009 0.8671 0.8330 0.8671 0.8330 1.1028 * 1.1009 0.8330 1.0878 0.8671 0.8671 1.0127 0.8671 0.8671 0.8671 0.8671 0.9927 0.8330 1.1009 0.8671 0.8815 1.1009 1.0878 0.8330 0.8330 0.8671 0.9768 0.8330 * 0.9927 * 0.9927 1.1009 0.9927 0.8705 0.8330 * 0.8330 1.1009 1.1009 0.8815 * 0.8671 0.8671 0.8671 1.1009 1.1009 0.8330 0.8330 0.8503 0.8717 0.8330 1.1009 0.8330 1.1009 0.8671 0.8633 0.8671 1.1009 1.1009 * * 0.8503 0.8330 1.1009 1.1009 0.8671 0.8330 0.8671 0.8330 1.1028 * 1.1009 0.8330 1.0878 0.8671 0.8671 1.0127 0.8671 0.8671 0.8671 0.8671 0.8503 0.8330 1.1009 0.8671 0.8815 1.1009 1.0878 0.8330 0.8330 0.8671 0.8503 0.8330 * 0.8503 * 0.9927 1.1009 0.9927 0.8705 0.8330 * 0.8330 1.1009 1.1009 0.8815 * 0.8671 0.8671 22.6630 26.4751 28.5563 20.0040 19.3332 21.2761 22.0556 21.6981 25.2209 19.4406 28.9238 21.8837 21.0694 21.2164 26.8153 26.1458 * 24.8042 21.8830 22.7210 28.2089 32.0827 22.4255 22.3260 23.6380 24.5256 25.1422 11.7774 27.5167 20.4408 27.8096 22.0222 19.5942 * 19.8863 25.1277 20.9510 21.9344 24.1682 21.6562 30.3725 17.1387 19.2731 24.8350 30.4264 25.7357 22.0117 21.3407 21.8871 21.2711 19.2308 20.0395 18.5516 23.1814 28.3480 24.9234 16.8529 19.9653 23.1486 24.8222 28.2741 25.6342 22.4472 26.4180 21.3281 22.8559 24.0473 27.7333 30.2722 20.3946 21.5001 22.2746 23.1408 22.5785 28.6269 20.9456 30.9374 23.1539 24.0685 22.6306 27.7250 28.7162 24.4738 22.1415 23.4877 24.2769 30.4246 32.5786 23.8041 25.2460 25.0971 24.1855 27.1539 * 30.0586 20.6982 31.2571 22.7493 21.4877 30.0900 22.1741 26.4971 24.9810 24.5820 27.2242 22.8220 32.6265 * 20.7270 27.2222 32.4375 24.4573 25.6554 22.5519 23.0202 22.3722 20.8761 21.2620 20.1024 25.4235 31.0019 25.7739 18.7222 21.3157 23.7471 26.3658 28.9054 28.6829 23.1450 28.0402 24.3610 25.1705 26.9445 29.2480 31.7572 21.0086 20.4058 22.7221 26.3071 23.9861 32.0389 21.8553 32.5496 24.3440 23.7197 22.8611 28.9482 29.6905 * 24.2200 24.4118 25.8021 33.4122 33.7285 24.9495 22.6594 26.5534 23.5572 29.9832 * 32.4096 23.0482 32.2600 21.6936 24.3824 35.4117 23.0960 26.4272 21.2366 26.1248 32.0181 24.2832 34.7231 24.2733 22.5141 28.3835 35.3578 26.0384 27.5253 23.0254 25.8770 23.2078 * 21.2310 * 27.5277 33.2707 26.2868 20.8448 22.4727 * 27.5466 30.2714 29.6658 24.3990 * 23.6716 25.2892 1.3855 1.4625 1.2624 1.1777 1.1753 1.2890 1.7647 1.1273 1.1806 1.2652 1.2773 1.1996 1.2097 1.3556 1.4330 1.6813 *** *** 1.4828 1.2362 1.3183 1.4259 1.4891 1.2802 1.3039 1.1581 1.3329 *** 1.4275 1.2257 1.3466 1.3458 1.1891 1.4444 1.2443 2.1047 1.1405 1.4614 1.4501 1.1370 1.6414 1.1087 1.3316 1.4585 1.4150 1.0829 1.1072 1.2051 1.2931 1.1310 1.1347 1.0319 *** 1.1231 1.5955 1.3853 1.1139 1.1937 *** 1.2935 1.6839 1.2831 1.2440 *** 1.2022 1.3065 PO 00000 Frm 00218 Fmt 4701 Sfmt 4702 E:\FR\FM\25APP2.SGM 25APP2 Average hourly wage** (3 years) 24.5624 27.8215 30.2754 20.4770 20.3988 22.1033 23.7780 22.7470 28.5662 20.7713 30.8978 23.1405 22.9210 22.2247 27.8442 28.2740 24.4738 23.7599 23.2305 24.2858 30.7557 32.8151 23.7235 23.4555 25.0934 24.0979 27.4878 11.7774 30.1880 21.3878 30.3947 22.1545 21.8172 32.5988 21.6744 26.0933 22.3853 24.3161 27.6964 22.9513 32.5879 19.5548 20.8263 26.8460 32.7463 25.3889 24.9187 22.3289 23.6157 22.3630 20.0637 20.8428 19.3425 25.4082 30.9412 25.6606 18.7246 21.2413 23.4231 26.2970 29.1517 28.0375 23.3310 27.0961 23.0524 24.4016 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules 24213 TABLE 2.—HOSPITAL CASE-MIX INDEXES FOR DISCHARGES OCCURRING IN FEDERAL FISCAL YEAR 2005; HOSPITAL WAGE INDEXES FOR FEDERAL FISCAL YEAR 2007; HOSPITAL AVERAGE HOURLY WAGES FOR FEDERAL FISCAL YEARS 2005 (2001 WAGE DATA), 2006 (2002 WAGE DATA), AND 2007 (2003 WAGE DATA); WAGE INDEXES AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY WAGES—Continued Case-mix index 3 wwhite on PROD1PC61 with PROPOSALS2 Provider No. 390220 390222 390223 390224 390225 390226 390228 390231 390233 390236 390237 390238 390246 390256 390258 390263 390265 390266 390267 390268 390270 390272 390278 390279 390285 390286 390287 390288 390289 390290 390291 390298 390299 390300 390301 390302 390303 390304 390307 390308 390309 390310 400001 400002 400003 400004 400005 400006 400007 400009 400010 400011 400012 400013 400014 400015 400016 400017 400018 400019 400021 400022 400024 400026 400028 400032 ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... VerDate Aug<31>2005 17:10 Apr 24, 2006 Jkt 208001 FY 2007 wage index (10/1/2006– 3/31/2007) FY 2007 wage index (4/1/2007– 9/30/2007) Average hourly wage FY 2005 1 Average hourly wage FY 2006 1 Average hourly wage FY 2007 1 1.1009 1.0878 1.1009 * 0.9768 1.1009 0.8671 1.1009 0.9514 0.8330 0.9927 * 0.8330 0.9413 1.1009 0.9927 0.8671 0.8815 0.8671 0.8804 0.9768 1.1009 1.1009 * 1.1009 1.1009 * * * 1.1009 * * * * * * * 1.1009 0.8815 1.1009 1.1009 0.8330 0.4396 0.4852 0.4852 0.4396 0.4396 0.4396 0.4396 0.3242 0.3917 0.4396 0.4396 0.4396 0.3856 0.4396 0.4396 0.4396 0.4396 0.4396 0.4884 0.4852 0.3856 0.3242 0.4852 0.4396 1.1009 1.0878 1.1009 * 0.9768 1.1009 0.8671 1.1009 0.9514 0.8330 0.8503 * 0.8330 0.9413 1.1009 0.9927 0.8671 0.8815 0.8671 0.8804 0.8503 1.1009 1.1009 * 1.1009 1.1009 * * * 1.1009 * * * * * * * 1.1009 0.8815 1.1009 1.1009 0.8330 0.4396 0.4852 0.4852 0.4396 0.4396 0.4396 0.4396 0.3242 0.3917 0.4396 0.4396 0.4396 0.3856 0.4396 0.4396 0.4396 0.4396 0.4396 0.4884 0.4852 0.3856 0.3242 0.4852 0.4396 24.7553 27.0954 28.2538 18.1226 23.4945 27.0061 22.5999 27.0576 22.8667 21.9199 24.6316 26.4748 23.3275 24.2331 27.2038 23.4202 21.6751 19.2836 22.5464 24.2050 24.0837 * 21.6893 15.3569 33.5347 27.4090 35.7147 28.5267 28.4577 36.4991 21.3015 26.8290 31.9423 40.4697 * * * * * * * * 16.1114 14.8607 13.0776 104716 102878 89919 87152 92007 109354 85868 83580 95584 11.7023 15.6066 15.3497 101238 107948 14.9892 13.8643 16.0539 91316 5.2085 103354 107195 41.6138 28.7488 27.6407 18.7624 24.9391 28.5890 23.3078 29.2653 24.8690 21.9169 26.9533 * 20.1581 26.3619 29.4626 26.0170 23.4836 20.3918 23.1051 25.0021 24.1496 * 23.6843 17.0012 35.0427 28.1761 37.6569 29.7287 28.8826 37.9040 * * * * 30.9838 * * * * * * * 13.1847 16.7583 12.8329 14.3108 107207 92265 92463 93116 100962 85534 83802 103347 12.2169 15.6349 14.7607 102734 11.6165 12.8029 14.1533 15.9246 12.4649 5.8200 109808 102652 28.3573 30.5995 29.4647 * 27.2964 32.2766 24.5021 30.8464 25.3424 22.6902 27.0591 * 25.5357 28.6363 30.3079 27.8037 24.6360 21.2245 24.4937 26.0621 25.6462 * 24.1725 * 37.2793 29.6638 38.9525 30.9493 30.7464 37.9834 * * * * * * 27.8974 30.8572 * * * * 13.9703 15.8300 14.2278 12.0952 108193 81860 102084 93834 100781 97022 11.9435 108428 105871 13.7075 16.5449 103148 11.7496 12.8992 14.4649 15.3806 105851 99034 11.4583 103523 1.0838 1.2542 1.9980 0.8611 1.1891 1.7575 1.3685 1.4447 1.3526 1.1748 1.5683 *** 1.1657 1.8697 1.5418 1.4554 1.4944 1.1801 1.1852 1.3621 1.4700 0.5282 0.5405 1.1033 1.4961 1.1710 *** *** *** 1.9127 *** *** *** *** *** 2.1291 *** 1.2893 2.0672 0.8968 1.1904 2.5154 1.3197 1.7815 1.2707 1.2677 1.1979 1.1645 1.2128 1.0167 0.8436 1.0360 1.4590 1.2317 1.3296 1.3552 1.4419 1.1236 1.1948 1.4382 1.3198 1.3733 0.8278 1.0863 1.2282 1.1613 PO 00000 Frm 00219 Fmt 4701 Sfmt 4702 E:\FR\FM\25APP2.SGM 25APP2 Average hourly wage** (3 years) 30.6553 28.8443 28.4678 18.4428 25.3940 29.3055 23.4828 29.0891 24.3814 22.1761 26.1468 26.4748 22.7908 26.4469 29.0897 25.8192 23.2649 20.3113 23.3733 25.1256 24.6744 * 23.1303 16.1698 35.2062 28.3830 37.4292 29.7053 29.2939 37.4690 21.3015 26.8290 31.9423 40.4697 30.9838 * 27.8974 30.8572 * * * * 14.2429 15.7293 13.3681 12.1371 106148 87958 93717 93007 103657 89770 93674 102803 11.4707 14.9492 15.5555 102269 11.4151 13.4598 14.1568 15.7699 104594 6.4832 109391 104470 24214 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules TABLE 2.—HOSPITAL CASE-MIX INDEXES FOR DISCHARGES OCCURRING IN FEDERAL FISCAL YEAR 2005; HOSPITAL WAGE INDEXES FOR FEDERAL FISCAL YEAR 2007; HOSPITAL AVERAGE HOURLY WAGES FOR FEDERAL FISCAL YEARS 2005 (2001 WAGE DATA), 2006 (2002 WAGE DATA), AND 2007 (2003 WAGE DATA); WAGE INDEXES AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY WAGES—Continued Case-mix index 3 wwhite on PROD1PC61 with PROPOSALS2 Provider No. 400044 ..................................................... 400048 ..................................................... 400061 ..................................................... 400079 ..................................................... 400087 ..................................................... 400094 ..................................................... 400098 ..................................................... 400102 ..................................................... 400103 ..................................................... 400104 ..................................................... 400105 ..................................................... 400106 ..................................................... 400109 ..................................................... 400110 ..................................................... 400111 ..................................................... 400112 ..................................................... 400113 ..................................................... 400114 ..................................................... 400115 ..................................................... 400117 ..................................................... 400118 ..................................................... 400120 ..................................................... 400121 ..................................................... 400122 ..................................................... 400123 ..................................................... 400124 ..................................................... 400125 ..................................................... 400126 ..................................................... 400127 ..................................................... 400128 ..................................................... 410001 ..................................................... 410004 ..................................................... 410005 ..................................................... 410006 ..................................................... 410007 ..................................................... 410008 ..................................................... 410009 ..................................................... 410010 ..................................................... 410011 ..................................................... 410012 ..................................................... 410013 ..................................................... 420002 ..................................................... 420004 ..................................................... 420005 ..................................................... 420006 ..................................................... 420007 ..................................................... 420009 ..................................................... 420010 ..................................................... 420011 ..................................................... 420014 ..................................................... 420015 ..................................................... 420016 ..................................................... 420018 ..................................................... 420019 ..................................................... 420020 ..................................................... 420023 ..................................................... 420026 ..................................................... 420027 ..................................................... 420030 ..................................................... 420033 ..................................................... 420036 ..................................................... 420037 ..................................................... 420038 ..................................................... 420039 ..................................................... 420043 h ................................................... 420048 ..................................................... VerDate Aug<31>2005 17:10 Apr 24, 2006 Jkt 208001 FY 2007 wage index (10/1/2006– 3/31/2007) FY 2007 wage index (4/1/2007– 9/30/2007) Average hourly wage FY 2005 1 Average hourly wage FY 2006 1 Average hourly wage FY 2007 1 0.4852 0.4396 0.4396 0.3917 0.4396 * 0.4396 0.4396 0.3856 0.4396 0.4396 0.4396 0.4396 0.3861 0.3917 0.4396 0.4852 0.4396 0.4396 0.4396 0.4396 0.4396 0.4396 0.4396 0.3856 0.4396 0.4047 0.4884 0.4396 * 1.0791 1.0791 1.0791 1.0791 1.0791 1.0791 1.0791 1.1318 1.0791 1.1318 1.2020 0.9520 0.9168 0.8604 * 0.9286 0.9286 0.8604 0.9708 * 0.9708 0.8604 0.8604 0.8604 0.9168 0.9708 0.8604 0.9286 0.9168 0.9708 0.9520 0.9708 0.9708 0.9192 0.9369 0.8604 0.4852 0.4396 0.4396 0.3917 0.4396 * 0.4396 0.4396 0.3856 0.4396 0.4396 0.4396 0.4396 0.3861 0.3917 0.4396 0.4852 0.4396 0.4396 0.4396 0.4396 0.4396 0.4396 0.4396 0.3856 0.4396 0.4047 0.4884 0.4396 * 1.0791 1.0791 1.0791 1.0791 1.0791 1.0791 1.0791 1.1318 1.0791 1.1318 1.2020 0.9520 0.9168 0.8604 * 0.9286 0.9286 0.8604 0.9708 * 0.9708 0.8604 0.8604 0.8604 0.9168 0.9708 0.8604 0.9286 0.9168 0.9708 0.9520 0.9708 0.9708 0.9192 0.9369 0.8604 107890 14.0887 15.1639 94218 95860 88646 13.7938 101795 12.8288 82758 12.7725 96902 14.2169 11.8458 13.4777 89469 100830 12.1920 91132 102911 11.9324 11.9714 86665 96463 11.8135 17.2258 107425 13.3932 * * 27.0309 25.4578 27.1171 27.1842 30.1360 28.4245 27.7337 30.7826 28.5875 32.1679 31.7482 27.9312 26.0279 19.8167 22.8920 25.0395 23.8668 21.6478 20.8895 21.5658 24.7383 17.3837 23.6356 20.5472 24.6592 25.1035 29.2961 22.8322 24.2847 27.5740 21.9641 26.8750 22.6741 24.0637 22.9764 23.1515 13.7509 104266 18.9123 12.7825 106849 * 12.8230 102677 93859 93854 14.0219 11.4507 14.2111 12.3449 14.5029 19.3945 96778 11.5478 13.7392 12.7600 12.5743 12.7955 82197 11.2325 12.3041 16.1812 11.6386 98008 * * 28.0816 27.4209 30.1606 29.4395 31.8548 29.6092 29.4094 32.8599 30.3787 32.6009 35.4624 28.2848 27.2620 23.1943 24.0811 25.2650 25.5079 23.4562 21.4030 * 26.2154 17.1229 24.8024 22.5312 25.8883 26.7263 27.4814 25.1692 26.0079 31.8759 22.8294 29.4156 24.2259 25.1148 23.0555 24.1923 15.0643 96590 18.1083 97136 11.1382 * 14.0632 105904 108059 11.4349 15.6682 107533 14.3015 11.4297 14.5980 101536 108360 101147 12.3253 102910 12.8655 13.5787 97450 89500 13.1036 17.5453 11.9805 14.4278 * * 28.7232 29.8160 28.0170 30.4938 33.2082 30.7042 31.8827 33.1837 34.1277 34.2578 36.1627 29.6120 28.2541 24.2198 24.5609 27.2262 27.3791 24.2841 21.7568 * 21.2872 20.8597 21.8989 21.4165 27.8386 27.9657 28.0609 26.4925 27.0672 31.3764 23.9791 30.4783 26.1603 27.2085 23.3824 26.0899 1.2533 1.1305 1.8741 1.1751 1.2553 *** 1.3208 1.2898 1.6742 1.1455 1.1547 1.1415 1.4063 1.1588 1.0981 1.1494 1.2376 1.1480 1.1597 1.1245 1.2557 1.3081 1.0060 1.9098 1.2218 2.9200 1.1716 1.2506 1.6978 1.0326 1.2798 1.2554 1.2518 1.3408 1.6795 1.2437 1.2546 1.2153 1.3425 1.7592 1.2452 1.5071 1.9971 1.0520 *** 1.6133 1.4085 1.1727 1.2007 *** 1.3233 0.9804 1.7486 1.0789 1.2657 1.7023 1.9244 1.6213 1.2546 1.1348 1.2159 1.3078 1.2810 1.0969 1.1624 1.2633 PO 00000 Frm 00220 Fmt 4701 Sfmt 4702 E:\FR\FM\25APP2.SGM 25APP2 Average hourly wage** (3 years) 13.2982 11.4085 17.4205 104627 104923 88646 13.4998 103382 106890 97084 14.1165 106057 14.2434 11.8994 14.1786 11.4865 101888 11.2106 11.4989 11.0109 12.4718 12.8169 88283 101687 12.4082 16.9794 11.4266 11.9045 * * 27.9407 27.5282 28.4104 29.0529 31.8053 29.5882 29.7343 32.3515 30.9611 33.0696 34.4667 28.6309 27.2127 22.4053 23.8460 25.8946 25.6316 23.1799 21.3667 21.5658 23.9502 18.3791 23.4144 21.4730 26.1025 26.5640 28.2225 24.8853 25.7933 30.3043 22.9381 28.9942 24.3482 25.4527 23.1477 24.4888 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules 24215 TABLE 2.—HOSPITAL CASE-MIX INDEXES FOR DISCHARGES OCCURRING IN FEDERAL FISCAL YEAR 2005; HOSPITAL WAGE INDEXES FOR FEDERAL FISCAL YEAR 2007; HOSPITAL AVERAGE HOURLY WAGES FOR FEDERAL FISCAL YEARS 2005 (2001 WAGE DATA), 2006 (2002 WAGE DATA), AND 2007 (2003 WAGE DATA); WAGE INDEXES AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY WAGES—Continued Case-mix index 3 wwhite on PROD1PC61 with PROPOSALS2 Provider No. 420049 ..................................................... 420051 ..................................................... 420053 ..................................................... 420054 ..................................................... 420055 ..................................................... 420056 ..................................................... 420057 ..................................................... 420059 ..................................................... 420061 ..................................................... 420062 ..................................................... 420064 ..................................................... 420065 ..................................................... 420066 ..................................................... 420067 ..................................................... 420068 ..................................................... 420069 ..................................................... 420070 ..................................................... 420071 ..................................................... 420072 ..................................................... 420073 ..................................................... 420075 ..................................................... 420078 ..................................................... 420079 ..................................................... 420080 ..................................................... 420082 ..................................................... 420083 ..................................................... 420085 ..................................................... 420086 ..................................................... 420087 ..................................................... 420088 ..................................................... 420089 ..................................................... 420091 ..................................................... 420093 ..................................................... 420097 ..................................................... 420098 ..................................................... 420100 ..................................................... 420101 ..................................................... 430005 ..................................................... 430008 2 ................................................... 430011 ..................................................... 430012 ..................................................... 430013 2 ................................................... 430014 ..................................................... 430015 ..................................................... 430016 ..................................................... 430027 ..................................................... 430029 ..................................................... 430031 2 ................................................... 430043 ..................................................... 430047 ..................................................... 430048 ..................................................... 430060 ..................................................... 430064 ..................................................... 430077 ..................................................... 430081 ..................................................... 430082 ..................................................... 430083 ..................................................... 430084 ..................................................... 430085 ..................................................... 430089 ..................................................... 430090 ..................................................... 430091 ..................................................... 430092 ..................................................... 430093 ..................................................... 430094 ..................................................... 430095 ..................................................... VerDate Aug<31>2005 17:10 Apr 24, 2006 Jkt 208001 FY 2007 wage index (10/1/2006– 3/31/2007) FY 2007 wage index (4/1/2007– 9/30/2007) Average hourly wage FY 2005 1 Average hourly wage FY 2006 1 Average hourly wage FY 2007 1 0.8819 0.8604 0.8604 0.8604 0.8604 0.8604 0.8604 * * 0.8739 0.8819 0.9168 0.8604 0.8958 0.9554 0.8604 0.8604 0.9286 0.8604 0.8604 * 0.9708 0.9168 0.8958 0.9681 0.9286 0.9516 0.8604 0.9168 * 0.9168 0.8604 * * 0.8639 * * 1.0359 0.9456 * 0.9456 0.9456 0.8485 0.9456 0.9559 0.9559 * * * * 0.9456 0.9456 0.9456 0.9456 1.4448 1.4448 1.4448 1.4448 1.4448 0.9201 0.9559 0.9456 0.8485 1.0359 0.9154 0.9559 0.8819 0.8604 0.8604 0.8604 0.8604 0.8604 0.8604 * * 0.8739 0.8819 0.9168 0.8604 0.8958 0.9554 0.8604 0.8604 0.9286 0.8604 0.8604 * 0.9708 0.9168 0.8958 0.9681 0.9286 0.9516 0.8604 0.9168 * 0.9168 0.8604 * * 0.8639 * * 0.8485 0.9559 * 0.9456 0.9559 0.8485 0.8485 0.9559 0.9559 * * * * 0.8485 0.8485 0.8485 1.0359 1.4448 1.4448 1.4448 1.4448 1.4448 0.9201 0.9559 1.0359 0.8485 1.0359 0.9154 0.9559 23.2156 23.9455 21.1177 24.0653 20.3599 21.1640 19.7653 21.4260 20.8684 25.6683 22.1290 22.8674 20.5893 24.6038 22.2638 19.6959 22.4370 23.1727 17.5899 24.0274 16.4816 25.3032 25.2939 28.4569 26.1221 25.3043 25.3180 25.1372 23.2230 23.1273 25.2729 23.4710 25.1457 24.7809 * * * 19.9454 20.9442 20.6597 22.7530 22.9675 25.5387 23.2035 26.1495 23.8477 20.2708 15.6112 17.2722 21.9116 21.1718 102704 16.4314 23.4835 * * * * * 21.1109 26.0851 23.8897 20.2570 23.1526 18.5429 24.7074 23.9722 24.8026 22.2825 24.8931 21.9764 21.6963 23.4311 * * 25.9526 23.3610 24.5715 23.9048 25.0345 23.4248 20.5546 23.4355 24.9418 18.6742 24.5813 * 28.9112 25.4935 28.4734 29.8528 27.1322 26.8692 25.8869 24.3609 * 26.0074 26.9214 27.4766 * * * * 22.3272 23.3790 * 24.0850 25.1378 26.4964 22.7947 27.8453 26.2139 * 16.0346 * 18.8982 23.0783 * 17.5376 25.1763 * * * * * 22.5625 25.8460 24.3021 20.9486 29.5244 18.9099 28.1749 25.5048 24.8652 22.7135 24.8011 23.3168 23.9218 22.2186 * * 26.9629 24.2786 25.3741 24.4148 25.3722 25.2900 21.6426 23.9471 25.6422 17.2143 25.8074 * 30.1670 26.9725 29.0327 30.7503 26.9176 27.7993 21.7594 25.4810 * 28.9297 26.0435 28.6727 * 31.3940 * * 23.0896 24.6127 * 24.9285 26.5894 27.4732 23.8702 30.2136 26.9443 * * * * 24.1611 11.7945 17.2636 31.1834 * * * * * 23.6025 28.9461 25.8667 23.4758 30.0783 22.5333 29.8113 1.2698 1.5632 1.1371 1.0765 1.0631 1.3401 1.2668 1.0763 *** 1.0673 1.2144 1.4215 0.9904 1.3417 1.3345 1.1105 1.3141 1.4059 1.0863 1.3790 0.9046 1.8782 1.5771 1.4619 1.5148 1.4829 1.5804 1.4224 1.8048 *** 1.3305 1.3534 *** *** 1.1589 1.9085 1.0458 1.3298 1.0746 *** 1.2579 1.1791 1.3196 1.1709 1.6875 1.7911 0.8746 0.9582 *** 1.0053 1.3110 0.9031 1.0621 1.7585 0.8530 0.7949 0.8473 0.9005 0.8408 1.6831 1.4802 2.1668 1.8623 0.9304 1.4722 2.4917 PO 00000 Frm 00221 Fmt 4701 Sfmt 4702 E:\FR\FM\25APP2.SGM 25APP2 Average hourly wage** (3 years) 24.2429 24.5591 22.0833 24.5877 21.9025 22.2405 21.7975 21.4260 20.8684 26.2354 23.2388 24.2923 22.9867 25.0243 23.6594 20.6460 23.3117 24.6317 17.8091 24.8472 16.4816 28.1072 25.9340 28.6601 28.8866 26.4627 26.6577 24.0808 24.3588 23.1273 26.7899 25.5227 27.2207 24.7809 31.3940 * * 21.7517 22.8729 20.6597 23.9166 24.8973 26.5372 23.2928 28.0429 25.7330 20.2708 15.8232 17.2722 20.4712 22.8614 109543 17.0895 26.6659 * * * * * 22.5500 27.1155 24.7276 21.5566 27.8638 19.9282 27.7110 24216 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules TABLE 2.—HOSPITAL CASE-MIX INDEXES FOR DISCHARGES OCCURRING IN FEDERAL FISCAL YEAR 2005; HOSPITAL WAGE INDEXES FOR FEDERAL FISCAL YEAR 2007; HOSPITAL AVERAGE HOURLY WAGES FOR FEDERAL FISCAL YEARS 2005 (2001 WAGE DATA), 2006 (2002 WAGE DATA), AND 2007 (2003 WAGE DATA); WAGE INDEXES AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY WAGES—Continued Case-mix index 3 wwhite on PROD1PC61 with PROPOSALS2 Provider No. 430096 ..................................................... 440001 ..................................................... 440002 ..................................................... 440003 ..................................................... 440006 ..................................................... 440007 ..................................................... 440008 ..................................................... 440009 ..................................................... 440010 ..................................................... 440011 ..................................................... 440012 ..................................................... 440015 ..................................................... 440016 ..................................................... 440017 ..................................................... 440018 ..................................................... 440019 ..................................................... 440020 ..................................................... 440023 ..................................................... 440024 ..................................................... 440025 ..................................................... 440026 ..................................................... 440029 ..................................................... 440030 ..................................................... 440031 ..................................................... 440032 ..................................................... 440033 ..................................................... 440034 ..................................................... 440035 ..................................................... 440039 ..................................................... 440040 ..................................................... 440041 ..................................................... 440046 ..................................................... 440047 ..................................................... 440048 ..................................................... 440049 ..................................................... 440050 ..................................................... 440051 ..................................................... 440052 ..................................................... 440053 ..................................................... 440054 ..................................................... 440056 ..................................................... 440057 ..................................................... 440058 ..................................................... 440059 ..................................................... 440060 ..................................................... 440061 ..................................................... 440063 ..................................................... 440064 ..................................................... 440065 ..................................................... 440067 ..................................................... 440068 ..................................................... 440070 ..................................................... 440072 ..................................................... 440073 ..................................................... 440081 h ................................................... 440082 ..................................................... 440083 ..................................................... 440084 ..................................................... 440091 ..................................................... 440102 ..................................................... 440104 ..................................................... 440105 ..................................................... 440109 ..................................................... 440110 ..................................................... 440111 ..................................................... 440114 ..................................................... VerDate Aug<31>2005 17:10 Apr 24, 2006 Jkt 208001 FY 2007 wage index (10/1/2006– 3/31/2007) FY 2007 wage index (4/1/2007– 9/30/2007) Average hourly wage FY 2005 1 Average hourly wage FY 2006 1 Average hourly wage FY 2007 1 0.8485 0.8070 0.9032 0.9853 0.9853 0.7957 0.8640 0.7957 0.7957 0.8278 0.8078 0.8278 0.7957 0.8078 0.8070 0.8278 0.8829 * 0.8841 0.8607 * 0.9853 0.8013 0.7957 0.8062 0.7957 0.8278 0.9571 0.9853 0.7957 * 0.9853 0.8456 0.9367 0.9367 0.9110 0.8061 0.7957 0.9853 0.7957 0.8278 0.7957 0.8841 0.9571 0.8640 0.7957 0.8081 0.8965 0.9853 0.8278 0.8841 0.7957 0.9032 0.9571 0.8278 0.9853 0.7957 0.7957 0.8965 0.7957 0.8965 0.8081 0.7957 0.8278 0.9853 * 0.8485 0.8070 0.9032 0.9853 0.9853 0.7957 0.8640 0.7957 0.7957 0.8278 0.8078 0.8278 0.7957 0.8078 0.8070 0.8278 0.8829 * 0.8841 0.8607 * 0.9853 0.8013 0.7957 0.8062 0.7957 0.8278 0.9571 0.9853 0.7957 * 0.9853 0.8456 0.9367 0.9367 0.9110 0.8061 0.7957 0.9853 0.7957 0.8278 0.7957 0.8841 0.9571 0.8640 0.7957 0.8081 0.8965 0.9853 0.8278 0.8841 0.7957 0.9032 0.9571 0.8278 0.9853 0.7957 0.7957 0.8965 0.7957 0.8965 0.8081 0.7957 0.8278 0.9853 * * 17.4802 23.2177 24.5168 26.7983 13.7042 22.1405 21.1274 16.9060 21.6861 21.4769 22.5583 20.0982 22.5313 21.7239 23.8802 23.1718 17.0335 20.3658 19.5995 26.9149 25.8538 20.0586 18.0944 16.0734 18.7749 23.1121 22.3230 26.4647 17.7647 17.4074 25.5329 20.4812 24.3283 22.9755 21.8972 20.7948 20.1875 23.9083 20.5992 20.4088 14.6242 22.6014 23.9301 22.7133 21.2085 21.8578 20.9742 21.4794 22.1410 23.1705 19.0240 20.9294 22.2959 19.0328 28.7828 16.0956 15.2825 26.1122 17.5140 23.3731 20.7821 18.2508 20.9039 25.8821 21.4271 21.6998 19.3100 24.6664 25.9209 28.5951 25.8236 23.4301 21.5970 17.1803 22.5068 22.3029 23.7422 22.1646 22.9364 23.3444 25.2553 23.9475 * 23.2716 20.6798 26.8986 28.0779 22.1217 19.6685 18.5277 20.7917 23.5403 24.3752 28.4678 17.8510 17.9409 26.1341 21.4280 27.7560 25.3043 23.1362 21.9108 21.1133 25.4345 21.4400 22.1068 16.4451 22.9263 26.3551 23.3014 21.8274 22.3256 22.0955 22.3247 23.1089 24.5971 19.4372 27.1443 23.9198 19.7878 27.9724 17.3329 16.3738 25.6797 17.5261 25.3739 22.3438 18.6720 21.3287 28.5705 24.0147 22.6901 20.2649 25.9742 28.8489 29.6894 19.4053 23.3316 23.1758 18.2555 23.9451 23.7400 25.0126 22.6177 24.4189 23.3049 25.8265 23.5480 * 23.6564 21.4831 28.1548 29.2583 23.8651 20.3131 19.6994 20.0504 24.4772 26.2379 29.9015 18.2335 * 27.6435 22.3132 29.3776 26.9042 24.6283 23.7561 21.8224 27.2143 22.9137 22.6402 16.2043 24.5733 27.0398 24.2289 23.7972 24.2436 23.2881 24.5839 23.6433 25.5084 19.0125 24.1118 26.0153 20.6628 30.5997 23.4452 17.5206 26.8144 20.0410 26.5346 22.6923 19.6599 21.2955 29.5053 * 1.9427 1.1169 1.7066 1.2347 1.4887 0.9516 1.0250 1.1899 0.9646 1.3341 1.5557 1.8501 1.0145 1.8336 1.1147 1.7779 1.0317 0.9906 1.3361 1.1289 0.6849 1.3750 1.3551 1.1563 1.1223 1.0675 1.6231 1.3627 2.1248 0.9305 0.9605 1.1823 0.8929 1.8553 1.6271 1.3256 0.9873 1.0493 1.2859 1.1108 1.1517 1.0894 1.1733 1.5230 1.1113 1.0612 1.5519 1.0269 1.2273 1.1704 1.1108 0.9767 1.1510 1.4478 1.1987 2.1349 0.9462 1.2049 1.6877 1.1120 1.8282 1.0151 0.9889 1.1019 1.2995 1.0157 PO 00000 Frm 00222 Fmt 4701 Sfmt 4702 E:\FR\FM\25APP2.SGM 25APP2 Average hourly wage** (3 years) 22.1655 19.0060 24.6541 26.4731 28.3900 18.8359 22.9571 22.0061 17.4628 22.7588 22.4984 23.7907 21.6373 23.3049 22.8330 24.9572 23.5575 17.0335 22.4300 20.6130 27.3132 27.8141 22.0702 19.3798 18.1087 19.8739 23.7187 24.3199 28.3486 17.9564 17.6972 26.4633 21.4112 27.0718 25.0712 23.2518 22.1363 21.0640 25.5366 21.6206 21.8021 15.7807 23.3536 25.7416 23.4440 22.1762 22.8424 22.0874 22.8185 22.9820 24.4008 19.1532 23.7250 24.0664 19.8630 29.1230 18.9853 16.4229 26.2154 18.3603 25.1499 21.9737 18.8870 21.1604 27.9706 22.7665 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules 24217 TABLE 2.—HOSPITAL CASE-MIX INDEXES FOR DISCHARGES OCCURRING IN FEDERAL FISCAL YEAR 2005; HOSPITAL WAGE INDEXES FOR FEDERAL FISCAL YEAR 2007; HOSPITAL AVERAGE HOURLY WAGES FOR FEDERAL FISCAL YEARS 2005 (2001 WAGE DATA), 2006 (2002 WAGE DATA), AND 2007 (2003 WAGE DATA); WAGE INDEXES AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY WAGES—Continued Case-mix index 3 wwhite on PROD1PC61 with PROPOSALS2 Provider No. 440115 440120 440125 440130 440131 440132 440133 440135 440137 440141 440143 440144 440145 440147 440148 440149 440150 440151 440152 440153 440156 440159 440161 440162 440166 440168 440173 440174 440175 440176 440180 440181 440182 440183 440184 440185 440186 440187 440189 440192 440193 440194 440197 440200 440203 440217 440218 440222 440225 440226 440227 440228 450002 450005 450007 450008 450010 450011 450014 450015 450016 450018 450020 450021 450023 450024 ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... VerDate Aug<31>2005 17:10 Apr 24, 2006 Jkt 208001 FY 2007 wage index (10/1/2006– 3/31/2007) FY 2007 wage index (4/1/2007– 9/30/2007) Average hourly wage FY 2005 1 Average hourly wage FY 2006 1 Average hourly wage FY 2007 1 0.8456 0.8278 0.8278 0.7957 0.9367 0.7957 0.9853 0.7957 0.7957 0.7957 * 0.7957 * * 0.9571 * 0.9853 0.9571 0.9367 0.7964 0.8965 0.9367 0.9853 * * 0.9367 0.8278 0.8329 0.9571 0.8078 0.8278 0.8364 0.7957 0.9367 0.8081 0.8841 0.9853 0.7957 0.8860 0.9571 0.9853 0.9853 0.9853 0.9853 0.7957 0.9367 0.9853 0.9367 0.8278 0.8278 0.9853 0.9367 0.9101 0.8612 0.8859 0.9131 0.8790 0.9064 * 1.0087 * 1.0030 * 1.0087 0.8554 0.9101 0.8456 0.8278 0.8278 0.7957 0.9367 0.7957 0.9853 0.7957 0.7957 0.7957 * 0.7957 * * 0.9571 * 0.9853 0.9571 0.9367 0.7964 0.8965 0.9367 0.9853 * * 0.9367 0.8278 0.8329 0.9571 0.8078 0.8278 0.8364 0.7957 0.9367 0.8081 0.8841 0.9853 0.7957 0.8860 0.9571 0.9853 0.9853 0.9853 0.9853 0.7957 0.9367 0.9853 0.9367 0.8278 0.8278 0.9853 0.9367 0.9101 0.8612 0.8859 0.9131 0.8360 0.9064 * 1.0087 * 1.0030 * 1.0087 0.8554 0.9101 20.0642 23.9003 21.9337 21.6480 22.4119 20.5716 27.5019 25.3928 18.2073 19.4528 21.0374 22.3671 20.9863 28.9038 23.0697 19.8020 25.4952 23.3037 25.9495 22.7744 25.6333 21.1073 28.6774 16.5305 27.1355 22.1764 20.8723 20.7960 24.0005 22.0079 21.9781 21.1406 20.2630 27.7769 20.8219 23.4172 24.6773 21.7637 24.7851 25.1119 24.3911 26.2498 26.4999 17.0633 17.7639 25.9667 26.3741 28.3879 * * * * 25.4975 23.4049 19.2875 22.0934 22.4133 24.1576 22.5001 24.0730 22.1368 24.6443 17.7148 28.5578 20.9278 22.4178 21.7830 25.5961 22.4196 23.4517 24.9598 21.5085 26.2422 26.6615 20.6663 21.3313 * 23.3828 20.7875 31.4012 24.6412 20.4562 26.8308 23.9808 26.5513 22.2846 26.9689 22.8645 * 21.1418 31.0779 22.8768 22.8846 22.0974 22.7299 23.6659 23.3808 22.7150 22.3612 27.1515 22.3475 23.9052 25.7445 21.3252 27.5435 25.7495 24.4299 26.6527 27.1534 17.7491 19.3864 28.5968 24.6465 29.7292 * * * * 25.7171 23.5576 20.7321 22.9669 23.7529 24.8831 * 27.4012 * 26.7999 18.3047 29.1350 22.0558 24.4195 22.4307 26.0172 22.9618 24.3338 26.2835 23.0374 28.9034 28.4307 21.9678 22.2645 * 23.6094 * 33.3608 24.2554 * 28.3249 26.7603 27.0829 22.7501 27.8265 24.4882 29.5526 28.0859 35.4275 27.8781 22.9918 24.1697 24.6413 23.1222 25.2167 24.3293 23.2013 28.8310 24.3699 25.1022 27.3448 22.8652 27.8595 26.7266 24.8439 29.9809 29.6975 19.9962 23.2355 29.4892 24.3645 29.2515 26.4444 26.5721 * * 28.0968 24.8874 22.7681 25.4507 25.0592 27.0743 * 29.3737 * 28.5226 * 30.1831 25.5410 25.4622 0.9925 1.5709 1.6399 1.1653 1.1555 1.2915 1.6608 1.0517 1.0820 1.0091 0.9346 1.2554 0.9924 *** 1.1184 1.0243 1.3664 1.0878 1.8573 1.0530 1.5372 1.4567 1.7891 *** *** 0.9738 1.6130 0.8839 1.0159 1.2251 1.2535 0.9526 0.9870 1.6248 1.0336 1.1495 1.0327 1.1095 1.3834 1.0715 1.2853 1.3338 1.3107 0.9957 0.9226 1.3383 1.7741 0.9844 0.8475 1.5408 1.2278 1.3652 1.4375 1.0954 1.3241 1.2987 1.6039 1.7202 *** 1.5860 *** 1.5062 0.9622 1.8322 1.4320 1.4841 PO 00000 Frm 00223 Fmt 4701 Sfmt 4702 E:\FR\FM\25APP2.SGM 25APP2 Average hourly wage** (3 years) 21.4405 25.1825 22.4439 23.1392 24.5883 21.6966 27.5284 26.8611 20.1924 21.1533 21.0374 23.1261 20.8882 31.2464 23.9966 20.1312 26.8782 24.6946 26.5411 22.6002 26.8113 22.9041 29.1459 21.5406 30.5015 24.3442 22.2791 22.3179 23.7639 22.9749 23.6141 22.7527 21.9586 27.9092 22.4690 24.2246 25.9302 21.9897 26.7516 25.8889 24.5603 27.7279 27.7361 18.2529 19.8845 28.0654 25.3056 29.1278 26.4444 26.5721 * * 26.4037 23.9095 20.9365 23.5297 23.7488 25.3503 22.5001 26.9851 22.1368 26.6104 18.0203 29.2883 22.7444 24.1268 24218 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules TABLE 2.—HOSPITAL CASE-MIX INDEXES FOR DISCHARGES OCCURRING IN FEDERAL FISCAL YEAR 2005; HOSPITAL WAGE INDEXES FOR FEDERAL FISCAL YEAR 2007; HOSPITAL AVERAGE HOURLY WAGES FOR FEDERAL FISCAL YEARS 2005 (2001 WAGE DATA), 2006 (2002 WAGE DATA), AND 2007 (2003 WAGE DATA); WAGE INDEXES AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY WAGES—Continued Case-mix index 3 wwhite on PROD1PC61 with PROPOSALS2 Provider No. 450028 450029 450031 450032 450033 450034 450035 450037 450039 450040 450042 450044 450046 450047 450050 450051 450052 450053 450054 450055 450056 450058 450059 450064 450068 450072 450073 450078 450079 450080 450082 450083 450085 450087 450090 450092 450094 450096 450097 450098 450099 450101 450102 450104 450107 450108 450112 450113 450119 450121 450123 450124 450126 450128 450130 450131 450132 450133 450135 450137 450140 450143 450144 450147 450148 450151 ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... VerDate Aug<31>2005 17:10 Apr 24, 2006 Jkt 208001 FY 2007 wage index (10/1/2006– 3/31/2007) FY 2007 wage index (4/1/2007– 9/30/2007) Average hourly wage FY 2005 1 Average hourly wage FY 2006 1 Average hourly wage FY 2007 1 0.9474 0.8003 1.0087 0.8715 0.9474 0.8612 1.0030 0.8905 0.9870 0.8626 0.8653 1.0087 0.8578 0.9474 * 1.0087 0.8003 0.8003 0.9131 0.8003 0.9360 0.8859 0.9360 0.9870 1.0030 1.0030 0.8051 0.8003 1.0087 0.8905 0.8003 0.8854 0.8003 0.9870 0.8003 0.8003 * 0.8612 1.0030 * 0.9177 0.8653 0.8854 0.8859 0.9101 0.8859 * * 0.8790 0.9870 0.8612 0.9360 1.0030 0.8790 0.8859 * 1.0119 0.9802 0.9870 0.9870 * 0.9360 0.9737 0.8554 0.9870 0.8003 0.9474 0.8003 1.0087 0.8715 0.9474 0.8612 1.0030 0.8905 0.9870 0.8626 0.8653 1.0087 0.8578 0.9474 * 1.0087 0.8003 0.8003 0.9131 0.8003 0.9360 0.8859 0.9360 0.9870 1.0030 1.0030 0.8051 0.8003 1.0087 0.8905 0.8003 0.8854 0.8003 0.9870 0.8003 0.8003 * 0.8612 1.0030 * 0.9177 0.8653 0.8854 0.8859 0.9101 0.8859 * * 0.8790 0.9870 0.8612 0.9360 1.0030 0.8790 0.8859 * 1.0119 0.9802 0.9870 0.9870 * 0.9360 0.9737 0.8554 0.9870 0.8003 25.6030 23.9709 27.0328 20.8306 29.0541 23.4615 25.4580 23.1176 23.3034 23.8047 22.6936 25.8403 22.0695 22.7242 21.6933 27.2523 19.7185 19.4978 25.1229 20.5235 25.6685 24.7442 26.8209 24.2920 26.2864 22.5010 20.0464 17.2196 27.0443 21.2482 20.9113 24.9182 19.4524 26.4203 17.6506 20.4921 25.3618 22.8722 24.9380 22.9005 24.0293 20.6575 23.1773 22.5165 23.8770 19.3561 22.5552 * 24.1392 25.8826 19.5872 26.0280 27.3021 21.4190 20.2777 23.2317 26.8476 25.0972 24.3858 27.0081 22.4695 19.7487 20.9599 24.6203 23.5037 20.1356 26.8250 23.2995 27.9626 27.0748 28.4781 24.1589 26.2838 24.2684 24.7347 24.9590 24.1181 29.4308 23.4907 19.8221 23.3044 28.0411 19.7774 21.9082 24.2782 22.1979 27.0530 25.9653 26.6535 23.8748 27.9633 24.0166 21.7337 15.8968 28.1096 22.9835 22.0442 25.8214 22.0840 29.1587 19.4244 23.2071 25.2434 24.1619 26.4965 22.6626 26.6796 23.6905 24.5503 23.8469 25.9326 19.4935 * 54.6681 25.7008 25.7051 21.2154 27.4198 28.3033 23.3633 21.5226 23.7098 28.6954 26.8344 26.0755 30.4254 * 21.8705 21.3289 23.9771 25.3498 22.2915 27.7693 23.7005 29.4827 21.2720 28.5174 26.2069 28.3361 26.3292 26.2041 25.9125 26.6885 32.4768 25.3629 21.2384 * 29.5795 21.1995 20.4980 27.7869 22.4127 28.2252 26.8533 27.4391 27.5350 29.9491 25.3658 24.6840 18.2067 29.8969 27.2213 23.3125 27.2160 23.4732 30.0371 20.9803 23.9641 * 26.1563 28.2316 * 28.8288 24.8496 25.3756 23.3944 27.9184 20.2479 * * 27.6154 29.0897 23.0469 28.1018 28.8116 24.1195 23.5398 26.3279 30.2134 29.2478 27.9663 31.4048 * 22.5280 25.6368 25.0247 27.5125 23.2545 1.5344 1.5535 1.4013 1.1925 1.6629 1.5793 1.5477 1.5982 1.3819 1.7828 1.7951 1.7267 1.5874 0.8361 0.9114 1.8871 0.9776 0.9826 1.7608 1.1174 1.8144 1.5775 1.3376 1.4386 2.0792 1.1764 0.9681 0.9553 1.6954 1.2691 1.0789 1.7780 1.0382 1.4483 1.2044 1.2084 *** 1.4283 1.4526 0.9594 1.2289 1.5872 1.8228 1.2091 1.4218 1.1901 *** *** 1.2924 1.4829 1.0580 1.8874 1.3432 1.2314 1.2180 *** 1.5414 1.6337 1.6922 1.6056 *** 1.0146 1.0731 1.4387 1.1848 1.2027 PO 00000 Frm 00224 Fmt 4701 Sfmt 4702 E:\FR\FM\25APP2.SGM 25APP2 Average hourly wage** (3 years) 26.7175 23.6494 28.2223 22.8525 28.6719 24.5798 26.6364 24.6149 24.8293 24.8722 24.5021 29.3230 23.6516 21.2173 22.5039 28.3261 20.1263 20.6324 25.6677 21.7257 26.8936 25.8582 26.9795 25.2944 28.0965 23.9560 22.0875 17.0494 28.2854 23.6862 22.0908 26.0725 21.7012 28.5792 19.3653 22.5714 25.3030 24.3175 26.5557 22.7778 26.4791 23.0430 24.3986 23.2732 25.8765 19.7198 22.5552 54.6681 25.8461 26.9221 21.1313 27.2284 28.2181 22.9163 21.8292 24.2678 28.5936 27.1707 26.2251 29.7868 22.4695 21.4534 22.5854 24.5527 25.5034 21.9494 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules 24219 TABLE 2.—HOSPITAL CASE-MIX INDEXES FOR DISCHARGES OCCURRING IN FEDERAL FISCAL YEAR 2005; HOSPITAL WAGE INDEXES FOR FEDERAL FISCAL YEAR 2007; HOSPITAL AVERAGE HOURLY WAGES FOR FEDERAL FISCAL YEARS 2005 (2001 WAGE DATA), 2006 (2002 WAGE DATA), AND 2007 (2003 WAGE DATA); WAGE INDEXES AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY WAGES—Continued Case-mix index 3 wwhite on PROD1PC61 with PROPOSALS2 Provider No. 450152 450154 450155 450157 450160 450162 450163 450165 450176 450177 450178 450184 450185 450187 450188 450191 450192 450193 450194 450196 450200 450201 450203 450209 450210 450211 450213 450214 450219 450221 450222 450224 450229 450231 450234 450235 450236 450237 450239 450241 450243 450249 450253 450264 450269 450270 450271 450272 450276 450280 450283 450289 450292 450293 450296 450299 450306 450315 450324 450330 450340 450346 450347 450348 450351 450352 ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... VerDate Aug<31>2005 17:10 Apr 24, 2006 Jkt 208001 FY 2007 wage index (10/1/2006– 3/31/2007) FY 2007 wage index (4/1/2007– 9/30/2007) Average hourly wage FY 2005 1 Average hourly wage FY 2006 1 Average hourly wage FY 2007 1 0.9131 0.8003 0.8003 * * 0.8626 0.8137 0.8859 0.8790 0.8003 0.8003 1.0030 * 1.0030 0.8003 0.9360 0.9870 1.0030 0.9870 0.9870 0.8133 0.8003 0.9591 0.9177 0.8003 1.0030 0.8859 1.0030 0.8003 0.8003 1.0030 0.8854 0.8051 0.9177 0.8003 0.8003 0.8003 0.8859 0.9131 0.8003 0.8003 * 1.0030 * * 0.8003 0.9591 0.9360 * 1.0087 0.9870 1.0030 1.0087 0.8003 1.0030 0.9064 0.8051 * 0.8677 1.0030 0.8385 0.8612 1.0030 0.8003 0.9591 1.0087 0.9131 0.8003 0.8003 * * 0.8626 0.8137 0.8859 0.8790 0.8003 0.8003 1.0030 * 1.0030 0.8003 0.9360 0.9870 1.0030 0.9870 0.9870 0.8133 0.8003 0.9591 0.9177 0.8003 1.0030 0.8859 1.0030 0.8003 0.8003 1.0030 0.8854 0.8051 0.9177 0.8003 0.8003 0.8003 0.8859 0.9131 0.8003 0.8003 * 1.0030 * * 0.8003 0.9591 0.9360 * 1.0087 0.9870 1.0030 1.0087 0.8003 1.0030 0.9064 0.8051 * 0.8677 1.0030 0.8385 0.8612 1.0030 0.8003 0.9591 1.0087 21.6351 18.6058 17.9306 17.8812 21.9118 31.0645 20.3280 20.2414 20.9392 19.7657 20.2992 25.3935 15.5838 24.2400 18.9586 25.9078 22.5118 29.2751 22.3348 23.6170 22.0923 20.3350 23.3953 24.4977 19.6340 20.7982 21.7930 23.9112 20.8255 20.6887 26.2975 22.2250 19.8279 23.9532 23.6695 19.1453 19.2987 25.1504 21.8595 18.1155 14.0589 16.5616 19.6379 15.4111 14.8204 15.0879 19.4299 23.7933 16.0264 27.4523 20.0069 27.3864 23.5330 20.0898 29.2006 25.8183 14.6699 27.9780 23.6362 24.4310 22.7826 21.9717 22.8133 17.0198 23.5895 23.4297 22.7463 21.2021 18.0589 * * 30.9903 23.1400 24.3242 20.9297 21.3322 24.7301 26.7821 * 25.6786 20.4070 26.0298 22.5880 32.2964 24.8972 24.7557 23.5344 20.9809 24.1675 26.0958 19.9832 23.8230 23.9676 25.9598 21.7934 20.3186 27.4426 24.1956 21.4459 25.2852 18.4451 21.5138 22.0788 24.8901 21.1945 18.7957 15.4636 * 20.6124 * * 14.4325 21.7719 25.7392 16.6319 28.7233 20.9680 28.5665 25.0411 21.3136 27.9690 26.4933 15.9854 * 24.9128 25.5820 24.0636 22.2469 27.2203 18.7675 25.6859 24.8012 24.1970 20.7952 21.3482 * * 31.9964 23.4148 27.6487 23.6030 22.6615 23.9597 28.4921 * 28.2045 21.4250 27.2533 23.8534 34.3517 23.5660 24.6006 24.2489 21.3642 25.9236 27.3634 21.1245 26.8071 25.1261 27.1030 22.0150 18.7121 30.3939 26.8950 23.2333 26.9729 19.9093 22.5969 22.4149 26.2898 21.1113 19.3886 13.3360 * 23.1000 * * 14.7319 23.0668 26.1100 * 29.7601 22.1481 31.2375 26.9725 21.3044 29.3120 28.2325 18.7874 37.5788 25.2508 26.3863 24.9329 23.2733 28.3157 20.1752 27.1819 26.8535 1.2274 1.3702 1.0271 *** 0.8255 1.3087 1.0883 1.0794 1.3564 1.1934 0.9382 1.5480 *** 1.1744 0.9551 1.1747 1.1719 2.0371 1.3875 1.4334 1.4680 0.9908 1.1593 1.9505 0.9811 1.3657 1.7804 1.1756 0.9943 1.1342 1.6242 1.3688 1.6311 1.6305 1.0419 1.0212 1.1103 1.6433 0.9627 1.0459 0.9884 *** 0.9522 *** *** 1.2028 1.1409 1.2287 0.9774 1.4735 1.0773 1.3615 1.2387 0.9057 1.0558 1.5796 0.9244 2.5813 1.5411 1.1740 1.4257 1.4440 1.1769 1.0382 1.3031 1.1235 PO 00000 Frm 00225 Fmt 4701 Sfmt 4702 E:\FR\FM\25APP2.SGM 25APP2 Average hourly wage** (3 years) 22.8540 20.1904 19.0936 17.8812 21.9118 31.3817 22.2842 24.0511 21.8256 21.2531 22.8868 26.9217 15.5838 26.0900 20.3073 26.4251 22.9951 32.0480 23.5448 24.3267 23.3064 20.8932 24.5529 25.9724 20.2859 23.6708 23.6580 25.6581 21.5883 19.9030 28.0745 24.3799 21.5168 25.4493 20.4175 21.1410 21.2880 25.4597 21.3735 18.7815 14.2632 16.5616 21.1869 15.4111 14.8204 14.7323 21.5257 25.2204 16.3591 28.6474 21.1023 29.0702 25.1945 20.9173 28.8474 26.8807 16.2370 29.8209 24.6392 25.4943 23.9318 22.5272 26.0371 18.7139 25.5145 24.9931 24220 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules TABLE 2.—HOSPITAL CASE-MIX INDEXES FOR DISCHARGES OCCURRING IN FEDERAL FISCAL YEAR 2005; HOSPITAL WAGE INDEXES FOR FEDERAL FISCAL YEAR 2007; HOSPITAL AVERAGE HOURLY WAGES FOR FEDERAL FISCAL YEARS 2005 (2001 WAGE DATA), 2006 (2002 WAGE DATA), AND 2007 (2003 WAGE DATA); WAGE INDEXES AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY WAGES—Continued Case-mix index 3 wwhite on PROD1PC61 with PROPOSALS2 Provider No. 450353 ..................................................... 450358 ..................................................... 450362 ..................................................... 450369 ..................................................... 450370 ..................................................... 450372 ..................................................... 450373 ..................................................... 450374 ..................................................... 450378 ..................................................... 450379 ..................................................... 450381 ..................................................... 450388 ..................................................... 450389 ..................................................... 450393 ..................................................... 450395 ..................................................... 450399 ..................................................... 450400 ..................................................... 450403 ..................................................... 450411 ..................................................... 450417 ..................................................... 450418 ..................................................... 450419 ..................................................... 450422 ..................................................... 450424 ..................................................... 450431 ..................................................... 450438 ..................................................... 450446 ..................................................... 450447 ..................................................... 450451 ..................................................... 450460 ..................................................... 450462 ..................................................... 450465 ..................................................... 450469 ..................................................... 450475 ..................................................... 450484 ..................................................... 450488 ..................................................... 450489 ..................................................... 450497 ..................................................... 450498 ..................................................... 450508 ..................................................... 450514 ..................................................... 450517 ..................................................... 450518 ..................................................... 450523 ..................................................... 450530 ..................................................... 450534 ..................................................... 450535 ..................................................... 450537 ..................................................... 450539 ..................................................... 450545 ..................................................... 450547 ..................................................... 450558 ..................................................... 450563 ..................................................... 450565 ..................................................... 450571 ..................................................... 450573 ..................................................... 450578 ..................................................... 450580 ..................................................... 450584 ..................................................... 450586 ..................................................... 450587 ..................................................... 450591 ..................................................... 450596 h ................................................... 450597 ..................................................... 450604 ..................................................... 450605 ..................................................... VerDate Aug<31>2005 17:10 Apr 24, 2006 Jkt 208001 FY 2007 wage index (10/1/2006– 3/31/2007) FY 2007 wage index (4/1/2007– 9/30/2007) Average hourly wage FY 2005 1 Average hourly wage FY 2006 1 Average hourly wage FY 2007 1 * 1.0030 * 0.8003 0.8261 1.0087 0.8003 * 1.0030 1.0087 * 0.8859 0.9870 * 1.0030 0.8003 0.8653 1.0087 0.8003 * 1.0030 0.9870 1.0087 1.0030 0.9360 1.0030 1.0030 0.9870 0.9591 0.8003 1.0087 0.8438 0.8677 0.8905 0.8905 0.8905 0.8003 0.8003 0.8003 0.8854 0.8612 * 0.8612 * 1.0030 * * 1.0087 0.8003 * 0.9870 0.8051 0.9870 0.8489 0.8385 0.8003 0.8003 0.8003 0.8003 0.8003 0.8003 1.0030 1.0399 0.8080 0.8003 0.8578 * 1.0030 * 0.8003 0.8261 1.0087 0.8003 * 1.0030 1.0087 * 0.8859 0.9870 * 1.0030 0.8003 0.8653 1.0087 0.8003 * 1.0030 0.9870 1.0087 1.0030 0.9360 1.0030 1.0030 0.9870 0.9591 0.8003 1.0087 0.8438 0.8677 0.8905 0.8905 0.8905 0.8003 0.8003 0.8003 0.8854 0.8612 * 0.8612 * 1.0030 * * 1.0087 0.8003 * 0.9870 0.8051 0.9870 0.8489 0.8385 0.8003 0.8003 0.8003 0.8003 0.8003 0.8003 1.0030 1.0399 0.8080 0.8003 0.8578 20.9271 29.3408 22.0223 17.5360 22.6815 26.8019 20.5789 17.4509 29.5108 31.1573 20.9200 24.1598 22.3803 24.6872 23.9689 19.5928 22.0103 27.8138 17.6570 17.8078 27.0283 28.4122 29.5592 23.1253 24.7346 22.0476 14.9983 22.5602 22.3834 19.5709 25.6952 23.0130 26.6781 20.7983 23.0604 22.3949 19.6884 17.6614 16.4358 23.5066 21.4034 15.2707 22.2587 28.6387 26.1998 20.4715 29.4427 23.9256 20.0343 22.8130 21.8106 25.0837 27.9427 22.1971 20.9651 21.6974 20.0454 20.4293 19.0373 14.6574 19.9712 22.4991 24.7477 22.9337 20.5273 23.8820 24.4454 30.4280 25.4372 18.4848 20.0832 28.3359 22.2213 23.2285 30.7684 30.6072 22.0482 25.8674 23.8764 18.4551 24.8656 18.2074 23.1739 29.3063 19.6086 20.0350 26.8434 31.0404 30.6659 28.3149 25.2477 21.9351 14.3132 23.5047 23.3042 20.5812 27.8923 22.4183 28.7890 23.5596 25.3527 23.9144 21.4771 18.8344 17.7822 23.9572 22.6552 * 24.1194 * 28.7451 * * 27.5856 21.0442 * 21.6542 26.1551 28.7289 23.8847 22.7703 20.1479 20.2695 21.1574 21.0808 16.1003 20.4512 23.9992 25.3317 23.1711 20.9514 22.2205 26.2804 31.6216 * 18.6148 23.1229 31.1141 24.4712 * 31.4184 33.2816 * 26.9369 25.8283 21.5604 25.9571 19.0372 23.2029 29.0923 19.9183 * 28.2373 32.0315 33.8259 28.0195 26.9028 24.2571 17.4158 25.6376 24.3091 20.8068 29.2836 25.7148 25.4635 22.5480 27.0061 21.6331 21.5002 20.3909 17.2624 27.4558 25.9817 * 27.9953 * 28.7154 * * 29.2821 22.4081 * 23.5794 27.2223 31.4753 25.0379 24.7674 21.0286 22.5427 21.0151 20.0078 16.9880 22.8245 24.9309 27.4357 24.0480 23.5413 21.2497 *** 1.9767 1.0967 1.0336 1.2149 1.3337 0.9464 0.9179 1.4503 1.3615 0.8992 1.6213 1.2133 0.6586 1.0000 0.9374 1.2473 1.3393 0.9521 0.8854 1.1696 1.2390 0.8834 1.3624 1.5063 1.1610 0.6285 1.2969 1.0902 0.9462 1.6945 1.1297 1.5249 1.0410 1.3812 1.0576 1.0092 1.0331 0.8847 1.4788 1.1107 0.9001 1.5203 *** 1.2387 *** *** 1.4256 1.1901 *** 0.9991 1.8627 1.4314 1.3311 1.5740 1.1346 0.9184 1.0999 1.0160 0.9542 1.2144 1.1954 1.2159 0.9663 1.3085 1.0415 PO 00000 Frm 00226 Fmt 4701 Sfmt 4702 E:\FR\FM\25APP2.SGM 25APP2 Average hourly wage** (3 years) 23.7695 30.5511 23.7705 18.2736 21.8052 28.7696 22.5214 19.8412 30.5485 31.6637 21.4845 25.8147 24.1448 21.5244 25.0000 18.9411 22.8044 28.7792 19.1051 18.9286 27.2737 30.5226 31.3662 26.6839 25.6684 22.6852 15.4882 23.9060 23.3428 20.3488 27.6909 23.7820 27.0045 22.3012 25.1666 22.6563 20.9158 18.9764 17.1563 25.0231 23.3480 15.2707 24.8239 28.6387 27.9282 20.4715 29.4427 26.9543 21.1538 22.8130 22.4240 26.1445 29.4391 23.7440 22.8421 20.9450 20.9417 20.8713 20.0299 15.9586 21.1183 23.8280 25.8078 23.3921 21.7183 22.3978 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules 24221 TABLE 2.—HOSPITAL CASE-MIX INDEXES FOR DISCHARGES OCCURRING IN FEDERAL FISCAL YEAR 2005; HOSPITAL WAGE INDEXES FOR FEDERAL FISCAL YEAR 2007; HOSPITAL AVERAGE HOURLY WAGES FOR FEDERAL FISCAL YEARS 2005 (2001 WAGE DATA), 2006 (2002 WAGE DATA), AND 2007 (2003 WAGE DATA); WAGE INDEXES AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY WAGES—Continued Case-mix index 3 wwhite on PROD1PC61 with PROPOSALS2 Provider No. 450609 450610 450615 450617 450620 450623 450626 450630 450631 450634 450638 450639 450641 450643 450644 450646 450647 450648 450649 450651 450653 450654 450656 450658 450659 450661 450662 450665 450668 450669 450670 450672 450673 450674 450675 450677 450678 450683 450684 450686 450688 450690 450694 450697 450698 450700 450702 450709 450711 450713 450715 450716 450718 450723 450730 450733 450742 450743 450746 450747 450749 450751 450754 450755 450758 450760 ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... VerDate Aug<31>2005 17:10 Apr 24, 2006 Jkt 208001 FY 2007 wage index (10/1/2006– 3/31/2007) FY 2007 wage index (4/1/2007– 9/30/2007) Average hourly wage FY 2005 1 Average hourly wage FY 2006 1 Average hourly wage FY 2007 1 * 1.0030 0.8003 1.0030 0.8003 * * 1.0030 * 1.0087 1.0030 0.9870 0.8003 0.8003 1.0030 0.9101 1.0087 * * 1.0087 0.9602 0.8003 0.8854 0.8003 1.0030 1.0119 0.9474 * 0.9101 1.0087 1.0030 0.9870 * 1.0030 0.9870 0.9870 1.0087 1.0087 1.0030 0.8626 1.0087 0.8854 1.0030 0.8859 0.8003 * 0.8905 1.0030 0.8790 0.9360 1.0087 1.0030 0.9360 1.0087 1.0087 * 1.0087 1.0087 0.8003 0.9870 0.8003 * 0.8003 0.8626 1.0087 0.9101 * 1.0030 0.8003 1.0030 0.8003 * * 1.0030 * 1.0087 1.0030 0.9870 0.8003 0.8003 1.0030 0.9101 1.0087 * * 1.0087 0.9602 0.8003 0.8854 0.8003 1.0030 1.0119 0.9474 * 0.9101 1.0087 1.0030 0.9870 * 1.0030 0.9870 0.9870 1.0087 1.0087 1.0030 0.8626 1.0087 0.8854 1.0030 0.8859 0.8003 * 0.8905 1.0030 0.8790 0.9360 1.0087 1.0030 0.9360 1.0087 1.0087 * 1.0087 1.0087 0.8003 0.9870 0.8003 * 0.8003 0.8626 1.0087 0.9101 18.3856 22.5451 18.2166 25.2211 18.1819 28.3354 21.4445 27.8856 24.5409 27.0412 29.5385 27.3593 17.0805 20.9674 27.2047 22.6541 28.8881 18.2826 18.1118 28.9829 21.8654 19.6054 22.7284 19.9597 28.8671 21.5537 24.5815 17.2566 26.4508 25.6411 22.0495 26.7785 19.4030 26.8081 26.1555 24.0218 30.1134 24.0080 26.2906 21.0565 23.7796 28.7529 22.3081 21.2662 18.5436 18.6373 24.8628 25.0932 24.8277 26.7190 16.1897 28.8043 27.6672 27.0055 30.7567 25.5624 26.3414 24.7397 16.9209 24.2674 18.4095 22.9070 21.3043 19.5168 24.0226 25.7453 * 26.8710 20.3028 26.5026 17.7138 28.3552 26.8375 29.6796 * 28.1705 29.6184 29.2669 17.5845 21.1205 29.0186 23.8908 30.7334 * * 32.4822 23.2603 19.9992 23.8280 20.5398 30.1727 23.2989 28.0913 18.6054 26.2375 27.4507 25.1575 27.6359 * * 28.7765 27.3728 30.1500 24.6609 27.6789 23.2367 27.9057 28.2531 23.5790 23.7155 18.6494 * 25.6147 25.4855 28.0104 27.2801 28.0365 30.8440 27.3408 28.0812 29.9430 26.4976 26.1190 27.3213 12.4748 22.2870 17.8227 19.3265 20.8968 18.0092 25.6548 24.6349 * 28.0329 20.8595 28.0634 18.2630 * * 29.5706 * 28.8277 31.5382 30.5176 18.0724 22.0843 30.0261 25.2251 31.6069 * * 31.4063 24.9719 20.3563 24.8352 22.5532 30.9251 30.1358 28.8369 * 28.4134 28.4801 25.6979 29.8113 * 29.9733 29.1940 26.2333 31.5997 27.8588 29.5071 24.1869 27.1644 26.2559 23.7874 25.2110 18.9770 * 27.5215 27.0908 26.9466 28.2291 16.2866 32.5978 28.2838 29.0905 31.7101 * 26.9752 28.8273 18.6717 24.3035 19.0712 18.5972 21.5435 18.3374 29.3846 24.2669 *** 1.6427 0.9957 1.5118 0.9569 1.1273 0.8874 1.5750 *** 1.6821 1.6272 1.4555 1.0274 1.3388 1.5418 1.3775 1.8824 *** *** 1.5268 1.1680 0.9380 1.4785 0.9159 1.4296 1.0957 1.5098 0.9162 1.5089 1.2095 1.3966 1.7679 *** 0.9764 1.4004 1.3370 1.4692 1.1779 1.2365 1.6848 1.1915 1.4400 1.0611 1.4245 0.8804 0.9190 1.5435 1.2686 1.5506 1.5698 1.2907 1.2709 1.2315 1.4898 1.1844 *** 1.2041 1.5163 0.9459 1.2804 1.0008 *** 0.9187 0.9654 1.9150 1.0178 PO 00000 Frm 00227 Fmt 4701 Sfmt 4702 E:\FR\FM\25APP2.SGM 25APP2 Average hourly wage** (3 years) 18.3856 25.7712 19.8661 26.6443 18.0543 28.3456 23.9299 29.0278 24.5409 28.0452 30.2289 29.1141 17.5796 21.4069 28.8421 23.9445 30.4271 18.2826 18.1118 30.9883 23.3175 20.0116 23.7707 21.0378 30.0073 25.0485 27.1837 17.9420 27.0380 27.2455 24.2873 28.0976 19.4030 28.3959 28.1661 25.8722 30.6214 25.4486 27.8823 22.8496 26.2965 27.8629 23.2343 23.5525 18.7269 18.6373 26.0104 25.8993 26.5934 27.4332 18.8856 30.7792 27.7793 28.0969 30.8172 26.0340 26.5000 27.0434 15.8396 23.6023 18.4140 20.2183 21.2570 18.5256 26.3194 24.8052 24222 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules TABLE 2.—HOSPITAL CASE-MIX INDEXES FOR DISCHARGES OCCURRING IN FEDERAL FISCAL YEAR 2005; HOSPITAL WAGE INDEXES FOR FEDERAL FISCAL YEAR 2007; HOSPITAL AVERAGE HOURLY WAGES FOR FEDERAL FISCAL YEARS 2005 (2001 WAGE DATA), 2006 (2002 WAGE DATA), AND 2007 (2003 WAGE DATA); WAGE INDEXES AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY WAGES—Continued Case-mix index 3 wwhite on PROD1PC61 with PROPOSALS2 Provider No. 450761 450763 450766 450770 450771 450774 450775 450779 450780 450788 450795 450796 450797 450801 450803 450804 450808 450809 450811 450813 450820 450822 450824 450825 450827 450828 450829 450830 450831 450832 450833 450834 450838 450839 450840 450841 450842 450844 450845 450846 450847 450848 450849 450850 450851 450852 450853 450854 450855 450856 450857 450860 450861 450862 450863 450864 450865 450866 450867 450868 450869 450870 450871 450872 450874 450875 ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... VerDate Aug<31>2005 17:10 Apr 24, 2006 Jkt 208001 FY 2007 wage index (10/1/2006– 3/31/2007) FY 2007 wage index (4/1/2007– 9/30/2007) Average hourly wage FY 2005 1 Average hourly wage FY 2006 1 Average hourly wage FY 2007 1 * * 1.0087 0.9360 1.0087 1.0030 1.0030 0.9870 0.8859 0.8578 1.0030 0.9177 * 0.8133 1.0030 1.0030 0.9360 0.9360 0.8790 0.8859 1.0030 1.0087 0.9360 0.8790 0.8360 0.8003 * 0.9737 1.0030 1.0030 1.0087 0.9064 0.8003 0.8715 1.0087 0.9474 * 1.0030 0.9101 * 1.0030 1.0030 * 0.9802 1.0087 * 1.0087 * 0.9474 0.8859 * 1.0030 * 1.0030 * 0.8854 0.9360 * 0.9360 1.0119 0.8790 * 0.9360 0.9870 1.0087 0.9177 * * 1.0087 0.9360 1.0087 1.0030 1.0030 0.9870 0.8859 0.8578 1.0030 0.9177 * 0.8133 1.0030 1.0030 0.9360 0.9360 0.8790 0.8859 1.0030 1.0087 0.9360 0.8790 0.8360 0.8003 * 0.9737 1.0030 1.0030 1.0087 0.9064 0.8003 0.8715 1.0087 0.9474 * 1.0030 0.9101 * 1.0030 1.0030 * 0.9802 1.0087 * 1.0087 * 0.9474 0.8859 * 1.0030 * 1.0030 * 0.8854 0.9360 * 0.9360 1.0119 0.8790 * 0.9360 0.9870 1.0087 0.9177 16.2605 21.4171 28.8576 20.1763 26.0618 24.8562 25.3924 22.5857 22.8688 24.2643 28.1448 24.7564 23.8708 22.2426 26.3054 26.0003 22.8247 24.7763 23.1022 22.1326 27.9187 29.7067 * 18.7069 21.1788 21.4128 18.2860 26.9917 20.0581 26.4725 26.1256 22.7691 15.0454 21.1905 29.5215 17.6635 23.0945 34.4235 26.5040 24.0791 26.8892 26.5609 * * * * * * * * * * * * * * * * * * * * * * * * 15.7483 22.4905 30.0441 20.3656 31.3924 24.9683 24.4006 26.9908 23.9516 25.4172 23.7510 27.9734 20.5379 23.0373 30.6093 26.0980 23.8067 26.3659 25.8491 25.5949 30.5288 31.1431 26.7803 20.2959 20.9704 22.3667 19.5014 28.1617 22.7885 26.6628 26.0044 21.2204 15.8026 22.9711 31.1914 18.9468 * 28.7296 27.7461 * 27.6854 27.8100 * 22.1334 30.1213 30.0191 * * * * * * * * * * * * * * * * * * * * * * 31.9184 23.9370 31.8002 28.2450 28.4183 29.7868 25.9821 26.4470 24.1271 33.1303 25.4943 24.0387 28.7427 27.6508 23.2037 26.8214 27.3501 19.7649 31.7443 32.3722 29.4735 20.8107 21.6247 23.8184 20.2816 27.4306 23.2295 27.5752 26.7732 21.6657 18.9487 24.5796 31.7263 21.5306 * 30.9678 29.4977 * 29.1327 29.8391 * 21.4794 32.3361 * 36.5119 26.3165 29.0580 35.3051 31.2379 23.8491 34.7198 31.8895 24.9637 23.3931 30.1339 15.5314 28.5160 28.5693 22.5945 37.1748 * * * * 0.8560 1.0996 1.9890 1.1856 1.7688 1.8338 1.2578 1.2479 1.8456 1.5907 1.4008 1.8052 *** 1.4998 1.1764 1.8999 1.5092 1.5817 1.7444 1.1556 1.2973 1.2957 2.5318 1.4848 1.3902 1.2653 *** 0.9567 1.5156 1.1631 1.1639 1.5529 1.1295 0.9411 1.0994 1.6187 *** 1.3022 1.9081 *** 1.2480 1.2400 2.1291 1.2694 2.5587 *** 1.9067 *** 1.5514 1.7966 *** 2.0577 *** 1.2197 *** 2.0286 1.1195 *** 1.3274 1.8150 1.9116 *** 1.8656 1.4150 1.4412 1.6727 PO 00000 Frm 00228 Fmt 4701 Sfmt 4702 E:\FR\FM\25APP2.SGM 25APP2 Average hourly wage** (3 years) 16.0004 21.9641 30.2287 21.5080 29.9828 26.1216 25.9897 26.4311 24.3116 25.3993 24.947 28.4434 23.0765 23.1400 28.4813 26.5919 23.2780 26.0351 25.5331 22.3615 30.4578 31.1755 28.1465 19.9847 21.2706 22.5374 19.3397 27.5236 22.2337 26.9176 26.3344 21.8609 16.8622 22.8436 30.9017 19.5628 23.0945 30.6606 28.0285 24.0791 27.9406 28.0986 * 21.7993 31.2575 30.0191 36.5119 26.3165 29.0580 35.3051 31.2379 23.8491 34.7198 31.8895 24.9637 23.3931 30.1339 15.5314 28.5160 28.5693 22.5945 37.1748 * * * * Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules 24223 TABLE 2.—HOSPITAL CASE-MIX INDEXES FOR DISCHARGES OCCURRING IN FEDERAL FISCAL YEAR 2005; HOSPITAL WAGE INDEXES FOR FEDERAL FISCAL YEAR 2007; HOSPITAL AVERAGE HOURLY WAGES FOR FEDERAL FISCAL YEARS 2005 (2001 WAGE DATA), 2006 (2002 WAGE DATA), AND 2007 (2003 WAGE DATA); WAGE INDEXES AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY WAGES—Continued Case-mix index 3 wwhite on PROD1PC61 with PROPOSALS2 Provider No. 450876 ..................................................... 450877 ..................................................... 450878 ..................................................... 450879 ..................................................... 450880 ..................................................... 450881 ..................................................... 450882 ..................................................... 450883 ..................................................... 450884 ..................................................... 450885 ..................................................... 450886 ..................................................... 450887 ..................................................... 450888 ..................................................... 450889 ..................................................... 450890 ..................................................... 450891 ..................................................... 450892 ..................................................... 450893 ..................................................... 450895 ..................................................... 460001 ..................................................... 460003 ..................................................... 460004 ..................................................... 460005 ..................................................... 460006 ..................................................... 460007 ..................................................... 460008 ..................................................... 460009 ..................................................... 460010 ..................................................... 460011 ..................................................... 460013 ..................................................... 460014 ..................................................... 460015 ..................................................... 460017 ..................................................... 460018 h ................................................... 460019 ..................................................... 460020 ..................................................... 460021 ..................................................... 460023 ..................................................... 460025 ..................................................... 460026 ..................................................... 460030 ..................................................... 460032 ..................................................... 460033 ..................................................... 460035 ..................................................... 460036 ..................................................... 460037 ..................................................... 460039 ..................................................... 460041 ..................................................... 460042 ..................................................... 460043 ..................................................... 460044 ..................................................... 460047 ..................................................... 460049 ..................................................... 460051 ..................................................... 460052 ..................................................... 460054 ..................................................... 470001 ..................................................... 470003 ..................................................... 470005 ..................................................... 470006 ..................................................... 470008 ..................................................... 470010 ..................................................... 470011 ..................................................... 470012 ..................................................... 470018 ..................................................... 470023 ..................................................... VerDate Aug<31>2005 17:10 Apr 24, 2006 Jkt 208001 FY 2007 wage index (10/1/2006– 3/31/2007) FY 2007 wage index (4/1/2007– 9/30/2007) Average hourly wage FY 2005 1 Average hourly wage FY 2006 1 Average hourly wage FY 2007 1 0.8626 0.9101 0.8859 0.8003 0.9870 0.8578 0.8854 1.0087 0.8905 1.0087 * * * * * * * * * 0.9537 0.9421 0.9421 0.9421 0.9421 0.9295 0.9421 0.9421 0.9421 0.9537 0.9537 0.9421 0.9049 0.8555 1.1611 0.8163 0.8163 1.1240 0.9537 * 0.8163 0.8163 * 0.8163 0.8163 * * 0.9021 0.9421 0.9421 0.9537 0.9421 0.9421 0.9421 0.9421 0.9537 0.9049 1.1381 1.1318 1.0986 * * * 1.0986 1.0986 * * 0.8626 0.9101 0.8859 0.8003 0.9870 0.8578 0.8854 1.0087 0.8905 1.0087 * * * * * * * * * 0.9537 0.9421 0.9421 0.9421 0.9421 0.9295 0.9421 0.9421 0.9421 0.9537 0.9537 0.9421 0.9049 0.8555 1.1611 0.8163 0.8163 1.1240 0.9537 * 0.8163 0.8163 * 0.8163 0.8163 * * 0.9021 0.9421 0.9421 0.9537 0.9421 0.9421 0.9421 0.9421 0.9537 0.9049 1.1381 1.0986 1.0986 * * * 1.0986 1.0986 * * * * * * * * * * * * * * * * * * * * * 25.6932 24.3527 25.2191 22.6809 24.4350 24.2875 24.4453 25.0984 26.2331 22.3601 23.4765 23.9400 24.0939 21.7082 18.8942 20.3625 19.4960 24.9725 25.0376 18.7978 22.7589 22.6129 22.8987 22.7816 16.9019 25.2647 19.8478 27.5912 24.0431 23.5819 26.6870 25.7342 25.1721 23.0683 23.4970 24.0797 23.5227 24.5499 24.6660 25.7288 26.0884 21.8951 22.9777 25.9246 22.9159 25.9300 26.7486 * * * * * * * * * * * * * * * * * * * 27.0757 26.1372 26.4498 23.5633 25.4787 25.6686 26.5672 26.2833 27.4648 23.4023 25.2448 24.1412 25.6576 23.0388 20.3755 19.9900 19.5669 26.3420 25.3094 * 24.1547 23.4679 * 22.0248 17.5723 27.2865 21.1035 28.5656 25.2744 22.9949 28.2089 26.6795 25.7920 24.5164 25.5881 25.3163 25.8668 27.7329 26.4919 29.8255 26.9651 * 26.1273 28.3911 24.3425 28.3419 * * * * * * * * * * * * * * * * * * * * 28.7686 31.2768 27.8490 24.6804 26.8666 26.9107 29.9748 26.7990 28.9206 25.0983 27.5186 27.2777 27.1745 24.4174 20.3940 23.5051 19.3185 27.5173 26.8796 * 26.3509 23.7148 * 23.5580 19.3857 * * 29.9657 26.7893 24.7532 29.4175 27.5967 28.0524 26.6558 27.8380 26.8923 25.1386 29.1057 28.1869 32.5203 * * * 29.2637 25.6468 * * 2.2693 1.4111 2.7773 1.2140 1.6144 1.1914 1.7221 1.7263 1.0379 1.4615 1.5918 1.4961 1.3795 1.0565 2.0428 1.3902 1.5347 1.4462 1.4125 1.8808 1.5603 1.7146 1.3478 1.3807 1.3872 1.3859 1.8418 2.0585 1.2849 1.4239 1.0606 1.3717 1.3339 0.9103 1.3095 1.0267 1.7313 1.2110 *** 1.0018 1.2733 *** 0.8966 0.9428 1.2276 0.9296 1.0985 1.3476 1.3789 1.2960 1.3067 1.6867 1.9512 1.1320 1.4773 1.7394 1.2603 1.9722 1.3563 1.1527 1.2850 1.2545 1.1897 1.2567 1.1212 *** PO 00000 Frm 00229 Fmt 4701 Sfmt 4702 E:\FR\FM\25APP2.SGM 25APP2 Average hourly wage** (3 years) * * * * * * * * * * * * * * * * * * * 27.1707 27.1512 26.5381 23.6496 25.6213 25.6767 26.8870 26.0960 27.5686 23.5591 25.4104 25.1819 25.6692 22.9891 19.9191 21.2559 19.4673 26.3816 25.7898 18.7978 24.3848 23.2667 22.8987 22.7910 18.0032 26.2960 20.4672 28.7173 25.3668 23.7828 28.1330 26.7083 26.3519 24.8008 25.7324 25.5154 24.8669 27.1069 26.4264 29.3642 26.5397 21.8951 24.5339 27.8893 24.3436 27.1737 26.7486 24224 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules TABLE 2.—HOSPITAL CASE-MIX INDEXES FOR DISCHARGES OCCURRING IN FEDERAL FISCAL YEAR 2005; HOSPITAL WAGE INDEXES FOR FEDERAL FISCAL YEAR 2007; HOSPITAL AVERAGE HOURLY WAGES FOR FEDERAL FISCAL YEARS 2005 (2001 WAGE DATA), 2006 (2002 WAGE DATA), AND 2007 (2003 WAGE DATA); WAGE INDEXES AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY WAGES—Continued Case-mix index 3 wwhite on PROD1PC61 with PROPOSALS2 Provider No. 470024 ..................................................... 470302 ..................................................... 490001 ..................................................... 490002 ..................................................... 490003 ..................................................... 490004 ..................................................... 490005 ..................................................... 490006 ..................................................... 490007 ..................................................... 490009 ..................................................... 490011 ..................................................... 490012 ..................................................... 490013 ..................................................... 490015 ..................................................... 490017 ..................................................... 490018 ..................................................... 490019 h ................................................... 490020 ..................................................... 490021 ..................................................... 490022 ..................................................... 490023 ..................................................... 490024 ..................................................... 490027 ..................................................... 490031 ..................................................... 490032 ..................................................... 490033 ..................................................... 490037 ..................................................... 490038 ..................................................... 490040 ..................................................... 490041 ..................................................... 490042 ..................................................... 490043 ..................................................... 490044 ..................................................... 490045 ..................................................... 490046 ..................................................... 490047 ..................................................... 490048 ..................................................... 490050 ..................................................... 490052 ..................................................... 490053 ..................................................... 490057 ..................................................... 490059 ..................................................... 490060 ..................................................... 490063 ..................................................... 490066 ..................................................... 490067 ..................................................... 490069 ..................................................... 490071 ..................................................... 490073 ..................................................... 490075 ..................................................... 490077 ..................................................... 490079 ..................................................... 490084 ..................................................... 490088 ..................................................... 490089 ..................................................... 490090 ..................................................... 490092 ..................................................... 490093 ..................................................... 490094 ..................................................... 490097 ..................................................... 490098 ..................................................... 490101 ..................................................... 490104 ..................................................... 490105 ..................................................... 490106 ..................................................... 490107 ..................................................... VerDate Aug<31>2005 17:10 Apr 24, 2006 Jkt 208001 FY 2007 wage index (10/1/2006– 3/31/2007) FY 2007 wage index (4/1/2007– 9/30/2007) Average hourly wage FY 2005 1 Average hourly wage FY 2006 1 Average hourly wage FY 2007 1 1.0986 * 0.8716 0.7966 * 0.9732 1.1076 * 0.8840 1.0140 0.8840 0.7966 0.8716 * 0.8840 0.9732 1.2316 0.9174 0.8716 1.1076 1.1076 0.8483 0.7966 * 0.9174 1.1076 0.7966 0.7988 1.1076 0.8840 0.8677 1.1076 0.8840 1.1076 0.8840 * 0.8716 1.1076 0.8840 0.8062 0.8840 0.9174 0.7966 1.1076 0.8840 0.9174 0.9174 0.9174 1.1076 0.8483 1.0140 0.8992 0.8133 0.8716 0.8677 0.7966 0.9174 0.8840 0.9174 0.7966 0.7966 1.1076 0.9174 0.8062 0.9732 1.1076 1.0986 * 0.7966 0.7966 * 0.9732 1.1076 * 0.8840 1.0140 0.8840 0.7966 0.8716 * 0.8840 0.9732 1.2316 0.9174 0.8716 1.1076 1.1076 0.8677 0.7966 * 0.9174 1.1076 0.7966 0.7988 1.1076 0.8840 0.8677 1.1076 0.8840 1.1076 0.8840 * 0.8716 1.1076 0.8840 0.8062 0.8840 0.9174 0.7966 1.1076 0.8840 0.9174 0.9174 0.9174 1.1076 0.8483 1.0140 0.8992 0.8133 0.8716 0.8677 0.7966 0.9174 0.8840 0.9174 0.7966 0.7966 1.1076 0.9174 0.8062 0.9732 1.1076 23.7745 * 21.7111 18.5220 23.8112 24.4580 27.6425 16.7679 24.9533 27.5905 22.4410 18.3697 21.4838 22.5641 22.9632 23.2215 24.4524 23.6611 23.5930 25.0277 28.8354 21.7268 19.8345 22.4300 22.8942 27.6355 19.0583 19.6427 30.1820 22.2955 20.5845 28.2969 22.1324 27.2132 24.6391 21.9156 24.1639 29.4660 21.4035 20.9367 25.1898 26.1518 21.0828 29.4216 23.3835 21.8730 24.4542 27.0374 25.2859 22.8303 24.8309 19.8100 22.7945 21.4818 21.2123 21.3410 21.6466 23.6779 26.0755 23.5366 20.9805 30.1800 33.1215 38.2813 30.1492 28.7296 25.2427 * 21.9953 19.5613 27.3456 25.4597 28.5744 * 26.2481 29.0740 24.5687 19.2275 22.4772 * 24.6845 24.5196 25.9761 24.8001 24.6440 28.0749 29.7774 23.0982 18.9409 22.0579 25.1381 30.0909 21.3035 22.3976 32.8738 24.5738 21.8749 30.8871 20.8351 28.8279 25.6328 22.5424 25.0097 30.5037 22.8889 21.8432 26.1128 28.7276 22.4200 30.3632 24.7146 22.9188 26.8791 28.4381 31.7743 23.8191 26.0800 23.4728 24.5965 22.4186 22.6461 22.2907 23.8656 25.0751 26.5726 23.8005 21.7231 30.4285 17.3295 24.7923 23.0199 29.7000 27.3942 * 22.9269 20.6251 * 26.9175 29.8963 * 27.6665 30.6705 26.3250 20.4238 23.9524 * 25.5899 25.5210 26.7428 26.6396 26.1509 32.2985 31.1609 25.7005 23.7402 * 25.6281 31.5482 23.3679 22.3842 33.5638 26.1445 24.4229 31.2740 23.3012 32.4604 26.6811 * 25.8371 31.8461 23.7544 22.7902 26.9303 28.7481 23.6087 32.4155 28.4793 24.5806 27.7682 29.7235 34.4692 25.1134 27.1434 23.3244 25.5067 24.1339 24.5879 24.3011 23.2472 26.1524 28.7249 25.7117 23.3102 31.9879 * 25.7327 23.7549 31.8461 1.2067 0.9778 1.0802 1.0693 *** 1.3075 1.6397 *** 2.2239 2.0155 1.4501 1.0263 1.3599 *** 1.4225 1.2773 1.1723 1.2380 1.4653 1.4931 1.2456 1.7466 1.1045 *** 1.9877 1.0717 1.1924 1.2207 1.5159 1.3928 1.3030 1.1470 1.4671 1.2905 1.5680 1.0319 1.4274 1.4890 1.6157 1.2486 1.6003 1.6024 1.0394 1.8203 1.3509 1.1965 1.5765 1.3096 1.7271 1.4710 1.4157 1.2785 1.1836 1.0918 1.0530 1.1113 1.0744 1.4535 0.9768 1.0622 1.1704 1.3361 0.8061 0.9463 0.9937 1.3553 PO 00000 Frm 00230 Fmt 4701 Sfmt 4702 E:\FR\FM\25APP2.SGM 25APP2 Average hourly wage** (3 years) 25.5325 * 22.2279 19.6010 25.4279 25.6513 28.7056 16.7679 26.3324 29.0947 24.4894 19.3376 22.6144 22.5641 24.4194 24.4582 25.7803 25.0712 24.8426 28.4160 29.9671 23.5054 20.7964 22.2427 24.5660 29.8331 21.2221 21.4601 32.1968 24.3175 22.3975 30.3070 22.0713 29.4320 25.6856 22.2282 25.0464 30.6123 22.6886 21.8500 26.0974 27.9332 22.3825 30.7714 25.5572 23.1010 26.4176 28.4129 29.6891 23.9198 26.0560 22.0780 24.2420 22.6632 22.9250 22.5541 22.8995 25.0724 27.1409 24.3445 22.0052 30.8879 22.8307 29.8754 26.2572 30.1409 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules 24225 TABLE 2.—HOSPITAL CASE-MIX INDEXES FOR DISCHARGES OCCURRING IN FEDERAL FISCAL YEAR 2005; HOSPITAL WAGE INDEXES FOR FEDERAL FISCAL YEAR 2007; HOSPITAL AVERAGE HOURLY WAGES FOR FEDERAL FISCAL YEARS 2005 (2001 WAGE DATA), 2006 (2002 WAGE DATA), AND 2007 (2003 WAGE DATA); WAGE INDEXES AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY WAGES—Continued Case-mix index 3 wwhite on PROD1PC61 with PROPOSALS2 Provider No. 490108 490109 490110 490111 490112 490113 490114 490115 490116 490117 490118 490119 490120 490122 490123 490124 490126 490127 490130 490133 490134 490135 490136 500001 500002 500003 500005 500007 500008 500011 500012 500014 500015 500016 500019 500021 500023 500024 500025 500026 500027 500030 500031 500033 500036 500037 500039 500041 500044 500049 500050 500051 500052 500053 500054 500057 500058 500060 500064 500065 500072 500077 500079 500084 500088 500092 ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... VerDate Aug<31>2005 17:10 Apr 24, 2006 Jkt 208001 FY 2007 wage index (10/1/2006– 3/31/2007) FY 2007 wage index (4/1/2007– 9/30/2007) Average hourly wage FY 2005 1 Average hourly wage FY 2006 1 Average hourly wage FY 2007 1 0.8716 0.9174 0.8324 0.7966 0.9174 1.1076 0.7966 0.7966 0.8242 0.7966 0.9174 0.8840 0.8840 1.1076 0.7966 * 0.7966 0.7966 0.8840 * 0.7966 0.8677 * 1.1438 1.0440 1.1255 1.1438 1.0722 1.1438 1.1438 1.0440 1.1438 1.1438 1.1255 1.0653 1.1255 * 1.0907 1.1438 1.1438 1.1438 1.1088 1.0440 1.0440 1.0440 1.0440 1.1255 1.1405 1.0448 1.0440 1.1405 1.1438 1.1438 1.0440 1.0448 * 1.0440 1.0440 1.1438 * 1.1255 1.0448 1.1255 1.1438 1.1438 * 0.8716 0.9174 0.8324 0.7966 0.9174 1.1076 0.7966 0.7966 0.8242 0.7966 0.9174 0.8840 0.8840 1.1076 0.7966 * 0.7966 0.7966 0.8840 * 0.7966 0.8677 * 1.1438 1.0440 1.1255 1.1438 1.0722 1.1438 1.1438 1.0440 1.1438 1.1438 1.1255 1.0653 1.1255 * 1.0907 1.1438 1.1438 1.1438 1.1088 1.0440 1.0440 1.0440 1.0440 1.1255 1.1405 1.0448 1.0440 1.1405 1.1438 1.1438 1.0440 1.0448 * 1.0440 1.0440 1.1438 * 1.1255 1.0448 1.1255 1.1438 1.1438 * 27.9090 28.0548 21.3126 20.6373 25.8312 29.1786 20.0555 20.3615 21.3083 17.4111 26.8810 23.7813 23.1535 28.7020 22.9511 29.7939 23.1423 19.4005 22.0769 * * * * 26.7502 25.0665 28.4174 31.4415 26.1318 31.0128 28.3391 29.2045 30.1061 30.1596 29.3634 26.9702 28.5926 27.3823 29.3946 31.7335 31.4152 29.5939 30.5926 28.5398 26.6704 26.0223 24.6548 27.9651 26.9101 26.9323 25.6104 26.8971 29.0100 * 26.8074 28.8062 21.4393 28.4247 33.5169 31.1459 26.0960 29.3087 27.8819 28.4934 27.6306 31.2757 23.2466 22.4345 21.9878 22.5974 22.0199 26.6453 29.5698 20.9116 21.4666 22.9017 18.0277 27.4050 25.2549 24.4434 31.0449 23.9233 * 22.2859 20.4289 22.8512 26.5683 * * * 29.3707 25.3347 29.6341 32.0972 28.0476 31.8837 30.6508 30.6856 33.7536 32.0592 31.4221 28.6669 30.1690 * 30.7917 34.7252 33.2937 34.2175 32.7446 31.2186 29.4627 27.0072 26.9969 29.8809 26.7829 30.3164 27.1819 29.9791 31.9406 * 28.4130 30.8067 * 30.4699 34.1523 31.5371 * 33.4863 29.4199 29.6623 29.3484 33.4302 * 22.7419 22.9347 24.4586 22.2094 27.5555 32.8354 21.8633 22.0483 24.2616 19.2372 28.6297 27.1954 26.2560 32.5825 25.0086 * 22.9757 21.4512 24.2270 * * * * 31.2869 27.7842 31.5127 33.3329 30.0980 33.3228 32.0074 30.4076 36.3225 34.5308 31.8609 30.4632 30.0500 * 32.9554 38.5672 34.0225 35.7683 32.8247 33.2070 30.0929 28.5158 28.6509 32.3485 29.6411 28.5880 28.3014 32.5722 33.4078 * 29.2529 32.1392 * 31.3325 37.1307 32.0554 * 31.8127 30.9414 31.8986 31.1336 34.7384 * 0.9836 0.9090 1.2759 1.2769 1.6505 1.2628 1.0602 1.1886 1.1906 1.1508 1.6833 1.2525 1.3625 1.4721 1.0815 *** 1.2231 1.1735 1.2008 *** 0.8128 0.6911 1.0827 1.6186 1.4423 1.3380 1.7822 1.3787 1.9554 1.3253 1.6684 1.6420 1.4667 1.7023 1.2686 1.3488 1.2010 1.7921 1.7858 1.4412 1.5753 1.7399 1.2764 1.3088 1.3769 1.0398 1.4810 1.3811 1.9738 1.3205 1.4378 1.7550 1.4362 1.2978 1.9895 *** 1.6738 1.3057 1.7930 *** 1.2016 1.4749 1.3526 1.3269 1.4147 *** PO 00000 Frm 00231 Fmt 4701 Sfmt 4702 E:\FR\FM\25APP2.SGM 25APP2 Average hourly wage** (3 years) 24.3793 24.2712 22.8433 21.6419 26.7023 30.5878 20.9404 21.3080 22.8382 18.2401 27.7063 25.4840 24.6055 30.7435 23.9568 29.7939 22.7925 20.3942 23.0561 26.5683 * * * 29.1920 26.0658 29.8891 32.2891 28.1844 32.1022 30.3834 30.0653 33.4938 32.3201 30.9249 28.6734 29.6659 27.3823 31.0696 34.8346 32.9380 33.2591 32.0831 31.0095 28.7252 27.2093 26.6844 30.1316 27.7279 28.6194 27.1121 29.8732 31.5494 * 28.1462 30.6203 21.4393 30.1884 34.9415 31.6041 26.0960 31.5390 29.4486 30.0378 29.4235 33.2062 23.2466 24226 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules TABLE 2.—HOSPITAL CASE-MIX INDEXES FOR DISCHARGES OCCURRING IN FEDERAL FISCAL YEAR 2005; HOSPITAL WAGE INDEXES FOR FEDERAL FISCAL YEAR 2007; HOSPITAL AVERAGE HOURLY WAGES FOR FEDERAL FISCAL YEARS 2005 (2001 WAGE DATA), 2006 (2002 WAGE DATA), AND 2007 (2003 WAGE DATA); WAGE INDEXES AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY WAGES—Continued Case-mix index 3 wwhite on PROD1PC61 with PROPOSALS2 Provider No. 500104 500108 500110 500118 500119 500122 500124 500129 500134 500139 500141 500143 500147 500148 500150 500329 500334 500337 510001 510002 510006 510007 510008 510012 510013 510018 510022 510023 510024 510026 510028 510029 510030 510031 510033 510038 510039 510043 510046 510047 510048 510050 510053 510055 510058 510059 510061 510062 510067 510068 510070 510071 510072 510077 510082 510085 510086 510088 510089 510090 520002 520003 520004 520008 520009 520010 ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... VerDate Aug<31>2005 17:10 Apr 24, 2006 Jkt 208001 FY 2007 wage index (10/1/2006– 3/31/2007) FY 2007 wage index (4/1/2007– 9/30/2007) Average hourly wage FY 2005 1 Average hourly wage FY 2006 1 Average hourly wage FY 2007 1 * 1.1255 * * 1.0448 * 1.1438 1.1255 1.1438 1.0907 1.1438 1.1119 * 1.0440 * * * * 0.8671 0.8677 0.8671 0.9009 0.9082 0.7637 0.7637 0.8294 0.8559 0.8072 0.8671 0.7637 * 0.8559 0.8449 0.8559 0.7964 0.7637 0.7749 * 0.8294 0.8671 0.7637 0.7749 0.7637 0.9009 0.7964 0.8559 * 0.8294 0.7637 * 0.8294 0.8294 0.7637 0.8759 0.7637 0.8559 0.7637 * * * 0.9625 * 0.9466 1.0241 0.9466 * * 1.1255 * * 1.0448 * 1.1438 1.1255 1.1438 1.0907 1.1438 1.1119 * 1.0440 * * * * 0.8671 0.8677 0.8671 0.9009 0.9082 0.7637 0.7637 0.8294 0.8559 0.8072 0.8671 0.7637 * 0.8559 0.8449 0.8559 0.7964 0.7637 0.7749 * 0.8294 0.8671 0.7637 0.7749 0.7637 0.9009 0.7964 0.8559 * 0.8294 0.7637 * 0.8294 0.8294 0.7637 0.8759 0.7637 0.8559 0.7637 * * * 0.9625 * 0.9466 1.0241 0.9466 * 27.0034 28.7206 25.4785 28.1074 27.2335 27.4405 28.6598 30.0223 24.2990 29.2357 30.7478 20.7093 16.3669 18.2168 * * * * 22.9351 22.4751 22.2947 24.3499 24.5293 18.5816 19.9710 21.8475 24.1481 19.4321 23.3115 18.0855 23.0518 21.7527 22.3658 21.6294 21.0707 16.8744 19.1280 16.0586 21.2792 23.2093 17.6785 20.1943 20.7538 29.3962 21.9352 18.8712 15.3355 21.1568 22.1582 20.0007 21.1895 21.5439 19.7990 22.8104 16.4742 22.6563 17.8234 18.3401 * * 23.7316 21.8662 24.4711 27.8127 23.4265 28.5569 * 29.4244 * * 30.9999 30.1396 31.5438 30.7536 26.8608 31.6591 30.5456 22.1419 24.5807 22.2161 * * * * 23.4477 25.9597 23.5727 25.2835 24.6959 18.2845 20.8782 20.5556 24.2125 20.4908 24.0444 16.6192 21.7134 22.4556 21.5583 21.7637 23.0305 17.2832 19.5468 * 21.2540 24.0954 17.5096 19.9766 20.8609 30.7868 22.6976 21.9550 * 23.3216 21.2099 23.1011 23.2382 23.1685 20.1997 23.6585 19.1878 23.7173 17.5933 * 27.7062 * 24.9950 * 25.4639 29.8354 26.1503 * * 31.8504 * * 29.2153 * 32.2351 32.5779 25.0035 34.6120 32.1853 22.6867 * 27.0350 * * * * 24.9395 24.0032 24.5450 25.2802 25.5366 18.8211 22.7404 22.8201 26.2125 20.7734 25.2181 17.3777 * 23.3861 23.3535 23.0714 22.5839 19.0992 19.9164 * 21.5642 26.2033 19.0606 20.8188 22.6334 29.1387 23.0760 21.8993 * 24.8582 24.1938 * 23.1691 23.8043 20.8822 24.6316 19.8764 25.8288 19.0144 * * * 26.5869 * 27.0690 31.0949 27.7845 * 1.1367 1.6392 *** 1.0815 1.3571 1.2515 1.3893 1.5958 0.5017 1.5171 1.3234 0.4565 0.9626 1.1035 1.1543 0.7676 0.6580 0.8865 1.8662 1.2073 1.3300 1.6577 1.2502 0.9616 1.1563 1.0576 1.8746 1.3100 1.8007 0.9938 0.9801 1.2865 1.1233 1.4609 1.5615 1.0077 1.2424 *** 1.3517 1.1634 1.1421 1.5568 1.1301 1.5283 1.3632 1.2304 *** 1.1472 1.1583 1.1019 1.2161 1.2876 1.0728 1.1020 1.0846 1.3124 1.1062 *** *** 2.2681 1.3605 *** 1.4679 1.5872 1.7236 1.1151 PO 00000 Frm 00232 Fmt 4701 Sfmt 4702 E:\FR\FM\25APP2.SGM 25APP2 Average hourly wage** (3 years) 27.0034 30.0479 25.4785 28.1074 29.1384 28.8217 30.8456 31.1547 25.4134 31.8023 31.2034 21.8786 16.9814 21.6967 * * * * 23.8162 24.1436 23.4754 24.9834 24.9190 18.5638 21.1637 21.7432 24.8409 20.2347 24.1883 17.2853 22.3847 22.5557 22.4378 22.1614 22.2245 17.7660 19.5208 16.0586 21.3655 24.4801 18.0744 20.3257 21.4364 29.7610 22.5822 20.7922 15.3355 23.0758 22.5714 21.5379 22.5946 22.8368 20.3279 23.7056 18.3863 24.1309 18.1416 18.3401 27.7062 * 25.1359 21.8662 25.6990 29.6152 25.7871 28.5569 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules 24227 TABLE 2.—HOSPITAL CASE-MIX INDEXES FOR DISCHARGES OCCURRING IN FEDERAL FISCAL YEAR 2005; HOSPITAL WAGE INDEXES FOR FEDERAL FISCAL YEAR 2007; HOSPITAL AVERAGE HOURLY WAGES FOR FEDERAL FISCAL YEARS 2005 (2001 WAGE DATA), 2006 (2002 WAGE DATA), AND 2007 (2003 WAGE DATA); WAGE INDEXES AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY WAGES—Continued Case-mix index 3 wwhite on PROD1PC61 with PROPOSALS2 Provider No. 520011 520013 520014 520015 520017 520019 520021 520024 520026 520027 520028 520030 520032 520033 520034 520035 520037 520038 520040 520041 520042 520044 520045 520047 520048 520049 520051 520057 520059 520060 520062 520063 520064 520066 520068 520070 520071 520075 520076 520078 520083 520084 520087 520088 520089 520091 520092 520094 520095 520096 520097 520098 520100 520102 520103 520107 520109 520111 520112 520113 520114 520116 520117 520123 520132 520135 ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... ..................................................... VerDate Aug<31>2005 17:10 Apr 24, 2006 Jkt 208001 FY 2007 wage index (10/1/2006– 3/31/2007) FY 2007 wage index (4/1/2007– 9/30/2007) Average hourly wage FY 2005 1 Average hourly wage FY 2006 1 Average hourly wage FY 2007 1 0.9466 0.9644 * * 0.9644 0.9466 1.0596 * * 1.0241 1.0502 0.9799 * 0.9466 0.9466 0.9543 0.9625 1.0241 1.0241 1.0731 * 0.9543 0.9466 * 0.9466 0.9791 1.0241 0.9584 1.0408 0.9489 1.0241 1.0241 1.0241 1.0502 * 0.9644 1.0098 0.9791 1.0502 1.0241 1.0731 * 0.9466 1.0098 1.0731 0.9466 * * 1.0502 1.0098 0.9791 1.0731 0.9685 1.0098 1.0241 0.9620 0.9466 * * 0.9620 * 1.0098 * * 0.9543 * 0.9466 0.9644 * * 0.9644 0.9466 1.0596 * * 1.0241 1.0502 0.9799 * 0.9466 0.9466 0.9543 0.9625 1.0241 1.0241 1.0731 * 0.9543 0.9466 * 0.9466 0.9791 1.0241 0.9584 1.0408 0.9489 1.0241 1.0241 1.0241 1.0502 * 0.9644 1.0098 0.9791 1.0502 1.0241 1.0731 * 0.9466 1.0098 1.0731 0.9466 * * 1.0502 1.0098 0.9791 1.0731 0.9685 1.0098 1.0241 0.9620 0.9466 * * 0.9620 * 1.0098 * * 0.9543 * 23.7785 24.4766 22.1064 23.0403 23.4044 24.9871 25.4872 18.5072 26.1056 26.2516 25.7778 25.3807 25.3059 23.9791 23.6563 23.2625 28.6984 24.6650 23.8501 22.8236 24.0788 24.9387 24.5844 25.5346 23.1653 24.1083 28.8249 23.3205 26.5596 22.0132 24.9988 25.3674 27.1120 25.8812 23.4746 23.9908 26.3154 26.0600 24.0879 25.7662 27.0012 25.5777 24.5280 26.0882 26.6013 24.8269 23.4043 25.3166 28.6376 22.9929 25.1135 28.0730 24.5914 25.6146 25.5361 27.7413 22.4048 26.3095 20.4034 26.7926 22.0536 26.3057 22.0023 22.2430 21.6025 18.5618 25.2747 26.6225 * * 24.6676 26.7433 26.6935 * * 27.6771 25.4164 27.0185 * 25.0854 23.9850 24.7767 29.7234 26.6470 27.2325 22.7596 * 26.0191 26.0030 * 25.1724 25.9256 28.4880 25.3745 28.0906 23.8817 28.2215 27.4101 28.6101 27.1657 24.8184 24.8935 27.6202 27.1699 26.1698 27.5989 28.8407 * 27.3374 26.9936 30.0448 24.6320 * 25.7567 26.7863 24.5758 26.3321 30.6150 26.2161 26.8234 27.9147 28.3431 23.3271 * * 27.4135 * 26.9902 * * 23.1941 * 27.1311 29.2111 * * 28.0839 29.3066 28.1218 * * 30.8126 26.5754 29.0074 * 27.3306 25.9625 26.8252 28.7221 29.7288 28.7706 23.3086 * 27.4740 27.9444 * 27.0266 27.4599 31.5274 27.6395 29.8632 24.7482 29.4194 28.9251 30.2879 28.3573 * 27.5457 29.3878 29.8136 28.1355 29.6321 31.3634 * 28.2823 29.8417 33.3398 25.9623 * * 28.5877 26.8566 29.8400 31.9008 29.0461 28.8280 29.8746 29.2809 24.2510 * * 30.6517 * 28.3092 * * 24.6842 * 1.3314 1.4452 *** *** 1.1783 1.3160 1.3354 1.0407 *** 1.2653 1.2954 1.7625 1.1081 1.2354 1.2062 1.3268 1.8330 1.2465 1.4799 1.0916 1.0028 1.3404 1.5980 *** 1.6307 2.1099 1.6916 1.2115 1.2603 1.2808 1.2708 1.1386 1.5155 1.4918 0.9097 1.7287 1.2004 1.4697 1.2383 1.5311 1.7261 *** 1.7272 1.2906 1.5216 1.2880 *** *** 1.2375 1.3505 1.3955 1.9798 1.2806 1.1190 1.5698 1.2555 1.0588 *** *** 1.2862 *** 1.2845 *** *** 0.9607 *** PO 00000 Frm 00233 Fmt 4701 Sfmt 4702 E:\FR\FM\25APP2.SGM 25APP2 Average hourly wage** (3 years) 25.4700 26.8019 22.1064 23.0403 25.3651 27.0110 26.8573 18.5072 26.1056 28.3796 25.9267 27.1779 25.3059 25.5391 24.5645 24.9975 29.0476 27.0582 26.5424 22.9766 24.0788 26.1760 26.1871 25.5346 25.0694 25.7460 29.7523 25.5004 28.1945 23.5443 27.5670 27.2413 28.6292 27.1367 24.1554 25.5329 27.7380 27.6374 26.1183 27.7034 29.1629 25.5777 26.6696 27.7181 30.0450 25.1681 23.4043 25.5399 27.9986 25.0076 27.1169 30.2555 26.6330 27.1398 27.9295 28.4726 23.3292 26.3095 20.4034 28.3197 22.0536 27.2488 22.0023 22.2430 23.1837 18.5618 24228 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules TABLE 2.—HOSPITAL CASE-MIX INDEXES FOR DISCHARGES OCCURRING IN FEDERAL FISCAL YEAR 2005; HOSPITAL WAGE INDEXES FOR FEDERAL FISCAL YEAR 2007; HOSPITAL AVERAGE HOURLY WAGES FOR FEDERAL FISCAL YEARS 2005 (2001 WAGE DATA), 2006 (2002 WAGE DATA), AND 2007 (2003 WAGE DATA); WAGE INDEXES AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY WAGES—Continued Case-mix index 3 Provider No. 520136 ..................................................... 520138 ..................................................... 520139 ..................................................... 520140 ..................................................... 520148 ..................................................... 520151 ..................................................... 520152 ..................................................... 520154 ..................................................... 520156 ..................................................... 520160 ..................................................... 520161 ..................................................... 520170 ..................................................... 520173 ..................................................... 520177 ..................................................... 520178 ..................................................... 520189 ..................................................... 520193 ..................................................... 520194 ..................................................... 520195 ..................................................... 520196 ..................................................... 520197 ..................................................... 520198 ..................................................... 520199 ..................................................... 520200 ..................................................... 520343 ..................................................... 520344 ..................................................... 520353 ..................................................... 530002 ..................................................... 530006 ..................................................... 530007 ..................................................... 530008 2 ................................................... 530009 ..................................................... 530010 2 ................................................... 530011 ..................................................... 530012 ..................................................... 530014 ..................................................... 530015 ..................................................... 530016 ..................................................... 530017 ..................................................... 530023 ..................................................... 530025 ..................................................... 530031 ..................................................... 530032 ..................................................... FY 2007 wage index (10/1/2006– 3/31/2007) FY 2007 wage index (4/1/2007– 9/30/2007) Average hourly wage FY 2005 1 Average hourly wage FY 2006 1 Average hourly wage FY 2007 1 1.0241 1.0241 1.0241 1.0241 * * 0.9466 * * 0.9466 * 1.0241 1.0157 1.0241 * 1.0596 0.9791 1.0241 * 0.9644 1.0241 0.9466 1.0241 * * * * 0.9303 0.9303 * 0.9303 0.9303 0.9303 0.9303 0.9303 0.9303 0.9303 * 0.9303 * 0.9594 * 0.9303 1.0241 1.0241 1.0241 1.0241 * * 0.9466 * * 0.9466 * 1.0241 1.0157 1.0241 * 1.0596 0.9791 1.0241 * 0.9644 1.0241 0.9466 1.0241 * * * * 0.9303 0.9303 * 0.9303 0.9303 0.9303 0.9303 0.9303 0.9303 0.9303 * 0.9303 * 0.9594 * 0.9303 25.5145 26.9047 25.4424 26.1616 26.2258 22.9592 23.2493 23.7160 24.9258 24.3528 24.0673 25.6124 26.2224 28.4663 23.0419 26.3172 * * * * * * * * * * * 25.2983 22.8344 19.3476 23.8271 24.2426 23.9255 24.1396 24.3454 23.6907 26.3107 21.6575 23.5415 24.1493 27.7988 16.3472 22.6584 27.7703 28.4394 26.5110 28.4433 * * 24.9392 * * 25.7588 * 27.2221 28.0995 30.7317 20.2666 28.4720 26.0885 24.9408 36.6973 35.1043 * * * * * * * 26.8356 24.9318 20.4391 23.8589 26.8316 25.8482 24.8245 25.2526 24.5947 27.6876 * 25.3362 21.3813 28.6938 * 25.7728 30.5973 30.1937 28.5712 30.7141 * * 28.9787 * * 28.0219 * 29.9758 29.7080 31.0104 * 28.1690 28.6187 31.0546 36.6166 40.4421 * * * * * * * 28.6510 27.3112 * 23.8665 25.4972 26.3785 27.8493 27.0939 26.8898 30.4674 * 27.8927 * 28.0007 * 23.6562 1.6741 1.8704 1.2833 1.6566 1.3242 *** 1.0783 *** *** 1.8305 *** 1.4056 1.1252 1.6429 0.9970 1.1658 1.6544 1.3272 *** 1.6814 2.6191 1.3597 2.3566 1.5982 0.8070 0.6245 0.6538 1.0826 1.1645 *** 1.1146 0.9305 1.2318 1.1121 1.6973 1.5419 1.2091 *** 0.9926 *** 1.2442 *** *** Average hourly wage** (3 years) 27.9356 28.5333 26.9062 28.4902 26.2258 22.9592 25.8522 23.7160 24.9258 26.0815 24.0673 27.6579 28.0206 30.1346 21.6760 27.7706 27.4400 27.9475 36.6568 37.6718 * * * * * * * 26.9256 24.9372 19.9218 23.8511 25.5320 25.3803 25.6567 25.5544 25.0653 28.1564 21.6575 25.7008 22.6795 28.1645 16.3472 23.9700 1 Based on salaries adjusted for occupational mix, according to the calculation in section III.G. of the preamble to this proposed rule. hospitals are assigned a wage index value under a special exceptions policy (FY 2005 IPPS final rule, 69 FR 49105). case-mix index is based on the billed DRGs in the FY 2005 MedPAR. It is not transfer adjusted. h These hospitals are assigned a wage index value under the rural hold harmless transition discussed in section III.H.3. of the preamble of the FY 2006 IPPS final rule (70 FR 47378). * Denotes wage data not available for the provider for that year. ** Based on the sum of the salaries and hours computed for Federal FYs 2005, 2006, and 2007. *** Denotes MedPAR data not available for the provider for FY 2005. 2 These 3 The TABLE 3A.—FY 2007 AND 3-YEAR AVERAGE HOURLY WAGE FOR URBAN AREAS BY CBSA [*Based on the salaries and hours computed for Federal Fiscal Years 2005, 2006, and 2007] wwhite on PROD1PC61 with PROPOSALS2 CBSA code 10180 10380 10420 10500 10580 10740 ....... ....... ....... ....... ....... ....... VerDate Aug<31>2005 FY 2007 average hourly wage Urban area Abilene, TX ............................................................................................................................................... ´ Aguadilla-Isabela-San Sebastian, PR ....................................................................................................... Akron, OH ................................................................................................................................................. Albany, GA ................................................................................................................................................ Albany-Schenectady-Troy, NY .................................................................................................................. Albuquerque, NM ...................................................................................................................................... 17:10 Apr 24, 2006 Jkt 208001 PO 00000 Frm 00234 Fmt 4701 Sfmt 4702 E:\FR\FM\25APP2.SGM 25APP2 3-year average hourly wage 23.7864 11.5958 25.5401 26.5516 25.9108 28.0546 22.2341 11.9816 24.8498 26.5372 24.3176 27.6389 24229 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules TABLE 3A.—FY 2007 AND 3-YEAR AVERAGE HOURLY WAGE FOR URBAN AREAS BY CBSA—Continued [*Based on the salaries and hours computed for Federal Fiscal Years 2005, 2006, and 2007] wwhite on PROD1PC61 with PROPOSALS2 CBSA code 10780 10900 11020 11100 11180 11260 11300 11340 11460 11500 11540 11700 12020 12060 12100 12220 12260 12420 12540 12580 12620 12700 12940 12980 13020 13140 13380 13460 13644 13740 13780 13820 13900 13980 14020 14060 14260 14484 14500 14540 14740 14860 15180 15260 15380 15500 15540 15764 15804 15940 15980 16180 16220 16300 16580 16620 16700 16740 16820 16860 16940 16974 17020 17140 17300 17420 17460 17660 17780 ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... VerDate Aug<31>2005 FY 2007 average hourly wage Urban area Alexandria, LA ........................................................................................................................................... Allentown-Bethlehem-Easton, PA–NJ ...................................................................................................... Altoona, PA ............................................................................................................................................... Amarillo, TX .............................................................................................................................................. Ames, IA ................................................................................................................................................... Anchorage, AK .......................................................................................................................................... Anderson, IN ............................................................................................................................................. Anderson, SC ............................................................................................................................................ Ann Arbor, MI ............................................................................................................................................ Anniston-Oxford, AL .................................................................................................................................. Appleton, WI ............................................................................................................................................. Asheville, NC ............................................................................................................................................ Athens-Clarke County, GA ....................................................................................................................... Atlanta-Sandy Springs-Marietta, GA ......................................................................................................... Atlantic City, NJ ........................................................................................................................................ Auburn-Opelika, AL ................................................................................................................................... Augusta-Richmond County, GA–SC ......................................................................................................... Austin-Round Rock, TX ............................................................................................................................ Bakersfield, CA ......................................................................................................................................... Baltimore-Towson, MD ............................................................................................................................. Bangor, ME ............................................................................................................................................... Barnstable Town, MA ............................................................................................................................... Baton Rouge, LA ...................................................................................................................................... Battle Creek, MI ........................................................................................................................................ Bay City, MI .............................................................................................................................................. Beaumont-Port Arthur, TX ........................................................................................................................ Bellingham, WA ........................................................................................................................................ Bend, OR .................................................................................................................................................. Bethesda-Gaithersburg-Frederick, MD ..................................................................................................... Billings, MT ............................................................................................................................................... Binghamton, NY ........................................................................................................................................ Birmingham-Hoover, AL ............................................................................................................................ Bismarck, ND ............................................................................................................................................ Blacksburg-Christiansburg-Radford, VA ................................................................................................... Bloomington, IN ........................................................................................................................................ Bloomington-Normal, IL ............................................................................................................................ Boise City-Nampa, ID ............................................................................................................................... Boston-Quincy, MA ................................................................................................................................... Boulder, CO .............................................................................................................................................. Bowling Green, KY ................................................................................................................................... Bremerton-Silverdale, WA ........................................................................................................................ Bridgeport-Stamford-Norwalk, CT ............................................................................................................. Brownsville-Harlingen, TX ......................................................................................................................... Brunswick, GA .......................................................................................................................................... Buffalo-Niagara Falls, NY ......................................................................................................................... Burlington, NC ........................................................................................................................................... Burlington-South Burlington, VT ............................................................................................................... Cambridge-Newton-Framingham, MA ...................................................................................................... Camden, NJ .............................................................................................................................................. Canton-Massillon, OH ............................................................................................................................... Cape Coral-Fort Myers, FL ....................................................................................................................... Carson City, NV ........................................................................................................................................ Casper, WY ............................................................................................................................................... Cedar Rapids, IA ...................................................................................................................................... Champaign-Urbana, IL .............................................................................................................................. Charleston, WV ......................................................................................................................................... Charleston-North Charleston, SC ............................................................................................................. Charlotte-Gastonia-Concord, NC–SC ....................................................................................................... Charlottesville, VA ..................................................................................................................................... Chattanooga, TN–GA ............................................................................................................................... Cheyenne, WY .......................................................................................................................................... Chicago-Naperville-Joliet, IL ..................................................................................................................... Chico, CA .................................................................................................................................................. Cincinnati-Middletown, OH–KY–IN ........................................................................................................... Clarksville, TN–KY .................................................................................................................................... Cleveland, TN ........................................................................................................................................... Cleveland-Elyria-Mentor, OH .................................................................................................................... Coeur d’Alene, ID ..................................................................................................................................... College Station-Bryan, TX ........................................................................................................................ 17:10 Apr 24, 2006 Jkt 208001 PO 00000 Frm 00235 Fmt 4701 Sfmt 4702 E:\FR\FM\25APP2.SGM 25APP2 3-year average hourly wage 23.7639 29.3872 25.8056 27.1670 28.9474 35.6559 26.1417 26.4925 32.1288 23.3427 27.9303 26.9690 29.0907 28.8960 34.7415 24.0249 28.6584 27.7087 31.4405 29.8705 28.7200 37.1619 23.9840 28.7918 27.4599 25.4926 32.8247 31.8191 32.2704 25.8722 26.0978 26.4036 21.4773 24.3978 25.3577 26.5223 27.8382 34.5981 30.6928 24.1674 32.3485 37.5692 28.0460 29.9555 28.0487 25.6875 28.0878 32.3023 30.7780 26.8199 27.6466 29.6855 27.0939 26.3211 28.5638 25.3369 27.0907 28.1830 30.0162 26.5381 26.8898 31.7996 32.7893 28.4143 24.9567 24.0739 27.7626 27.6683 26.8320 22.6218 27.4903 24.3129 25.6933 26.8746 33.7320 24.4749 24.8853 30.6219 21.9251 25.9663 25.7974 27.8508 27.5475 32.0814 22.8346 26.7093 26.5210 29.2570 27.9108 27.6266 35.0590 23.3500 26.6912 26.3249 23.9070 32.0831 30.0560 31.0786 24.7779 24.1488 25.2200 20.8617 22.6378 23.9071 25.3191 25.9580 32.6876 28.2498 22.8806 30.1316 35.6119 27.4783 28.9712 26.4035 24.7454 26.3208 31.0383 29.4794 25.1102 26.1863 28.5533 25.5544 24.9097 26.8316 24.1265 25.9477 27.0104 28.5508 25.4499 25.0653 30.2340 29.9719 26.7824 23.0900 22.5520 26.3460 26.4480 25.3789 24230 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules TABLE 3A.—FY 2007 AND 3-YEAR AVERAGE HOURLY WAGE FOR URBAN AREAS BY CBSA—Continued [*Based on the salaries and hours computed for Federal Fiscal Years 2005, 2006, and 2007] wwhite on PROD1PC61 with PROPOSALS2 CBSA code 17820 17860 17900 17980 18020 18140 18580 18700 19060 19124 19140 19180 19260 19340 19380 19460 19500 19660 19740 19780 19804 20020 20100 20220 20260 20500 20740 20764 20940 21060 21140 21300 21340 21500 21604 21660 21780 21820 21940 22020 22140 22180 22220 22380 22420 22500 22520 22540 22660 22744 22900 23020 23060 23104 23420 23460 23540 23580 23844 24020 24140 24220 24300 24340 24500 24540 24580 24660 24780 ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... VerDate Aug<31>2005 FY 2007 average hourly wage Urban area Colorado Springs, CO ............................................................................................................................... Columbia, MO ........................................................................................................................................... Columbia, SC ............................................................................................................................................ Columbus, GA–AL .................................................................................................................................... Columbus, IN ............................................................................................................................................ Columbus, OH .......................................................................................................................................... Corpus Christi, TX .................................................................................................................................... Corvallis, OR ............................................................................................................................................. Cumberland, MD–WV ............................................................................................................................... Dallas-Plano-Irving, TX ............................................................................................................................. Dalton, GA ................................................................................................................................................ Danville, IL ................................................................................................................................................ Danville, VA .............................................................................................................................................. Davenport-Moline-Rock Island, IA–IL ....................................................................................................... Dayton, OH ............................................................................................................................................... Decatur, AL ............................................................................................................................................... Decatur, IL ................................................................................................................................................ Deltona-Daytona Beach-Ormond Beach, FL ............................................................................................ Denver-Aurora, CO ................................................................................................................................... Des Moines-West Des Moines,IA ............................................................................................................. Detroit-Livonia-Dearborn, MI ..................................................................................................................... Dothan, AL ................................................................................................................................................ Dover, DE ................................................................................................................................................. Dubuque, IA .............................................................................................................................................. Duluth, MN–WI .......................................................................................................................................... Durham, NC .............................................................................................................................................. Eau Claire, WI ........................................................................................................................................... Edison, NJ ................................................................................................................................................. El Centro, CA ............................................................................................................................................ Elizabethtown, KY ..................................................................................................................................... Elkhart-Goshen, IN ................................................................................................................................... Elmira, NY ................................................................................................................................................. El Paso, TX ............................................................................................................................................... Erie, PA ..................................................................................................................................................... Essex County, MA .................................................................................................................................... Eugene-Springfield, OR ............................................................................................................................ Evansville, IN–KY ..................................................................................................................................... Fairbanks, AK ........................................................................................................................................... Fajardo, PR ............................................................................................................................................... Fargo, ND–MN .......................................................................................................................................... Farmington, NM ........................................................................................................................................ Fayetteville, NC ......................................................................................................................................... Fayetteville-Springdale-Rogers, AR–MO .................................................................................................. Flagstaff, AZ .............................................................................................................................................. Flint, MI ..................................................................................................................................................... Florence, SC ............................................................................................................................................. Florence-Muscle Shoals, AL ..................................................................................................................... Fond du Lac, WI ....................................................................................................................................... Fort Collins-Loveland, CO ........................................................................................................................ Ft Lauderdale-Pompano Beach-Deerfield ................................................................................................ Fort Smith, AR–OK ................................................................................................................................... Fort Walton Beach-Crestview-Destin, FL ................................................................................................. Fort Wayne, IN .......................................................................................................................................... Fort Worth-Arlington, TX ........................................................................................................................... Fresno, CA ................................................................................................................................................ Gadsden, AL ............................................................................................................................................. Gainesville, FL .......................................................................................................................................... Gainesville, GA ......................................................................................................................................... Gary, IN ..................................................................................................................................................... Glens Falls, NY ......................................................................................................................................... Goldsboro, NC .......................................................................................................................................... Grand Forks, ND–MN ............................................................................................................................... Grand Junction, CO .................................................................................................................................. Grand Rapids-Wyoming, MI ..................................................................................................................... Great Falls, MT ......................................................................................................................................... Greeley, CO .............................................................................................................................................. Green Bay, WI .......................................................................................................................................... Greensboro-High Point, NC ...................................................................................................................... Greenville, NC ........................................................................................................................................... 17:10 Apr 24, 2006 Jkt 208001 PO 00000 Frm 00236 Fmt 4701 Sfmt 4702 E:\FR\FM\25APP2.SGM 25APP2 3-year average hourly wage 28.7059 25.3105 23.7907 24.4401 27.6269 29.9564 25.3934 34.1502 26.1797 29.8607 26.7899 27.5152 25.1134 25.2896 26.7881 24.3313 24.2290 27.4687 32.3384 27.0441 30.2990 22.1225 29.3258 27.0318 29.7746 29.0174 28.5480 33.1853 27.0989 25.8098 27.8902 24.3652 26.9405 25.7679 30.8807 32.2004 26.1797 32.7496 11.9805 24.4385 25.4686 26.5301 25.9870 34.3731 32.4969 24.9953 23.6570 29.8417 28.2139 30.0138 22.9758 25.6192 28.1177 28.3931 32.5994 23.9989 27.5283 26.6096 27.4642 24.7436 27.1894 23.6479 28.7625 28.0304 25.4356 28.5246 28.9831 25.9172 27.9072 26.9783 23.5598 24.6287 23.7713 26.4443 27.7794 24.0550 30.6441 24.9454 28.3711 25.7890 24.7343 23.9198 24.2728 25.5826 23.8254 22.7819 25.7159 30.3491 26.1907 28.9283 21.2814 27.6577 25.1096 28.5452 28.2855 26.1872 31.3795 25.2992 24.4828 26.4406 23.2597 25.4867 24.3509 29.5199 30.4380 24.1900 31.3425 11.2321 24.0588 23.5378 25.8728 24.3862 32.2119 30.5849 24.5176 22.5629 27.7181 27.8290 28.6681 22.6470 24.5301 27.1394 26.7339 30.1075 22.5094 26.2765 25.6552 26.1115 23.7211 24.9795 23.2868 27.2627 26.4158 24.6351 26.7856 27.0003 25.2493 26.1644 24231 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules TABLE 3A.—FY 2007 AND 3-YEAR AVERAGE HOURLY WAGE FOR URBAN AREAS BY CBSA—Continued [*Based on the salaries and hours computed for Federal Fiscal Years 2005, 2006, and 2007] Urban area FY 2007 average hourly wage 3-year average hourly wage Greenville, SC ........................................................................................................................................... Guayama, PR ........................................................................................................................................... Gulfport-Biloxi, MS .................................................................................................................................... Hagerstown-Martinsburg, MD–WV ........................................................................................................... Hanford-Corcoran, CA .............................................................................................................................. Harrisburg-Carlisle, PA ............................................................................................................................. Harrisonburg, VA ...................................................................................................................................... Hartford-West Hartford-East Hartford, C .................................................................................................. Hattiesburg, MS ........................................................................................................................................ Hickory-Lenoir-Morganton, NC ................................................................................................................. 1 Hinesville-Fort Stewart, GA .................................................................................................................... Holland-Grand Haven, MI ......................................................................................................................... Honolulu, HI .............................................................................................................................................. Hot Springs, AR ........................................................................................................................................ Houma-Bayou Cane-Thibodaux, LA ......................................................................................................... Houston-Sugar Land-Baytown, TX ........................................................................................................... Huntington-Ashland, WV–KY–OH ............................................................................................................ Huntsville, AL ............................................................................................................................................ Idaho Falls, ID ........................................................................................................................................... Indianapolis-Carmel, IN ............................................................................................................................ Iowa City, IA .............................................................................................................................................. Ithaca, NY ................................................................................................................................................. Jackson, MI ............................................................................................................................................... Jackson, MS ............................................................................................................................................. Jackson, TN .............................................................................................................................................. Jacksonville, FL ........................................................................................................................................ Jacksonville, NC ....................................................................................................................................... Janesville, WI ............................................................................................................................................ Jefferson City, MO .................................................................................................................................... Johnson City, TN ...................................................................................................................................... Johnstown, PA .......................................................................................................................................... Jonesboro, AR .......................................................................................................................................... Joplin, MO ................................................................................................................................................. Kalamazoo-Portage, MI ............................................................................................................................ Kankakee-Bradley, IL ................................................................................................................................ Kansas City, MO–KS ................................................................................................................................ Kennewick-Richland-Pasco, WA .............................................................................................................. Killeen-Temple-Fort Hood, TX .................................................................................................................. Kingsport-Bristol-Bristol, TN–VA ............................................................................................................... Kingston, NY ............................................................................................................................................. Knoxville, TN ............................................................................................................................................. Kokomo, IN ............................................................................................................................................... La Crosse, WI–MN ................................................................................................................................... Lafayette, IN .............................................................................................................................................. Lafayette, LA ............................................................................................................................................. Lake Charles, LA ...................................................................................................................................... Lake County-Kenosha County, IL–WI ...................................................................................................... Lakeland, FL ............................................................................................................................................. Lancaster, PA ........................................................................................................................................... Lansing-East Lansing, MI ......................................................................................................................... Laredo, TX ................................................................................................................................................ Las Cruces, NM ........................................................................................................................................ Las Vegas-Paradise, NV .......................................................................................................................... Lawrence, KS ............................................................................................................................................ Lawton, OK ............................................................................................................................................... Lebanon, PA ............................................................................................................................................. Lewiston, ID–WA ...................................................................................................................................... Lewiston-Auburn, ME ................................................................................................................................ Lexington-Fayette, KY .............................................................................................................................. Lima, OH ................................................................................................................................................... Lincoln, NE ................................................................................................................................................ Little Rock-North Little Rock, AR .............................................................................................................. Logan, UT–ID ............................................................................................................................................ Longview, TX ............................................................................................................................................ Longview, WA ........................................................................................................................................... Los Angeles-Long Beach-Santa Ana, CA ................................................................................................ Louisville-Jefferson County, KY–IN .......................................................................................................... Lubbock, TX .............................................................................................................................................. Lynchburg, VA .......................................................................................................................................... 28.7379 09.5985 26.3877 26.8867 30.1059 27.8666 26.9175 32.3195 22.0583 26.7289 .................... 27.3564 32.7585 26.0849 23.6912 29.6912 26.6703 26.7216 26.8982 28.8843 28.7929 29.2568 28.3070 24.5054 26.2283 26.7802 24.3666 28.6711 24.6931 23.8898 25.5195 22.6678 25.5168 31.7833 29.6189 28.1260 30.6359 27.0302 23.5950 27.7882 24.5065 28.1040 27.9055 26.5151 24.5278 23.4856 30.8117 26.3688 28.5843 29.8859 23.2381 27.4404 33.7979 24.7063 24.0253 26.3047 29.1686 27.0588 27.1389 26.7593 29.8510 26.3993 26.7880 26.0655 29.6411 34.8198 27.0486 25.5361 25.8004 27.2856 09.6952 24.9138 26.4121 27.7628 26.2093 25.6513 30.8426 20.9235 25.6097 .................... 25.9294 31.0670 25.2942 22.0451 28.0218 26.1438 25.2160 25.7696 27.7580 27.2014 27.4840 26.0872 23.2406 24.9470 26.0119 23.1693 26.9103 23.4008 22.5898 23.6154 22.1975 24.1603 29.6496 29.2729 26.6597 29.2912 25.1082 22.6623 25.8209 23.6085 26.2399 26.3466 24.9248 23.3229 22.1071 29.1933 25.0264 27.3304 27.5256 23.0084 24.7091 31.9159 23.8048 22.6783 24.5398 26.9241 26.1610 25.7178 25.7193 28.4796 24.7894 25.5328 24.6081 27.7279 32.9747 25.7096 24.4128 24.6790 wwhite on PROD1PC61 with PROPOSALS2 CBSA code 24860 25020 25060 25180 25260 25420 25500 25540 25620 25860 25980 26100 26180 26300 26380 26420 26580 26620 26820 26900 26980 27060 27100 27140 27180 27260 27340 27500 27620 27740 27780 27860 27900 28020 28100 28140 28420 28660 28700 28740 28940 29020 29100 29140 29180 29340 29404 29460 29540 29620 29700 29740 29820 29940 30020 30140 30300 30340 30460 30620 30700 30780 30860 30980 31020 31084 31140 31180 31340 ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... VerDate Aug<31>2005 17:10 Apr 24, 2006 Jkt 208001 PO 00000 Frm 00237 Fmt 4701 Sfmt 4702 E:\FR\FM\25APP2.SGM 25APP2 24232 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules TABLE 3A.—FY 2007 AND 3-YEAR AVERAGE HOURLY WAGE FOR URBAN AREAS BY CBSA—Continued [*Based on the salaries and hours computed for Federal Fiscal Years 2005, 2006, and 2007] wwhite on PROD1PC61 with PROPOSALS2 CBSA code 31420 31460 31540 31700 31900 32420 32580 32780 32820 32900 33124 33140 33260 33340 33460 33540 33660 33700 33740 33780 33860 34060 34100 34580 34620 34740 34820 34900 34940 34980 35004 35084 35300 35380 35644 35660 35980 36084 36100 36140 36220 36260 36420 36500 36540 36740 36780 36980 37100 37340 37460 37620 37700 37860 37900 37964 38060 38220 38300 38340 38540 38660 38860 38900 38940 39100 39140 39300 39340 ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... VerDate Aug<31>2005 FY 2007 average hourly wage Urban area Macon, GA ................................................................................................................................................ Madera, CA ............................................................................................................................................... Madison, WI .............................................................................................................................................. Manchester-Nashua, NH .......................................................................................................................... Mansfield, OH ........................................................................................................................................... ¨ Mayaguez, PR .......................................................................................................................................... McAllen-Edinburg-Mission, TX .................................................................................................................. Medford, OR ............................................................................................................................................. Memphis, TN–MS–AR .............................................................................................................................. Merced, CA ............................................................................................................................................... Miami-Miami Beach-Kendall, FL ............................................................................................................... Michigan City-La Porte, IN ........................................................................................................................ Midland, TX ............................................................................................................................................... Milwaukee-Waukesha-West Allis, WI ....................................................................................................... Minneapolis-St. Paul-Bloomington, MN–WI .............................................................................................. Missoula, MT ............................................................................................................................................. Mobile, AL ................................................................................................................................................. Modesto, CA ............................................................................................................................................. Monroe, LA ............................................................................................................................................... Monroe, MI ................................................................................................................................................ Montgomery, AL ........................................................................................................................................ Morgantown, WV ...................................................................................................................................... Morristown, TN .......................................................................................................................................... Mount Vernon-Anacortes, WA .................................................................................................................. Muncie, IN ................................................................................................................................................. Muskegon-Norton Shores, MI ................................................................................................................... Myrtle Beach-Conway-North Myrtle Beach, ............................................................................................. Napa, CA .................................................................................................................................................. Naples-Marco Island, FL ........................................................................................................................... Nashville-Davidson—Murfreesboro, TN ................................................................................................... Nassau-Suffolk, NY ................................................................................................................................... Newark-Union, NJ–PA .............................................................................................................................. New Haven-Milford, CT ............................................................................................................................ New Orleans-Metairie-Kenner, LA ............................................................................................................ New York-White Plains-Wayne, NY–NJ ................................................................................................... Niles-Benton Harbor, MI ........................................................................................................................... Norwich-New London, CT ......................................................................................................................... Oakland-Fremont-Hayward, CA ................................................................................................................ Ocala, FL .................................................................................................................................................. Ocean City, NJ .......................................................................................................................................... Odessa, TX ............................................................................................................................................... Ogden-Clearfield, UT ................................................................................................................................ Oklahoma City, OK ................................................................................................................................... Olympia, WA ............................................................................................................................................. Omaha-Council Bluffs, NE–IA .................................................................................................................. Orlando-Kissimmee, FL ............................................................................................................................ Oshkosh-Neenah, WI ................................................................................................................................ Owensboro, KY ......................................................................................................................................... Oxnard-Thousand Oaks-Ventura, CA ....................................................................................................... Palm Bay-Melbourne-Titusville, FL ........................................................................................................... Panama City-Lynn Haven, FL .................................................................................................................. Parkersburg-Marietta-Vienna, WV–OH ..................................................................................................... Pascagoula, MS ........................................................................................................................................ Pensacola-Ferry Pass-Brent, FL .............................................................................................................. Peoria, IL ................................................................................................................................................... Philadelphia, PA ........................................................................................................................................ Phoenix-Mesa-Scottsdale, AZ .................................................................................................................. Pine Bluff, AR ........................................................................................................................................... Pittsburgh, PA ........................................................................................................................................... Pittsfield, MA ............................................................................................................................................. Pocatello, ID .............................................................................................................................................. Ponce, PR ................................................................................................................................................. Portland-South Portland-Biddeford, ME ................................................................................................... Portland-Vancouver-Beaverton, OR–WA ................................................................................................. Port St. Lucie-Fort Pierce, FL ................................................................................................................... Poughkeepsie-Newburgh-Middletown, NY ............................................................................................... Prescott, AZ .............................................................................................................................................. Providence-New Bedford-Fall River, RI–M ............................................................................................... Provo-Orem, UT ........................................................................................................................................ 17:10 Apr 24, 2006 Jkt 208001 PO 00000 Frm 00238 Fmt 4701 Sfmt 4702 E:\FR\FM\25APP2.SGM 25APP2 3-year average hourly wage 28.2812 24.1895 31.7670 30.3488 27.5254 11.4161 26.0218 32.0766 27.7288 33.8080 29.0857 26.9182 29.0179 30.3159 32.3959 26.3724 23.5488 34.3892 23.7257 28.7593 23.7850 25.0126 23.5331 31.1247 24.6068 29.4886 26.1078 39.9176 29.4100 29.1670 37.5989 35.1861 35.5112 26.2137 39.1188 26.4279 35.4758 45.5784 26.3570 31.0823 29.9544 26.6673 26.2178 32.8460 27.9830 27.8531 27.5278 25.9911 34.2883 27.9443 23.9351 23.5762 24.3614 23.6805 26.5635 32.5912 30.5119 24.9343 25.6688 30.4192 27.8274 14.3623 29.3543 33.7621 29.1805 32.3052 29.1830 31.9448 28.2332 27.0212 23.7007 29.6038 29.1140 26.5502 11.4868 24.4402 29.5178 26.1237 30.8250 27.5003 25.9742 26.8535 28.4862 30.8366 26.0288 22.1987 33.1922 22.3272 26.7894 23.2495 23.9182 22.1874 29.4347 24.0532 27.5164 24.9580 36.1438 28.5222 27.6979 35.8100 33.0916 33.3802 25.1311 37.0666 24.9042 32.7007 42.9783 25.2302 30.1687 27.9474 25.4290 25.1040 30.8309 26.8115 26.6896 25.6702 24.2496 32.1061 27.0172 22.6108 22.9231 22.7858 22.7437 24.9170 30.7325 28.4597 24.0918 24.4659 28.8465 26.4330 13.8007 28.3363 31.7618 28.0566 30.9565 27.7138 30.5097 26.6782 24233 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules TABLE 3A.—FY 2007 AND 3-YEAR AVERAGE HOURLY WAGE FOR URBAN AREAS BY CBSA—Continued [*Based on the salaries and hours computed for Federal Fiscal Years 2005, 2006, and 2007] wwhite on PROD1PC61 with PROPOSALS2 CBSA code 39380 39460 39540 39580 39660 39740 39820 39900 40060 40140 40220 40340 40380 40420 40484 40580 40660 40900 40980 41060 41100 41140 41180 41420 41500 41540 41620 41660 41700 41740 41780 41884 41900 41940 41980 42020 42044 42060 42100 42140 42220 42260 42340 42540 42644 42680 43100 43300 43340 43580 43620 43780 43900 44060 44100 44140 44180 44220 44300 44700 44940 45060 45104 45220 45300 45460 45500 45780 45820 ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... VerDate Aug<31>2005 FY 2007 average hourly wage Urban area Pueblo, CO ............................................................................................................................................... Punta Gorda, FL ....................................................................................................................................... Racine, WI ................................................................................................................................................ Raleigh-Cary, NC ...................................................................................................................................... Rapid City, SD .......................................................................................................................................... Reading, PA .............................................................................................................................................. Redding, CA .............................................................................................................................................. Reno-Sparks, NV ...................................................................................................................................... Richmond, VA ........................................................................................................................................... Riverside-San Bernardino-Ontario, CA ..................................................................................................... Roanoke, VA ............................................................................................................................................. Rochester, MN .......................................................................................................................................... Rochester, NY ........................................................................................................................................... Rockford, IL ............................................................................................................................................... Rockingham County, NH .......................................................................................................................... Rocky Mount, NC ...................................................................................................................................... Rome, GA ................................................................................................................................................. Sacramento—Arden-Arcade—Roseville, CA ............................................................................................ Saginaw-Saginaw Township North, MI ..................................................................................................... St. Cloud, MN ........................................................................................................................................... St. George, UT .......................................................................................................................................... St. Joseph, MO–KS .................................................................................................................................. St. Louis, MO–IL ....................................................................................................................................... Salem, OR ................................................................................................................................................ Salinas, CA ............................................................................................................................................... Salisbury, MD ............................................................................................................................................ Salt Lake City, UT ..................................................................................................................................... San Angelo, TX ......................................................................................................................................... San Antonio, TX ........................................................................................................................................ San Diego-Carlsbad-San Marcos, CA ...................................................................................................... Sandusky, OH ........................................................................................................................................... San Francisco-San Mateo-Redwood City, CA ......................................................................................... ´ San German-Cabo Rojo, PR .................................................................................................................... San Jose-Sunnyvale-Santa Clara, CA ..................................................................................................... San Juan-Caguas-Guaynabo, PR ............................................................................................................ San Luis Obispo-Paso Robles, CA .......................................................................................................... Santa Ana-Anaheim-Irvine, CA ................................................................................................................. Santa Barbara-Santa Maria, CA ............................................................................................................... Santa Cruz-Watsonville, CA ..................................................................................................................... Santa Fe, NM ............................................................................................................................................ Santa Rosa-Petaluma, CA ........................................................................................................................ Sarasota-Bradenton-Venice, FL ............................................................................................................... Savannah, GA ........................................................................................................................................... Scranton—Wilkes-Barre, PA ..................................................................................................................... Seattle-Bellevue-Everett, WA ................................................................................................................... Sebastian-Vero Beach,FL ......................................................................................................................... Sheboygan, WI ......................................................................................................................................... Sherman-Denison, TX .............................................................................................................................. Shreveport-Bossier City, LA ..................................................................................................................... Sioux City, IA–NE–SD .............................................................................................................................. Sioux Falls, SD ......................................................................................................................................... South Bend-Mishawaka, IN–MI ................................................................................................................ Spartanburg, SC ....................................................................................................................................... Spokane, WA ............................................................................................................................................ Springfield, IL ............................................................................................................................................ Springfield, MA .......................................................................................................................................... Springfield, MO ......................................................................................................................................... Springfield, OH .......................................................................................................................................... State College, PA ..................................................................................................................................... Stockton, CA ............................................................................................................................................. Sumter, SC ............................................................................................................................................... Syracuse, NY ............................................................................................................................................ Tacoma, WA ............................................................................................................................................. Tallahassee, FL ........................................................................................................................................ Tampa-St. Petersburg-Clearwater, FL ...................................................................................................... Terre Haute, IN ......................................................................................................................................... Texarkana, TX-Texarkana, AR ................................................................................................................. Toledo, OH ................................................................................................................................................ Topeka, KS ............................................................................................................................................... 17:10 Apr 24, 2006 Jkt 208001 PO 00000 Frm 00239 Fmt 4701 Sfmt 4702 E:\FR\FM\25APP2.SGM 25APP2 3-year average hourly wage 25.3116 27.9209 27.2461 29.1738 30.6665 28.5418 39.0919 35.4486 27.1570 32.3625 25.6872 33.2903 26.6628 29.5658 30.0790 26.2562 27.5523 39.5208 26.4685 30.9000 27.5173 30.1186 26.6920 30.9397 42.7963 26.5170 27.8903 24.8207 26.2255 33.6627 27.6127 44.5507 14.4590 45.2357 13.0139 34.3866 33.3993 32.7438 45.9115 32.0322 42.8035 29.2047 26.9048 25.1702 33.8592 28.4305 26.8090 25.2237 26.2834 27.2365 28.2963 28.6471 27.2103 30.9283 26.3463 29.8434 25.1318 25.0325 26.0621 33.9933 23.9471 28.7825 31.9839 27.5786 27.2651 25.6447 24.0388 28.3827 25.8676 24.2019 26.2796 25.4815 27.5962 26.5155 26.7025 34.6214 31.1844 25.9892 30.7856 23.8222 31.5856 25.5814 27.6241 28.7345 25.0051 25.7704 35.6723 26.0187 28.6361 26.3816 27.9482 25.2435 29.3934 39.6031 25.2945 26.5336 23.1919 25.0650 31.8471 25.5029 41.8255 13.7105 42.1510 12.7401 31.7461 32.1497 31.2878 42.4999 30.4616 38.1447 27.1715 26.1364 23.8157 32.2085 26.6512 25.1793 25.7451 24.9546 25.7643 26.7140 26.9212 26.0456 29.8346 24.5714 28.5001 23.6337 23.8848 23.8363 31.2290 23.3117 26.8883 30.4570 24.8630 25.7804 23.6038 23.1664 26.7423 24.7876 24234 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules TABLE 3A.—FY 2007 AND 3-YEAR AVERAGE HOURLY WAGE FOR URBAN AREAS BY CBSA—Continued [*Based on the salaries and hours computed for Federal Fiscal Years 2005, 2006, and 2007] CBSA code 45940 46060 46140 46220 46340 46540 46660 46700 47020 47220 47260 47300 47380 47580 47644 47894 47940 48140 48260 48300 48424 48540 48620 48660 48700 48864 48900 49020 49180 49340 49420 49500 49620 49660 49700 49740 ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... 1 This FY 2007 average hourly wage Urban area Trenton-Ewing, NJ .................................................................................................................................... Tucson, AZ ................................................................................................................................................ Tulsa, OK .................................................................................................................................................. Tuscaloosa, AL ......................................................................................................................................... Tyler, TX ................................................................................................................................................... U a-Rome, NY .......................................................................................................................................... Valdosta, GA ............................................................................................................................................. Vallejo-Fairfield, CA .................................................................................................................................. Victoria, TX ............................................................................................................................................... Vineland-Millville-Bridgeton, NJ ................................................................................................................ Virginia Beach-Norfolk-Newport News, VA .............................................................................................. Visalia-Porterville, CA ............................................................................................................................... Waco, TX .................................................................................................................................................. Warner Robins, GA ................................................................................................................................... Warren-Troy-Farmington-Hills, MI ............................................................................................................ Washington-Arlington-Alexandria DC-VA ................................................................................................. Waterloo-Cedar Falls, IA .......................................................................................................................... Wausau, WI .............................................................................................................................................. Weirton-Steubenville, WV–OH .................................................................................................................. Wenatchee, WA ........................................................................................................................................ West Palm Beach-Boca Raton-Boynton FL ............................................................................................. Wheeling, WV–OH .................................................................................................................................... Wichita, KS ............................................................................................................................................... Wichita Falls, TX ....................................................................................................................................... Williamsport, PA ........................................................................................................................................ Wilmington, DE–MD–NJ ........................................................................................................................... Wilmington, NC ......................................................................................................................................... Winchester, VA-WV .................................................................................................................................. Winston-Salem, NC .................................................................................................................................. Worcester, MA .......................................................................................................................................... Yakima, WA .............................................................................................................................................. Yauco, PR ................................................................................................................................................. York-Hanover, PA ..................................................................................................................................... Youngstown-Warren-Boardman, OH–PA ................................................................................................. Yuba City, CA ........................................................................................................................................... Yuma, AZ .................................................................................................................................................. 3-year average hourly wage 32.1787 27.3501 24.0631 25.5886 26.1668 24.9320 24.6888 44.8596 25.3226 29.1612 26.1678 29.6516 25.6153 24.8717 29.9684 32.7894 24.9273 29.0074 23.8952 30.6283 28.5424 20.7847 26.9190 24.7483 24.0257 31.8188 29.1306 29.8963 27.5311 31.8136 29.1929 11.4297 27.8747 26.0937 31.8777 27.1721 29.9319 25.4760 23.6948 23.9087 25.6693 23.4183 23.8783 41.7866 23.4143 28.2024 24.8408 28.2016 23.6453 23.8719 28.0982 30.8030 23.9407 27.1779 22.5028 27.7041 27.9681 20.1450 25.8412 23.3505 23.2070 30.2275 26.7990 28.7056 25.8316 30.5516 28.2566 11.8994 26.0746 24.8356 29.9596 25.5234 area has no average hourly wage because there are no short-term, acute care hospitals in the area. TABLE 3B.—FY 2007 AND 3-YEAR AVERAGE HOURLY WAGE FOR URBAN AREAS BY CBSA [*Based on the sum of the salaries and hours computed for Federal Fiscal Years 2005, 2006, and 2007] Urban area FY 2007 average hourly wage 3-year average hourly wage Alabama .................................................................................................................................................... Alaska ....................................................................................................................................................... Arizona ...................................................................................................................................................... Arkansas ................................................................................................................................................... California ................................................................................................................................................... Colorado .................................................................................................................................................... Connecticut ............................................................................................................................................... Delaware ................................................................................................................................................... Florida ....................................................................................................................................................... Georgia ..................................................................................................................................................... Hawaii ....................................................................................................................................................... Idaho ......................................................................................................................................................... Illinois ........................................................................................................................................................ Indiana ...................................................................................................................................................... Iowa ........................................................................................................................................................... Kansas ...................................................................................................................................................... Kentucky ................................................................................................................................................... Louisiana ................................................................................................................................................... Maine ........................................................................................................................................................ Maryland ................................................................................................................................................... Massachusetts 1 ........................................................................................................................................ Michigan .................................................................................................................................................... Minnesota .................................................................................................................................................. 22.7063 31.5838 26.4457 21.7888 33.4249 27.6222 34.7826 28.7837 25.4848 22.4296 31.0888 24.1337 24.6699 25.0993 25.7422 23.6947 23.0690 22.1373 24.8632 26.4816 .................... 26.8050 27.1347 21.2325 32.0136 24.8708 20.7414 30.5217 26.1254 33.0280 26.9334 24.0976 21.4509 29.5623 22.6410 23.2118 23.9775 23.7781 22.4420 21.7676 20.7518 24.4350 25.6822 .................... 24.9080 25.6682 wwhite on PROD1PC61 with PROPOSALS2 CBSA code 01 02 03 04 05 06 07 08 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. VerDate Aug<31>2005 17:10 Apr 24, 2006 Jkt 208001 PO 00000 Frm 00240 Fmt 4701 Sfmt 4702 E:\FR\FM\25APP2.SGM 25APP2 24235 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules TABLE 3B.—FY 2007 AND 3-YEAR AVERAGE HOURLY WAGE FOR URBAN AREAS BY CBSA—Continued [*Based on the sum of the salaries and hours computed for Federal Fiscal Years 2005, 2006, and 2007] Urban area FY 2007 average hourly wage 3-year average hourly wage Mississippi ................................................................................................................................................. Missouri ..................................................................................................................................................... Montana .................................................................................................................................................... Nebraska ................................................................................................................................................... Nevada ...................................................................................................................................................... New Hampshire ........................................................................................................................................ New Jersey 1 ............................................................................................................................................. New Mexico .............................................................................................................................................. New York .................................................................................................................................................. North Carolina ........................................................................................................................................... North Dakota ............................................................................................................................................. Ohio ........................................................................................................................................................... Oklahoma .................................................................................................................................................. Oregon ...................................................................................................................................................... Pennsylvania ............................................................................................................................................. Puerto Rico 1 ............................................................................................................................................. Rhode Island 1 ........................................................................................................................................... South Carolina .......................................................................................................................................... South Dakota ............................................................................................................................................ Tennessee ................................................................................................................................................ Texas ........................................................................................................................................................ Utah ........................................................................................................................................................... Vermont ..................................................................................................................................................... Virginia ...................................................................................................................................................... Washington ............................................................................................................................................... West Virginia ............................................................................................................................................. Wisconsin .................................................................................................................................................. Wyoming ................................................................................................................................................... 22.4345 23.5321 25.4332 25.7283 26.5440 31.9560 .................... 24.7274 24.4634 25.4805 21.4222 25.6736 22.6848 28.8984 24.6593 .................... .................... 25.4710 25.1178 23.2955 23.6920 24.1638 29.3826 23.5825 30.4489 22.6063 28.0229 27.5393 21.3758 22.0469 24.2378 24.5703 25.4110 29.2334 .................... 23.9765 22.9464 24.0022 20.7057 24.4091 21.4287 27.3817 23.2635 .................... .................... 24.2433 23.6533 22.0862 22.3956 22.8805 26.8610 22.4069 28.8509 21.6759 26.4234 25.7950 CBSA code 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 49 50 51 52 53 ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. 1 All counties in the State or Territory are classified as urban, with the exception of Massachusetts. Massachusetts has area(s) designated as rural. However, no short-term, acute care hospitals were located in Rural Massachusetts during FY 2003, the base year for the FY 2007 wage index. TABLE 4A–1.—WAGE INDEX AND CAPITAL GEOGRAPHIC ADJUSTMENT FACTOR (GAF) FOR URBAN AREAS BY CBSA— FY 2007 CBSA code Urban area (constituent counties) 10180 ....... Abilene, TX ....................................................................................................................................................... Callahan County, TX. Jones County, TX. Taylor County, TX. ´ Aguadilla-Isabela-San Sebastian, PR ............................................................................................................... Aguada Municipio, PR. Aguadilla Municipio, PR. ˜ Anasco Municipio, PR. Isabela Municipio, PR. Lares Municipio, PR. Moca Municipio, PR. ´ Rincon Municipio, PR. ´ San Sebastian Municipio, PR. Akron, OH ......................................................................................................................................................... Portage County, OH. Summit County, OH. Albany, GA ........................................................................................................................................................ Baker County, GA. Dougherty County, GA. Lee County, GA. Terrell County, GA. Worth County, GA. Albany-Schenectady-Troy, NY .......................................................................................................................... Albany County, NY. Rensselaer County, NY. Saratoga County, NY. Schenectady County, NY. Schoharie County, NY. Albuquerque, NM .............................................................................................................................................. Bernalillo County, NM. 10380 ....... 10420 ....... wwhite on PROD1PC61 with PROPOSALS2 10500 ....... 10580 ....... 10740 ....... VerDate Aug<31>2005 17:10 Apr 24, 2006 Jkt 208001 PO 00000 Frm 00241 Fmt 4701 Sfmt 4702 Wage index E:\FR\FM\25APP2.SGM 25APP2 GAF 0.8051 0.8620 0.3917 0.5263 0.8737 0.9117 0.8969 0.9282 0.8753 0.9128 0.9477 0.9639 24236 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules TABLE 4A–1.—WAGE INDEX AND CAPITAL GEOGRAPHIC ADJUSTMENT FACTOR (GAF) FOR URBAN AREAS BY CBSA— FY 2007—Continued CBSA code 10780 ....... 10900 ....... 10900 ....... 11020 ....... 11100 ....... 11180 ....... 11260 ....... 11300 ....... 11340 ....... 11460 ....... 11500 ....... 11540 ....... 11700 ....... 12020 ....... wwhite on PROD1PC61 with PROPOSALS2 12060 ....... VerDate Aug<31>2005 Wage index Urban area (constituent counties) Sandoval County, NM. Torrance County, NM. Valencia County, NM. Alexandria, LA ................................................................................................................................................... Grant Parish, LA. Rapides Parish, LA. Allentown-Bethlehem-Easton, PA–NJ (PA Hospitals) ...................................................................................... Warren County, NJ. Carbon County, PA. Lehigh County, PA. Northampton County, PA. 2 Allentown-Bethlehem-Easton, PA–NJ (NJ Hospitals) .................................................................................... Warren County, NJ. Carbon County, PA. Lehigh County, PA. Northampton County, PA. Altoona, PA ....................................................................................................................................................... Blair County, PA. Amarillo, TX ...................................................................................................................................................... Armstrong County, TX. Carson County, TX. Potter County, TX. Randall County, TX. Ames, IA ........................................................................................................................................................... Story County, IA. Anchorage, AK .................................................................................................................................................. Anchorage Municipality, AK. Matanuska-Susitna Borough, AK. Anderson, IN ..................................................................................................................................................... Madison County, IN. Anderson, SC .................................................................................................................................................... Anderson County, SC. 3 Ann Arbor, MI .................................................................................................................................................. Washtenaw County, MI. Anniston-Oxford, AL .......................................................................................................................................... Calhoun County, AL. 2 Appleton, WI ................................................................................................................................................... Calumet County, WI. Outagamie County, WI. Asheville, NC .................................................................................................................................................... Buncombe County, NC. Haywood County, NC. Henderson County, NC. Madison County, NC. Athens-Clarke County, GA ................................................................................................................................ Clarke County, GA. Madison County, GA. Oconee County, GA. Oglethorpe County, GA. 1 Atlanta-Sandy Springs-Marietta, GA ............................................................................................................... Barrow County, GA. Bartow County, GA. Butts County, GA. Carroll County, GA. Cherokee County, GA. Clayton County, GA. Cobb County, GA. Coweta County, GA. Dawson County, GA. DeKalb County, GA. Douglas County, GA. Fayette County, GA. Forsyth County, GA. Fulton County, GA. Gwinnett County, GA. Haralson County, GA. Heard County, GA. Henry County, GA. Jasper County, GA. Lamar County, GA. 17:10 Apr 24, 2006 Jkt 208001 PO 00000 Frm 00242 Fmt 4701 Sfmt 4702 E:\FR\FM\25APP2.SGM 25APP2 GAF 0.8028 0.8603 0.9927 0.9950 1.1226 1.0824 0.8717 0.9103 0.9177 0.9429 0.9779 0.9848 1.2062 1.1370 0.8831 0.9184 0.8949 0.9268 1.0853 1.0577 0.7978 0.8567 0.9466 0.9631 0.9110 0.9382 0.9827 0.9881 0.9761 0.9836 24237 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules TABLE 4A–1.—WAGE INDEX AND CAPITAL GEOGRAPHIC ADJUSTMENT FACTOR (GAF) FOR URBAN AREAS BY CBSA— FY 2007—Continued CBSA code 12100 ....... 12220 ....... 12260 ....... 12420 ....... 12540 ....... 12580 ....... 12620 ....... 12700 ....... 12940 ....... 12980 ....... 13020 ....... 13140 ....... 13380 ....... 13460 ....... wwhite on PROD1PC61 with PROPOSALS2 13644 ....... 13740 ....... 13780 ....... VerDate Aug<31>2005 Wage index Urban area (constituent counties) Meriwether County, GA. Newton County, GA. Paulding County, GA. Pickens County, GA. Pike County, GA. Rockdale County, GA. Spalding County, GA. Walton County, GA. Atlantic City, NJ ................................................................................................................................................ Atlantic County, NJ. Auburn-Opelika, AL ........................................................................................................................................... Lee County, AL. Augusta-Richmond County, GA–SC ................................................................................................................. Burke County, GA. Columbia County, GA. McDuffie County, GA. Richmond County, GA. Aiken County, SC. Edgefield County, SC. 1 Austin-Round Rock, TX .................................................................................................................................. Bastrop County, TX. Caldwell County, TX. Hays County, TX. Travis County, TX. Williamson County, TX. 2 Bakersfield, CA ............................................................................................................................................... Kern County, CA. 1 Baltimore-Towson, MD ................................................................................................................................... Anne Arundel County, MD. Baltimore County, MD. Carroll County, MD. Harford County, MD. Howard County, MD. Queen Anne’s County, MD. Baltimore City, MD. Bangor, ME ....................................................................................................................................................... Penobscot County, ME. Barnstable Town, MA ........................................................................................................................................ Barnstable County, MA. Baton Rouge, LA .............................................................................................................................................. Ascension Parish, LA. East Baton Rouge Parish, LA. East Feliciana Parish, LA. Iberville Parish, LA. Livingston Parish, LA. Pointe Coupee Parish, LA. St. Helena Parish, LA. West Baton Rouge Parish, LA. West Feliciana Parish, LA. Battle Creek, MI ................................................................................................................................................ Calhoun County, MI. Bay City, MI ...................................................................................................................................................... Bay County, MI. Beaumont-Port Arthur, TX ................................................................................................................................ Hardin County, TX. Jefferson County, TX. Orange County, TX. Bellingham, WA ................................................................................................................................................ Whatcom County, WA. Bend, OR .......................................................................................................................................................... Deschutes County, OR. 1 Bethesda-Gaithersburg-Frederick, MD ........................................................................................................... Frederick County, MD. Montgomery County, MD. Billings, MT ....................................................................................................................................................... Carbon County, MT. Yellowstone County, MT. Binghamton, NY ................................................................................................................................................ Broome County, NY. Tioga County, NY. 17:10 Apr 24, 2006 Jkt 208001 PO 00000 Frm 00243 Fmt 4701 Sfmt 4702 E:\FR\FM\25APP2.SGM 25APP2 GAF 1.1736 1.1159 0.8116 0.8668 0.9681 0.9780 0.9360 0.9557 1.1291 1.0867 1.0090 1.0062 0.9702 0.9795 1.2553 1.1685 0.8102 0.8658 0.9726 0.9812 1.0040 1.0027 0.8612 0.9027 1.1088 1.0733 1.0749 1.0507 1.1028 1.0693 0.8740 0.9119 0.8816 0.9173 24238 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules TABLE 4A–1.—WAGE INDEX AND CAPITAL GEOGRAPHIC ADJUSTMENT FACTOR (GAF) FOR URBAN AREAS BY CBSA— FY 2007—Continued CBSA code 13820 ....... 13900 ....... 13980 ....... 14020 ....... 14060 ....... 14260 ....... 14484 ....... 14500 ....... 14540 ....... 14740 ....... 14860 ....... 15180 ....... 15260 ....... 15380 ....... 15500 ....... 15540 ....... 15764 ....... wwhite on PROD1PC61 with PROPOSALS2 15804 ....... 15940 ....... 15980 ....... 16180 ....... 16220 ....... VerDate Aug<31>2005 Wage index Urban area (constituent counties) 1 Birmingham-Hoover, AL .................................................................................................................................. Bibb County, AL. Blount County, AL. Chilton County, AL. Jefferson County, AL. St. Clair County, AL. Shelby County, AL. Walker County, AL. Bismarck, ND .................................................................................................................................................... Burleigh County, ND. Morton County, ND. Blacksburg-Christiansburg-Radford, VA ........................................................................................................... Giles County, VA. Montgomery County, VA. Pulaski County, VA. Radford City, VA. Bloomington, IN ................................................................................................................................................ Greene County, IN. Monroe County, IN. Owen County, IN. Bloomington-Normal, IL .................................................................................................................................... McLean County, IL. Boise City-Nampa, ID ....................................................................................................................................... Ada County, ID. Boise County, ID. Canyon County, ID. Gem County, ID. Owyhee County, ID. 1 Boston-Quincy, MA ......................................................................................................................................... Norfolk County, MA. Plymouth County, MA. Suffolk County, MA. Boulder, CO ...................................................................................................................................................... Boulder County, CO. Bowling Green, KY ........................................................................................................................................... Edmonson County, KY. Warren County, KY. Bremerton-Silverdale, WA ................................................................................................................................. Kitsap County, WA. Bridgeport-Stamford-Norwalk, CT ..................................................................................................................... Fairfield County, CT. Brownsville-Harlingen, TX ................................................................................................................................. Cameron County, TX. Brunswick, GA .................................................................................................................................................. Brantley County, GA. Glynn County, GA. McIntosh County, GA. 1 Buffalo-Niagara Falls, NY ............................................................................................................................... Erie County, NY. Niagara County, NY. Burlington, NC ................................................................................................................................................... Alamance County, NC. 2 Burlington-South Burlington, VT ..................................................................................................................... Chittenden County, VT. Franklin County, VT. Grand Isle County, VT. 1 Cambridge-Newton-Framingham, MA ............................................................................................................ Middlesex County, MA. 1 Camden, NJ .................................................................................................................................................... Burlington County, NJ. Camden County, NJ. Gloucester County, NJ. Canton-Massillon, OH ....................................................................................................................................... Carroll County, OH. Stark County, OH. Cape Coral-Fort Myers, FL ............................................................................................................................... Lee County, FL. Carson City, NV ................................................................................................................................................ Carson City, NV. 2 Casper, WY ..................................................................................................................................................... 17:10 Apr 24, 2006 Jkt 208001 PO 00000 Frm 00244 Fmt 4701 Sfmt 4702 E:\FR\FM\25APP2.SGM 25APP2 GAF 0.8919 0.9246 0.7255 0.8027 0.8242 0.8760 0.8566 0.8994 0.8959 0.9275 0.9404 0.9588 1.1687 1.1127 1.0368 1.0251 0.8164 0.8703 1.0927 1.0626 1.2691 1.1773 0.9474 0.9637 1.0119 1.0081 0.9475 0.9637 0.8677 0.9074 1.0986 1.0665 1.0912 1.0616 1.1226 1.0824 0.9060 0.9346 0.9339 0.9542 1.0028 1.0019 0.9303 0.9517 24239 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules TABLE 4A–1.—WAGE INDEX AND CAPITAL GEOGRAPHIC ADJUSTMENT FACTOR (GAF) FOR URBAN AREAS BY CBSA— FY 2007—Continued CBSA code 16300 ....... 16580 ....... 16620 ....... 16700 ....... 16740 ....... 16820 ....... 16860 ....... 16940 ....... 16974 ....... 17020 ....... wwhite on PROD1PC61 with PROPOSALS2 17140 ....... 17300 ....... VerDate Aug<31>2005 Wage index Urban area (constituent counties) Natrona County, WY. Cedar Rapids, IA .............................................................................................................................................. Benton County, IA. Jones County, IA. Linn County, IA. Champaign-Urbana, IL ...................................................................................................................................... Champaign County, IL. Ford County, IL. Piatt County, IL. Charleston, WV ................................................................................................................................................. Boone County, WV. Clay County, WV. Kanawha County, WV. Lincoln County, WV. Putnam County, WV. Charleston-North Charleston, SC ..................................................................................................................... Berkeley County, SC. Charleston County, SC. Dorchester County, SC. 1 Charlotte-Gastonia-Concord, NC–SC ............................................................................................................. Anson County, NC. Cabarrus County, NC. Gaston County, NC. Mecklenburg County, NC. Stanly County, NC. Union County, NC. York County, SC. Charlottesville, VA ............................................................................................................................................. Albemarle County, VA. Fluvanna County, VA. Greene County, VA. Nelson County, VA. Charlottesville City, VA. Chattanooga, TN–GA ....................................................................................................................................... Catoosa County, GA. Dade County, GA. Walker County, GA. Hamilton County, TN. Marion County, TN. Sequatchie County, TN. 2 Cheyenne, WY ................................................................................................................................................ Laramie County, WY. 1 Chicago-Naperville-Joliet, IL ........................................................................................................................... Cook County, IL. DeKalb County, IL. DuPage County, IL. Grundy County, IL. Kane County, IL. Kendall County, IL. McHenry County, IL. Will County, IL. 2 Chico, CA ........................................................................................................................................................ Butte County, CA. 1 Cincinnati-Middletown, OH–KY–IN ................................................................................................................. Dearborn County, IN. Franklin County, IN. Ohio County, IN. Boone County, KY. Bracken County, KY. Campbell County, KY. Gallatin County, KY. Grant County, KY. Kenton County, KY. Pendleton County, KY. Brown County, OH. Butler County, OH. Clermont County, OH. Hamilton County, OH. Warren County, OH. Clarksville, TN–KY ............................................................................................................................................ 17:10 Apr 24, 2006 Jkt 208001 PO 00000 Frm 00245 Fmt 4701 Sfmt 4702 E:\FR\FM\25APP2.SGM 25APP2 GAF 0.8891 0.9227 0.9649 0.9758 0.8559 0.8989 0.9168 0.9422 0.9520 0.9669 1.0140 1.0096 0.8965 0.9279 0.9303 0.9517 1.0742 1.0502 1.1291 1.0867 0.9599 0.9724 0.8431 0.8897 24240 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules TABLE 4A–1.—WAGE INDEX AND CAPITAL GEOGRAPHIC ADJUSTMENT FACTOR (GAF) FOR URBAN AREAS BY CBSA— FY 2007—Continued CBSA code 17420 ....... 17460 ....... 17660 ....... 17780 ....... 17820 ....... 17860 ....... 17900 ....... 17980 ....... 18020 ....... 18140 ....... 18580 ....... 18700 ....... 19060 ....... 19060 ....... wwhite on PROD1PC61 with PROPOSALS2 19124 ....... VerDate Aug<31>2005 Wage index Urban area (constituent counties) Christian County, KY. Trigg County, KY. Montgomery County, TN. Stewart County, TN. Cleveland, TN ................................................................................................................................................... Bradley County, TN. Polk County, TN. 1 Cleveland-Elyria-Mentor, OH .......................................................................................................................... Cuyahoga County, OH. Geauga County, OH. Lake County, OH. Lorain County, OH. Medina County, OH. Coeur d’Alene, ID ............................................................................................................................................. Kootenai County, ID. College Station-Bryan, TX ................................................................................................................................ Brazos County, TX. Burleson County, TX. Robertson County, TX. Colorado Springs, CO ....................................................................................................................................... El Paso County, CO. Teller County, CO. Columbia, MO ................................................................................................................................................... Boone County, MO. Howard County, MO. 2 Columbia, SC .................................................................................................................................................. Calhoun County, SC. Fairfield County, SC. Kershaw County, SC. Lexington County, SC. Richland County, SC. Saluda County, SC. Columbus, GA–AL ............................................................................................................................................ Russell County, AL. Chattahoochee County, GA. Harris County, GA. Marion County, GA. Muscogee County, GA. Columbus, IN .................................................................................................................................................... Bartholomew County, IN. 1 Columbus, OH ................................................................................................................................................ Delaware County, OH. Fairfield County, OH. Franklin County, OH. Licking County, OH. Madison County, OH. Morrow County, OH. Pickaway County, OH. Union County, OH. Corpus Christi, TX ............................................................................................................................................. Aransas County, TX. Nueces County, TX. San Patricio County, TX. Corvallis, OR ..................................................................................................................................................... Benton County, OR. 2 Cumberland, MD–WV (MD Hospitals) ............................................................................................................ Allegany County, MD. Mineral County, WV. Cumberland, MD–WV (WV Hospitals) .............................................................................................................. Allegany County, MD. Mineral County, WV. 1 Dallas-Plano-Irving, TX ................................................................................................................................... Collin County, TX. Dallas County, TX. Delta County, TX. Denton County, TX. Ellis County, TX. Hunt County, TX. Kaufman County, TX. Rockwall County, TX. 17:10 Apr 24, 2006 Jkt 208001 PO 00000 Frm 00246 Fmt 4701 Sfmt 4702 E:\FR\FM\25APP2.SGM 25APP2 GAF 0.8132 0.8680 0.9378 0.9570 0.9347 0.9548 0.9064 0.9349 0.9697 0.9792 0.8550 0.8983 0.8604 0.9022 0.8256 0.8770 0.9333 0.9538 1.0119 1.0081 0.8578 0.9003 1.1536 1.1028 0.8946 0.9266 0.8844 0.9193 1.0087 1.0059 24241 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules TABLE 4A–1.—WAGE INDEX AND CAPITAL GEOGRAPHIC ADJUSTMENT FACTOR (GAF) FOR URBAN AREAS BY CBSA— FY 2007—Continued CBSA code Urban area (constituent counties) 19140 ....... Dalton, GA ........................................................................................................................................................ Murray County, GA. Whitfield County, GA. Danville, IL ........................................................................................................................................................ Vermilion County, IL. Danville, VA ...................................................................................................................................................... Pittsylvania County, VA. Danville City, VA. 2 Davenport-Moline-Rock Island, IA–IL (IA Hospitals) ...................................................................................... Henry County, IL. Mercer County, IL. Rock Island County, IL. Scott County, IA. Davenport-Moline-Rock Island, IA–IL (IL Hospitals) ......................................................................................... Henry County, IL. Mercer County, IL. Rock Island County, IL. Scott County, IA. Dayton, OH ....................................................................................................................................................... Greene County, OH. Miami County, OH. Montgomery County, OH. Preble County, OH. Decatur, AL ....................................................................................................................................................... Lawrence County, AL. Morgan County, AL. 2 Decatur, IL ...................................................................................................................................................... Macon County, IL. Deltona-Daytona Beach-Ormond Beach, FL .................................................................................................... Volusia County, FL. 1 Denver-Aurora, CO ......................................................................................................................................... Adams County, CO. Arapahoe County, CO. Broomfield County, CO. Clear Creek County, CO. Denver County, CO. Douglas County, CO. Elbert County, CO. Gilpin County, CO. Jefferson County, CO. Park County, CO. Des Moines-West Des Moines, IA .................................................................................................................... Dallas County, IA. Guthrie County, IA. Madison County, IA. Polk County, IA. Warren County, IA. 1 Detroit-Livonia-Dearborn, MI ........................................................................................................................... Wayne County, MI. 2 Dothan, AL ...................................................................................................................................................... Geneva County, AL. Henry County, AL. Houston County, AL. Dover, DE ......................................................................................................................................................... Kent County, DE. Dubuque, IA ...................................................................................................................................................... Dubuque County, IA. Duluth, MN–WI .................................................................................................................................................. Carlton County, MN. St. Louis County, MN. Douglas County, WI. Durham, NC ...................................................................................................................................................... Chatham County, NC. Durham County, NC. Orange County, NC. Person County, NC. Eau Claire, WI ................................................................................................................................................... Chippewa County, WI. Eau Claire County, WI. 1 Edison, NJ ....................................................................................................................................................... 19180 ....... 19260 ....... 19340 ....... 19340 ....... 19380 ....... 19460 ....... 19500 ....... 19660 ....... 19740 ....... 19780 ....... 19804 ....... 20020 ....... 20100 ....... 20220 ....... 20260 ....... wwhite on PROD1PC61 with PROPOSALS2 20500 ....... 20740 ....... 20764 ....... VerDate Aug<31>2005 17:10 Apr 24, 2006 Jkt 208001 PO 00000 Frm 00247 Fmt 4701 Sfmt 4702 Wage index E:\FR\FM\25APP2.SGM 25APP2 GAF 0.9050 0.9339 0.9295 0.9512 0.8483 0.8935 0.8696 0.9088 0.8569 0.8996 0.9049 0.9339 0.8220 0.8744 0.8334 0.8827 0.9279 0.9500 1.0924 1.0624 0.9136 0.9400 1.0235 1.0160 0.7670 0.8339 0.9906 0.9936 0.9132 0.9397 1.0157 1.0107 0.9805 0.9866 0.9644 0.9755 1.1242 1.0835 24242 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules TABLE 4A–1.—WAGE INDEX AND CAPITAL GEOGRAPHIC ADJUSTMENT FACTOR (GAF) FOR URBAN AREAS BY CBSA— FY 2007—Continued CBSA code 20940 ....... 21060 ....... 21140 ....... 21300 ....... 21340 ....... 21500 ....... 21604 ....... 21660 ....... 21780 ....... 21820 ....... 21940 ....... 22020 ....... 22020 ....... 22140 ....... 22180 ....... 22220 ....... 22380 ....... 22420 ....... 22500 ....... 22520 ....... wwhite on PROD1PC61 with PROPOSALS2 22540 ....... 22660 ....... 22744 ....... 22900 ....... VerDate Aug<31>2005 Wage index Urban area (constituent counties) Middlesex County, NJ. Monmouth County, NJ. Ocean County, NJ. Somerset County, NJ. 2 El Centro, CA .................................................................................................................................................. Imperial County, CA. Elizabethtown, KY ............................................................................................................................................. Hardin County, KY. Larue County, KY. Elkhart-Goshen, IN ........................................................................................................................................... Elkhart County, IN. 2 Elmira, NY ....................................................................................................................................................... Chemung County, NY. El Paso, TX ....................................................................................................................................................... El Paso County, TX. Erie, PA ............................................................................................................................................................. Erie County, PA. 2 Essex County, MA .......................................................................................................................................... Essex County, MA. Eugene-Springfield, OR .................................................................................................................................... Lane County, OR. Evansville, IN–KY ............................................................................................................................................. Gibson County, IN. Posey County, IN. Vanderburgh County, IN. Warrick County, IN. Henderson County, KY. Webster County, KY. Fairbanks, AK ................................................................................................................................................... Fairbanks North Star Borough, AK. Fajardo, PR ....................................................................................................................................................... Ceiba Municipio, PR. Fajardo Municipio, PR. Luquillo Municipio, PR. Fargo, ND–MN (ND Hospitals) ......................................................................................................................... Clay County, MN. Cass County, ND. 2 Fargo, ND–MN (MN Hospitals) ....................................................................................................................... Clay County, MN. Cass County, ND. Farmington, NM ................................................................................................................................................ San Juan County, NM. Fayetteville, NC ................................................................................................................................................. Cumberland County, NC. Hoke County, NC. Fayetteville-Springdale-Rogers, AR–MO .......................................................................................................... Benton County, AR. Madison County, AR. Washington County, AR. McDonald County, MO. Flagstaff, AZ ...................................................................................................................................................... Coconino County, AZ. Flint, MI ............................................................................................................................................................. Genesee County, MI. 2 Florence, SC ................................................................................................................................................... Darlington County, SC. Florence County, SC. Florence-Muscle Shoals, AL ............................................................................................................................. Colbert County, AL. Lauderdale County, AL. Fond du Lac, WI ............................................................................................................................................... Fond du Lac County, WI. Fort Collins-Loveland, CO ................................................................................................................................. Larimer County, CO. 1 Fort Lauderdale-Pompano Beach-Deerfield Beach, FL ................................................................................. Broward County, FL. Fort Smith, AR–OK ........................................................................................................................................... Crawford County, AR. Franklin County, AR. Sebastian County, AR. 17:10 Apr 24, 2006 Jkt 208001 PO 00000 Frm 00248 Fmt 4701 Sfmt 4702 E:\FR\FM\25APP2.SGM 25APP2 GAF 1.1291 1.0867 0.8719 0.9104 0.9421 0.9600 0.8267 0.8778 0.9101 0.9375 0.8705 0.9094 1.0664 1.0450 1.0877 1.0593 0.8844 0.9193 1.1063 1.0716 0.4047 0.5382 0.8485 0.8936 0.9256 0.9484 0.8603 0.9021 0.8962 0.9277 0.8779 0.9147 1.1611 1.1077 1.0978 1.0660 0.8604 0.9022 0.8008 0.8589 1.0081 1.0055 0.9594 0.9720 1.0470 1.0320 0.7761 0.8407 24243 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules TABLE 4A–1.—WAGE INDEX AND CAPITAL GEOGRAPHIC ADJUSTMENT FACTOR (GAF) FOR URBAN AREAS BY CBSA— FY 2007—Continued CBSA code 23020 ....... 23060 ....... 23104 ....... 23420 ....... 23460 ....... 23540 ....... 23580 ....... 23844 ....... 24020 ....... 24140 ....... 24220 ....... 24220 ....... 24300 ....... 24340 ....... 24500 ....... 24540 ....... 24580 ....... 24660 ....... 24780 ....... wwhite on PROD1PC61 with PROPOSALS2 24860 ....... 25020 ....... 25060 ....... VerDate Aug<31>2005 Wage index Urban area (constituent counties) Le Flore County, OK. Sequoyah County, OK. Fort Walton Beach-Crestview-Destin, FL ......................................................................................................... Okaloosa County, FL. Fort Wayne, IN .................................................................................................................................................. Allen County, IN. Wells County, IN. Whitley County, IN. 1 Fort Worth-Arlington, TX ................................................................................................................................. Johnson County, TX. Parker County, TX. Tarrant County, TX. Wise County, TX. 2 Fresno, CA ...................................................................................................................................................... Fresno County, CA. Gadsden, AL ..................................................................................................................................................... Etowah County, AL. Gainesville, FL .................................................................................................................................................. Alachua County, FL. Gilchrist County, FL. Gainesville, GA ................................................................................................................................................. Hall County, GA. Gary, IN ............................................................................................................................................................. Jasper County, IN. Lake County, IN. Newton County, IN. Porter County, IN. Glens Falls, NY ................................................................................................................................................. Warren County, NY. Washington County, NY. Goldsboro, NC .................................................................................................................................................. Wayne County, NC. Grand Forks, ND–MN (ND Hospitals) .............................................................................................................. Polk County, MN. Grand Forks County, ND. 2 Grand Forks, ND–MN (MN Hospitals) ............................................................................................................ Polk County, MN. Grand Forks County, ND. Grand Junction, CO .......................................................................................................................................... Mesa County, CO. Grand Rapids-Wyoming, MI .............................................................................................................................. Barry County, MI. Ionia County, MI. Kent County, MI. Newaygo County, MI. Great Falls, MT ................................................................................................................................................. Cascade County, MT. Greeley, CO ...................................................................................................................................................... Weld County, CO. Green Bay, WI .................................................................................................................................................. Brown County, WI. Kewaunee County, WI. Oconto County, WI. Greensboro-High Point, NC .............................................................................................................................. Guilford County, NC. Randolph County, NC. Rockingham County, NC. Greenville, NC ................................................................................................................................................... Greene County, NC. Pitt County, NC. Greenville, SC ................................................................................................................................................... Greenville County, SC. Laurens County, SC. Pickens County, SC. Guayama, PR ................................................................................................................................................... Arroyo Municipio, PR. Guayama Municipio, PR. Patillas Municipio, PR. Gulfport-Biloxi, MS ............................................................................................................................................ Hancock County, MS. 17:10 Apr 24, 2006 Jkt 208001 PO 00000 Frm 00249 Fmt 4701 Sfmt 4702 E:\FR\FM\25APP2.SGM 25APP2 GAF 0.8654 0.9057 0.9498 0.9653 0.9591 0.9718 1.1291 1.0867 0.8107 0.8661 0.9299 0.9514 0.8989 0.9296 0.9278 0.9500 0.8359 0.8845 0.9185 0.9434 0.7988 0.8574 0.9256 0.9484 1.0037 1.0025 0.9469 0.9633 0.8781 0.9148 0.9636 0.9749 0.9791 0.9856 0.8992 0.9298 0.9427 0.9604 0.9708 0.9799 0.3242 0.4624 0.8914 0.9243 24244 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules TABLE 4A–1.—WAGE INDEX AND CAPITAL GEOGRAPHIC ADJUSTMENT FACTOR (GAF) FOR URBAN AREAS BY CBSA— FY 2007—Continued CBSA code 25180 ....... 25260 ....... 25420 ....... 25500 ....... 25540 ....... 25620 ....... 25860 ....... 25980 ....... 26100 ....... 26180 ....... 26300 ....... 26380 ....... 26420 ....... 26580 ....... 26620 ....... wwhite on PROD1PC61 with PROPOSALS2 26820 ....... 26900 ....... VerDate Aug<31>2005 Wage index Urban area (constituent counties) Harrison County, MS. Stone County, MS. Hagerstown-Martinsburg, MD–WV ................................................................................................................... Washington County, MD. Berkeley County, WV. Morgan County, WV. 2 Hanford-Corcoran, CA .................................................................................................................................... Kings County, CA. Harrisburg-Carlisle, PA ..................................................................................................................................... Cumberland County, PA. Dauphin County, PA. Perry County, PA. Harrisonburg, VA .............................................................................................................................................. Rockingham County, VA. Harrisonburg City, VA. 1 2 Hartford-West Hartford-East Hartford, CT .................................................................................................... Hartford County, CT. Litchfield County, CT. Middlesex County, CT. Tolland County, CT. 2 Hattiesburg, MS .............................................................................................................................................. Forrest County, MS. Lamar County, MS. Perry County, MS. Hickory-Lenoir-Morganton, NC ......................................................................................................................... Alexander County, NC. Burke County, NC. Caldwell County, NC. Catawba County, NC. Hinesville-Fort Stewart, GA ............................................................................................................................... Liberty County, GA. Long County, GA. Holland-Grand Haven, MI ................................................................................................................................. Ottawa County, MI. Honolulu, HI ...................................................................................................................................................... Honolulu County, HI. Hot Springs, AR ................................................................................................................................................ Garland County, AR. Houma-Bayou Cane-Thibodaux, LA ................................................................................................................. Lafourche Parish, LA. Terrebonne Parish, LA. 1 Houston-Sugar Land-Baytown, TX ................................................................................................................. Austin County, TX. Brazoria County, TX. Chambers County, TX. Fort Bend County, TX. Galveston County, TX. Harris County, TX. Liberty County, TX. Montgomery County, TX. San Jacinto County, TX. Waller County, TX. Huntington-Ashland, WV–KY–OH .................................................................................................................... Boyd County, KY. Greenup County, KY. Lawrence County, OH. Cabell County, WV. Wayne County, WV. Huntsville, AL .................................................................................................................................................... Limestone County, AL. Madison County, AL. Idaho Falls, ID ................................................................................................................................................... Bonneville County, ID. Jefferson County, ID. 1 Indianapolis-Carmel, IN .................................................................................................................................. Boone County, IN. Brown County, IN. Hamilton County, IN. Hancock County, IN. Hendricks County, IN. 17:10 Apr 24, 2006 Jkt 208001 PO 00000 Frm 00250 Fmt 4701 Sfmt 4702 E:\FR\FM\25APP2.SGM 25APP2 GAF 0.9082 0.9362 1.1291 1.0867 0.9413 0.9594 0.9093 0.9370 1.1750 1.1168 0.7579 0.8271 0.9029 0.9324 0.7577 0.8270 0.9241 0.9474 1.1066 1.0718 0.8812 0.9170 0.8003 0.8585 1.0030 1.0021 0.9009 0.9310 0.9027 0.9323 0.9300 0.9515 0.9757 0.9833 24245 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules TABLE 4A–1.—WAGE INDEX AND CAPITAL GEOGRAPHIC ADJUSTMENT FACTOR (GAF) FOR URBAN AREAS BY CBSA— FY 2007—Continued CBSA code 26980 ....... 27060 ....... 27100 ....... 27140 ....... 27180 ....... 27260 ....... 27340 ....... 27500 ....... 27620 ....... 27740 ....... 27780 ....... 27860 ....... 27900 ....... 28020 ....... 28100 ....... wwhite on PROD1PC61 with PROPOSALS2 28140 ....... 28420 ....... VerDate Aug<31>2005 Wage index Urban area (constituent counties) Johnson County, IN. Marion County, IN. Morgan County, IN. Putnam County, IN. Shelby County, IN. Iowa City, IA ...................................................................................................................................................... Johnson County, IA. Washington County, IA. Ithaca, NY ......................................................................................................................................................... Tompkins County, NY. Jackson, MI ....................................................................................................................................................... Jackson County, MI. Jackson, MS ..................................................................................................................................................... Copiah County, MS. Hinds County, MS. Madison County, MS. Rankin County, MS. Simpson County, MS ..................................................................................................................................... Jackson, TN. Chester County, TN. Madison County, TN. 1 Jacksonville, FL .............................................................................................................................................. Baker County, FL. Clay County, FL. Duval County, FL. Nassau County, FL. St. Johns County, FL. 2 Jacksonville, NC ............................................................................................................................................. Onslow County, NC. Janesville, WI .................................................................................................................................................... Rock County, WI. Jefferson City, MO ............................................................................................................................................ Callaway County, MO. Cole County, MO. Moniteau County, MO. Osage County, MO. Johnson City, TN .............................................................................................................................................. Carter County, TN. Unicoi County, TN. Washington County, TN. Johnstown, PA .................................................................................................................................................. Cambria County, PA. Jonesboro, AR .................................................................................................................................................. Craighead County, AR. Poinsett County, AR. Joplin, MO ......................................................................................................................................................... Jasper County, MO. Newton County, MO. Kalamazoo-Portage, MI .................................................................................................................................... Kalamazoo County, MI. Van Buren County, MI. Kankakee-Bradley, IL ........................................................................................................................................ Kankakee County, IL. 1 Kansas City, MO–KS ...................................................................................................................................... Franklin County, KS. Johnson County, KS. Leavenworth County, KS. Linn County, KS. Miami County, KS. Wyandotte County, KS. Bates County, MO. Caldwell County, MO. Cass County, MO. Clay County, MO. Clinton County, MO. Jackson County, MO. Lafayette County, MO. Platte County, MO. Ray County, MO. 2 Kennewick-Richland-Pasco, WA .................................................................................................................... 17:10 Apr 24, 2006 Jkt 208001 PO 00000 Frm 00251 Fmt 4701 Sfmt 4702 E:\FR\FM\25APP2.SGM 25APP2 GAF 0.9726 0.9812 0.9883 0.9920 0.9562 0.9698 0.8278 0.8786 0.8860 0.9205 0.9046 0.9336 0.8607 0.9024 0.9685 0.9783 0.8341 0.8832 0.8070 0.8634 0.8621 0.9034 0.7952 0.8548 0.8620 0.9033 1.0737 1.0499 1.0005 1.0003 0.9501 0.9656 1.0440 1.0299 24246 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules TABLE 4A–1.—WAGE INDEX AND CAPITAL GEOGRAPHIC ADJUSTMENT FACTOR (GAF) FOR URBAN AREAS BY CBSA— FY 2007—Continued CBSA code 28660 ....... 28700 ....... 28740 ....... 28940 ....... 29020 ....... 29100 ....... 29100 ....... 29140 ....... 29180 ....... 29340 ....... 29400 ....... 29460 ....... 29540 ....... 29620 ....... 29700 ....... 29740 ....... 29820 ....... 29940 ....... 30020 ....... wwhite on PROD1PC61 with PROPOSALS2 30140 ....... 30300 ....... 30300 ....... 30340 ....... VerDate Aug<31>2005 Wage index Urban area (constituent counties) Benton County, WA. Franklin County, WA. Killeen-Temple-Fort Hood, TX .......................................................................................................................... Bell County, TX. Coryell County, TX. Lampasas County, TX. Kingsport-Bristol-Bristol, TN–VA ....................................................................................................................... Hawkins County, TN. Sullivan County, TN. Bristol City, VA. Scott County, VA. Washington County, VA. Kingston, NY ..................................................................................................................................................... Ulster County, NY. Knoxville, TN ..................................................................................................................................................... Anderson County, TN. Blount County, TN. Knox County, TN. Loudon County, TN. Union County, TN. Kokomo, IN ....................................................................................................................................................... Howard County, IN. Tipton County, IN. 2 La Crosse, WI–MN (WI Hospitals) ................................................................................................................. Houston County, MN. La Crosse County, WI. La Crosse, WI–MN (MN Hospitals) .................................................................................................................. Houston County, MN. La Crosse County, WI. Lafayette, IN ...................................................................................................................................................... Benton County, IN. Carroll County, IN. Tippecanoe County, IN. Lafayette, LA ..................................................................................................................................................... Lafayette Parish, LA. St. Martin Parish, LA. Lake Charles, LA .............................................................................................................................................. Calcasieu Parish, LA. Cameron Parish, LA. Lake County-Kenosha County, IL–WI .............................................................................................................. Lake County, IL. Kenosha County, WI. Lakeland, FL ..................................................................................................................................................... Polk County, FL. Lancaster, PA ................................................................................................................................................... Lancaster County, PA. Lansing-East Lansing, MI ................................................................................................................................. Clinton County, MI. Eaton County, MI. Ingham County, MI. 2 Laredo, TX ...................................................................................................................................................... Webb County, TX. Las Cruces, NM ................................................................................................................................................ Dona Ana County, NM. 1 Las Vegas-Paradise, NV ................................................................................................................................ Clark County, NV. Lawrence, KS .................................................................................................................................................... Douglas County, KS. Lawton, OK ....................................................................................................................................................... Comanche County, OK. Lebanon, PA ..................................................................................................................................................... Lebanon County, PA. Lewiston, ID–WA (ID Hospitals) ....................................................................................................................... Nez Perce County, ID. Asotin County, WA. 2 Lewiston, ID–WA (WA Hospitals) ................................................................................................................... Nez Perce County, ID. Asotin County, WA. Lewiston-Auburn, ME ........................................................................................................................................ Androscoggin County, ME. 17:10 Apr 24, 2006 Jkt 208001 PO 00000 Frm 00252 Fmt 4701 Sfmt 4702 E:\FR\FM\25APP2.SGM 25APP2 GAF 0.9131 0.9396 0.8062 0.8628 0.9387 0.9576 0.8278 0.8786 0.9494 0.9651 0.9466 0.9631 0.9427 0.9604 0.8957 0.9273 0.8300 0.8802 0.7934 0.8534 1.0408 1.0278 0.8908 0.9239 0.9768 0.9841 1.0096 1.0066 0.8003 0.8585 0.9270 0.9494 1.1417 1.0950 0.8346 0.8835 0.8116 0.8668 0.8886 0.9223 0.9853 0.9899 1.0440 1.0299 0.9141 0.9403 24247 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules TABLE 4A–1.—WAGE INDEX AND CAPITAL GEOGRAPHIC ADJUSTMENT FACTOR (GAF) FOR URBAN AREAS BY CBSA— FY 2007—Continued CBSA code Urban area (constituent counties) 30460 ....... Lexington-Fayette, KY ...................................................................................................................................... Bourbon County, KY. Clark County, KY. Fayette County, KY. Jessamine County, KY. Scott County, KY. Woodford County, KY. Lima, OH ........................................................................................................................................................... Allen County, OH. Lincoln, NE ........................................................................................................................................................ Lancaster County, NE. Seward County, NE. Little Rock-North Little Rock, AR ...................................................................................................................... Faulkner County, AR. Grant County, AR. Lonoke County, AR. Perry County, AR. Pulaski County, AR. Saline County, AR. Logan, UT–ID .................................................................................................................................................... Franklin County, ID. Cache County, UT. Longview, TX .................................................................................................................................................... Gregg County, TX. Rusk County, TX. Upshur County, TX. 2 Longview, WA ................................................................................................................................................. Cowlitz County, WA. 1 3 Los Angeles-Long Beach-Glendale, CA ....................................................................................................... Los Angeles County, CA. 1 Louisville-Jefferson County, KY–IN ................................................................................................................ Clark County, IN. Floyd County, IN. Harrison County, IN. Washington County, IN. Bullitt County, KY. Henry County, KY. Jefferson County, KY. Meade County, KY. Nelson County, KY. Oldham County, KY. Shelby County, KY. Spencer County, KY. Trimble County, KY. Lubbock, TX ...................................................................................................................................................... Crosby County, TX. Lubbock County, TX. Lynchburg, VA .................................................................................................................................................. Amherst County, VA. Appomattox County, VA. Bedford County, VA. Campbell County, VA. Bedford City, VA. Lynchburg City, VA. Macon, GA ........................................................................................................................................................ Bibb County, GA. Crawford County, GA. Jones County, GA. Monroe County, GA. Twiggs County, GA. 2 Madera, CA ..................................................................................................................................................... Madera County, CA. Madison, WI ...................................................................................................................................................... Columbia County, WI. Dane County, WI. Iowa County, WI. 2 Manchester-Nashua, NH ................................................................................................................................ Hillsborough County, NH. Merrimack County, NH. Mansfield, OH ................................................................................................................................................... 30620 ....... 30700 ....... 30780 ....... 30860 ....... 30980 ....... 31020 ....... 31084 ....... 31140 ....... 31180 ....... 31340 ....... 31420 ....... wwhite on PROD1PC61 with PROPOSALS2 31460 ....... 31540 ....... 31700 ....... 31900 ....... VerDate Aug<31>2005 17:10 Apr 24, 2006 Jkt 208001 PO 00000 Frm 00253 Fmt 4701 Sfmt 4702 Wage index E:\FR\FM\25APP2.SGM 25APP2 GAF 0.9168 0.9422 0.9060 0.9346 1.0084 1.0057 0.8918 0.9246 0.9049 0.9339 0.8905 0.9237 1.0440 1.0299 1.1762 1.1175 0.9137 0.9401 0.8626 0.9037 0.8716 0.9102 0.9554 0.9692 1.1291 1.0867 1.0731 1.0495 1.1665 1.1112 0.9298 0.9514 24248 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules TABLE 4A–1.—WAGE INDEX AND CAPITAL GEOGRAPHIC ADJUSTMENT FACTOR (GAF) FOR URBAN AREAS BY CBSA— FY 2007—Continued CBSA code 32420 ....... 32580 ....... 32780 ....... 32820 ....... 32900 ....... 33124 ....... 33140 ....... 33260 ....... 33340 ....... 33460 ....... 33540 ....... 33660 ....... 33700 ....... 33740 ....... 33780 ....... 33860 ....... wwhite on PROD1PC61 with PROPOSALS2 34060 ....... 34100 ....... 34580 ....... 34620 ....... VerDate Aug<31>2005 Wage index Urban area (constituent counties) Richland County, OH. ¨ Mayaguez, PR .................................................................................................................................................. Hormigueros Municipio, PR. ¨ Mayaguez Municipio, PR. McAllen-Edinburg-Mission, TX .......................................................................................................................... Hidalgo County, TX. Medford, OR ..................................................................................................................................................... Jackson County, OR. 1 Memphis, TN–MS–AR .................................................................................................................................... Crittenden County, AR. DeSoto County, MS. Marshall County, MS. Tate County, MS. Tunica County, MS. Fayette County, TN. Shelby County, TN. Tipton County, TN. Merced, CA ....................................................................................................................................................... Merced County, CA. 1 Miami-Miami Beach-Kendall, FL ..................................................................................................................... Miami-Dade County, FL. Michigan City-La Porte, IN ................................................................................................................................ LaPorte County, IN. Midland, TX ....................................................................................................................................................... Midland County, TX. 1 Milwaukee-Waukesha-West Allis, WI ............................................................................................................. Milwaukee County, WI. Ozaukee County, WI. Washington County, WI. Waukesha County, WI. 1 Minneapolis-St. Paul-Bloomington, MN–WI .................................................................................................... Anoka County, MN. Carver County, MN. Chisago County, MN. Dakota County, MN. Hennepin County, MN. Isanti County, MN. Ramsey County, MN. Scott County, MN. Sherburne County, MN. Washington County, MN. Wright County, MN. Pierce County, WI. St. Croix County, WI. Missoula, MT ..................................................................................................................................................... Missoula County, MT. Mobile, AL ......................................................................................................................................................... Mobile County, AL. Modesto, CA ..................................................................................................................................................... Stanislaus County, CA. Monroe, LA ....................................................................................................................................................... Ouachita Parish, LA. Union Parish, LA. Monroe, MI ........................................................................................................................................................ Monroe County, MI. Montgomery, AL ................................................................................................................................................ Autauga County, AL. Elmore County, AL. Lowndes County, AL. Montgomery County, AL. Morgantown, WV .............................................................................................................................................. Monongalia County, WV. Preston County, WV. 2 Morristown, TN ................................................................................................................................................ Grainger County, TN. Hamblen County, TN. Jefferson County, TN. Mount Vernon-Anacortes, WA .......................................................................................................................... Skagit County, WA. 2 Muncie, IN ....................................................................................................................................................... 17:10 Apr 24, 2006 Jkt 208001 PO 00000 Frm 00254 Fmt 4701 Sfmt 4702 E:\FR\FM\25APP2.SGM 25APP2 GAF 0.3856 0.5207 0.8790 0.9155 1.0836 1.0565 0.9367 0.9562 1.1421 1.0953 0.9825 0.9880 0.9093 0.9370 0.9802 0.9864 1.0241 1.0164 1.0943 1.0637 0.8909 0.9239 0.7955 0.8550 1.1731 1.1155 0.8015 0.8594 0.9715 0.9804 0.8035 0.8609 0.8449 0.8910 0.7957 0.8551 1.0514 1.0349 0.8479 0.8932 24249 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules TABLE 4A–1.—WAGE INDEX AND CAPITAL GEOGRAPHIC ADJUSTMENT FACTOR (GAF) FOR URBAN AREAS BY CBSA— FY 2007—Continued CBSA code 34740 ....... 34820 ....... 34900 ....... 34940 ....... 34980 ....... 35004 ....... 35080 ....... 35300 ....... 35380 ....... 35644 ....... 35660 ....... 35980 ....... wwhite on PROD1PC61 with PROPOSALS2 36084 ....... 36100 ....... 36140 ....... 36220 ....... 36260 ....... VerDate Aug<31>2005 Wage index Urban area (constituent counties) Delaware County, IN. Shores, MI ......................................................................................................................... Muskegon County, MI. Myrtle Beach-Conway-North Myrtle Beach, SC ............................................................................................... Horry County, SC. Napa, CA .......................................................................................................................................................... Napa County, CA. Naples-Marco Island, FL ................................................................................................................................... Collier County, FL. 1 Nashville-Davidson-Murfreesboro, TN ............................................................................................................ Cannon County, TN. Cheatham County, TN. Davidson County, TN. Dickson County, TN. Hickman County, TN. Macon County, TN. Robertson County, TN. Rutherford County, TN. Smith County, TN. Sumner County, TN. Trousdale County, TN. Williamson County, TN. Wilson County, TN. 1 3 Nassau-Suffolk, NY ...................................................................................................................................... Nassau County, NY. Suffolk County, NY. 1 Newark-Union, NJ–PA .................................................................................................................................... Essex County, NJ. Hunterdon County, NJ. Morris County, NJ. Sussex County, NJ. Union County, NJ. Pike County, PA. New Haven-Milford, CT ..................................................................................................................................... New Haven County, CT. 1 New Orleans-Metairie-Kenner, LA .................................................................................................................. Jefferson Parish, LA. Orleans Parish, LA. Plaquemines Parish, LA. St. Bernard Parish, LA. St. Charles Parish, LA. St. John the Baptist Parish, LA. St. Tammany Parish, LA. 1 3 New York-White Plains-Wayne, NY–NJ ....................................................................................................... Bergen County, NJ. Hudson County, NJ. Passaic County, NJ. Bronx County, NY. Kings County, NY. New York County, NY. Putnam County, NY. Queens County, NY. Richmond County, NY. Rockland County, NY. Westchester County, NY. 2 Niles-Benton Harbor, MI ................................................................................................................................. Berrien County, MI. Norwich-New London, CT ............................................................................................................................. New London County, CT. 1 Oakland-Fremont-Hayward, CA ...................................................................................................................... Alameda County, CA. Contra Costa County, CA. Ocala, FL .......................................................................................................................................................... Marion County, FL. 2 Ocean City, NJ ................................................................................................................................................ Cape May County, NJ. Odessa, TX ....................................................................................................................................................... Ector County, TX. Ogden-Clearfield, UT ........................................................................................................................................ Davis County, UT. 3 Muskegon-Norton 17:10 Apr 24, 2006 Jkt 208001 PO 00000 Frm 00255 Fmt 4701 Sfmt 4702 E:\FR\FM\25APP2.SGM 25APP2 GAF 0.9961 0.9973 0.8819 0.9175 1.3484 1.2272 0.9935 0.9955 0.9853 0.9899 1.2701 1.1779 1.1886 1.1256 1.2093 1.1390 0.8855 0.9201 1.3215 1.2103 0.9055 0.9343 1.2020 1.1343 1.5669 1.3601 0.8904 0.9236 1.1226 1.0824 1.0119 1.0081 0.9021 0.9319 24250 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules TABLE 4A–1.—WAGE INDEX AND CAPITAL GEOGRAPHIC ADJUSTMENT FACTOR (GAF) FOR URBAN AREAS BY CBSA— FY 2007—Continued CBSA code 36420 ....... 36500 ....... 36540 ....... 36740 ....... 36780 ....... 36980 ....... 37100 ....... 37340 ....... 37460 ....... 37620 ....... 37620 ....... 37700 ....... 37860 ....... 37900 ....... wwhite on PROD1PC61 with PROPOSALS2 37964 ....... 38060 ....... 38220 ....... VerDate Aug<31>2005 Wage index Urban area (constituent counties) Morgan County, UT. Weber County, UT. 1 Oklahoma City, OK ......................................................................................................................................... Canadian County, OK. Cleveland County, OK. Grady County, OK. Lincoln County, OK. Logan County, OK. McClain County, OK. Oklahoma County, OK. Olympia, WA ..................................................................................................................................................... Thurston County, WA. Omaha-Council Bluffs, NE–IA ........................................................................................................................... Harrison County, IA. Mills County, IA. Pottawattamie County, IA. Cass County, NE. Douglas County, NE. Sarpy County, NE. Saunders County, NE. Washington County, NE. 1 Orlando-Kissimmee, FL .................................................................................................................................. Lake County, FL. Orange County, FL. Osceola County, FL. Seminole County, FL. 2 Oshkosh-Neenah, WI ...................................................................................................................................... Winnebago County, WI. Owensboro, KY ................................................................................................................................................. Daviess County, KY. Hancock County, KY. McLean County, KY. Oxnard-Thousand Oaks-Ventura, CA ............................................................................................................... Ventura County, CA. Palm Bay-Melbourne-Titusville, FL ................................................................................................................... Brevard County, FL. 2 Panama City-Lynn Haven, FL ........................................................................................................................ Bay County, FL. Parkersburg-Marietta-Vienna, WV–OH (WV Hospitals) ................................................................................... Washington County, OH. Pleasants County, WV. Wirt County, WV. Wood County, WV. 2 Parkersburg-Marietta-Vienna, WV–OH (OH Hospitals) .................................................................................. Washington County, OH. Pleasants County, WV. Wirt County, WV. Wood County, WV. Pascagoula, MS ................................................................................................................................................ George County, MS. Jackson County, MS. 2 Pensacola-Ferry Pass-Brent, FL .................................................................................................................... Escambia County, FL. Santa Rosa County, FL. Peoria, IL ........................................................................................................................................................... Marshall County, IL. Peoria County, IL. Stark County, IL. Tazewell County, IL. Woodford County, IL. 1 Philadelphia, PA .............................................................................................................................................. Bucks County, PA. Chester County, PA. Delaware County, PA. Montgomery County, PA. Philadelphia County, PA. 1 Phoenix-Mesa-Scottsdale, AZ ........................................................................................................................ Maricopa County, AZ. Pinal County, AZ. Pine Bluff, AR ................................................................................................................................................... 17:10 Apr 24, 2006 Jkt 208001 PO 00000 Frm 00256 Fmt 4701 Sfmt 4702 E:\FR\FM\25APP2.SGM 25APP2 GAF 0.8857 0.9202 1.1096 1.0738 0.9453 0.9622 0.9409 0.9591 0.9466 0.9631 0.8780 0.9148 1.1583 1.1059 0.9440 0.9613 0.8609 0.9025 0.7964 0.8556 0.8673 0.9071 0.8229 0.8750 0.8609 0.9025 0.8973 0.9285 1.1009 1.0680 1.0307 1.0209 0.8423 0.8891 24251 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules TABLE 4A–1.—WAGE INDEX AND CAPITAL GEOGRAPHIC ADJUSTMENT FACTOR (GAF) FOR URBAN AREAS BY CBSA— FY 2007—Continued CBSA code 38300 ....... 38340 ....... 38540 ....... 38660 ....... 38860 ....... 38900 ....... 38940 ....... 39100 ....... 39140 ....... 39300 ....... 39340 ....... 39380 ....... 39460 ....... 39540 ....... 39580 ....... wwhite on PROD1PC61 with PROPOSALS2 39660 ....... 39740 ....... 39820 ....... 39900 ....... VerDate Aug<31>2005 Wage index Urban area (constituent counties) Cleveland County, AR. Jefferson County, AR. Lincoln County, AR. 1 Pittsburgh, PA ................................................................................................................................................. Allegheny County, PA. Armstrong County, PA. Beaver County, PA. Butler County, PA. Fayette County, PA. Washington County, PA. Westmoreland County, PA. 2 Pittsfield, MA ................................................................................................................................................... Berkshire County, MA. Pocatello, ID ...................................................................................................................................................... Bannock County, ID. Power County, ID. Ponce, PR ......................................................................................................................................................... ´ Juana Dıaz Municipio, PR. Ponce Municipio, PR. Villalba Municipio, PR. Portland-South Portland-Biddeford, ME ............................................................................................................ Cumberland County, ME. Sagadahoc County, ME. York County, ME. 1 Portland-Vancouver-Beaverton, OR–WA ....................................................................................................... Clackamas County, OR. Columbia County, OR. Multnomah County, OR. Washington County, OR. Yamhill County, OR. Clark County, WA. Skamania County, WA. Port St. Lucie-Fort Pierce, FL ........................................................................................................................... Martin County, FL. St. Lucie County, FL. Poughkeepsie-Newburgh-Middletown, NY ....................................................................................................... Dutchess County, NY. Orange County, NY. Prescott, AZ ...................................................................................................................................................... Yavapai County, AZ. 1 Providence-New Bedford-Fall River, RI–MA .................................................................................................. Bristol County, MA. Bristol County, RI. Kent County, RI. Newport County, RI. Providence County, RI. Washington County, RI. Provo-Orem, UT ................................................................................................................................................ Juab County, UT. Utah County, UT. 2 Pueblo, CO ..................................................................................................................................................... Pueblo County, CO. Punta Gorda, FL ............................................................................................................................................... Charlotte County, FL. 2 Racine, WI ...................................................................................................................................................... Racine County, WI. Raleigh-Cary, NC .............................................................................................................................................. Franklin County, NC. Johnston County, NC. Wake County, NC. Rapid City, SD .................................................................................................................................................. Meade County, SD. Pennington County, SD. Reading, PA ...................................................................................................................................................... Berks County, PA. Redding, CA ...................................................................................................................................................... Shasta County, CA. Reno-Sparks, NV .............................................................................................................................................. Storey County, NV. Washoe County, NV. 17:10 Apr 24, 2006 Jkt 208001 PO 00000 Frm 00257 Fmt 4701 Sfmt 4702 E:\FR\FM\25APP2.SGM 25APP2 GAF 0.8671 0.9070 1.0664 1.0450 0.9400 0.9585 0.4852 0.6094 0.9916 0.9942 1.1405 1.0942 0.9857 0.9902 1.0913 1.0617 0.9858 0.9903 1.0791 1.0535 0.9537 0.9681 0.9331 0.9537 0.9432 0.9607 0.9466 0.9631 0.9855 0.9900 1.0359 1.0244 0.9642 0.9753 1.3205 1.2097 1.1975 1.1314 24252 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules TABLE 4A–1.—WAGE INDEX AND CAPITAL GEOGRAPHIC ADJUSTMENT FACTOR (GAF) FOR URBAN AREAS BY CBSA— FY 2007—Continued CBSA code 40060 ....... 40140 ....... 40220 ....... 40340 ....... 40380 ....... 40420 ....... 40484 ....... 40580 ....... 40660 ....... 40900 ....... 40980 ....... wwhite on PROD1PC61 with PROPOSALS2 41060 ....... 41100 ....... 41140 ....... 41180 ....... VerDate Aug<31>2005 Wage index Urban area (constituent counties) 1 Richmond, VA ................................................................................................................................................. Amelia County, VA. Caroline County, VA. Charles City County, VA. Chesterfield County, VA. Cumberland County, VA. Dinwiddie County, VA. Goochland County, VA. Hanover County, VA. Henrico County, VA. King and Queen County, VA. King William County, VA. Louisa County, VA. New Kent County, VA. Powhatan County, VA. Prince George County, VA. Sussex County, VA. Colonial Heights City, VA. Hopewell City, VA. Petersburg City, VA. Richmond City, VA. 1 2 Riverside-San Bernardino-Ontario, CA ........................................................................................................ Riverside County, CA. San Bernardino County, CA. Roanoke, VA ..................................................................................................................................................... Botetourt County, VA. Craig County, VA. Franklin County, VA. Roanoke County, VA. Roanoke City, VA. Salem City, VA. Rochester, MN .................................................................................................................................................. Dodge County, MN. Olmsted County, MN. Wabasha County, MN. 1 Rochester, NY ................................................................................................................................................. Livingston County, NY. Monroe County, NY. Ontario County, NY. Orleans County, NY. Wayne County, NY. Rockford, IL ....................................................................................................................................................... Boone County, IL. Winnebago County, IL. 2 Rockingham County-Strafford County, NH ..................................................................................................... Rockingham County, NH. Strafford County, NH. Rocky Mount, NC .............................................................................................................................................. Edgecombe County, NC. Nash County, NC. Rome, GA ......................................................................................................................................................... Floyd County, GA. 1 Sacramento—Arden-Arcade—Roseville, CA .................................................................................................. El Dorado County, CA. Placer County, CA. Sacramento County, CA. Yolo County, CA. 2 Saginaw-Saginaw Township North, MI ........................................................................................................... Saginaw County, MI. St. Cloud, MN ................................................................................................................................................... Benton County, MN. Stearns County, MN. St. George, UT .................................................................................................................................................. Washington County, UT. St. Joseph, MO–KS .......................................................................................................................................... Doniphan County, KS. Andrew County, MO. Buchanan County, MO. DeKalb County, MO. 1 St. Louis, MO–IL ............................................................................................................................................. 17:10 Apr 24, 2006 Jkt 208001 PO 00000 Frm 00258 Fmt 4701 Sfmt 4702 E:\FR\FM\25APP2.SGM 25APP2 GAF 0.9174 0.9427 1.1291 1.0867 0.8677 0.9074 1.1246 1.0837 0.9007 0.9309 0.9987 0.9991 1.1665 1.1112 0.8869 0.9211 0.9307 0.9520 1.3350 1.2188 0.9055 0.9343 1.0438 1.0298 0.9295 0.9512 1.0174 1.0119 0.9017 0.9316 24253 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules TABLE 4A–1.—WAGE INDEX AND CAPITAL GEOGRAPHIC ADJUSTMENT FACTOR (GAF) FOR URBAN AREAS BY CBSA— FY 2007—Continued CBSA code 41420 ....... 41500 ....... 41540 ....... 41620 ....... 41660 ....... 41700 ....... 41740 ....... 41780 ....... 41884 ....... 41900 ....... 41940 ....... wwhite on PROD1PC61 with PROPOSALS2 41980 ....... VerDate Aug<31>2005 Wage index Urban area (constituent counties) Bond County, IL. Calhoun County, IL. Clinton County, IL. Jersey County, IL. Macoupin County, IL. Madison County, IL. Monroe County, IL. St. Clair County, IL. Crawford County, MO. Franklin County, MO. Jefferson County, MO. Lincoln County, MO. St. Charles County, MO. St. Louis County, MO. Warren County, MO. Washington County, MO. St. Louis City, MO. Salem, OR ........................................................................................................................................................ Marion County, OR. Polk County, OR. Salinas, CA ....................................................................................................................................................... Monterey County, CA. Salisbury, MD .................................................................................................................................................... Somerset County, MD. Wicomico County, MD. Salt Lake City, UT ............................................................................................................................................. Salt Lake County, UT. Summit County, UT. Tooele County, UT. San Angelo, TX ................................................................................................................................................. Irion County, TX. Tom Green County, TX. 1 San Antonio, TX .............................................................................................................................................. Atascosa County, TX. Bandera County, TX. Bexar County, TX. Comal County, TX. Guadalupe County, TX. Kendall County, TX. Medina County, TX. Wilson County, TX. 1 San Diego-Carlsbad-San Marcos, CA ............................................................................................................ San Diego County, CA. Sandusky, OH ................................................................................................................................................... Erie County, OH. 1 San Francisco-San Mateo-Redwood City, CA ............................................................................................... Marin County, CA. San Francisco County, CA. San Mateo County, CA. ´ San German-Cabo Rojo, PR ............................................................................................................................ Cabo Rojo Municipio, PR. Lajas Municipio, PR. Sabana Grande Municipio, PR. ´ San German Municipio, PR. 1 San Jose-Sunnyvale-Santa Clara, CA ........................................................................................................... San Benito County, CA. Santa Clara County, CA. 1 San Juan-Caguas-Guaynabo, PR .................................................................................................................. Aguas Buenas Municipio, PR. Aibonito Municipio, PR. Arecibo Municipio, PR. Barceloneta Municipio, PR. Barranquitas Municipio, PR. ´ Bayamon Municipio, PR. Caguas Municipio, PR. Camuy Municipio, PR. ´ Canovanas Municipio, PR. Carolina Municipio, PR. ˜ Catano Municipio, PR. Cayey Municipio, PR. 17:10 Apr 24, 2006 Jkt 208001 PO 00000 Frm 00259 Fmt 4701 Sfmt 4702 E:\FR\FM\25APP2.SGM 25APP2 GAF 1.0452 1.0307 1.4457 1.2871 0.8958 0.9274 0.9421 0.9600 0.8385 0.8864 0.8859 0.9204 1.1371 1.0920 0.9328 0.9535 1.5049 1.3230 0.4884 0.6122 1.5281 1.3369 0.4396 0.5696 24254 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules TABLE 4A–1.—WAGE INDEX AND CAPITAL GEOGRAPHIC ADJUSTMENT FACTOR (GAF) FOR URBAN AREAS BY CBSA— FY 2007—Continued CBSA code 42020 ....... 42044 ....... 42060 ....... 42100 ....... 42140 ....... 42220 ....... 42260 ....... 42340 ....... 42540 ....... 42644 ....... 42680 ....... 43100 ....... 43300 ....... wwhite on PROD1PC61 with PROPOSALS2 43340 ....... 43580 ....... VerDate Aug<31>2005 Wage index Urban area (constituent counties) Ciales Municipio, PR. Cidra Municipio, PR. ´ Comerıo Municipio, PR. Corozal Municipio, PR. Dorado Municipio, PR. Florida Municipio, PR. Guaynabo Municipio, PR. Gurabo Municipio, PR. Hatillo Municipio, PR. Humacao Municipio, PR. Juncos Municipio, PR. Las Piedras Municipio, PR. ´ Loıza Municipio, PR. ´ Manatı Municipio, PR. Maunabo Municipio, PR. Morovis Municipio, PR. Naguabo Municipio, PR. Naranjito Municipio, PR. Orocovis Municipio, PR. Quebradillas Municipio, PR. ´ Rıo Grande Municipio, PR. San Juan Municipio, PR. San Lorenzo Municipio, PR. Toa Alta Municipio, PR. Toa Baja Municipio, PR. Trujillo Alto Municipio, PR. Vega Alta Municipio, PR. Vega Baja Municipio, PR. Yabucoa Municipio, PR. San Luis Obispo-Paso Robles, CA ................................................................................................................... San Luis Obispo County, CA. 1 2 Santa Ana-Anaheim-Irvine, CA .................................................................................................................... Orange County, CA. 2 Santa Barbara-Santa Maria, CA ..................................................................................................................... Santa Barbara County, CA. Santa Cruz-Watsonville, CA ............................................................................................................................. Santa Cruz County, CA. Santa Fe, NM .................................................................................................................................................... Santa Fe County, NM. Santa Rosa-Petaluma, CA ................................................................................................................................ Sonoma County, CA. Sarasota-Bradenton-Venice, FL ........................................................................................................................ Manatee County, FL. Sarasota County, FL. Savannah, GA ................................................................................................................................................... Bryan County, GA. Chatham County, GA. Effingham County, GA. Scranton—Wilkes-Barre, PA ............................................................................................................................. Lackawanna County, PA. Luzerne County, PA. Wyoming County, PA. 1 Seattle-Bellevue-Everett, WA ......................................................................................................................... King County, WA. Snohomish County, WA. Sebastian-Vero Beach, FL ................................................................................................................................ Indian River County, FL. 2 Sheboygan, WI ............................................................................................................................................... Sheboygan County, WI. Sherman-Denison, TX ....................................................................................................................................... Grayson County, TX. Shreveport-Bossier City, LA .............................................................................................................................. Bossier Parish, LA. Caddo Parish, LA. De Soto Parish, LA. Sioux City, IA–NE–SD ...................................................................................................................................... Woodbury County, IA. Dakota County, NE. Dixon County, NE. Union County, SD. 17:10 Apr 24, 2006 Jkt 208001 PO 00000 Frm 00260 Fmt 4701 Sfmt 4702 E:\FR\FM\25APP2.SGM 25APP2 GAF 1.1616 1.1080 1.1291 1.0867 1.1291 1.0867 1.5509 1.3506 1.0821 1.0555 1.4459 1.2872 0.9866 0.9908 0.9089 0.9367 0.8503 0.8949 1.1438 1.0964 0.9604 0.9727 0.9466 0.9631 0.8521 0.8962 0.8879 0.9218 0.9201 0.9446 24255 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules TABLE 4A–1.—WAGE INDEX AND CAPITAL GEOGRAPHIC ADJUSTMENT FACTOR (GAF) FOR URBAN AREAS BY CBSA— FY 2007—Continued CBSA code Urban area (constituent counties) 43620 ....... Sioux Falls, SD ................................................................................................................................................. Lincoln County, SD. McCook County, SD. Minnehaha County, SD. Turner County, SD. South Bend-Mishawaka, IN–MI ........................................................................................................................ St. Joseph County, IN. Cass County, MI. Spartanburg, SC ............................................................................................................................................... Spartanburg County, SC. Spokane, WA .................................................................................................................................................... Spokane County, WA. Springfield, IL .................................................................................................................................................... Menard County, IL. Sangamon County, IL. 2 Springfield, MA ................................................................................................................................................ Franklin County, MA. Hampden County, MA. Hampshire County, MA. Springfield, MO ................................................................................................................................................. Christian County, MO. Dallas County, MO. Greene County, MO. Polk County, MO. Webster County, MO. 2 Springfield, OH ................................................................................................................................................ Clark County, OH. State College, PA ............................................................................................................................................. Centre County, PA. Stockton, CA ..................................................................................................................................................... San Joaquin County, CA. 2 Sumter, SC ..................................................................................................................................................... Sumter County, SC. Syracuse, NY .................................................................................................................................................... Madison County, NY. Onondaga County, NY. Oswego County, NY. Tacoma, WA ..................................................................................................................................................... Pierce County, WA. Tallahassee, FL ................................................................................................................................................ Gadsden County, FL. Jefferson County, FL. Leon County, FL. Wakulla County, FL. 1 Tampa-St. Petersburg-Clearwater, FL ............................................................................................................ Hernando County, FL. Hillsborough County, FL. Pasco County, FL. Pinellas County, FL. Terre Haute, IN ................................................................................................................................................. Clay County, IN. Sullivan County, IN. Vermillion County, IN. Vigo County, IN. Texarkana, TX-Texarkana, AR ......................................................................................................................... Miller County, AR. Bowie County, TX. Toledo, OH ........................................................................................................................................................ Fulton County, OH. Lucas County, OH. Ottawa County, OH. Wood County, OH. Topeka, KS ....................................................................................................................................................... Jackson County, KS. Jefferson County, KS. Osage County, KS. Shawnee County, KS. Wabaunsee County, KS. 2 Trenton-Ewing, NJ .......................................................................................................................................... Mercer County, NJ. 43780 ....... 43900 ....... 44060 ....... 44100 ....... 44140 ....... 44180 ....... 44220 ....... 44300 ....... 44700 ....... 44940 ....... 45060 ....... 45104 ....... 45220 ....... 45300 ....... 45460 ....... 45500 ....... wwhite on PROD1PC61 with PROPOSALS2 45780 ....... 45820 ....... 45940 ....... VerDate Aug<31>2005 17:10 Apr 24, 2006 Jkt 208001 PO 00000 Frm 00261 Fmt 4701 Sfmt 4702 Wage index E:\FR\FM\25APP2.SGM 25APP2 GAF 0.9559 0.9696 0.9677 0.9778 0.9192 0.9439 1.0448 1.0305 0.8900 0.9233 1.0664 1.0450 0.8490 0.8940 0.8673 0.9071 0.8804 0.9165 1.1483 1.0993 0.8604 0.9022 0.9723 0.9809 1.0907 1.0613 0.9316 0.9526 0.9249 0.9479 0.8663 0.9064 0.8133 0.8680 0.9588 0.9716 0.8738 0.9118 1.1226 1.0824 24256 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules TABLE 4A–1.—WAGE INDEX AND CAPITAL GEOGRAPHIC ADJUSTMENT FACTOR (GAF) FOR URBAN AREAS BY CBSA— FY 2007—Continued CBSA code Urban area (constituent counties) 46060 ....... Tucson, AZ ........................................................................................................................................................ Pima County, AZ. Tulsa, OK .......................................................................................................................................................... Creek County, OK. Okmulgee County, OK. Osage County, OK. Pawnee County, OK. Rogers County, OK. Tulsa County, OK. Wagoner County, OK. Tuscaloosa, AL ................................................................................................................................................. Greene County, AL. Hale County, AL. Tuscaloosa County, AL. Tyler, TX ........................................................................................................................................................... Smith County, TX. Utica-Rome, NY ................................................................................................................................................ Herkimer County, NY. Oneida County, NY. Valdosta, GA ..................................................................................................................................................... Brooks County, GA. Echols County, GA. Lanier County, GA. Lowndes County, GA. Vallejo-Fairfield, CA .......................................................................................................................................... Solano County, CA. Victoria, TX ....................................................................................................................................................... Calhoun County, TX. Goliad County, TX. Victoria County, TX. 2 Vineland-Millville-Bridgeton, NJ ...................................................................................................................... Cumberland County, NJ. 1 Virginia Beach-Norfolk-Newport News, VA–NC ............................................................................................. Currituck County, NC. Gloucester County, VA. Isle of Wight County, VA. James City County, VA. Mathews County, VA. Surry County, VA. York County, VA. Chesapeake City, VA. Hampton City, VA. Newport News City, VA. Norfolk City, VA. Poquoson City, VA. Portsmouth City, VA. Suffolk City, VA. Virginia Beach City, VA. Williamsburg City, VA. 1 Visalia-Porterville, CA ..................................................................................................................................... Tulare County, CA. Waco, TX .......................................................................................................................................................... McLennan County, TX. Warner Robins, GA ........................................................................................................................................... Houston County, GA. 1 Warren-Troy-Farmington Hills, MI .................................................................................................................. Lapeer County, MI. Livingston County, MI. Macomb County, MI. Oakland County, MI. St. Clair County, MI. 1 Washington-Arlington-Alexandria, DC–VA–MD–WV ...................................................................................... District of Columbia, DC. Calvert County, MD. Charles County, MD. Prince George’s County, MD. Arlington County, VA. Clarke County, VA. Fairfax County, VA. Fauquier County, VA. 46140 ....... 46220 ....... 46340 ....... 46540 ....... 46660 ....... 46700 ....... 47020 ....... 47220 ....... 47260 ....... 47300 ....... 47380 ....... 47580 ....... 47644 ....... wwhite on PROD1PC61 with PROPOSALS2 47894 ....... VerDate Aug<31>2005 17:10 Apr 24, 2006 Jkt 208001 PO 00000 Frm 00262 Fmt 4701 Sfmt 4702 Wage index E:\FR\FM\25APP2.SGM 25APP2 GAF 0.9239 0.9472 0.8146 0.8690 0.8644 0.9050 0.8854 0.9200 0.8422 0.8890 0.8340 0.8831 1.5154 1.3293 0.8554 0.8986 1.1226 1.0824 0.8840 0.9190 1.1291 1.0867 0.8653 0.9057 0.8402 0.8876 1.0123 1.0084 1.1076 1.0725 24257 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules TABLE 4A–1.—WAGE INDEX AND CAPITAL GEOGRAPHIC ADJUSTMENT FACTOR (GAF) FOR URBAN AREAS BY CBSA— FY 2007—Continued CBSA code 47940 ....... 48140 ....... 48260 ....... 48260 ....... 48300 ....... 48424 ....... 48540 ....... 48540 ....... 48620 ....... 48660 ....... 48700 ....... 48864 ....... 48864 ....... wwhite on PROD1PC61 with PROPOSALS2 48900 ....... 49020 ....... 49180 ....... VerDate Aug<31>2005 Wage index Urban area (constituent counties) Loudoun County, VA. Prince William County, VA. Spotsylvania County, VA. Stafford County, VA. Warren County, VA. Alexandria City, VA. Fairfax City, VA. Falls Church City, VA. Fredericksburg City, VA. Manassas City, VA. Manassas Park City, VA. Jefferson County, WV. 2 Waterloo-Cedar Falls, IA ................................................................................................................................ Black Hawk County, IA. Bremer County, IA. Grundy County, IA. Wausau, WI ...................................................................................................................................................... Marathon County, WI. Weirton-Steubenville, WV–OH (WV Hospitals) ................................................................................................ Jefferson County, OH. Brooke County, WV. Hancock County, WV. 2 Weirton-Steubenville, WV–OH (OH Hospitals) ............................................................................................... Jefferson County, OH. Brooke County, WV. Hancock County, WV. 2 Wenatchee, WA .............................................................................................................................................. Chelan County, WA. Douglas County, WA. 1 West Palm Beach-Boca Raton-Boynton Beach, FL ....................................................................................... Palm Beach County, FL. 2 Wheeling, WV–OH (WV Hospitals) ................................................................................................................ Belmont County, OH. Marshall County, WV. Ohio County, WV. 2 Wheeling, WV–OH (OH Hospitals) ................................................................................................................. Belmont County, OH. Marshall County, WV. Ohio County, WV. Wichita, KS ....................................................................................................................................................... Butler County, KS. Harvey County, KS. Sedgwick County, KS. Sumner County, KS. Wichita Falls, TX ............................................................................................................................................... Archer County, TX. Clay County, TX. Wichita County, TX. 2 Williamsport, PA .............................................................................................................................................. Lycoming County, PA. Wilmington, DE–MD–NJ (DE, MD Hospitals) ................................................................................................... New Castle County, DE. Cecil County, MD. Salem County, NJ. 2 Wilmington, DE–MD–NJ (NJ Hospitals) ......................................................................................................... New Castle County, DE. Cecil County, MD. Salem County, NJ. Wilmington, NC ................................................................................................................................................. Brunswick County, NC. New Hanover County, NC. Pender County, NC. Winchester, VA–WV ......................................................................................................................................... Frederick County, VA. Winchester City, VA. Hampshire County, WV. Winston-Salem, NC ........................................................................................................................................... Davie County, NC. Forsyth County, NC. Stokes County, NC. 17:10 Apr 24, 2006 Jkt 208001 PO 00000 Frm 00263 Fmt 4701 Sfmt 4702 E:\FR\FM\25APP2.SGM 25APP2 GAF 0.8696 0.9088 0.9799 0.9862 0.8072 0.8636 0.8673 0.9071 1.0440 1.0299 0.9642 0.9753 0.7637 0.8314 0.8673 0.9071 0.9093 0.9370 0.8360 0.8846 0.8330 0.8824 1.0878 1.0593 1.1226 1.0824 0.9840 0.9890 1.0099 1.0068 0.9300 0.9515 24258 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules TABLE 4A–1.—WAGE INDEX AND CAPITAL GEOGRAPHIC ADJUSTMENT FACTOR (GAF) FOR URBAN AREAS BY CBSA— FY 2007—Continued CBSA code 49340 ....... 49420 ....... 49500 ....... 49620 ....... 49660 ....... 49700 ....... 49740 ....... Wage index Urban area (constituent counties) Yadkin County, NC. Worcester, MA .................................................................................................................................................. Worcester County, MA. 2 Yakima, WA .................................................................................................................................................... Yakima County, WA. Yauco, PR ......................................................................................................................................................... ´ Guanica Municipio, PR. Guayanilla Municipio, PR. ˜ Penuelas Municipio, PR. Yauco Municipio, PR. York-Hanover, PA ............................................................................................................................................. York County, PA. Youngstown-Warren-Boardman, OH–PA ......................................................................................................... Mahoning County, OH. Trumbull County, OH. Mercer County, PA. 2 Yuba City, CA ................................................................................................................................................. Sutter County, CA. Yuba County, CA. Yuma, AZ .......................................................................................................................................................... Yuma County, AZ. GAF 1.0747 1.0506 1.0440 1.0299 0.3861 0.5212 0.9416 0.9596 0.8815 0.9173 1.1291 1.0867 0.9179 0.9430 1 Large urban area. 2 Hospitals geographically located in the area are assigned the 3 For this area, the wage index and GAF on this table are only statewide rural wage index for FY 2007. effective from October 1, 2006 through March 31, 2007. See Table 4A–2 for the values that are effective from April 1 through September 30, 2007. TABLE 4A–2.—WAGE INDEX AND CAPITAL GEOGRAPHIC ADJUSTMENT FACTOR (GAF) FOR CERTAIN URBAN AREAS BY CBSA FOR THE PERIOD APRIL 1 THROUGH SEPTEMBER 30, 2007* CBSA code Urban area (constituent counties) 11460 ....... Ann Arbor, MI .................................................................................................................................................... Washtenaw County, MI Los Angeles-Long Beach-Glendale, CA ........................................................................................................... Los Angeles County, CA. Muskegon-Norton Shores, MI ........................................................................................................................... Muskegon County, MI. 1 Nassau-Suffolk, NY ......................................................................................................................................... Nassau County, NY. Suffolk County, NY. 1 New York-White Plains-Wayne, NY–NJ ......................................................................................................... Bergen County, NJ. Hudson County, NJ. Passaic County, NJ. Bronx County, NY. Kings County, NY. New York County, NY. Putnam County, NY. Queens County, NY. Richmond County, NY. Rockland County, NY. Westchester County, NY. 31084 ....... 34740 ....... 35004 ....... 35644 ....... Wage index GAF 1.0853 1.0577 1.1762 1.1175 0.9961 0.9973 1.2701 1.1779 1.3215 1.2103 1 Large urban area. * See Table 4A–1 for the wage index and GAF that are effective from October 1, 2006 through March 31, 2007. (For areas that are not listed on this table, the wage index and GAF on Table 4A–1 are effective for the entire FY 2007.) TABLE 4B.—WAGE INDEX AND CAPITAL GEORGRAPHIC ADJUSTMENT (GAF) FOR RURAL AREAS BY CBSA–FY 2007 wwhite on PROD1PC61 with PROPOSALS2 CBSA code 01 02 03 04 05 06 07 ............. ............. ............. ............. ............. ............. ............. VerDate Aug<31>2005 Wage index Nonurban area Alabama ............................................................................................................................................................ Alaska ............................................................................................................................................................... Arizona .............................................................................................................................................................. Arkansas ........................................................................................................................................................... California ........................................................................................................................................................... Colorado ............................................................................................................................................................ Connecticut ....................................................................................................................................................... 17:10 Apr 24, 2006 Jkt 208001 PO 00000 Frm 00264 Fmt 4701 Sfmt 4702 E:\FR\FM\25APP2.SGM 25APP2 0.7670 1.0669 0.9158 0.7366 1.1291 0.9331 1.1750 GAF 0.8339 1.0453 0.9415 0.8111 1.0867 0.9537 1.1168 24259 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules TABLE 4B.—WAGE INDEX AND CAPITAL GEORGRAPHIC ADJUSTMENT (GAF) FOR RURAL AREAS BY CBSA–FY 2007— Continued CBSA code 08 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 49 50 51 52 53 ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. Nonurban area Wage index GAF Delaware ........................................................................................................................................................... Florida ............................................................................................................................................................... Georgia ............................................................................................................................................................. Hawaii ............................................................................................................................................................... Idaho ................................................................................................................................................................. Illinois ................................................................................................................................................................ Indiana .............................................................................................................................................................. Iowa ................................................................................................................................................................... Kansas .............................................................................................................................................................. Kentucky ........................................................................................................................................................... Louisiana ........................................................................................................................................................... Maine ................................................................................................................................................................ Maryland ........................................................................................................................................................... Massachusetts 1 ................................................................................................................................................ Michigan ............................................................................................................................................................ Minnesota .......................................................................................................................................................... Mississippi ......................................................................................................................................................... Missouri ............................................................................................................................................................. Montana ............................................................................................................................................................ Nebraska ........................................................................................................................................................... Nevada .............................................................................................................................................................. New Hampshire ................................................................................................................................................ New Jersey 1 ..................................................................................................................................................... New Mexico ...................................................................................................................................................... New York .......................................................................................................................................................... North Carolina ................................................................................................................................................... North Dakota ..................................................................................................................................................... Ohio ................................................................................................................................................................... Oklahoma .......................................................................................................................................................... Oregon .............................................................................................................................................................. Pennsylvania ..................................................................................................................................................... Puerto Rico 1 ..................................................................................................................................................... Rhode Island 1 ................................................................................................................................................... South Carolina .................................................................................................................................................. South Dakota .................................................................................................................................................... Tennessee ........................................................................................................................................................ Texas ................................................................................................................................................................ Utah ................................................................................................................................................................... Vermont ............................................................................................................................................................. Virginia .............................................................................................................................................................. Washington ....................................................................................................................................................... West Virginia ..................................................................................................................................................... Wisconsin .......................................................................................................................................................... Wyoming ........................................................................................................................................................... 0.9843 0.8609 0.7577 1.0502 0.8674 0.8334 0.8479 0.8696 0.8017 0.7793 0.7487 0.8399 0.8946 1.0664 0.9055 0.9256 0.7579 0.8206 0.8591 0.8691 0.8967 1.1665 1.1226 0.8353 0.8267 0.8607 0.7237 0.8673 0.7663 0.9826 0.8330 ................ 1.0791 0.8604 0.8485 0.7957 0.8003 0.8163 1.0986 0.7966 1.0440 0.7637 0.9466 0.9303 0.9892 0.9025 0.8270 1.0341 0.9072 0.8827 0.8932 0.9088 0.8595 0.8430 0.8202 0.8874 0.9266 1.0450 0.9343 0.9484 0.8271 0.8734 0.9012 0.9084 0.9281 1.1112 1.0824 0.8841 0.8778 0.9024 0.8014 0.9071 0.8334 0.9881 0.8824 ................ 1.0535 0.9022 0.8936 0.8551 0.8585 0.8702 1.0665 0.8558 1.0299 0.8314 0.9631 0.9517 1 All counties in the State or Territory are classified as urban, with the exception of Massachusetts. Massachusetts has area(s) designated as rural. However, no short-term, acute care hospitals were located in Rural Massachusetts during FY 2003, the base year for the FY 2007 wage index. Massachusetts, New Jersey, and Rhode Island rural floors are imputed as discussed in the FY 2005 IPPS final rule (69 FR 49109). TABLE 4C–1.—WAGE INDEX AND CAPITAL GEOGRAPHIC ADJUSTMENT FACTOR (GAF) FOR HOSPITALS THAT ARE RECLASSIFIED BY CBSA—FY 2007 wwhite on PROD1PC61 with PROPOSALS2 CBSA code 10180 10420 10580 10740 10780 10900 11100 11260 11460 11500 11700 12020 12060 12260 ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... VerDate Aug<31>2005 Wage index Area Abilene, TX ....................................................................................................................................................... Akron, OH ......................................................................................................................................................... Albany-Schenectady-Troy, NY .......................................................................................................................... Albuquerque, NM .............................................................................................................................................. Alexandria, LA ................................................................................................................................................... Allentown-Bethlehem-Easton, PA–NJ ............................................................................................................... Amarillo, TX ...................................................................................................................................................... Anchorage, AK .................................................................................................................................................. 1Ann Arbor, MI .................................................................................................................................................. Anniston-Oxford, AL .......................................................................................................................................... Asheville, NC .................................................................................................................................................... Athens-Clarke County, GA ................................................................................................................................ Atlanta-Sandy Springs-Marietta, GA ................................................................................................................. Augusta-Richmond County, GA–SC ................................................................................................................. 17:10 Apr 24, 2006 Jkt 208001 PO 00000 Frm 00265 Fmt 4701 Sfmt 4702 E:\FR\FM\25APP2.SGM 25APP2 0.8051 0.8737 0.8753 0.9477 0.8028 0.9927 0.9177 1.2062 1.0630 0.7978 0.9110 0.9707 0.9644 0.9554 GAF 0.8620 0.9117 0.9128 0.9639 0.8603 0.9950 0.9429 1.1370 1.0427 0.8567 0.9382 0.9798 0.9755 0.9692 24260 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules TABLE 4C–1.—WAGE INDEX AND CAPITAL GEOGRAPHIC ADJUSTMENT FACTOR (GAF) FOR HOSPITALS THAT ARE RECLASSIFIED BY CBSA—FY 2007—Continued wwhite on PROD1PC61 with PROPOSALS2 CBSA code 12420 12620 12700 12940 13020 13644 13780 13820 13900 14484 14540 15380 15540 15764 15764 16180 16580 16620 16700 16740 16820 16860 16974 17140 17300 17460 17780 17860 17900 17980 18140 18700 19124 19340 19380 19460 19740 19780 19804 20100 20260 20500 20764 21060 21500 21604 21660 21780 22020 22180 22220 22380 22420 22520 22540 22660 22744 22900 23020 23060 23104 23540 23844 24300 24340 24500 24540 24580 24660 24780 ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... VerDate Aug<31>2005 Wage index Area Austin-Round Rock, TX .................................................................................................................................... Bangor, ME ....................................................................................................................................................... Barnstable Town, MA ........................................................................................................................................ Baton Rouge, LA .............................................................................................................................................. Bay City, MI ...................................................................................................................................................... Bethesda-Gaithersburg-Frederick, MD ............................................................................................................. Binghamton, NY ................................................................................................................................................ Birmingham-Hoover, AL .................................................................................................................................... Bismarck, ND .................................................................................................................................................... Boston-Quincy, MA ........................................................................................................................................... Bowling Green, KY ........................................................................................................................................... Buffalo-Niagara Falls, NY ................................................................................................................................. Burlington-South Burlington, VT ....................................................................................................................... Cambridge-Newton-Framingham, MA (VT Hospitals) ...................................................................................... Cambridge-Newton-Framingham, MA (NH Hospitals) ...................................................................................... Carson City, NV ................................................................................................................................................ Champaign-Urbana, IL ...................................................................................................................................... Charleston, WV ................................................................................................................................................. Charleston-North Charleston, SC ..................................................................................................................... Charlotte-Gastonia-Concord, NC–SC ............................................................................................................... Charlottesville, VA ............................................................................................................................................. Chattanooga, TN–GA ....................................................................................................................................... Chicago-Naperville-Joliet, IL ............................................................................................................................. Cincinnati-Middletown, OH–KY–IN ................................................................................................................... Clarksville, TN–KY ............................................................................................................................................ Cleveland-Elyria-Mentor, OH ............................................................................................................................ College Station-Bryan, TX ................................................................................................................................ Columbia, MO ................................................................................................................................................... Columbia, SC .................................................................................................................................................... Columbus, GA–AL ............................................................................................................................................ Columbus, OH .................................................................................................................................................. Corvallis, OR ..................................................................................................................................................... Dallas-Plano-Irving, TX ..................................................................................................................................... Davenport-Moline-Rock Island, IA–IL ............................................................................................................... Dayton, OH ....................................................................................................................................................... Decatur, AL ....................................................................................................................................................... Denver-Aurora, CO ........................................................................................................................................... Des Moines-West Des Moines, IA .................................................................................................................... Detroit-Livonia-Dearborn, MI ............................................................................................................................. Dover, DE ......................................................................................................................................................... Duluth, MN–WI .................................................................................................................................................. Durham, NC ...................................................................................................................................................... Edison, NJ ......................................................................................................................................................... Elizabethtown, KY ............................................................................................................................................. Erie, PA ............................................................................................................................................................. Essex County, MA ............................................................................................................................................ Eugene-Springfield, OR .................................................................................................................................... Evansville, IN–KY ............................................................................................................................................. Fargo, ND–MN .................................................................................................................................................. Fayetteville, NC ................................................................................................................................................. Fayetteville-Springdale-Rogers, AR–MO .......................................................................................................... Flagstaff, AZ ...................................................................................................................................................... Flint, MI ............................................................................................................................................................. Florence-Muscle Shoals, AL ............................................................................................................................. Fond du Lac, WI ............................................................................................................................................... Fort Collins-Loveland, CO ................................................................................................................................. Fort Lauderdale-Pompano Beach-Deerfield Beach, FL ................................................................................... Fort Smith, AR–OK ........................................................................................................................................... Fort Walton Beach-Crestview-Destin, FL ......................................................................................................... Fort Wayne, IN .................................................................................................................................................. Fort Worth-Arlington, TX ................................................................................................................................... Gainesville, FL .................................................................................................................................................. Gary, IN ............................................................................................................................................................. Grand Junction, CO .......................................................................................................................................... Grand Rapids-Wyoming, MI .............................................................................................................................. Great Falls, MT ................................................................................................................................................. Greeley, CO ...................................................................................................................................................... Green Bay, WI .................................................................................................................................................. Greensboro-High Point, NC .............................................................................................................................. Greenville, NC ................................................................................................................................................... 17:10 Apr 24, 2006 Jkt 208001 PO 00000 Frm 00266 Fmt 4701 Sfmt 4702 E:\FR\FM\25APP2.SGM 25APP2 0.9360 0.9702 1.2181 0.8102 1.0040 1.1028 0.8499 0.8919 0.7255 1.1318 0.8164 0.9475 0.9355 1.0986 1.1665 0.9569 0.9155 0.8294 0.9168 0.9520 0.9732 0.8841 1.0596 0.9599 0.8094 0.9212 0.9064 0.8550 0.8604 0.8256 0.9919 1.1175 0.9870 0.8696 0.9049 0.8220 1.0805 0.8976 1.0235 0.9843 1.0157 0.9805 1.1242 0.8207 0.8360 1.1665 1.0525 0.8545 0.8485 0.8962 0.8599 1.1121 1.0685 0.8008 0.9489 0.9594 1.0470 0.7663 0.8609 0.9498 0.9591 0.9299 0.9278 1.0037 0.9469 0.8781 0.9636 0.9620 0.8992 0.9300 GAF 0.9557 0.9795 1.1447 0.8658 1.0027 1.0693 0.8946 0.9246 0.8027 1.0885 0.8703 0.9637 0.9554 1.0665 1.1112 0.9703 0.9413 0.8798 0.9422 0.9669 0.9816 0.9191 1.0404 0.9724 0.8652 0.9453 0.9349 0.8983 0.9022 0.8770 0.9944 1.0790 0.9911 0.9088 0.9339 0.8744 1.0545 0.9287 1.0160 0.9892 1.0107 0.9866 1.0835 0.8734 0.8846 1.1112 1.0357 0.8979 0.8936 0.9277 0.9018 1.0755 1.0464 0.8589 0.9647 0.9720 1.0320 0.8334 0.9025 0.9653 0.9718 0.9514 0.9500 1.0025 0.9633 0.9148 0.9749 0.9738 0.9298 0.9515 24261 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules TABLE 4C–1.—WAGE INDEX AND CAPITAL GEOGRAPHIC ADJUSTMENT FACTOR (GAF) FOR HOSPITALS THAT ARE RECLASSIFIED BY CBSA—FY 2007—Continued wwhite on PROD1PC61 with PROPOSALS2 CBSA code 24860 25060 25420 25540 25540 25860 26100 26180 26420 26580 26620 26820 26820 26900 26980 27060 27140 27180 27260 27860 27860 27900 28020 28100 28140 28420 28420 28700 28740 28940 29180 29404 29460 29540 29620 29740 29820 30020 30460 30620 30700 30780 30980 31084 31140 31180 31340 31420 31540 31700 32780 32820 33124 33260 33340 33460 33540 33700 33740 33860 34060 34980 35084 35300 35380 35644 35980 36084 36140 36220 ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... VerDate Aug<31>2005 Wage index Area Greenville, SC ................................................................................................................................................... Gulfport-Biloxi, MS ............................................................................................................................................ Harrisburg-Carlisle, PA ..................................................................................................................................... Hartford-West Hartford-East Hartford, CT (CT Hospitals) ................................................................................ Hartford-West Hartford-East Hartford, CT (MA Hospitals) ............................................................................... Hickory-Lenoir-Morganton, NC ......................................................................................................................... Holland-Grand Haven, MI ................................................................................................................................. Honolulu, HI ...................................................................................................................................................... Houston-Sugar Land-Baytown, TX ................................................................................................................... Huntington-Ashland, WV–KY–OH .................................................................................................................... Huntsville, AL .................................................................................................................................................... Idaho Falls, ID (ID Hospitals) ............................................................................................................................ Idaho Falls, ID (WY Hospitals) ......................................................................................................................... Indianapolis-Carmel, IN ..................................................................................................................................... Iowa City, IA ...................................................................................................................................................... Ithaca, NY ......................................................................................................................................................... Jackson, MS ..................................................................................................................................................... Jackson, TN ...................................................................................................................................................... Jacksonville, FL ................................................................................................................................................ Jonesboro, AR (AR Hospitals) .......................................................................................................................... Jonesboro, AR (MO Hospitals) ......................................................................................................................... Joplin, MO ......................................................................................................................................................... Kalamazoo-Portage, MI .................................................................................................................................... Kankakee-Bradley, IL ........................................................................................................................................ Kansas City, MO–KS ........................................................................................................................................ Kennewick-Richland-Pasco, WA (WA Hospitals) ............................................................................................. Kennewick-Richland-Pasco, WA (ID Hospitals) ............................................................................................... Kingsport-Bristol-Bristol, TN–VA ....................................................................................................................... Kingston, NY ..................................................................................................................................................... Knoxville, TN ..................................................................................................................................................... Lafayette, LA ..................................................................................................................................................... Lake County-Kenosha County, IL–WI .............................................................................................................. Lakeland, FL ..................................................................................................................................................... Lancaster, PA ................................................................................................................................................... Lansing-East Lansing, MI ................................................................................................................................. Las Cruces, NM ................................................................................................................................................ Las Vegas-Paradise, NV ................................................................................................................................... Lawton, OK ....................................................................................................................................................... Lexington-Fayette, KY ...................................................................................................................................... Lima, OH ........................................................................................................................................................... Lincoln, NE ........................................................................................................................................................ Little Rock-North Little Rock, AR ...................................................................................................................... Longview, TX .................................................................................................................................................... 1 Los Angeles-Long Beach-Santa Ana, CA ...................................................................................................... Louisville-Jefferson County, KY–IN .................................................................................................................. Lubbock, TX ...................................................................................................................................................... Lynchburg, VA .................................................................................................................................................. Macon, GA ........................................................................................................................................................ Madison, WI ...................................................................................................................................................... Manchester-Nashua, NH ................................................................................................................................... Medford, OR ..................................................................................................................................................... Memphis, TN–MS–AR ...................................................................................................................................... Miami-Miami Beach-Kendall, FL ....................................................................................................................... Midland, TX ....................................................................................................................................................... Milwaukee-Waukesha-West Allis, WI ............................................................................................................... Minneapolis-St. Paul-Bloomington, MN–WI ...................................................................................................... Missoula, MT ..................................................................................................................................................... Modesto, CA ..................................................................................................................................................... Monroe, LA ....................................................................................................................................................... Montgomery, AL ................................................................................................................................................ Morgantown, WV .............................................................................................................................................. Nashville-Davidson—Murfreesboro, TN ............................................................................................................ Newark-Union, NJ–PA ...................................................................................................................................... New Haven-Milford, CT ..................................................................................................................................... New Orleans-Metairie-Kenner, LA .................................................................................................................... 1 New York-White Plains-Wayne, NY–NJ ......................................................................................................... Norwich-New London, CT ................................................................................................................................. Oakland-Fremont-Hayward, CA ........................................................................................................................ Ocean City, NJ .................................................................................................................................................. Odessa, TX ....................................................................................................................................................... 17:10 Apr 24, 2006 Jkt 208001 PO 00000 Frm 00267 Fmt 4701 Sfmt 4702 E:\FR\FM\25APP2.SGM 25APP2 0.9286 0.8607 0.9263 1.1750 1.0918 0.8901 0.9241 1.1066 1.0030 0.8759 0.8829 0.9300 0.9303 0.9582 0.9568 0.9439 0.8278 0.8640 0.9046 0.7952 0.8206 0.8620 1.0737 0.9728 0.9501 1.0440 1.0033 0.8062 0.9058 0.8278 0.8300 1.0408 0.8908 0.9768 0.9823 0.9270 1.1240 0.8116 0.8928 0.9060 0.9746 0.8667 0.8905 1.1600 0.9137 0.8626 0.8716 0.9176 1.0502 1.1665 1.0450 0.9032 0.9825 0.9602 1.0098 1.0842 0.8909 1.1731 0.8015 0.8035 0.8449 0.9571 1.1886 1.2093 0.8855 1.3038 1.2020 1.5669 1.0254 0.9737 GAF 0.9505 0.9024 0.9489 1.1168 1.0620 0.9234 0.9474 1.0718 1.0021 0.9133 0.9182 0.9515 0.9517 0.9712 0.9702 0.9612 0.8786 0.9047 0.9336 0.8548 0.8734 0.9033 1.0499 0.9813 0.9656 1.0299 1.0023 0.8628 0.9345 0.8786 0.8802 1.0278 0.9239 0.9841 0.9878 0.9494 1.0833 0.8668 0.9253 0.9346 0.9825 0.9067 0.9237 1.1070 0.9401 0.9037 0.9102 0.9428 1.0341 1.1112 1.0306 0.9327 0.9880 0.9726 1.0067 1.0569 0.9239 1.1155 0.8594 0.8609 0.8910 0.9704 1.1256 1.1390 0.9201 1.1992 1.1343 1.3601 1.0173 0.9819 24262 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules TABLE 4C–1.—WAGE INDEX AND CAPITAL GEOGRAPHIC ADJUSTMENT FACTOR (GAF) FOR HOSPITALS THAT ARE RECLASSIFIED BY CBSA—FY 2007—Continued wwhite on PROD1PC61 with PROPOSALS2 CBSA code 36260 36420 36540 36740 37860 37900 37964 37964 38220 38300 38300 38340 38540 38860 38900 38940 39100 39340 39580 39740 39820 39900 40060 40220 40340 40380 40420 40484 40660 40900 40980 41060 41100 41140 41180 41620 41700 41884 41980 42044 42140 42220 42260 42340 42644 43300 43340 43580 43620 43780 43900 44060 44180 44300 44940 45060 45104 45220 45300 45500 45780 45820 46140 46220 46340 46660 46700 47260 47380 47894 ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... VerDate Aug<31>2005 Wage index Area Ogden-Clearfield, UT ........................................................................................................................................ Oklahoma City, OK ........................................................................................................................................... Omaha-Council Bluffs, NE–IA ........................................................................................................................... Orlando-Kissimmee, FL .................................................................................................................................... Pensacola-Ferry Pass-Brent, FL ....................................................................................................................... Peoria, IL ........................................................................................................................................................... Philadelphia, PA (PA Hospitals) ....................................................................................................................... Philadelphia, PA (NJ Hospitals) ........................................................................................................................ Pine Bluff, AR ................................................................................................................................................... Pittsburgh, PA (PA and WV Hospitals) ............................................................................................................. Pittsburgh, PA (OH Hospitals) .......................................................................................................................... Pittsfield, MA ..................................................................................................................................................... Pocatello, ID ...................................................................................................................................................... Portland-South Portland-Biddeford, ME ............................................................................................................ Portland-Vancouver-Beaverton, OR–WA .......................................................................................................... Port St. Lucie-Fort Pierce, FL ........................................................................................................................... Poughkeepsie-Newburgh-Middletown, NY ....................................................................................................... Provo-Orem, UT ................................................................................................................................................ Raleigh-Cary, NC .............................................................................................................................................. Reading, PA ...................................................................................................................................................... Redding, CA ...................................................................................................................................................... Reno-Sparks, NV .............................................................................................................................................. Richmond, VA ................................................................................................................................................... Roanoke, VA ..................................................................................................................................................... Rochester, MN .................................................................................................................................................. Rochester, NY ................................................................................................................................................... Rockford, IL ....................................................................................................................................................... Rockingham County, NH .................................................................................................................................. Rome, GA ......................................................................................................................................................... Sacramento—Arden-Arcade—Roseville, CA .................................................................................................... Saginaw-Saginaw Township North, MI ............................................................................................................. St. Cloud, MN ................................................................................................................................................... St. George, UT .................................................................................................................................................. St. Joseph, MO–KS .......................................................................................................................................... St. Louis, MO–IL ............................................................................................................................................... Salt Lake City, UT ............................................................................................................................................. San Antonio, TX ................................................................................................................................................ San Francisco-San Mateo-Redwood City, CA ................................................................................................. San Juan-Caguas-Guaynabo, PR .................................................................................................................... Santa Ana-Anaheim-Irvine, CA ......................................................................................................................... Santa Fe, NM .................................................................................................................................................... Santa Rosa-Petaluma, CA ................................................................................................................................ Sarasota-Bradenton-Venice, FL ........................................................................................................................ Savannah, GA ................................................................................................................................................... Seattle-Bellevue-Everett, WA ............................................................................................................................ Sherman-Denison, TX ....................................................................................................................................... Shreveport-Bossier City, LA .............................................................................................................................. Sioux City, IA–NE–SD ...................................................................................................................................... Sioux Falls, SD ................................................................................................................................................. South Bend-Mishawaka, IN–MI ........................................................................................................................ Spartanburg, SC ............................................................................................................................................... Spokane, WA .................................................................................................................................................... Springfield, MO ................................................................................................................................................. State College, PA ............................................................................................................................................. Sumter, SC ....................................................................................................................................................... Syracuse, NY .................................................................................................................................................... Tacoma, WA ..................................................................................................................................................... Tallahassee, FL ................................................................................................................................................ Tampa-St. Petersburg-Clearwater, FL .............................................................................................................. Texarkana, TX-Texarkana, AR ......................................................................................................................... Toledo, OH ........................................................................................................................................................ Topeka, KS ....................................................................................................................................................... Tulsa, OK .......................................................................................................................................................... Tuscaloosa, AL ................................................................................................................................................. Tyler, TX ........................................................................................................................................................... Valdosta, GA ..................................................................................................................................................... Vallejo-Fairfield, CA .......................................................................................................................................... Virginia Beach-Norfolk-Newport News, VA ....................................................................................................... Waco, TX .......................................................................................................................................................... Washington-Arlington-Alexandria DC-VA ......................................................................................................... 17:10 Apr 24, 2006 Jkt 208001 PO 00000 Frm 00268 Fmt 4701 Sfmt 4702 E:\FR\FM\25APP2.SGM 25APP2 0.9021 0.8857 0.9453 0.9409 0.7999 0.8827 1.1009 1.1226 0.8224 0.8671 0.8673 1.0986 0.9400 0.9487 1.1405 0.9857 1.0583 0.9537 0.9570 0.9534 1.2884 1.1524 0.9174 0.8677 1.1246 0.9007 0.9773 1.0309 0.9307 1.3350 0.9055 0.9971 0.9295 0.9993 0.8902 0.9421 0.8859 1.5049 0.4396 1.1291 0.9814 1.4294 0.9866 0.8958 1.1255 0.8376 0.8715 0.8816 0.9456 0.9543 0.9192 1.0284 0.8345 0.8361 0.8604 0.9428 1.0907 0.8982 0.9249 0.8133 0.9588 0.8591 0.8146 0.7785 0.8854 0.8101 1.4527 0.8840 0.8653 1.1076 GAF 0.9319 0.9202 0.9622 0.9591 0.8582 0.9181 1.0680 1.0824 0.8747 0.9070 0.9071 1.0665 0.9585 0.9646 1.0942 0.9902 1.0396 0.9681 0.9704 0.9678 1.1895 1.1020 0.9427 0.9074 1.0837 0.9309 0.9844 1.0211 0.9520 1.2188 0.9343 0.9980 0.9512 0.9995 0.9234 0.9600 0.9204 1.3230 0.5696 1.0867 0.9872 1.2772 0.9908 0.9274 1.0843 0.8857 0.9101 0.9173 0.9624 0.9685 0.9439 1.0194 0.8835 0.8846 0.9022 0.9605 1.0613 0.9291 0.9479 0.8680 0.9716 0.9012 0.8690 0.8424 0.9200 0.8657 1.2914 0.9190 0.9057 1.0725 24263 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules TABLE 4C–1.—WAGE INDEX AND CAPITAL GEOGRAPHIC ADJUSTMENT FACTOR (GAF) FOR HOSPITALS THAT ARE RECLASSIFIED BY CBSA—FY 2007—Continued CBSA code Area Wage index 48140 ....... 48620 ....... 48700 ....... 48864 ....... 48900 ....... 49180 ....... 49340 ....... 49660 ....... 04 ............. 05 ............. 07 ............. 10 ............. 14 ............. 16 ............. 17 ............. 19 ............. 23 ............. 24 ............. 26 ............. 29 ............. 30 ............. 33 ............. 34 ............. 36 ............. 37 ............. 38 ............. 39 ............. 44 ............. 45 ............. 47 ............. 50 ............. 53 ............. Wausau, WI ...................................................................................................................................................... Wichita, KS ....................................................................................................................................................... Williamsport, PA ................................................................................................................................................ Wilmington, DE–MD–NJ ................................................................................................................................... Wilmington, NC ................................................................................................................................................. Winston-Salem, NC ........................................................................................................................................... Worcester, MA .................................................................................................................................................. Youngstown-Warren-Boardman, OH–PA ......................................................................................................... Arkansas ........................................................................................................................................................... California ........................................................................................................................................................... Connecticut ....................................................................................................................................................... Florida ............................................................................................................................................................... Illinois ................................................................................................................................................................ Iowa ................................................................................................................................................................... Kansas .............................................................................................................................................................. Louisiana ........................................................................................................................................................... Michigan ............................................................................................................................................................ Minnesota .......................................................................................................................................................... Missouri ............................................................................................................................................................. Nevada .............................................................................................................................................................. New Hampshire ................................................................................................................................................ New York .......................................................................................................................................................... North Carolina ................................................................................................................................................... Ohio ................................................................................................................................................................... Oklahoma .......................................................................................................................................................... Oregon .............................................................................................................................................................. Pennsylvania ..................................................................................................................................................... Tennessee ........................................................................................................................................................ Texas ................................................................................................................................................................ Vermont ............................................................................................................................................................. Washington ....................................................................................................................................................... Wyoming ........................................................................................................................................................... 0.9625 0.8832 0.8330 1.0878 0.9516 0.9129 1.1665 0.8815 0.7487 1.1291 1.1750 0.8609 0.8210 0.8696 0.8017 0.7487 0.9055 0.9256 0.8206 0.8674 1.1381 0.8267 0.8607 0.8673 0.7663 0.9826 0.8330 0.7957 0.8003 0.9974 1.0440 0.9154 GAF 0.9742 0.9185 0.8824 1.0593 0.9666 0.9395 1.1112 0.9173 0.8202 1.0867 1.1168 0.9025 0.8737 0.9088 0.8595 0.8202 0.9343 0.9484 0.8734 0.9072 1.0926 0.8778 0.9024 0.9071 0.8334 0.9881 0.8824 0.8551 0.8585 0.9982 1.0299 0.9413 1 For this area, the wage index and GAF on this table are only effective from October 1, 2006 through March 31, 2007. See Table 4C–2 for the values that are effective from April 1 through September 30, 2007. TABLE 4C–2.—WAGE INDEX AND CAPITAL GEOGRAPHIC ADJUSTMENT FACTOR (GAF) FOR CERTAIN HOSPITALS THAT ARE RECLASSIFIED BY CBSA FOR THE PERIOD APRIL 1 THROUGH SEPTEMBER 30, 2007* CBSA code 11460 31084 34740 35004 35644 ....... ....... ....... ....... ....... Wage index Area Ann Arbor, MI .................................................................................................................................................... Los Angeles-Long Beach-Santa Ana, CA ........................................................................................................ Muskegon-Norton Shores, MI ........................................................................................................................... Nassau-Suffolk, NY ........................................................................................................................................... New York-White Plains-Wayne, NY–NJ ........................................................................................................... 1.0391 1.1603 0.9683 1.2511 1.3008 GAF 1.0266 1.1072 0.9782 1.1658 1.1973 * See Table 4C–1 for the wage index and GAF that are effective from October 1, 2006 through March 31, 2007. (For areas that are not listed on this table, the wage index and GAF on Table 4C–1 are effective for the entire FY 2007.) TABLE 4F.—PUERTO RICO WAGE INDEX AND CAPITAL GEOGRAPHIC ADJUSTMENT FACTOR (GAF) BY CBSA—FY 2007 wwhite on PROD1PC61 with PROPOSALS2 CBSA code 10380 21940 25020 32420 38660 41900 41980 49500 ....... ....... ....... ....... ....... ....... ....... ....... ´ Aguadilla-Isabela-San Sebastian, PR ....................................................... Fajardo, PR ............................................................................................... Guayama, PR ............................................................................................ ¨ Mayaguez, PR ........................................................................................... Ponce, PR ................................................................................................. ´ San German-Cabo Rojo, PR .................................................................... San Juan-Caguas-Guaynabo, PR ............................................................. Yauco, PR ................................................................................................. The following list represents all hospitals that are eligible to have their wage index VerDate Aug<31>2005 Wage index Area 17:10 Apr 24, 2006 Jkt 208001 Frm 00269 Fmt 4701 Sfmt 4702 Wage index— reclassified hospitals GAS—reclassified hospitals 0.9268 0.9478 0.8144 0.9170 1.0732 1.0781 1.0031 0.9177 ........................ ........................ ........................ ........................ ........................ ........................ 1.0045 ........................ ........................ ........................ ........................ ........................ ........................ ........................ 1.0031 ........................ 0.8950 0.9247 0.7409 0.8812 1.1086 1.1160 1.0045 0.8822 increased by the out-migration adjustment listed in this table. Hospitals cannot receive PO 00000 GAF the out-migration adjustment if they are reclassified under section 1886(d)(10) of the E:\FR\FM\25APP2.SGM 25APP2 24264 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules Act, reclassified under section 508 of Pub. L. 108–173, or redesignated under section 1886(d)(8) of the Act. If a hospital has a half fiscal year reclassification, the hospital will be eligible for the out-migration adjustment for the portion of the fiscal year that it is not reclassified. Hospitals that have already been reclassified under section 1886(d)(10) of the Act, reclassified under section 508 of Pub. L. 108–173, or redesignated under section 1886(d)(8) of the Act for any portion of the fiscal year are designated with an asterisk Hospitals have 45 days from the publication of this proposed rule to review their individual situations to determine whether to submit a request to withdraw their reclassification/redesignation and receive the out-migration adjustment instead. We will automatically assume that hospitals that have already been reclassified under section 1886(d)(10) of the Act, reclassified under section 508 of Pub. L. 108–173, or redesignated under section 1886(d)(8) of the Act wish to retain their reclassification/ redesignation status and waive the application of the out-migration adjustment. Hospitals are not required to provide CMS with any type of formal notification that they wish to remain reclassified/redesignated. TABLE 4J.—OUT-MIGRATION ADJUSTMENT—FY 2007 Reclassified between 10/1/06 and 3/31/07 wwhite on PROD1PC61 with PROPOSALS2 Provider No. 010005 010008 010009 010010 010012 010022 010025 010029 010035 010038 010045 010047 010052 010054 010061 010065 010072 010078 010083 010085 010100 010101 010109 010129 010143 010146 010150 010158 010164 040014 040019 040047 040069 040071 040076 040100 050008 050009 050013 050014 050016 050042 050046 050047 050055 050065 050069 050073 050076 050082 050084 050089 050090 050099 050101 050117 050118 050122 050129 050131 ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... VerDate Aug<31>2005 17:10 Apr 24, 2006 Jkt 208001 Reclassified between 4/1/07 and 9/30/2007 * * * ............................ * * * * * ............................ * ............................ ............................ * ............................ * * ............................ * * * * ............................ ............................ * ............................ * * * * * * * * * * ............................ * * * ............................ * ............................ ............................ ............................ * * * * ............................ ............................ * * * * ............................ * ............................ * ............................ * * * ............................ * * * * * ............................ * ............................ ............................ * ............................ * * ............................ * * * * ............................ ............................ * ............................ * * * * * * * * * * ............................ * * * ............................ * * ............................ ............................ * * * * * ............................ * * * * ............................ * ............................ * ............................ PO 00000 Frm 00270 Fmt 4701 Sfmt 4702 Out-migration adjustment 0.0259 0.0212 0.0092 0.0259 0.0205 0.0714 0.0235 0.0107 0.0375 0.0062 0.0160 0.0155 0.0121 0.0092 0.0506 0.0121 0.0310 0.0062 0.0121 0.0092 0.0121 0.0310 0.0451 0.0121 0.0375 0.0062 0.0155 0.0093 0.0310 0.0159 0.0697 0.0090 0.0140 0.0026 0.1075 0.0159 0.0026 0.0478 0.0478 0.0131 0.0103 0.0219 0.0156 0.0026 0.0026 0.0029 0.0029 0.0269 0.0026 0.0156 0.0555 0.0152 0.0308 0.0152 0.0269 0.0463 0.0555 0.0555 0.0152 0.0033 E:\FR\FM\25APP2.SGM Qualifying county name MARSHALL. CRENSHAW. MORGAN. MARSHALL. DE KALB. CHEROKEE. CHAMBERS. LEE. CULLMAN. CALHOUN. FAYETTE. BUTLER. TALLAPOOSA. MORGAN. JACKSON. TALLAPOOSA. TALLADEGA. CALHOUN. BALDWIN. MORGAN. BALDWIN. TALLADEGA. PICKENS. BALDWIN. CULLMAN CALHOUN. BUTLER. FRANKLIN. TALLADEGA. WHITE. ST. FRANCIS. RANDOLPH. MISSISSIPPI. JEFFERSON. HOT SPRING. WHITE. SAN FRANCISCO. NAPA. NAPA. AMADOR. SAN LUIS OBISPO. TEHAMA. VENTURA. SAN FRANCISCO. SAN FRANCISCO. ORANGE. ORANGE. SOLANO. SAN FRANCISCO. VENTURA. SAN JOAQUIN. SAN BERNARDINO. SONOMA. SAN BERNARDINO. SOLANO. MERCED. SAN JOAQUIN. SAN JOAQUIN. SAN BERNARDINO. MARIN. 25APP2 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules TABLE 4J.—OUT-MIGRATION ADJUSTMENT—FY 2007—Continued Reclassified between 10/1/06 and 3/31/07 wwhite on PROD1PC61 with PROPOSALS2 Provider No. 050133 050136 050140 050150 050152 050159 050167 050168 050173 050174 050177 050193 050224 050226 050228 050230 050232 050236 050245 050272 050279 050291 050298 050300 050313 050325 050327 050335 050336 050348 050360 050367 050385 050394 050407 050426 050444 050454 050457 050469 050476 050494 050506 050510 050517 050526 050528 050535 050543 050547 050548 050549 050550 050551 050567 050568 050570 050580 050584 050585 050586 050589 050592 050594 050603 050609 050616 050618 050633 050667 ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... VerDate Aug<31>2005 17:10 Apr 24, 2006 Jkt 208001 Reclassified between 4/1/07 and 9/30/2007 ............................ * * * ............................ ............................ ............................ * * * ............................ * * * * * ............................ ............................ * * * * * * ............................ ............................ * ............................ ............................ * ............................ * * ............................ ............................ * ............................ ............................ ............................ * ............................ * ............................ * * * * * * * * * * * * ............................ * * * * * * * * * * ............................ * ............................ * ............................ * * * ............................ * ............................ * * * ............................ * * * * * ............................ * * * * * * * ............................ ............................ * ............................ ............................ * ............................ * * * ............................ * ............................ ............................ ............................ * ............................ ............................ ............................ * * * * * * * * * * * * ............................ * * * * * * * * * * * * ............................ * PO 00000 Frm 00271 Fmt 4701 Sfmt 4702 Out-migration adjustment 0.0170 0.0308 0.0152 0.0316 0.0026 0.0156 0.0555 0.0029 0.0029 0.0308 0.0156 0.0029 0.0029 0.0029 0.0026 0.0029 0.0103 0.0156 0.0152 0.0152 0.0152 0.0308 0.0152 0.0152 0.0555 0.0176 0.0152 0.0176 0.0555 0.0029 0.0033 0.0269 0.0308 0.0156 0.0026 0.0029 0.0463 0.0026 0.0026 0.0152 0.0257 0.0316 0.0103 0.0033 0.0152 0.0029 0.0463 0.0029 0.0029 0.0308 0.0029 0.0156 0.0029 0.0029 0.0029 0.0062 0.0029 0.0029 0.0152 0.0029 0.0152 0.0029 0.0029 0.0029 0.0029 0.0029 0.0156 0.0152 0.0103 0.0478 E:\FR\FM\25APP2.SGM Qualifying county name YUBA. SONOMA. SAN BERNARDINO. NEVADA. SAN FRANCISCO. VENTURA. SAN JOAQUIN. ORANGE. ORANGE. SONOMA. VENTURA. ORANGE. ORANGE. ORANGE. SAN FRANCISCO. ORANGE. SAN LUIS OBISPO. VENTURA. SAN BERNARDINO. SAN BERNARDINO. SAN BERNARDINO. SONOMA. SAN BERNARDINO. SAN BERNARDINO. SAN JOAQUIN. TUOLUMNE. SAN BERNARDINO. TUOLUMNE. SAN JOAQUIN. ORANGE. MARIN. SOLANO. SONOMA. VENTURA. SAN FRANCISCO. ORANGE. MERCED. SAN FRANCISCO. SAN FRANCISCO. SAN BERNARDINO. LAKE. NEVADA. SAN LUIS OBISPO. MARIN. SAN BERNARDINO. ORANGE. MERCED. ORANGE. ORANGE. SONOMA. ORANGE. VENTURA. ORANGE. ORANGE. ORANGE. MADERA. ORANGE. ORANGE. SAN BERNARDINO. ORANGE. SAN BERNARDINO. ORANGE. ORANGE. ORANGE. ORANGE. ORANGE. VENTURA. SAN BERNARDINO. SAN LUIS OBISPO. NAPA. 25APP2 24265 24266 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules TABLE 4J.—OUT-MIGRATION ADJUSTMENT—FY 2007—Continued Reclassified between 10/1/06 and 3/31/07 wwhite on PROD1PC61 with PROPOSALS2 Provider No. 050668 050678 050680 050690 050693 050695 050720 050728 050731 060001 060003 060010 060027 060030 060103 070003 070006 070010 070018 070020 070021 070028 070033 070034 080001 080003 100014 100017 100045 100047 100062 100068 100072 100077 100102 100118 100156 100175 100212 100232 100236 100252 100290 110023 110027 110029 110041 110069 110124 110136 110146 110150 110153 110187 110189 110190 110205 130003 130024 130049 130066 140012 140026 140033 140043 140058 140084 140100 140110 140130 ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... VerDate Aug<31>2005 17:10 Apr 24, 2006 Jkt 208001 Reclassified between 4/1/07 and 9/30/2007 ............................ * * * * ............................ * * ............................ ............................ * ............................ * ............................ * * * * * ............................ * * * * ............................ ............................ ............................ ............................ * ............................ ............................ ............................ ............................ ............................ ............................ * ............................ ............................ ............................ * ............................ * ............................ * ............................ * * * ............................ ............................ ............................ * * * * ............................ * * ............................ * ............................ * ............................ * * * * * * * ............................ * * * * ............................ * * ............................ ............................ * ............................ * ............................ * * * * * ............................ * * * * ............................ ............................ ............................ ............................ * ............................ ............................ ............................ ............................ ............................ ............................ * ............................ ............................ ............................ * ............................ * ............................ * ............................ * * * ............................ ............................ ............................ * * * * ............................ * * ............................ * ............................ * ............................ * * * * * * * PO 00000 Frm 00272 Fmt 4701 Sfmt 4702 Out-migration adjustment 0.0026 0.0029 0.0269 0.0308 0.0029 0.0555 0.0029 0.0308 0.0152 0.0294 0.0203 0.0095 0.0203 0.0095 0.0203 0.0009 0.0047 0.0047 0.0047 0.0073 0.0009 0.0047 0.0047 0.0047 0.0063 0.0063 0.0118 0.0118 0.0118 0.0021 0.0060 0.0118 0.0118 0.0021 0.0125 0.0398 0.0125 0.0231 0.0060 0.0347 0.0021 0.0233 0.0582 0.0500 0.0387 0.0063 0.0777 0.0474 0.0428 0.0261 0.0786 0.0261 0.0474 0.1172 0.0031 0.0182 0.0779 0.0095 0.0275 0.0349 0.0349 0.0220 0.0346 0.0147 0.0046 0.0081 0.0147 0.0147 0.0346 0.0147 E:\FR\FM\25APP2.SGM Qualifying county name SAN FRANCISCO. ORANGE. SOLANO. SONOMA. ORANGE. SAN JOAQUIN. ORANGE. SONOMA. SAN BERNARDINO. WELD. BOULDER. LARIMER. BOULDER. LARIMER. BOULDER. WINDHAM. FAIRFIELD. FAIRFIELD. FAIRFIELD. MIDDLESEX. WINDHAM. FAIRFIELD. FAIRFIELD. FAIRFIELD. NEW CASTLE. NEW CASTLE. VOLUSIA. VOLUSIA. VOLUSIA. CHARLOTTE. MARION. VOLUSIA. VOLUSIA. CHARLOTTE. COLUMBIA. FLAGLER. COLUMBIA. DE SOTO. MARION. PUTNAM. CHARLOTTE. OKEECHOBEE. SUMTER. GORDON. FRANKLIN. HALL. HABERSHAM. HOUSTON. WAYNE. BALDWIN CAMDEN. BALDWIN HOUSTON. LUMPKIN. FANNIN. MACON. GILMER. NEZ PERCE. BONNER. KOOTENAI. KOOTENAI. LEE. LA SALLE. LAKE. WHITESIDE. MORGAN. LAKE. LAKE. LA SALLE. LAKE. 25APP2 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules TABLE 4J.—OUT-MIGRATION ADJUSTMENT—FY 2007—Continued Reclassified between 10/1/06 and 3/31/07 wwhite on PROD1PC61 with PROPOSALS2 Provider No. 140155 140160 140161 140186 140202 140205 140234 140291 150006 150015 150022 150030 150035 150045 150065 150076 150088 150091 150102 150113 150122 150146 160013 160030 160032 160080 170137 180012 180049 180066 180127 180128 190001 190003 190015 190017 190054 190078 190088 190099 190106 190133 190144 190184 190190 190191 190246 200002 200024 200032 200034 200050 210001 210004 210016 210018 210022 210023 210028 210043 210048 210057 220001 220002 220006 220010 220011 220019 220025 220028 ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... VerDate Aug<31>2005 17:10 Apr 24, 2006 Jkt 208001 Reclassified between 4/1/07 and 9/30/2007 ............................ * * ............................ * ............................ * * * * ............................ * ............................ ............................ * * * ............................ * * * * ............................ ............................ ............................ * * * ............................ * * ............................ * * * ............................ ............................ ............................ ............................ * * ............................ ............................ ............................ ............................ * ............................ ............................ * ............................ * * ............................ ............................ ............................ ............................ ............................ ............................ ............................ ............................ ............................ ............................ * * ............................ * * * * * ............................ * * ............................ * ............................ * * * * ............................ * ............................ ............................ * * * ............................ * * * * ............................ ............................ ............................ * * * ............................ * * ............................ * * * ............................ ............................ ............................ ............................ * * ............................ ............................ ............................ ............................ * ............................ ............................ * ............................ * * ............................ ............................ ............................ ............................ ............................ ............................ ............................ ............................ ............................ ............................ * * ............................ * * * * * PO 00000 Frm 00273 Fmt 4701 Sfmt 4702 Out-migration adjustment 0.0027 0.0286 0.0138 0.0027 0.0147 0.0163 0.0346 0.0147 0.0084 0.0084 0.0249 0.0201 0.0083 0.0416 0.0139 0.0189 0.0196 0.0573 0.0160 0.0196 0.0199 0.0440 0.0218 0.0040 0.0272 0.0049 0.0336 0.0083 0.0576 0.0567 0.0352 0.0282 0.0645 0.0107 0.0401 0.0235 0.0107 0.0235 0.0705 0.0390 0.0238 0.0238 0.0705 0.0161 0.0161 0.0235 0.0161 0.0129 0.0071 0.0466 0.0071 0.0140 0.0129 0.0040 0.0040 0.0040 0.0040 0.0209 0.0512 0.0209 0.0287 0.0040 0.0056 0.0249 0.0306 0.0306 0.0249 0.0056 0.0056 0.0056 E:\FR\FM\25APP2.SGM Qualifying county name KANKAKEE. STEPHENSON. LIVINGSTON. KANKAKEE. LAKE. BOONE. LA SALLE. LAKE. LA PORTE. LA PORTE. MONTGOMERY. HENRY. PORTER. DE KALB. JACKSON. MARSHALL. MADISON. HUNTINGTON. STARKE. MADISON. RIPLEY. NOBLE. MUSCATINE. STORY. JASPER. CLINTON. DOUGLAS. HARDIN. MADISON. LOGAN. FRANKLIN. LAWRENCE. WASHINGTON. IBERIA. TANGIPAHOA. ST. LANDRY. IBERIA. ST. LANDRY. WEBSTER. AVOYELLES. ALLEN. ALLEN. WEBSTER. CALDWELL. CALDWELL. ST. LANDRY. CALDWELL. LINCOLN. ANDROSCOGGIN. OXFORD. ANDROSCOGGIN. HANCOCK. WASHINGTON. MONTGOMERY. MONTGOMERY. MONTGOMERY. MONTGOMERY. ANNE ARUNDEL. ST. MARYS. ANNE ARUNDEL. HOWARD. MONTGOMERY. WORCESTER. MIDDLESEX. ESSEX. ESSEX. MIDDLESEX. WORCESTER. WORCESTER. WORCESTER. 25APP2 24267 24268 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules TABLE 4J.—OUT-MIGRATION ADJUSTMENT—FY 2007—Continued Reclassified between 10/1/06 and 3/31/07 wwhite on PROD1PC61 with PROPOSALS2 Provider No. 220029 220033 220035 220049 220058 220062 220063 220070 220080 220082 220084 220089 220090 220095 220098 220101 220105 220163 220171 220174 230003 230013 230015 230019 230021 230022 230029 230037 230041 230047 230069 230071 230072 230075 230078 230092 230093 230096 230099 230106 230121 230130 230151 230174 230184 230195 230204 230207 230217 230222 230223 230227 230254 230257 230264 230269 230277 230279 240018 240044 240064 240069 240071 240187 240211 250040 260011 260047 260074 260097 ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... VerDate Aug<31>2005 17:10 Apr 24, 2006 Jkt 208001 Reclassified between 4/1/07 and 9/30/2007 * * * * * * * * * * * ............................ * * * * * * * * * * ............................ * ............................ * * * ............................ * * * * ............................ * * * * * ............................ * * * * ............................ * * * * ............................ * * * * * * * * * ............................ * * * * * * * * * ............................ * * * * * * * * * * * ............................ * * * * * * * * * * ............................ * ............................ * * * ............................ * * * * ............................ * * * * * * * * * * ............................ * * * * ............................ * * * * * * * * * ............................ * * * * * * * * * ............................ PO 00000 Frm 00274 Fmt 4701 Sfmt 4702 Out-migration adjustment 0.0306 0.0306 0.0306 0.0249 0.0056 0.0056 0.0249 0.0249 0.0306 0.0249 0.0249 0.0249 0.0056 0.0056 0.0249 0.0249 0.0249 0.0056 0.0249 0.0306 0.0035 0.0091 0.0359 0.0091 0.0136 0.0113 0.0091 0.0178 0.0099 0.0082 0.0487 0.0091 0.0035 0.0145 0.0136 0.0389 0.0079 0.0359 0.0339 0.0030 0.0691 0.0091 0.0091 0.0035 0.0389 0.0082 0.0082 0.0091 0.0145 0.0228 0.0091 0.0082 0.0091 0.0082 0.0082 0.0091 0.0091 0.0487 0.1196 0.0868 0.0138 0.0419 0.0454 0.0506 0.0705 0.0294 0.0007 0.0007 0.0158 0.0425 E:\FR\FM\25APP2.SGM Qualifying county name ESSEX. ESSEX. ESSEX. MIDDLESEX. WORCESTER. WORCESTER. MIDDLESEX. MIDDLESEX. ESSEX. MIDDLESEX. MIDDLESEX. MIDDLESEX. WORCESTER. WORCESTER. MIDDLESEX. MIDDLESEX. MIDDLESEX. WORCESTER. MIDDLESEX. ESSEX. OTTAWA. OAKLAND. ST. JOSEPH. OAKLAND. BERRIEN. BRANCH. OAKLAND. HILLSADLE. BAY. MACOMB. LIVINGSTON. OAKLAND. OTTAWA. CALHOUN. BERRIEN. JACKSON. MECOSTA. ST. JOSEPH. MONROE. NEWAYGO. SHIAWASSEE. OAKLAND. OAKLAND. OTTAWA. JACKSON. MACOMB. MACOMB. OAKLAND. CALHOUN. MIDLAND. OAKLAND. MACOMB. OAKLAND. MACOMB. MACOMB. OAKLAND. OAKLAND. LIVINGSTON. GOODHUE. WINONA. ITASCA. STEELE. RICE. MC LEOD. PINE. JACKSON. COLE. COLE. RANDOLPH. JOHNSON. 25APP2 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules TABLE 4J.—OUT-MIGRATION ADJUSTMENT—FY 2007—Continued Reclassified between 10/1/06 and 3/31/07 wwhite on PROD1PC61 with PROPOSALS2 Provider No. 280077 280123 290019 290049 300011 300012 300017 300020 300023 300029 300034 310002 310009 310010 310011 310013 310018 310021 310038 310039 310044 310054 310070 310076 310078 310083 310092 310093 310096 310108 310110 310119 310123 310124 320003 320011 320018 320085 330004 330008 330027 330094 330106 330126 330135 330167 330181 330182 330191 330198 330205 330209 330224 330225 330235 330259 330264 330276 330331 330332 330372 330386 340015 340020 340021 340037 340039 340069 340070 340073 ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... VerDate Aug<31>2005 17:10 Apr 24, 2006 Jkt 208001 Reclassified between 4/1/07 and 9/30/2007 * ............................ * ............................ * * * * * * * * * ............................ ............................ * * * * * ............................ * * * * * ............................ * * * ............................ * ............................ ............................ ............................ ............................ ............................ ............................ * * * * * * * ............................ ............................ * * ............................ * * * ............................ * ............................ * ............................ ............................ ............................ ............................ * ............................ ............................ * ............................ * * * * * ............................ * ............................ * * * * * * * * * ............................ ............................ * * * * * ............................ * * * * * ............................ * * * ............................ * ............................ ............................ ............................ ............................ ............................ ............................ * * * * * ............................ ............................ * * * * * ............................ ............................ * * * * ............................ ............................ * * * * ............................ ............................ * ............................ * * * * PO 00000 Frm 00275 Fmt 4701 Sfmt 4702 Out-migration adjustment 0.0089 0.0137 0.0026 0.0026 0.0069 0.0069 0.0361 0.0069 0.0361 0.0361 0.0069 0.0351 0.0351 0.0092 0.0115 0.0351 0.0351 0.0092 0.0350 0.0350 0.0092 0.0351 0.0350 0.0351 0.0351 0.0351 0.0092 0.0351 0.0351 0.0350 0.0092 0.0351 0.0351 0.0350 0.0629 0.0442 0.0063 0.0063 0.0959 0.0470 0.0137 0.0778 0.0137 0.0560 0.0560 0.0137 0.0137 0.0137 0.0026 0.0137 0.0560 0.0560 0.0959 0.0137 0.0270 0.0137 0.0560 0.0063 0.0137 0.0137 0.0137 0.1139 0.0267 0.0207 0.0216 0.0216 0.0144 0.0053 0.0448 0.0053 E:\FR\FM\25APP2.SGM Qualifying county name DODGE. GAGE. CARSON CITY. CARSON CITY. HILLSBOURGH. HILLSBOURGH. ROCKINGHAM. HILLSBOURGH. ROCKINGHAM. ROCKINGHAM. HILLSBOURGH. ESSEX. ESSEX. MERCER. CAPE MAY. ESSEX. ESSEX. MERCER. MIDDLESEX. MIDDLESEX. MERCER. ESSEX. MIDDLESEX. ESSEX. ESSEX. ESSEX. MERCER. ESSEX. ESSEX. MIDDLESEX. MERCER. ESSEX. ESSEX. MIDDLESEX. SAN MIGUEL RIO ARRIBA. DONA ANA. DONA ANA. ULSTER. WYOMING. NASSAU. COLUMBIA. NASSAU. ORANGE. ORANGE. NASSAU. NASSAU. NASSAU. WARREN. NASSAU. ORANGE. ORANGE. ULSTER. NASSAU. CAYUGA. NASSAU. ORANGE. FULTON. NASSAU. NASSAU. NASSAU. SULLIVAN. ROWAN. LEE. CLEVELAND. CLEVELAND. IREDELL. WAKE. ALAMANCE. WAKE. 25APP2 24269 24270 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules TABLE 4J.—OUT-MIGRATION ADJUSTMENT—FY 2007—Continued Reclassified between 10/1/06 and 3/31/07 wwhite on PROD1PC61 with PROPOSALS2 Provider No. 340085 340096 340104 340114 340126 340127 340129 340133 340138 340144 340145 340173 360013 360025 360036 360065 360070 360078 360084 360086 360095 360100 360107 360131 360151 360156 360175 360187 360197 360267 370004 370014 370015 370023 370065 370113 370149 380002 380022 380029 380051 380056 390011 390030 390031 390044 390046 390056 390065 390066 390096 390101 390110 390130 390138 390146 390150 390151 390162 390181 390183 390201 390233 420007 420009 420020 420027 420030 420039 420043 ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... VerDate Aug<31>2005 17:10 Apr 24, 2006 Jkt 208001 Reclassified between 4/1/07 and 9/30/2007 ............................ ............................ ............................ * * * * ............................ * * * * * * * * ............................ * * * * ............................ * ............................ ............................ ............................ * * * ............................ * * * ............................ ............................ * ............................ ............................ * ............................ ............................ ............................ ............................ * * ............................ * ............................ * * ............................ ............................ * ............................ * * * * ............................ * * * ............................ * * * * * * ............................ ............................ ............................ ............................ * * * * ............................ * * * * * * * * ............................ * * * * ............................ * ............................ ............................ ............................ * * * ............................ * * * ............................ ............................ * ............................ ............................ * ............................ ............................ ............................ ............................ * * ............................ * ............................ * * ............................ ............................ * ............................ * * * * ............................ * * * ............................ * * * * * * ............................ PO 00000 Frm 00276 Fmt 4701 Sfmt 4702 Out-migration adjustment 0.0377 0.0377 0.0216 0.0053 0.0161 0.0961 0.0144 0.0308 0.0053 0.0144 0.0563 0.0053 0.0166 0.0087 0.0263 0.0141 0.0028 0.0159 0.0028 0.0168 0.0087 0.0028 0.0213 0.0028 0.0028 0.0213 0.0159 0.0168 0.0092 0.0028 0.0193 0.0831 0.0463 0.0084 0.0121 0.0205 0.0356 0.0130 0.0201 0.0075 0.0075 0.0075 0.0012 0.0276 0.0276 0.0200 0.0098 0.0042 0.0501 0.0259 0.0200 0.0098 0.0012 0.0012 0.0325 0.0053 0.0206 0.0325 0.0200 0.0276 0.0276 0.1127 0.0098 0.0001 0.0153 0.0035 0.0210 0.0103 0.0153 0.0177 E:\FR\FM\25APP2.SGM Qualifying county name DAVIDSON. DAVIDSON. CLEVELAND. WAKE. WILSON. GRANVILLE. IREDELL. MARTIN. WAKE. IREDELL. LINCOLN. WAKE. SHELBY. ERIE. WAYNE. HURON. STARK. PORTAGE. STARK. CLARK. HANCOCK. STARK. SANDUSKY STARK. STARK. SANDUSKY CLINTON. CLARK. LOGAN. STARK. OTTAWA. BRYAN. MAYES. STEPHENS. CRAIG. DELAWRE. POTTAWATOMIE. JOSEPHINE. LINN. MARION. MARION. MARION. CAMBRIA. SCHUYLKILL. SCHUYLKILL. BERKS. YORK. HUNTINGDON. ADAMS. LEBANON. BERKS. YORK. CAMBRIA. CAMBRIA. FRANKLIN. WARREN. GREENE. FRANKLIN. NORTHAMPTON. SCHUYLKILL. SCHUYLKILL. MONROE. YORK. SPARTANBURG. OCONEE. GEORGETOWN. ANDERSON. COLLETON. UNION. CHEROKEE. 25APP2 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules TABLE 4J.—OUT-MIGRATION ADJUSTMENT—FY 2007—Continued Reclassified between 10/1/06 and 3/31/07 wwhite on PROD1PC61 with PROPOSALS2 Provider No. 420062 420068 420070 420083 420093 420098 440008 440012 440017 440024 440030 440035 440047 440051 440056 440060 440063 440067 440073 440105 440115 440148 440153 440174 440176 440181 440184 440185 450032 450039 450059 450064 450087 450099 450121 450135 450137 450144 450163 450187 450194 450214 450224 450324 450347 450370 450389 450395 450419 450438 450447 450451 450465 450469 450547 450563 450565 450596 450597 450639 450672 450675 450677 450694 450747 450755 450779 450813 450858 450872 ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... VerDate Aug<31>2005 17:10 Apr 24, 2006 Jkt 208001 Reclassified between 4/1/07 and 9/30/2007 ............................ * * * ............................ ............................ * ............................ ............................ * ............................ * ............................ ............................ ............................ * ............................ * * ............................ ............................ * ............................ ............................ ............................ ............................ ............................ * * * * * * * * * * * ............................ * * * * ............................ * ............................ * * * * * * ............................ ............................ * * ............................ ............................ ............................ * * * * * * * * * * * ............................ * * * ............................ ............................ * ............................ ............................ * ............................ * ............................ ............................ ............................ * ............................ * * ............................ ............................ * ............................ ............................ ............................ ............................ ............................ * * * * * * * * * * * ............................ * * * * ............................ * ............................ * * * * * * ............................ ............................ * * ............................ ............................ ............................ * * * * * * * * * * * PO 00000 Frm 00277 Fmt 4701 Sfmt 4702 Out-migration adjustment 0.0135 0.0097 0.0101 0.0001 0.0001 0.0035 0.0663 0.0016 0.0016 0.0387 0.0056 0.0441 0.0499 0.0104 0.0321 0.0499 0.0011 0.0056 0.0513 0.0011 0.0499 0.0568 0.0007 0.0372 0.0016 0.0407 0.0011 0.0387 0.0416 0.0097 0.0073 0.0097 0.0097 0.0180 0.0097 0.0097 0.0097 0.0573 0.0134 0.0264 0.0328 0.0368 0.0411 0.0156 0.0427 0.0258 0.0881 0.0484 0.0097 0.0258 0.0358 0.0551 0.0435 0.0156 0.0411 0.0097 0.0486 0.0808 0.0077 0.0097 0.0097 0.0097 0.0097 0.0368 0.0195 0.0484 0.0097 0.0195 0.0097 0.0097 E:\FR\FM\25APP2.SGM Qualifying county name CHESTERFIELD. ORANGE.BURG SUMTER. SPARTANBURG. SPARTANBURG. GEORGETOWN. HENDERSON. SULLIVAN. SULLIVAN. BRADLEY. HAMBLEN. MONTGOMERY. GIBSON. MC NAIRY. JEFFERSON. GIBSON. WASHINGTON. HAMBLEN. MAURY. WASHINGTON. GIBSON. DE KALB. COCKE. HAYWOOD. SULLIVAN. HARDEMAN. WASHINGTON. BRADLEY. HARRISON. TARRANT. COMAL. TARRANT. TARRANT. GRAY. TARRANT. TARRANT. TARRANT. ANDREWS. KELBERG. WASHINGTON. CHEROKEE. WHARTON. WOOD. GRAYSON. WALKER. COLORADO. HENDERSON. POLK. TARRANT. COLORADO. NAVARRO. SOMERVELL. MATAGORDA. GRAYSON. WOOD. TARRANT. PALO PINTO. HOOD. DE WIT. TARRANT. TARRANT. TARRANT. TARRANT. WHARTON. ANDERSON. HOCKLEY. TARRANT. ANDERSON. TARRANT. TARRANT. 25APP2 24271 24272 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules TABLE 4J.—OUT-MIGRATION ADJUSTMENT—FY 2007—Continued Reclassified between 10/1/06 and 3/31/07 Reclassified between 4/1/07 and 9/30/2007 * ............................ * ............................ ............................ ............................ * ............................ * ............................ ............................ * * * * * * * * ............................ * ............................ * ............................ * * ............................ ............................ ............................ * * * * * * ............................ * ............................ * ............................ ............................ ............................ * ............................ * ............................ ............................ * * * * * * * * ............................ * ............................ * ............................ * * ............................ ............................ ............................ * * * * * * ............................ Provider No. 450880 460017 460039 490019 490038 490084 490105 490110 500003 500007 500019 500021 500024 500039 500041 500079 500108 500129 500139 500143 510018 510039 510047 510050 510077 520028 520035 520044 520057 520059 520071 520095 520096 520102 520116 520132 ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... ...................................................... Out-migration adjustment 0.0097 0.0392 0.0392 0.1240 0.0022 0.0167 0.0022 0.0082 0.0208 0.0208 0.0213 0.0055 0.0023 0.0174 0.0118 0.0055 0.0055 0.0055 0.0023 0.0023 0.0209 0.0112 0.0275 0.0112 0.0021 0.0157 0.0077 0.0077 0.0118 0.0200 0.0239 0.0118 0.0200 0.0298 0.0239 0.0077 Qualifying county name TARRANT. BOX ELDER. BOX ELDER. CULPEPER. SMYTH. ESSEX. SMYTH. MONTGOMERY. SKAGIT. SKAGIT. LEWIS. PIERCE. THURSTON. KITSAP. COWLITZ. PIERCE. PIERCE. PIERCE. THURSTON. THURSTON. JACKSON. OHIO. MARION. OHIO. MINGO. GREEN. SHEBOYGAN. SHEBOYGAN. SAUK. RACINE. JEFFERSON. SAUK. RACINE. WALWORTH JEFFERSON. SHEBOYGAN. TABLE 5.—LIST OF DIAGNOSIS-RELATED GROUPS, RELATIVE WEIGHTING FACTORS, AND GEOMETRIC AND ARITHMETIC MEAN LENGTH OF STAY (LOS) DRG FY 07 proposed rule post-acute care DRG FY 07 proposed rule special pay DRG MDC .......... .......... .......... .......... .......... .......... .......... Yes .......... Yes .......... No ............ No ............ No ............ No ............ Yes .......... No ............ No ............ No ............ No ............ No ............ No ............ Yes .......... 8 .......... Yes .......... 9 .......... 10 ........ 11 ........ Type DRG title 01 01 01 01 01 01 01 SURG ...... SURG ...... SURG* ..... SURG ...... SURG ...... SURG ...... SURG ...... Yes .......... 01 SURG ...... No ............ Yes .......... Yes .......... No ............ No ............ No ............ 01 01 01 MED ......... MED ......... MED ......... 12 ........ Yes .......... No ............ 01 MED ......... 13 ........ Yes .......... No ............ 01 MED ......... 14 ........ Yes .......... No ............ 01 MED ......... 15 ........ Yes .......... No ............ 01 MED ......... 16 ........ Yes .......... No ............ 01 MED ......... CRANIOTOMY AGE >17 W CC .................. CRANIOTOMY AGE >17 W/O CC .............. CRANIOTOMY AGE 0–17 ........................... NO LONGER VALID .................................... NO LONGER VALID .................................... CARPAL TUNNEL RELEASE ...................... PERIPH & CRANIAL NERVE & DOTHER NERV SYST PROC W CC. PERIPH & CRANIAL NERVE & DOTHER NERV SYST PROC W/O CC. SPINAL DISORDERS & INJURIES ............. NERVOUS SYSTEM NEOPLASMS W CC NERVOUS SYSTEM DNEOPLASMS W/O CC. DEGENERATIVE NERVOUS SYSTEM DISORDERS. MULTIPLE SCLEROSIS & DCEREBELLAR ATAXIA. INTRACRANIAL HEMORRHAGE OR DCEREBRAL INFARCTION. NONSPECIFIC CVA & PRECEREBRAL OCCLUSION W/O INFARCT. NONSPECIFIC CEREBROVASCULAR DISORDERS W CC. wwhite on PROD1PC61 with PROPOSALS2 1 2 3 4 5 6 7 VerDate Aug<31>2005 17:10 Apr 24, 2006 Jkt 208001 PO 00000 Frm 00278 Fmt 4701 Sfmt 4702 E:\FR\FM\25APP2.SGM Geometric mean LOS Arithmetic mean LOS 3.5289 1.9870 1.9870 0.0000 0.0000 0.7965 2.5775 7.3 3.4 9.2 0.0 0.0 2.1 6.6 9.8 4.4 12.5 0.0 0.0 3.1 9.5 1.4057 2.0 2.8 1.4543 1.2513 0.8359 4.4 4.6 2.7 6.2 6.0 3.6 1.0105 4.4 5.6 0.9266 4.0 4.9 1.2480 4.3 5.5 0.9170 3.1 4.0 1.3632 5.0 6.4 Weights 25APP2 24273 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules TABLE 5.—LIST OF DIAGNOSIS-RELATED GROUPS, RELATIVE WEIGHTING FACTORS, AND GEOMETRIC AND ARITHMETIC MEAN LENGTH OF STAY (LOS)—Continued DRG FY 07 proposed rule post-acute care DRG FY 07 proposed rule special pay DRG MDC 17 ........ Yes .......... No ............ 18 ........ Yes .......... 19 ........ Type DRG title 01 MED ......... No ............ 01 MED ......... Yes .......... No ............ 01 MED ......... 20 ........ Yes .......... No ............ 01 MED ......... 21 22 23 24 25 26 27 ........ ........ ........ ........ ........ ........ ........ No ............ No ............ No ............ Yes .......... Yes .......... No ............ No ............ No No No No No No No ............ ............ ............ ............ ............ ............ ............ 01 01 01 01 01 01 01 MED MED MED MED MED MED MED 28 ........ Yes .......... No ............ 01 MED ......... 29 ........ Yes .......... No ............ 01 MED ......... 30 ........ No ............ No ............ 01 MED* ....... 31 32 33 34 ........ ........ ........ ........ No ............ No ............ No ............ Yes .......... No No No No ............ ............ ............ ............ 01 01 01 01 MED ......... MED ......... MED* ....... MED ......... 35 ........ Yes .......... No ............ 01 MED ......... 36 37 38 39 No No No No No No No No ............ ............ ............ ............ 02 02 02 02 SURG SURG SURG SURG NONSPECIFIC CEREBROVASCULAR ISORDERS W/O CC. CRANIAL & PERIPHERAL NERVE DISORDERS W CC. CRANIAL & PERIPHERAL NERVE DISORDERS W/O CC. NERVOUS SYSTEM INFECTION EXCEPT VIRAL DMENINGITIS. VIRAL MENINGITIS ..................................... HYPERTENSIVE ENCEPHALOPATHY ...... NONTRAUMATIC STUPOR & COMA ......... SEIZURE & HEADACHE AGE >17 W CC .. SEIZURE & HEADACHE AGE >17 W/O CC SEIZURE & HEADACHE AGE 0–17 ........... TRAUMATIC STUPOR & COMA, COMA >1 HR. TRAUMATIC STUPOR & COMA, COMA <1 HR AGE >17 W CC. TRAUMATIC STUPOR & COMA, COMA <1 HR AGE >17 W/O CC. TRAUMATIC STUPOR & COMA, COMA <1 HR AGE 0–17. CONCUSSION AGE >17 W CC .................. CONCUSSION AGE >17 W/O CC .............. CONCUSSION AGE 0–17 ........................... OTHER DISORDERS OF NERVOUS SYSTEM W CC. OTHER DISORDERS OF NERVOUS SYSTEM W/O CC. RETINAL PROCEDURES ............................ ORBITAL PROCEDURES ............................ PRIMARY IRIS PROCEDURES .................. LENS PROCEDURES WITH OR WITHOUT VITRECTOMY. EXTRAOCULAR PROCEDURES EXCEPT ORBIT AGE >17. EXTRAOCULAR PROCEDURES EXCEPT ORBIT AGE 0–17. INTRAOCULAR PROCEDURES EXCEPT RETINA, IRIS & LENS. HYPHEMA .................................................... ACUTE MAJOR EYE INFECTIONS ............ NEUROLOGICAL EYE DISORDERS .......... OTHER DISORDERS OF THE EYE AGE >17 W CC. OTHER DISORDERS OF THE EYE AGE >17 W/O CC. OTHER DISORDERS OF THE EYE AGE 0–17. MAJOR HEAD & NECK PROCEDURES .... SIALOADENECTOMY .................................. SALIVARY GLAND PROCEDURES EXCEPT SIALOADENECTOMY. CLEFT LIP & PALATE REPAIR .................. SINUS & MASTOID PROCEDURES AGE >17. SINUS & MASTOID PROCEDURES AGE 0–17. MISCELLANEOUS EAR, NOSE, MOUTH & THROAT PROCEDURES. RHINOPLASTY ............................................ T&A PROC, EXCEPT TONSILLECTOMY &/OR ADENOIDECTOMY ONLY, AGE >17. T&A PROC, EXCEPT TONSILLECTOMY &/OR ADENOIDECTOMY ONLY, AGE 0–17. ........ ........ ........ ........ ............ ............ ............ ............ ......... ......... ......... ......... ......... ......... ......... ...... ...... ...... ...... 40 ........ No ............ No ............ 02 SURG ...... 41 ........ No ............ No ............ 02 SURG* ..... 42 ........ No ............ No ............ 02 SURG ...... 43 44 45 46 No No No No No No No No ............ ............ ............ ............ 02 02 02 02 MED MED MED MED ........ ........ ........ ........ ............ ............ ............ ............ ......... ......... ......... ......... No ............ No ............ 02 MED ......... 48 ........ No ............ No ............ 02 MED* ....... 49 ........ 50 ........ 51 ........ No ............ No ............ No ............ No ............ No ............ No ............ 03 03 03 SURG ...... SURG ...... SURG ...... 52 ........ 53 ........ No ............ No ............ No ............ No ............ 03 03 SURG ...... SURG ...... 54 ........ No ............ No ............ 03 SURG* ..... 55 ........ wwhite on PROD1PC61 with PROPOSALS2 47 ........ No ............ No ............ 03 SURG ...... 56 ........ 57 ........ No ............ No ............ No ............ No ............ 03 03 SURG ...... SURG ...... 58 ........ No ............ No ............ 03 SURG* ..... VerDate Aug<31>2005 17:10 Apr 24, 2006 Jkt 208001 PO 00000 Frm 00279 Fmt 4701 Sfmt 4702 E:\FR\FM\25APP2.SGM Geometric mean LOS Arithmetic mean LOS 0.6692 2.4 3.0 1.0501 4.1 5.2 0.7128 2.7 3.4 2.7596 8.0 10.3 1.4536 1.2386 0.8423 1.0388 0.6436 1.1844 1.4281 4.7 3.9 3.0 3.5 2.5 2.6 3.1 6.2 5.0 3.9 4.7 3.1 3.8 4.8 1.4037 4.2 5.7 0.7658 2.6 3.2 0.7658 * * 0.9511 0.5859 0.5859 1.0347 3.0 1.8 * 3.6 3.9 2.3 * 4.8 0.6453 2.5 3.1 0.7936 1.2193 0.5783 0.7098 1.3 2.7 2.2 1.5 1.7 4.1 2.8 2.0 1.1061 3.0 4.1 1.1061 * * 0.9264 2.1 3.0 0.5799 0.8191 0.6809 0.8135 2.4 3.8 2.5 3.2 3.0 4.8 3.0 4.2 0.5728 2.4 3.0 0.5728 * * 1.7653 0.8292 0.8841 3.2 1.5 1.9 4.5 1.9 2.7 0.7608 1.2984 1.4 2.5 1.7 4.0 1.2984 * * 0.9555 1.9 2.9 0.9535 1.0220 1.9 2.1 2.7 3.2 1.0220 * * Weights 25APP2 24274 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules TABLE 5.—LIST OF DIAGNOSIS-RELATED GROUPS, RELATIVE WEIGHTING FACTORS, AND GEOMETRIC AND ARITHMETIC MEAN LENGTH OF STAY (LOS)—Continued DRG FY 07 proposed rule post-acute care DRG FY 07 proposed rule special pay DRG MDC 59 ........ No ............ No ............ 60 ........ No ............ 61 ........ DRG title 03 SURG ...... No ............ 03 SURG* ..... No ............ No ............ 03 SURG ...... 62 ........ No ............ No ............ 03 SURG* ..... 63 ........ No ............ No ............ 03 SURG ...... 64 ........ No ............ No ............ 03 MED ......... 65 66 67 68 69 70 71 72 73 ........ ........ ........ ........ ........ ........ ........ ........ ........ No ............ No ............ No ............ No ............ No ............ No ............ No ............ No ............ Yes .......... No No No No No No No No No ............ ............ ............ ............ ............ ............ ............ ............ ............ 03 03 03 03 03 03 03 03 03 MED MED MED MED MED MED MED MED MED 74 ........ No ............ No ............ 03 MED* ....... 75 ........ 76 ........ Yes .......... Yes .......... No ............ No ............ 04 04 SURG ...... SURG ...... 77 ........ Yes .......... No ............ 04 SURG ...... 78 ........ 79 ........ Yes .......... Yes .......... No ............ No ............ 04 04 MED ......... MED ......... 80 ........ Yes .......... No ............ 04 MED ......... 81 ........ No ............ No ............ 04 MED* ....... 82 83 84 85 86 87 ........ ........ ........ ........ ........ ........ Yes .......... Yes .......... Yes .......... Yes .......... Yes .......... No ............ No No No No No No ............ ............ ............ ............ ............ ............ 04 04 04 04 04 04 MED MED MED MED MED MED 88 ........ No ............ No ............ 04 MED ......... 89 ........ Yes .......... No ............ 04 MED ......... 90 ........ Yes .......... No ............ 04 MED ......... 91 ........ No ............ No ............ 04 MED ......... 92 93 94 95 96 97 wwhite on PROD1PC61 with PROPOSALS2 Type ........ ........ ........ ........ ........ ........ Yes .......... Yes .......... No ............ No ............ No ............ No ............ No No No No No No ............ ............ ............ ............ ............ ............ 04 04 04 04 04 04 MED MED MED MED MED MED 98 ........ 99 ........ No ............ No ............ No ............ No ............ 04 04 MED ......... MED ......... 100 ...... No ............ No ............ 04 MED ......... 101 ...... Yes .......... No ............ 04 MED ......... 102 ...... Yes .......... No ............ 04 MED ......... TONSILLECTOMY &/OR ADENOIDECTOMY ONLY, AGE >17. TONSILLECTOMY &/OR ADENOIDECTOMY ONLY, AGE 0–17. MYRINGOTOMY W TUBE INSERTION AGE >17. MYRINGOTOMY W TUBE INSERTION AGE 0–17. OTHER EAR, NOSE, MOUTH & THROAT O.R. PROCEDURES. EAR, NOSE, MOUTH & THROAT MALIGNANCY. DYSEQUILIBRIUM ....................................... EPISTAXIS ................................................... EPIGLOTTITIS ............................................. OTITIS MEDIA & URI AGE >17 W CC ... OTITIS MEDIA & URI AGE >17 W/O CC OTITIS MEDIA & URI AGE 0–17 ................ LARYNGOTRACHEITIS ............................... NASAL TRAUMA & DEFORMITY ............... OTHER EAR, NOSE, MOUTH & THROAT DIAGNOSES AGE >17. OTHER EAR, NOSE, MOUTH & THROAT DIAGNOSES AGE 0–17. MAJOR CHEST PROCEDURES ................. OTHER RESP SYSTEM O.R. PROCEDURES W CC. OTHER RESP SYSTEM O.R. PROCEDURES W/O CC. PULMONARY EMBOLISM ........................... RESPIRATORY INFECTIONS & INFLAMMATIONS AGE >17 W CC. RESPIRATORY INFECTIONS & INFLAMMATIONS AGE >17 W/O CC. RESPIRATORY INFECTIONS & INFLAMMATIONS AGE 0–7. RESPIRATORY NEOPLASMS .................... MAJOR CHEST TRAUMA W CC ................ MAJOR CHEST TRAUMA W/O CC ............ PLEURAL EFFUSION W CC ....................... PLEURAL EFFUSION W/O CC ................... PULMONARY EDEMA & ESPIRATORY FAILURE. CHRONIC OBSTRUCTIVE PULMONARY DISEASE. SIMPLE PNEUMONIA & PLEURISY AGE >17 W CC. SIMPLE PNEUMONIA & PLEURISY AGE >17 W/O CC. SIMPLE PNEUMONIA & PLEURISY AGE 0–17. INTERSTITIAL LUNG DISEASE W CC ....... INTERSTITIAL LUNG DISEASE W/O CC ... PNEUMOTHORAX W CC ............................ PNEUMOTHORAX W/O CC ........................ BRONCHITIS & ASTHMA AGE >17 W CC BRONCHITIS & ASTHMA AGE >17 W/O CC. BRONCHITIS & ASTHMA AGE 0–17 .......... RESPIRATORY SIGNS & SYMPTOMS W CC. RESPIRATORY SIGNS & SYMPTOMS W/ O CC. OTHER RESPIRATORY DSYSTEM DIAGNOSES W CC. OTHER RESPIRATORY SYSTEM DIAGNOSES W/O CC. VerDate Aug<31>2005 17:10 Apr 24, 2006 Jkt 208001 PO 00000 ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... Frm 00280 Fmt 4701 Sfmt 4702 E:\FR\FM\25APP2.SGM Geometric mean LOS Arithmetic mean LOS 0.7380 1.8 2.4 0.7380 1.4 1.7 1.5534 3.7 6.1 1.5534 1.3 1.5 1.4153 3.0 4.5 1.2875 4.2 6.3 0.5799 0.6790 0.9830 0.7572 0.5706 0.4794 0.9064 0.7502 0.9140 2.3 2.4 2.8 3.1 2.5 2.0 3.4 2.6 3.3 2.8 3.1 3.7 3.8 2.9 2.3 4.4 3.3 4.3 0.9140 3.3 3.3 3.0790 2.7410 7.4 8.2 9.7 10.7 1.1515 3.3 4.5 1.3229 1.7331 5.3 6.7 6.2 8.3 1.0190 4.3 5.3 1.7331 5.2 6.2 1.4335 1.1185 0.6523 1.2935 0.7154 1.5310 5.1 4.2 2.6 4.7 2.7 4.9 6.8 5.3 3.2 6.2 3.5 6.4 0.9557 4.0 4.9 1.1291 4.6 5.6 0.7043 3.2 3.7 0.7054 2.5 3.4 1.2410 0.7539 1.2852 0.7018 0.8093 0.6199 4.8 3.0 4.5 2.7 3.5 2.8 6.0 3.8 5.9 3.4 4.3 3.4 0.6892 0.7101 2.8 2.4 3.1 3.1 0.5098 1.7 2.1 0.9106 3.2 4.2 0.5625 2.0 2.5 Weights 25APP2 24275 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules TABLE 5.—LIST OF DIAGNOSIS-RELATED GROUPS, RELATIVE WEIGHTING FACTORS, AND GEOMETRIC AND ARITHMETIC MEAN LENGTH OF STAY (LOS)—Continued DRG FY 07 proposed rule post-acute care DRG FY 07 proposed rule special pay DRG MDC 103 ...... No ............ No ............ 104 ...... Yes .......... 105 ...... Type DRG title PRE SURG ...... No ............ 05 SURG ...... Yes .......... No ............ 05 SURG ...... 106 ...... 107 ...... 108 ...... No ............ Yes .......... Yes .......... No ............ No ............ No ............ 05 05 05 SURG ...... SURG ...... SURG ...... 109 ...... 110 ...... Yes .......... No ............ No ............ No ............ 05 05 SURG ...... SURG ...... 111 ...... No ............ No ............ 05 SURG ...... 112 ...... 113 ...... No ............ Yes .......... No ............ No ............ 05 05 SURG ...... SURG ...... 114 ...... Yes .......... No ............ 05 SURG ...... 115 ...... 116 ...... 117 ...... No ............ No ............ No ............ No ............ No ............ No ............ 05 05 05 SURG ...... SURG ...... SURG ...... 118 ...... No ............ No ............ 05 SURG ...... 119 ...... 120 ...... No ............ Yes .......... No ............ No ............ 05 05 SURG ...... SURG ...... 121 ...... Yes .......... No ............ 05 MED ......... 122 ...... No ............ No ............ 05 MED ......... 123 ...... No ............ No ............ 05 MED ......... 124 ...... No ............ No ............ 05 MED ......... 125 ...... No ............ No ............ 05 MED ......... 126 127 128 129 130 ...... ...... ...... ...... ...... Yes .......... Yes .......... No ............ No ............ Yes .......... No No No No No ............ ............ ............ ............ ............ 05 05 05 05 05 MED MED MED MED MED 131 ...... Yes .......... No ............ 05 MED ......... 132 133 134 135 No No No No No No No No ............ ............ ............ ............ 05 05 05 05 MED MED MED MED HEART TRANSPLANT OR IMPLANT OF HEART ASSIST SYSTEM. CARDIAC VALVE & OTH MAJOR CARDIOTHORACIC PROC W CARD CATH. CARDIAC VALVE & OTH MAJOR CARDIOTHORACIC PROC W/O CARD CATH. CORONARY BYPASS W PTCA .................. NO LONGER VALID .................................... OTHER CARDIOTHORACIC PROCEDURES. NO LONGER VALID .................................... MAJOR CARDIOVASCULAR PROCEDURES W CC. MAJOR CARDIOVASCULAR PROCEDURES W/O CC. NO LONGER VALID .................................... AMPUTATION FOR CIRC SYSTEM DISORDERS EXCEPT UPPER LIMB & TOE. UPPER LIMB & TOE AMPUTATION FOR CIRC SYSTEM DISORDERS. NO LONGER VALID .................................... NO LONGER VALID .................................... CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT. CARDIAC PACEMAKER DEVICE REPLACEMENT. VEIN LIGATION & STRIPPING ................... OTHER CIRCULATORY SYSTEM O.R. PROCEDURES. CIRCULATORY DISORDERS W AMI & MAJOR COMP, DISCHARGED ALIVE. CIRCULATORY DISORDERS W AMI W/O MAJOR COMP, DISCHARGED ALIVE. CIRCULATORY DISORDERS W AMI, EXPIRED. CIRCULATORY DISORDERS EXCEPT AMI, W CARD CATH & COMPLEX DIAG. CIRCULATORY DISORDERS EXCEPT AMI, W CARD CATH W/O COMPLEX DIAG. ACUTE & SUBACUTE ENDOCARDITIS ..... HEART FAILURE & SHOCK ....................... DEEP VEIN THROMBOPHLEBITIS ............ CARDIAC ARREST, UNEXPLAINED .......... PERIPHERAL VASCULAR DISORDERS W CC. PERIPHERAL VASCULAR DISORDERS W/O CC. ATHEROSCLEROSIS W CC ....................... ATHEROSCLEROSIS W/O CC ................... HYPERTENSION ......................................... CARDIAC CONGENITAL & VALVULAR DISORDERS AGE >17 W CC. CARDIAC CONGENITAL & VALVULAR DISORDERS AGE >17 W/O CC. CARDIAC CONGENITAL & VALVULAR DISORDERS AGE 0–17. CARDIAC ARRHYTHMIA & CONDUCTION DISORDERS W CC. CARDIAC ARRHYTHMIA & CONDUCTION DISORDERS W/O CC. ANGINA PECTORIS .................................... SYNCOPE & COLLAPSE W CC ................. SYNCOPE & COLLAPSE W/O CC ............. CHEST PAIN ................................................ ...... ...... ...... ...... ............ ............ ............ ............ ......... ......... ......... ......... ......... ......... ......... ......... ......... No ............ No ............ 05 MED ......... 137 ...... wwhite on PROD1PC61 with PROPOSALS2 136 ...... No ............ No ............ 05 MED* ....... 138 ...... No ............ No ............ 05 MED ......... 139 ...... No ............ No ............ 05 MED ......... 140 141 142 143 No No No No No No No No 05 05 05 05 MED MED MED MED ...... ...... ...... ...... VerDate Aug<31>2005 ............ ............ ............ ............ ............ ............ ............ ............ 17:10 Apr 24, 2006 Jkt 208001 PO 00000 ......... ......... ......... ......... Frm 00281 Fmt 4701 Sfmt 4702 E:\FR\FM\25APP2.SGM Geometric mean LOS Arithmetic mean LOS 19.5988 22.2 35.1 7.4447 12.8 15.1 5.6619 8.4 10.2 5.9701 0.0000 5.4207 9.3 0.0 8.8 10.9 0.0 10.9 0.0000 3.6419 0.0 5.4 0.0 8.1 2.2318 2.3 3.1 0.0000 3.3828 0.0 10.8 0.0 13.7 1.8874 6.6 8.7 0.0000 0.0000 1.2528 0.0 0.0 2.6 0.0 0.0 4.3 1.3882 2.0 3.0 1.4787 2.3109 3.3 6.0 5.4 9.2 1.6883 5.2 6.5 0.9802 2.7 3.4 1.6053 2.9 4.7 1.1670 3.3 4.4 0.7862 2.1 2.7 2.5526 1.0635 0.8850 1.1301 1.0637 9.0 4.1 4.4 1.6 4.3 11.3 5.1 5.2 2.5 5.5 0.6813 3.1 3.7 0.6482 0.5237 0.6464 0.9122 2.2 1.8 2.5 3.3 2.8 2.1 3.1 4.3 0.5684 2.1 2.7 0.9122 * * 0.8504 3.0 3.9 0.5221 2.0 2.4 0.5846 0.7009 0.5312 0.5137 1.9 2.7 2.1 1.7 2.4 3.4 2.5 2.1 Weights 25APP2 24276 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules TABLE 5.—LIST OF DIAGNOSIS-RELATED GROUPS, RELATIVE WEIGHTING FACTORS, AND GEOMETRIC AND ARITHMETIC MEAN LENGTH OF STAY (LOS)—Continued DRG FY 07 proposed rule post-acute care DRG FY 07 proposed rule special pay DRG MDC 144 ...... Yes .......... No ............ 145 ...... Yes .......... 146 ...... 147 ...... 148 ...... DRG title 05 MED ......... No ............ 05 MED ......... Yes .......... Yes .......... Yes .......... No ............ No ............ No ............ 06 06 06 SURG ...... SURG ...... SURG ...... 149 ...... Yes .......... No ............ 06 SURG ...... 150 ...... 151 ...... 152 ...... Yes .......... Yes .......... No ............ No ............ No ............ No ............ 06 06 06 SURG ...... SURG ...... SURG ...... 153 ...... No ............ No ............ 06 SURG ...... 154 ...... Yes .......... No ............ 06 SURG ...... 155 ...... Yes .......... No ............ 06 SURG ...... 156 ...... No ............ No ............ 06 SURG ...... 157 ...... 158 ...... 159 ...... Yes .......... Yes .......... No ............ No ............ No ............ No ............ 06 06 06 SURG ...... SURG ...... SURG ...... 160 ...... No ............ No ............ 06 SURG ...... 161 ...... No ............ No ............ 06 SURG ...... 162 ...... No ............ No ............ 06 SURG ...... 163 ...... 164 ...... No ............ No ............ No ............ No ............ 06 06 SURG* ..... SURG ...... 165 ...... No ............ No ............ 06 SURG ...... 166 ...... No ............ No ............ 06 SURG ...... 167 ...... No ............ No ............ 06 SURG ...... 168 ...... 169 ...... 170 ...... No ............ No ............ Yes .......... No ............ No ............ No ............ 03 03 06 SURG ...... SURG ...... SURG ...... 171 ...... Yes .......... No ............ 06 SURG ...... 172 173 174 175 176 177 178 ...... ...... ...... ...... ...... ...... ...... Yes .......... Yes .......... No ............ No ............ Yes .......... No ............ No ............ No No No No No No No ............ ............ ............ ............ ............ ............ ............ 06 06 06 06 06 06 06 MED MED MED MED MED MED MED ......... ......... ......... ......... ......... ......... ......... 179 180 181 182 wwhite on PROD1PC61 with PROPOSALS2 Type ...... ...... ...... ...... No ............ Yes .......... Yes .......... No ............ No No No No ............ ............ ............ ............ 06 06 06 06 MED MED MED MED ......... ......... ......... ......... 183 ...... No ............ No ............ 06 MED ......... 184 ...... No ............ No ............ 06 MED ......... 185 ...... No ............ No ............ 03 MED ......... 186 ...... No ............ No ............ 03 MED* ....... OTHER CIRCULATORY SYSTEM DIAGNOSES W CC. OTHER CIRCULATORY SYSTEM DIAGNOSES W/O CC. RECTAL RESECTION W CC ...................... RECTAL RESECTION W/O CC .................. MAJOR SMALL & LARGE BOWEL PROCEDURES W CC. MAJOR SMALL & LARGE BOWEL PROCEDURES W/O CC. PERITONEAL ADHESIOLYSIS W CC ........ PERITONEAL ADHESIOLYSIS W/O CC .... MINOR SMALL & LARGE BOWEL PROCEDURES W CC. MINOR SMALL & LARGE BOWEL PROCEDURES W/O CC. STOMACH, ESOPHAGEAL & DUODENAL PROCEDURES AGE >17 W CC. STOMACH, ESOPHAGEAL & DUODENAL PROCEDURES AGE >17 W/O CC. STOMACH, ESOPHAGEAL & DUODENAL PROCEDURES AGE 0–17. ANAL & STOMAL PROCEDURES W CC ... ANAL & STOMAL PROCEDURES W/O CC HERNIA PROCEDURES EXCEPT INGUINAL & FEMORAL AGE >17 W CC. HERNIA PROCEDURES EXCEPT INGUINAL & FEMORAL AGE >17 W/O CC. INGUINAL & FEMORAL HERNIA PROCEDURES AGE >17 W CC. INGUINAL & FEMORAL HERNIA PROCEDURES AGE >17 W/O CC. HERNIA PROCEDURES AGE 0–17 ........... APPENDECTOMY W COMPLICATED PRINCIPAL DIAG W CC. APPENDECTOMY W COMPLICATED PRINCIPAL DIAG W/O CC. APPENDECTOMY W/O COMPLICATED PRINCIPAL DIAG W CC. APPENDECTOMY W/O COMPLICATED PRINCIPAL DIAG W/O CC. MOUTH PROCEDURES W CC ................... MOUTH PROCEDURES W/O CC ............... OTHER DIGESTIVE SYSTEM O.R. PROCEDURES W CC. OTHER DIGESTIVE SYSTEM O.R. PROCEDURES W/O CC. DIGESTIVE MALIGNANCY W CC .............. DIGESTIVE MALIGNANCY W/O CC ........... G.I. HEMORRHAGE W CC ......................... G.I. HEMORRHAGE W/O CC ...................... COMPLICATED PEPTIC ULCER ................ UNCOMPLICATED PEPTIC ULCER W CC UNCOMPLICATED PEPTIC ULCER W/O CC. INFLAMMATORY BOWEL DISEASE .......... G.I. OBSTRUCTION W CC ......................... G.I. OBSTRUCTION W/O CC ...................... ESOPHAGITIS, GASTROENT & MISC DIGEST DISORDERS AGE >17 W CC. ESOPHAGITIS, GASTROENT & MISC DIGEST DISORDERS AGE >17 W/O CC. ESOPHAGITIS, GASTROENT & MISC DIGEST DISORDERS AGE 0–17. DENTAL & ORAL DIS EXCEPT EXTRACTIONS & RESTORATIONS, AGE >17. DENTAL & ORAL DIS EXCEPT EXTRACTIONS & RESTORATIONS, AGE 0–17. VerDate Aug<31>2005 17:10 Apr 24, 2006 Jkt 208001 PO 00000 Frm 00282 Fmt 4701 Sfmt 4702 E:\FR\FM\25APP2.SGM Geometric mean LOS Arithmetic mean LOS 1.3781 4.2 5.9 0.5993 2.0 2.5 2.8001 1.5698 3.5831 8.4 4.9 9.9 9.9 5.6 12.1 1.5441 5.1 5.7 2.9172 1.3530 2.0074 8.7 4.0 6.5 10.8 5.0 7.9 1.1984 4.4 4.9 4.2032 9.7 13.2 1.3089 3.0 4.0 1.3089 8.9 9.3 1.4076 0.7114 1.4745 4.2 2.1 3.7 5.8 2.6 5.1 0.8749 2.2 2.7 1.2461 3.2 4.5 0.6982 1.7 2.1 0.6982 2.2048 2.3 6.4 2.8 7.7 1.1907 3.4 4.0 1.3900 3.2 4.3 0.8536 1.8 2.1 1.3278 0.7643 2.9351 3.4 1.9 7.8 4.9 2.4 10.9 1.2434 3.1 4.2 1.4585 0.7562 1.1360 0.6295 1.1757 0.9595 0.6833 5.1 2.7 3.8 2.4 4.0 3.6 2.6 6.9 3.5 4.7 2.9 5.1 4.4 3.1 1.1460 1.0702 0.6400 0.9046 4.5 4.1 2.8 3.4 5.8 5.3 3.3 4.5 0.6078 2.4 2.9 0.8504 2.8 4.3 0.9381 3.3 4.5 0.9381 2.6 3.1 Weights 25APP2 24277 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules TABLE 5.—LIST OF DIAGNOSIS-RELATED GROUPS, RELATIVE WEIGHTING FACTORS, AND GEOMETRIC AND ARITHMETIC MEAN LENGTH OF STAY (LOS)—Continued DRG FY 07 proposed rule post-acute care DRG FY 07 proposed rule special pay DRG MDC 187 ...... No ............ No ............ 188 ...... Yes .......... 189 ...... DRG title 03 MED ......... No ............ 06 MED ......... Yes .......... No ............ 06 MED ......... 190 ...... No ............ No ............ 06 MED ......... 191 ...... Yes .......... No ............ 07 SURG ...... 192 ...... Yes .......... No ............ 07 SURG ...... 193 ...... No ............ No ............ 07 SURG ...... 194 ...... No ............ No ............ 07 SURG ...... 195 ...... 196 ...... 197 ...... No ............ No ............ Yes .......... No ............ No ............ No ............ 07 07 07 SURG ...... SURG ...... SURG ...... 198 ...... Yes .......... No ............ 07 SURG ...... 199 ...... No ............ No ............ 07 SURG ...... 200 ...... No ............ No ............ 07 SURG ...... 201 ...... No ............ No ............ 07 SURG ...... 202 ...... 203 ...... No ............ No ............ No ............ No ............ 07 07 MED ......... MED ......... 204 ...... No ............ No ............ 07 MED ......... 205 ...... Yes .......... No ............ 07 MED ......... 206 ...... Yes .......... No ............ 07 MED ......... 207 ...... No ............ No ............ 07 MED ......... 208 ...... No ............ No ............ 07 MED ......... 209 ...... 210 ...... No ............ Yes .......... No ............ Yes .......... 08 08 SURG ...... SURG ...... 211 ...... Yes .......... Yes .......... 08 SURG ...... 212 ...... No ............ No ............ 08 SURG ...... 213 ...... Yes .......... No ............ 08 SURG ...... 214 ...... 215 ...... 216 ...... No ............ No ............ Yes .......... No ............ No ............ No ............ 08 08 08 SURG ...... SURG ...... SURG ...... 217 ...... Yes .......... No ............ 08 SURG ...... 218 ...... wwhite on PROD1PC61 with PROPOSALS2 Type Yes .......... No ............ 08 SURG ...... 219 ...... Yes .......... No ............ 08 SURG ...... 220 ...... No ............ No ............ 08 SURG* ..... 221 ...... 222 ...... No ............ No ............ No ............ No ............ 08 08 SURG ...... SURG ...... DENTAL EXTRACTIONS & RESTORATIONS. OTHER DIGESTIVE SYSTEM DIAGNOSES AGE >17 W CC. OTHER DIGESTIVE SYSTEM DIAGNOSES AGE >17 W/O CC. OTHER DIGESTIVE SYSTEM DIAGNOSES AGE 0–17. PANCREAS, LIVER & SHUNT PROCEDURES W CC. PANCREAS, LIVER & SHUNT PROCEDURES W/O CC. BILIARY TRACT PROC EXCEPT ONLY CHOLECYST W OR W/O C.D.E. W CC. BILIARY TRACT PROC EXCEPT ONLY CHOLECYST W OR W/O C.D.E. W/O CC. CHOLECYSTECTOMY W C.D.E. W CC ..... CHOLECYSTECTOMY W C.D.E. W/O CC CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE W/O C.D.E. W CC. CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE W/O C.D.E. W/O CC. HEPATOBILIARY DIAGNOSTIC PROCEDURE FOR MALIGNANCY. HEPATOBILIARY DIAGNOSTIC PROCEDURE FOR NON-MALIGNANCY. OTHER HEPATOBILIARY OR PANCREAS O.R. PROCEDURES. CIRRHOSIS & ALCOHOLIC HEPATITIS .... MALIGNANCY OF HEPATOBILIARY SYSTEM OR PANCREAS. DISORDERS OF PANCREAS EXCEPT MALIGNANCY. DISORDERS OF LIVER EXCEPT MALIG,CIRR,ALC HEPA W CC. DISORDERS OF LIVER EXCEPT MALIG,CIRR,ALC HEPA W/O CC. DISORDERS OF THE BILIARY TRACT W CC. DISORDERS OF THE BILIARY TRACT W/ O CC. NO LONGER VALID .................................... HIP & FEMUR PROCEDURES EXCEPT MAJOR JOINT AGE >17 W CC. HIP & FEMUR PROCEDURES EXCEPT MAJOR JOINT AGE >17 W/O CC. HIP & FEMUR PROCEDURES EXCEPT MAJOR JOINT AGE 0–17. AMPUTATION FOR MUSCULOSKELETAL SYSTEM & CONN TISSUE DISORDERS. NO LONGER VALID .................................... NO LONGER VALID .................................... BIOPSIES OF MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE. WND DEBRID & SKN GRFT EXCEPT HAND,FOR MUSCSKELET & CONN TISS DIS. LOWER EXTREM & HUMER PROC EXCEPT HIP,FOOT,FEMUR AGE >17 W CC. LOWER EXTREM & HUMER PROC EXCEPT HIP,FOOT,FEMUR AGE >17 W/O CC. LOWER EXTREM & HUMER PROC EXCEPT HIP,FOOT,FEMUR AGE 0–17. NO LONGER VALID .................................... NO LONGER VALID .................................... VerDate Aug<31>2005 17:10 Apr 24, 2006 Jkt 208001 PO 00000 Frm 00283 Fmt 4701 Sfmt 4702 E:\FR\FM\25APP2.SGM Geometric mean LOS Arithmetic mean LOS 0.8880 3.1 4.2 1.1808 4.1 5.5 0.6314 2.4 3.1 1.0119 3.5 4.9 3.9647 8.8 12.5 1.7088 4.2 5.5 3.4693 10.1 12.6 1.6583 5.4 6.4 3.0330 1.5984 2.6196 8.8 4.5 7.4 10.6 5.3 9.1 1.2463 3.7 4.3 2.3139 6.4 9.0 3.0580 6.5 10.4 3.6519 10.0 13.6 1.4205 1.3745 4.6 4.8 6.2 6.5 1.1749 4.1 5.4 1.2942 4.4 5.9 0.7720 3.0 3.8 1.2145 4.1 5.3 0.6986 2.4 3.0 0.0000 2.0150 0.0 6.0 0.0 6.8 1.3653 4.3 4.6 0.9730 2.2 2.5 2.2463 7.1 9.5 0.0000 0.0000 1.7169 0.0 0.0 3.1 0.0 0.0 5.4 3.1361 9.0 12.8 1.7105 4.4 5.5 1.1071 2.7 3.2 1.1071 2.6 4.0 0.0000 0.0000 0.0 0.0 0.0 0.0 Weights 25APP2 24278 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules TABLE 5.—LIST OF DIAGNOSIS-RELATED GROUPS, RELATIVE WEIGHTING FACTORS, AND GEOMETRIC AND ARITHMETIC MEAN LENGTH OF STAY (LOS)—Continued DRG FY 07 proposed rule post-acute care DRG FY 07 proposed rule special pay DRG MDC 223 ...... No ............ No ............ 224 ...... No ............ 225 226 227 228 ...... ...... ...... ...... DRG title 08 SURG ...... No ............ 08 SURG ...... Yes .......... Yes .......... Yes .......... No ............ No No No No ............ ............ ............ ............ 08 08 08 08 SURG SURG SURG SURG 229 ...... No ............ No ............ 08 SURG ...... 230 ...... No ............ No ............ 08 SURG ...... 231 ...... 232 ...... 233 ...... No ............ No ............ Yes .......... No ............ No ............ Yes .......... 08 08 08 SURG ...... SURG ...... SURG ...... 234 ...... Yes .......... Yes .......... 08 SURG ...... 235 ...... 236 ...... 237 ...... Yes .......... Yes .......... No ............ No ............ No ............ No ............ 08 08 08 MED ......... MED ......... MED ......... 238 ...... 239 ...... Yes .......... Yes .......... No ............ No ............ 08 08 MED ......... MED ......... 240 ...... Yes .......... No ............ 08 MED ......... 241 ...... Yes .......... No ............ 08 MED ......... 242 ...... 243 ...... 244 ...... No ............ No ............ Yes .......... No ............ No ............ No ............ 08 08 08 MED ......... MED ......... MED ......... 245 ...... Yes .......... No ............ 08 MED ......... 246 ...... 247 ...... No ............ No ............ No ............ No ............ 08 08 MED ......... MED ......... 248 ...... 249 ...... No ............ No ............ No ............ No ............ 08 08 MED ......... MED ......... 250 ...... Yes .......... No ............ 08 MED ......... 251 ...... Yes .......... No ............ 08 MED ......... 252 ...... No ............ No ............ 08 MED* ....... 253 ...... Yes .......... No ............ 08 MED ......... 254 ...... Yes .......... No ............ 08 MED ......... 255 ...... No ............ No ............ 08 MED* ....... 256 ...... wwhite on PROD1PC61 with PROPOSALS2 Type Yes .......... No ............ 08 MED ......... 257 ...... No ............ No ............ 09 SURG ...... 258 ...... No ............ No ............ 09 SURG ...... 259 ...... No ............ No ............ 09 SURG ...... 260 ...... No ............ No ............ 09 SURG ...... MAJOR SHOULDER/ELBOW PROC, OR OTHER UPPER EXTREMITY PROC W CC. SHOULDER,ELBOW OR FOREARM PROC,EXC MAJOR JOINT PROC, W/O CC. FOOT PROCEDURES ................................. SOFT TISSUE PROCEDURES W CC ........ SOFT TISSUE PROCEDURES W/O CC .... MAJOR THUMB OR JOINT PROC,OR OTH HAND OR WRIST PROC W CC. HAND OR WRIST PROC, EXCEPT MAJOR JOINT PROC, W/O CC. LOCAL EXCISION & REMOVAL OF INT FIX DEVICES OF HIP & FEMUR. NO LONGER VALID .................................... ARTHROSCOPY .......................................... OTHER MUSCULOSKELET SYS & CONN TISS O.R. PROC W CC. OTHER MUSCULOSKELET SYS & CONN TISS O.R. PROC W/O CC. FRACTURES OF FEMUR ........................... FRACTURES OF HIP & PELVIS ................. SPRAINS, STRAINS, & DISLOCATIONS OF HIP, PELVIS & THIGH. OSTEOMYELITIS ......................................... PATHOLOGICAL FRACTURES & MUSCULOSKELETAL & CONN TISS MALIGNANCY. CONNECTIVE TISSUE DISORDERS W CC. CONNECTIVE TISSUE DISORDERS W/O CC. SEPTIC ARTHRITIS .................................... MEDICAL BACK PROBLEMS ..................... BONE DISEASES & SPECIFIC ARTHROPATHIES W CC. BONE DISEASES & SPECIFIC ARTHROPATHIES W/O CC. NON-SPECIFIC ARTHROPATHIES ............ SIGNS & SYMPTOMS OF MUSCULOSKELETAL SYSTEM & CONN TISSUE. TENDONITIS, MYOSITIS & BURSITIS ....... AFTERCARE, MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE. FX, SPRN, STRN & DISL OF FOREARM, HAND, FOOT AGE >17 W CC. FX, SPRN, STRN & DISL OF FOREARM, HAND, FOOT AGE >17 W/O CC. FX, SPRN, STRN & DISL OF FOREARM, HAND, FOOT AGE 0–17. FX, SPRN, STRN & DISL OF DUPARM, LOWLEG EX FOOT AGE >17 W CC. FX, SPRN, STRN & DISL OF UPARM, LOWLEG EX FOOT AGE >17 W/O CC. FX, SPRN, STRN & DISL OF UPARM, LOWLEG EX FOOT AGE 0–17. OTHER MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE DIAGNOSES. TOTAL MASTECTOMY FOR MALIGNANCY W CC. TOTAL MASTECTOMY FOR MALIGNANCY W/O CC. SUBTOTAL MASTECTOMY FOR MALIGNANCY W CC. SUBTOTAL MASTECTOMY FOR MALIGNANCY W/O CC. VerDate Aug<31>2005 17:10 Apr 24, 2006 Jkt 208001 PO 00000 ...... ...... ...... ...... Frm 00284 Fmt 4701 Sfmt 4702 E:\FR\FM\25APP2.SGM Geometric mean LOS Arithmetic mean LOS 1.1303 2.4 3.3 0.8067 1.6 1.9 1.3235 1.6783 0.8719 1.1877 3.8 4.6 2.1 2.9 5.4 6.5 2.6 4.2 0.7617 2.0 2.5 1.4347 3.6 5.4 0.0000 0.9804 1.8831 0.0 1.9 4.4 0.0 2.7 6.4 1.1441 1.9 2.7 0.9366 0.8791 0.7345 3.8 3.8 3.0 4.9 4.5 3.8 1.5466 1.2001 6.5 4.9 8.4 6.2 1.4523 4.9 6.5 0.7172 3.0 3.6 1.2350 0.8680 0.8186 5.1 3.6 3.6 6.5 4.5 4.5 0.5581 2.5 3.1 0.6742 0.6852 2.8 2.6 3.6 3.3 0.9368 0.8157 3.8 2.8 4.8 4.0 0.7774 3.2 3.9 0.5561 2.3 2.8 0.5561 * * 0.9049 3.8 4.6 0.5741 2.6 3.1 0.5741 * * 0.9598 3.9 5.1 0.9016 2.0 2.6 0.7045 1.5 1.7 0.9445 1.8 2.8 0.6437 1.2 1.4 Weights 25APP2 24279 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules TABLE 5.—LIST OF DIAGNOSIS-RELATED GROUPS, RELATIVE WEIGHTING FACTORS, AND GEOMETRIC AND ARITHMETIC MEAN LENGTH OF STAY (LOS)—Continued DRG FY 07 proposed rule post-acute care DRG FY 07 proposed rule special pay DRG MDC 261 ...... No ............ No ............ 262 ...... No ............ 263 ...... DRG title 09 SURG ...... No ............ 09 SURG ...... Yes .......... No ............ 09 SURG ...... 264 ...... Yes .......... No ............ 09 SURG ...... 265 ...... Yes .......... No ............ 09 SURG ...... 266 ...... Yes .......... No ............ 09 SURG ...... 267 ...... 268 ...... No ............ No ............ No ............ No ............ 09 09 SURG ...... SURG ...... 269 ...... Yes .......... No ............ 09 SURG ...... 270 ...... Yes .......... No ............ 09 SURG ...... 271 272 273 274 275 ...... ...... ...... ...... ...... Yes .......... Yes .......... Yes .......... No ............ No ............ No No No No No ............ ............ ............ ............ ............ 09 09 09 09 09 MED MED MED MED MED 276 277 278 279 280 ...... ...... ...... ...... ...... No ............ Yes .......... Yes .......... No ............ Yes .......... No No No No No ............ ............ ............ ............ ............ 09 09 09 09 09 MED ......... MED ......... MED ......... MED* ....... MED ......... 281 ...... Yes .......... No ............ 09 MED ......... 282 ...... No ............ No ............ 09 MED* ....... 283 ...... 284 ...... 285 ...... Yes .......... Yes .......... Yes .......... No ............ No ............ No ............ 09 09 10 MED ......... MED ......... SURG ...... 286 ...... 287 ...... No ............ Yes .......... No ............ No ............ 10 10 SURG ...... SURG ...... 288 289 290 291 292 ...... ...... ...... ...... ...... No ............ No ............ No ............ No ............ Yes .......... No No No No No ............ ............ ............ ............ ............ 10 10 10 10 10 SURG SURG SURG SURG SURG 293 ...... Yes .......... No ............ 10 SURG ...... 294 ...... 295 ...... 296 ...... Yes .......... No ............ Yes .......... No ............ No ............ No ............ 10 10 10 MED ......... MED ......... MED ......... 297 ...... Yes .......... No ............ 10 MED ......... 298 ...... wwhite on PROD1PC61 with PROPOSALS2 Type No ............ No ............ 10 MED ......... 299 300 301 302 303 ...... ...... ...... ...... ...... No ............ Yes .......... Yes .......... No ............ No ............ No No No No No ............ ............ ............ ............ ............ 10 10 10 11 11 MED ......... MED ......... MED ......... SURG ...... SURG ...... 304 ...... Yes .......... No ............ 11 SURG ...... BREAST PROC FOR NON-MALIGNANCY EXCEPT BIOPSY & LOCAL EXCISION. BREAST BIOPSY & LOCAL EXCISION FOR NON-MALIGNANCY. SKIN GRAFT &/OR DEBRID FOR SKN ULCER OR CELLULITIS W CC. SKIN GRAFT &/OR DEBRID FOR SKN ULCER OR CELLULITIS W/O CC. SKIN GRAFT &/OR DEBRID EXCEPT FOR SKIN ULCER OR CELLULITIS W CC. SKIN GRAFT &/OR DEBRID EXCEPT FOR SKIN ULCER OR CELLULITIS W/O CC. PERIANAL & PILONIDAL PROCEDURES .. SKIN, SUBCUTANEOUS TISSUE & BREAST PLASTIC PROCEDURES. OTHER SKIN, SUBCUT TISS & BREAST PROC W CC. OTHER SKIN, SUBCUT TISS & BREAST PROC W/O CC. SKIN ULCERS ............................................. MAJOR SKIN DISORDERS W CC .............. MAJOR SKIN DISORDERS W/O CC .......... MALIGNANT BREAST DISORDERS W CC MALIGNANT BREAST DISORDERS W/O CC. NON-MALIGANT BREAST DISORDERS .... CELLULITIS AGE >17 W CC ...................... CELLULITIS AGE >17 W/O CC .................. CELLULITIS AGE 0–17 ............................... TRAUMA TO THE SKIN, SUBCUT TISS & BREAST AGE >17 W CC. TRAUMA TO THE SKIN, SUBCUT TISS & BREAST AGE >17 W/O CC. TRAUMA TO THE SKIN, SUBCUT TISS & BREAST AGE 0–17. MINOR SKIN DISORDERS W CC .............. MINOR SKIN DISORDERS W/O CC ........... AMPUTAT OF LOWER LIMB FOR ENDOCRINE, NUTRIT, & METABOL DISORDERS. ADRENAL & PITUITARY PROCEDURES .. SKIN GRAFTS & WOUND DEBRID FOR ENDOC, NUTRIT & METAB DISORDERS. O.R. PROCEDURES FOR OBESITY .......... PARATHYROID PROCEDURES ................. THYROID PROCEDURES ........................... THYROGLOSSAL PROCEDURES .............. OTHER ENDOCRINE, NUTRIT & METAB O.R. PROC W CC. OTHER ENDOCRINE, NUTRIT & METAB O.R. PROC W/O CC. DIABETES AGE >35 .................................... DIABETES AGE 0–35 .................................. NUTRITIONAL & MISC METABOLIC DISORDERS AGE >17 W CC. NUTRITIONAL & MISC METABOLIC DISORDERS AGE >17 W/O CC. NUTRITIONAL & MISC METABOLIC DISORDERS AGE 0–17. INBORN ERRORS OF METABOLISM ........ ENDOCRINE DISORDERS W CC .............. ENDOCRINE DISORDERS W/O CC ........... KIDNEY TRANSPLANT ............................... KIDNEY, URETER & MAJOR BLADDER PROCEDURES FOR NEOPLASM. KIDNEY, URETER & MAJOR BLADDER PROC FOR NON-NEOPL W CC. VerDate Aug<31>2005 17:10 Apr 24, 2006 Jkt 208001 PO 00000 ......... ......... ......... ......... ......... ...... ...... ...... ...... ...... Frm 00285 Fmt 4701 Sfmt 4702 E:\FR\FM\25APP2.SGM Geometric mean LOS Arithmetic mean LOS 0.8875 1.6 2.2 1.0346 3.2 4.6 2.2702 8.3 11.1 1.2644 4.9 6.4 1.6907 4.2 6.7 0.9200 2.2 3.0 0.9870 1.2352 2.8 2.4 4.2 3.7 1.8802 6.0 8.2 0.8949 2.7 3.6 1.2353 1.1364 0.6838 1.2180 0.6697 5.6 4.5 2.9 4.5 2.3 7.1 5.9 3.7 6.2 3.3 0.8441 1.0015 0.6817 0.6817 0.8212 3.6 4.5 3.4 3.9 3.2 4.6 5.5 4.0 4.2 4.1 0.5678 2.3 2.8 0.5678 * * 0.8525 0.5295 2.3169 3.5 2.3 8.1 4.6 2.9 10.3 1.9369 2.0354 3.8 7.6 5.2 10.0 1.7332 0.8548 0.8454 0.5867 2.6043 2.9 1.6 1.5 1.3 7.3 3.7 2.4 2.0 1.5 10.2 1.3605 3.4 4.7 0.8642 0.9301 0.9041 3.3 2.8 3.6 4.3 3.7 4.7 0.5589 2.5 3.0 0.7622 2.5 3.6 1.1353 1.1666 0.6427 5.5466 2.3084 3.8 4.6 2.7 6.8 5.7 5.1 5.9 3.4 8.0 7.3 2.3631 6.0 8.5 Weights 25APP2 24280 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules TABLE 5.—LIST OF DIAGNOSIS-RELATED GROUPS, RELATIVE WEIGHTING FACTORS, AND GEOMETRIC AND ARITHMETIC MEAN LENGTH OF STAY (LOS)—Continued DRG FY 07 proposed rule post-acute care DRG FY 07 proposed rule special pay DRG MDC 305 ...... Yes .......... No ............ 306 307 308 309 No No No No No No No No ...... ...... ...... ...... ............ ............ ............ ............ Type DRG title 11 SURG ...... ............ ............ ............ ............ 11 11 11 11 SURG SURG SURG SURG KIDNEY, URETER & MAJOR BLADDER PROC FOR NON-NEOPL W/O CC. PROSTATECTOMY W CC .......................... PROSTATECTOMY W/O CC ...................... MINOR BLADDER PROCEDURES W CC .. MINOR BLADDER PROCEDURES W/O CC. TRANSURETHRAL PROCEDURES W CC TRANSURETHRAL PROCEDURES W/O CC. URETHRAL PROCEDURES, AGE >17 W CC. URETHRAL PROCEDURES, AGE >17 W/ O CC. URETHRAL PROCEDURES, AGE 0–17 ..... OTHER KIDNEY & URINARY TRACT O.R. PROCEDURES. RENAL FAILURE ......................................... ADMIT FOR RENAL DIALYSIS ................... KIDNEY & URINARY TRACT NEOPLASMS W CC. KIDNEY & URINARY TRACT NEOPLASMS W/O CC. KIDNEY & URINARY TRACT INFECTIONS AGE >17 W CC. KIDNEY & URINARY TRACT INFECTIONS AGE >17 W/O CC. KIDNEY & URINARY TRACT INFECTIONS AGE 0–17. URINARY STONES W CC, D&/OR ESW LITHOTRIPSY. URINARY STONES W/O CC ....................... KIDNEY & URINARY TRACT SIGNS & SYMPTOMS AGE >17 W CC. KIDNEY & URINARY TRACT SIGNS & SYMPTOMS AGE >17 W/O CC. KIDNEY & URINARY TRACT SIGNS & SYMPTOMS AGE 0–17. URETHRAL STRICTURE AGE >17 W CC URETHRAL STRICTURE AGE >17 W/O CC. URETHRAL STRICTURE AGE 0–17 .......... OTHER KIDNEY & URINARY TRACT DIAGNOSES AGE >17 W CC. OTHER KIDNEY & URINARY TRACT DIAGNOSES AGE >17 W/O CC. OTHER KIDNEY & URINARY TRACT DIAGNOSES AGE 0–17. MAJOR MALE PELVIC PROCEDURES W CC. MAJOR MALE PELVIC PROCEDURES W/ O CC. TRANSURETHRAL PROSTATECTOMY W CC. TRANSURETHRAL PROSTATECTOMY W/ O CC. TESTES PROCEDURES, FOR MALIGNANCY. TESTES PROCEDURES, NON-MALIGNANCY AGE >17. TESTES PROCEDURES, NON-MALIGNANCY AGE 0–17. PENIS PROCEDURES ................................ CIRCUMCISION AGE >17 ........................... CIRCUMCISION AGE 0–17 ......................... OTHER MALE REPRODUCTIVE SYSTEM O.R. PROCEDURES FOR MALIGNANCY. ...... ...... ...... ...... No ............ No ............ No ............ No ............ 11 11 SURG ...... SURG ...... 312 ...... No ............ No ............ 11 SURG ...... 313 ...... No ............ No ............ 11 SURG ...... 314 ...... 315 ...... No ............ No ............ No ............ No ............ 11 11 SURG* ..... SURG ...... 316 ...... 317 ...... 318 ...... Yes .......... No ............ No ............ No ............ No ............ No ............ 11 11 11 MED ......... MED ......... MED ......... 319 ...... No ............ No ............ 11 MED ......... 320 ...... Yes .......... No ............ 11 MED ......... 321 ...... Yes .......... No ............ 11 MED ......... 322 ...... No ............ No ............ 11 MED ......... 323 ...... No ............ No ............ 11 MED ......... 324 ...... 325 ...... No ............ No ............ No ............ No ............ 11 11 MED ......... MED ......... 326 ...... No ............ No ............ 11 MED ......... 327 ...... No ............ No ............ 11 MED ......... 328 ...... 329 ...... No ............ No ............ No ............ No ............ 11 11 MED ......... MED ......... 330 ...... 331 ...... No ............ Yes .......... No ............ No ............ 11 11 MED* ....... MED ......... 332 ...... Yes .......... No ............ 11 MED ......... 333 ...... No ............ No ............ 11 MED ......... 334 ...... No ............ No ............ 12 SURG ...... 335 ...... No ............ No ............ 12 SURG ...... 336 ...... No ............ No ............ 12 SURG ...... 337 ...... No ............ No ............ 12 SURG ...... 338 ...... No ............ No ............ 12 SURG ...... 339 ...... wwhite on PROD1PC61 with PROPOSALS2 310 ...... 311 ...... No ............ No ............ 12 SURG ...... 340 ...... No ............ No ............ 12 SURG* ..... 341 342 343 344 No No No No No No No No 12 12 12 12 SURG ...... SURG ...... SURG* ..... SURG ...... ...... ...... ...... ...... VerDate Aug<31>2005 ............ ............ ............ ............ ............ ............ ............ ............ 17:10 Apr 24, 2006 Jkt 208001 PO 00000 Frm 00286 Fmt 4701 Sfmt 4702 E:\FR\FM\25APP2.SGM Geometric mean LOS Arithmetic mean LOS 1.1498 2.5 3.1 1.3307 0.6569 1.7066 0.9014 3.6 1.7 3.9 1.6 5.6 2.0 6.2 2.0 1.1913 0.6397 3.1 1.5 4.5 1.9 1.1947 3.3 4.9 0.7523 1.8 2.4 0.7523 1.9482 29.4 3.7 89.0 6.7 1.3481 0.8454 1.2571 4.8 2.4 4.4 6.3 3.5 6.0 0.6169 1.9 2.6 0.9538 4.1 5.1 0.6512 3.0 3.6 0.7212 3.1 3.6 0.8239 2.3 3.1 0.5233 0.7334 1.6 2.9 1.8 3.7 0.4932 2.1 2.6 0.3724 1.8 2.0 0.7346 0.4671 2.5 1.4 3.4 1.7 0.4671 1.1580 * 4.2 * 5.5 0.6602 2.4 3.1 1.1833 3.7 5.4 1.4154 3.3 4.0 1.0701 2.2 2.5 0.8824 2.4 3.2 0.5989 1.6 1.8 1.4072 3.7 5.8 1.3418 3.3 5.2 1.3418 * * 1.2527 0.8546 0.8546 1.1078 1.9 2.3 * 1.8 3.2 3.0 * 2.7 Weights 25APP2 24281 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules TABLE 5.—LIST OF DIAGNOSIS-RELATED GROUPS, RELATIVE WEIGHTING FACTORS, AND GEOMETRIC AND ARITHMETIC MEAN LENGTH OF STAY (LOS)—Continued DRG FY 07 proposed rule post-acute care DRG FY 07 proposed rule special pay DRG MDC 345 ...... No ............ No ............ 346 ...... No ............ 347 ...... DRG title 12 SURG ...... No ............ 12 MED ......... No ............ No ............ 12 MED ......... 348 ...... No ............ No ............ 12 MED ......... 349 ...... No ............ No ............ 12 MED ......... 350 ...... No ............ No ............ 12 MED ......... 351 ...... 352 ...... No ............ No ............ No ............ No ............ 12 12 MED* ....... MED ......... 353 ...... No ............ No ............ 13 SURG ...... 354 ...... No ............ No ............ 13 SURG ...... 355 ...... No ............ No ............ 13 SURG ...... 356 ...... No ............ No ............ 13 SURG ...... 357 ...... No ............ No ............ 13 SURG ...... 358 ...... No ............ No ............ 13 SURG ...... 359 ...... No ............ No ............ 13 SURG ...... 360 ...... No ............ No ............ 13 SURG ...... 361 ...... No ............ No ............ 13 SURG ...... 362 ...... 363 ...... No ............ No ............ No ............ No ............ 13 13 SURG* ..... SURG ...... 364 ...... No ............ No ............ 13 SURG ...... 365 ...... No ............ No ............ 13 SURG ...... 366 ...... No ............ No ............ 13 MED ......... 367 ...... No ............ No ............ 13 MED ......... 368 ...... No ............ No ............ 13 MED ......... 369 ...... No ............ No ............ 13 MED ......... 370 ...... 371 ...... 372 ...... No ............ No ............ No ............ No ............ No ............ No ............ 14 14 14 SURG ...... SURG ...... MED ......... 373 ...... No ............ No ............ 14 MED ......... 374 ...... No ............ No ............ 14 SURG ...... 375 ...... wwhite on PROD1PC61 with PROPOSALS2 Type No ............ No ............ 14 SURG ...... 376 ...... No ............ No ............ 14 MED ......... 377 ...... No ............ No ............ 14 SURG ...... 378 ...... 379 ...... 380 ...... No ............ No ............ No ............ No ............ No ............ No ............ 14 14 14 MED ......... MED ......... MED ......... OTHER MALE REPRODUCTIVE SYSTEM O.R. PROC EXCEPT FOR MALIGNANCY. MALIGNANCY, MALE REPRODUCTIVE SYSTEM, W CC. MALIGNANCY, MALE REPRODUCTIVE SYSTEM, W/O CC. BENIGN PROSTATIC HYPERTROPHY W CC. BENIGN PROSTATIC HYPERTROPHY W/ O CC. INFLAMMATION OF THE MALE REPRODUCTIVE SYSTEM. STERILIZATION, MALE ............................... OTHER MALE REPRODUCTIVE SYSTEM DIAGNOSES. PELVIC EVISCERATION, DRADICAL HYSTERECTOMY & RADICAL VULVECTOMY. UTERINE, ADNEXA PROC FOR NONOVARIAN/ADNEXAL MALIG W CC. UTERINE, ADNEXA PROC FOR NONOVARIAN/ADNEXAL MALIG W/O CC. FEMALE REPRODUCTIVE SYSTEM RECONSTRUCTIVE PROCEDURES. UTERINE & ADNEXA PROC FOR OVARIAN OR ADNEXAL MALIGNANCY. UTERINE & ADNEXA PROC FOR NONMALIGNANCY W CC. UTERINE & ADNEXA PROC FOR NONMALIGNANCY W/O CC. VAGINA, CERVIX & VULVA PROCEDURES. LAPAROSCOPY & INCISIONAL TUBAL INTERRUPTION. ENDOSCOPIC TUBAL INTERRUPTION .... D&C, CONIZATION & RADIO-IMPLANT, FOR MALIGNANCY. D&C, CONIZATION EXCEPT FOR MALIGNANCY. OTHER FEMALE REPRODUCTIVE SYSTEM O.R. PROCEDURES. MALIGNANCY, FEMALE REPRODUCTIVE SYSTEM W CC. MALIGNANCY, FEMALE REPRODUCTIVE SYSTEM W/O CC. INFECTIONS, FEMALE REPRODUCTIVE SYSTEM. MENSTRUAL & OTHER FEMALE REPRODUCTIVE SYSTEM DISORDERS. CESAREAN SECTION W CC ...................... CESAREAN SECTION W/O CC .................. VAGINAL DELIVERY W COMPLICATING DIAGNOSES. VAGINAL DELIVERY W/O COMPLICATING DIAGNOSES. VAGINAL DELIVERY W STERILIZATION &/OR D&C. VAGINAL DELIVERY W O.R. PROC EXCEPT STERIL &/OR D&C. POSTPARTUM & POST ABORTION DIAGNOSES W/O O.R. PROCEDURE. POSTPARTUM & POST ABORTION DIAGNOSES W O.R. PROCEDURE. ECTOPIC PREGNANCY .............................. THREATENED ABORTION ......................... ABORTION W/O D&C .................................. VerDate Aug<31>2005 17:10 Apr 24, 2006 Jkt 208001 PO 00000 Frm 00287 Fmt 4701 Sfmt 4702 E:\FR\FM\25APP2.SGM Geometric mean LOS Arithmetic mean LOS 1.3524 3.4 5.4 1.1351 4.5 5.9 0.5734 2.0 2.7 0.7721 3.1 4.0 0.4942 2.1 2.6 0.8552 3.6 4.5 0.8690 0.8690 * 3.0 * 4.2 1.7446 4.5 6.0 1.5594 4.5 5.6 0.9349 2.8 3.0 0.7426 1.6 1.9 2.2785 6.4 8.0 1.1816 3.1 3.9 0.8258 2.1 2.3 0.8803 2.0 2.5 1.1046 2.1 3.0 1.1046 1.0198 1.0 2.8 1.0 4.1 0.9331 3.0 4.2 2.0803 5.3 7.9 1.2888 4.6 6.3 0.5895 2.3 3.0 1.2262 5.0 6.4 0.6696 2.5 3.3 1.1080 0.7664 0.7390 4.0 3.1 2.7 5.0 3.4 3.5 0.5276 2.1 2.2 0.7708 2.4 3.0 1.2156 4.0 6.2 0.7273 2.5 3.3 1.5307 3.1 4.4 0.7782 0.5628 0.4872 1.8 2.2 1.5 2.2 3.2 2.0 Weights 25APP2 24282 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules TABLE 5.—LIST OF DIAGNOSIS-RELATED GROUPS, RELATIVE WEIGHTING FACTORS, AND GEOMETRIC AND ARITHMETIC MEAN LENGTH OF STAY (LOS)—Continued DRG FY 07 proposed rule post-acute care DRG FY 07 proposed rule special pay DRG MDC 381 ...... No ............ No ............ 382 ...... 383 ...... No ............ No ............ 384 ...... Type DRG title 14 SURG ...... No ............ No ............ 14 14 MED ......... MED ......... No ............ No ............ 14 MED ......... 385 ...... No ............ No ............ 15 MED* ....... 386 ...... No ............ No ............ 15 MED* ....... 387 ...... 388 ...... 389 ...... No ............ No ............ No ............ No ............ No ............ No ............ 15 15 15 MED* ....... MED* ....... MED* ....... 390 ...... No ............ No ............ 15 MED* ....... 391 392 393 394 No No No No No No No No ............ ............ ............ ............ 15 16 16 16 MED* ....... SURG ...... SURG* ..... SURG ...... ABORTION W D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY. FALSE LABOR ............................................. OTHER ANTEPARTUM DIAGNOSES W MEDICAL COMPLICATIONS. OTHER ANTEPARTUM DIAGNOSES W/O MEDICAL COMPLICATIONS. NEONATES, DIED OR TRANSFERRED TO ANOTHER ACUTE CARE FACILITY. EXTREME IMMATURITY OR RESPIRATORY DISTRESS SYNDROME, NEONATE. PREMATURITY W MAJOR PROBLEMS .... PREMATURITY W/O MAJOR PROBLEMS FULL TERM NEONATE W MAJOR PROBLEMS. NEONATE W OTHER SIGNIFICANT PROBLEMS. NORMAL NEWBORN .................................. SPLENECTOMY AGE >17 .......................... SPLENECTOMY AGE 0-–7 ......................... OTHER O.R. PROCEDURES OF THE BLOOD AND BLOOD FORMING ORGANS. RED BLOOD CELL DISORDERS AGE >17 RED BLOOD CELL DISORDERS AGE 0– 17. COAGULATION DISORDERS ..................... RETICULOENDOTHELIAL & IMMUNITY DISORDERS W CC. RETICULOENDOTHELIAL & IMMUNITY DISORDERS W/O CC. NO LONGER VALID .................................... LYMPHOMA & NON-ACUTE LEUKEMIA W OTHER O.R. PROC W CC. LYMPHOMA & NON-ACUTE LEUKEMIA W OTHER O.R. PROC W/O CC. LYMPHOMA & NON-ACUTE LEUKEMIA W CC. LYMPHOMA & NON-ACUTE LEUKEMIA W/O CC. ACUTE LEUKEMIA W/O MAJOR O.R. PROCEDURE AGE 0–17. MYELOPROLIF DISORD OR POORLY DIFF NEOPL W MAJ O.R.PROC W CC. MYELOPROLIF DISORD OR POORLY DIFF NEOPL W MAJ O.R.PROC W/O CC. MYELOPROLIF DISORD OR POORLY DIFF NEOPL W OTHER O.R.PROC. RADIOTHERAPY ......................................... CHEMOTHERAPY W/O ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS. HISTORY OF MALIGNANCY W/O ENDOSCOPY. HISTORY OF MALIGNANCY W ENDOSCOPY. OTHER MYELOPROLIF DIS OR POORLY DIFF NEOPL DIAG W CC. OTHER MYELOPROLIF DIS OR POORLY DIFF NEOPL DIAG W/O CC. O.R. PROCEDURE FOR INFECTIOUS & PARASITIC DISEASES. SEPTICEMIA AGE >17 ................................ SEPTICEMIA AGE 0–17 .............................. POSTOPERATIVE & POST-TRAUMATIC INFECTIONS. ...... ...... ...... ...... ............ ............ ............ ............ Yes .......... No ............ No ............ No ............ 16 16 MED ......... MED ......... 397 ...... 398 ...... No ............ No ............ No ............ No ............ 16 16 MED ......... MED ......... 399 ...... No ............ No ............ 16 MED ......... 400 ...... 401 ...... No ............ Yes .......... No ............ No ............ 17 17 SURG ...... SURG ...... 402 ...... Yes .......... No ............ 17 SURG ...... 403 ...... Yes .......... No ............ 17 MED ......... 404 ...... Yes .......... No ............ 17 MED ......... 405 ...... No ............ No ............ 17 MED* ....... 406 ...... No ............ No ............ 17 SURG ...... 407 ...... No ............ No ............ 17 SURG ...... 408 ...... No ............ No ............ 17 SURG ...... 409 ...... 410 ...... No ............ No ............ No ............ No ............ 17 17 MED ......... MED ......... 411 ...... No ............ No ............ 17 MED* ....... 412 ...... No ............ No ............ 17 MED* ....... 413 ...... wwhite on PROD1PC61 with PROPOSALS2 395 ...... 396 ...... No ............ No ............ 17 MED ......... 414 ...... No ............ No ............ 17 MED ......... 415 ...... Yes .......... No ............ 18 SURG ...... 416 ...... 417 ...... 418 ...... Yes .......... No ............ Yes .......... No ............ No ............ No ............ 18 18 18 MED ......... MED ......... MED ......... VerDate Aug<31>2005 17:10 Apr 24, 2006 Jkt 208001 PO 00000 Frm 00288 Fmt 4701 Sfmt 4702 E:\FR\FM\25APP2.SGM Geometric mean LOS Arithmetic mean LOS 0.7239 1.7 2.4 0.2783 0.6683 1.3 2.6 1.5 3.7 0.4601 1.7 2.5 1.4095 * * 4.648 * * 3.1744 1.9153 3.2608 * * 1.8 * * 2.0 1.1541 * * 0.1562 3.1188 3.1188 1.8725 * 6.3 * 4.4 * 8.8 * 7.3 0.9413 0.6888 3.2 2.5 4.3 3.0 1.3611 1.2912 3.7 4.4 5.1 5.7 0.7064 2.7 3.4 0.0000 2.8703 0.0 8.1 0.0 11.2 1.1380 2.8 3.9 1.8986 5.7 8.0 0.9137 3.0 4.0 3.4703 * * 2.7839 6.7 9.4 1.1617 2.9 3.5 2.1388 5.1 8.2 1.2059 1.0178 4.5 2.9 6.0 3.8 0.6205 1.6 2.0 0.6205 1.4 1.5 1.4097 5.1 6.8 0.8055 3.0 4.0 4.1393 11.0 14.8 1.8340 1.9140 1.1938 5.7 5.2 4.7 7.6 6.5 6.1 Weights 25APP2 24283 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules TABLE 5.—LIST OF DIAGNOSIS-RELATED GROUPS, RELATIVE WEIGHTING FACTORS, AND GEOMETRIC AND ARITHMETIC MEAN LENGTH OF STAY (LOS)—Continued DRG FY 07 proposed rule post-acute care DRG FY 07 proposed rule special pay DRG MDC 419 ...... No ............ No ............ 420 ...... No ............ 421 ...... 422 ...... DRG title 18 MED ......... No ............ 18 MED ......... No ............ No ............ No ............ No ............ 18 18 MED ......... MED ......... 423 ...... Yes .......... No ............ 18 MED ......... 424 ...... No ............ No ............ 19 SURG ...... 425 ...... No ............ No ............ 19 MED ......... 426 ...... 427 ...... 428 ...... No ............ No ............ No ............ No ............ No ............ No ............ 19 19 19 MED ......... MED ......... MED ......... 429 ...... Yes .......... No ............ 19 MED ......... 430 431 432 433 ...... ...... ...... ...... Yes .......... No ............ No ............ No ............ No No No No ............ ............ ............ ............ 19 19 19 20 MED MED MED MED 434 435 436 437 438 439 440 441 442 ...... ...... ...... ...... ...... ...... ...... ...... ...... No ............ No ............ No ............ No ............ No ............ No ............ Yes .......... No ............ Yes .......... No No No No No No No No No ............ ............ ............ ............ ............ ............ ............ ............ ............ 20 20 20 20 20 21 21 21 21 MED ......... MED ......... MED ......... MED ......... MED ......... SURG ...... SURG ...... SURG ...... SURG ...... 443 ...... Yes .......... No ............ 21 SURG ...... 444 445 446 447 448 449 ...... ...... ...... ...... ...... ...... Yes .......... Yes .......... No ............ No ............ No ............ No ............ No No No No No No ............ ............ ............ ............ ............ ............ 21 21 21 21 21 21 MED ......... MED ......... MED* ....... MED ......... MED* ....... MED ......... 450 ...... No ............ No ............ 21 MED ......... 451 ...... No ............ No ............ 21 MED* ....... 452 ...... 453 ...... No ............ No ............ No ............ No ............ 21 21 MED ......... MED ......... 454 ...... No ............ No ............ 21 MED ......... 455 ...... No ............ No ............ 21 MED ......... 456 457 458 459 460 461 wwhite on PROD1PC61 with PROPOSALS2 Type ...... ...... ...... ...... ...... ...... No No No No No No ............ ............ ............ ............ ............ ............ No No No No No No ............ ............ ............ ............ ............ ............ 22 22 22 22 22 23 MED ......... MED ......... SURG ...... SURG ...... MED ......... SURG ...... 462 463 464 465 ...... ...... ...... ...... Yes .......... Yes .......... Yes .......... No ............ No No No No ............ ............ ............ ............ 23 23 23 23 MED MED MED MED 466 ...... No ............ No ............ 23 MED ......... FEVER OF UNKNOWN ORIGIN AGE >17 W CC. FEVER OF UNKNOWN ORIGIN AGE >17 W/O CC. VIRAL ILLNESS AGE >17 ........................... VIRAL ILLNESS & FEVER OF UNKNOWN ORIGIN AGE 0–17. OTHER INFECTIOUS & PARASITIC DISEASES DIAGNOSES. O.R. PROCEDURE W PRINCIPAL DIAGNOSES OF MENTAL ILLNESS. ACUTE ADJUSTMENT REACTION & PSYCHOSOCIAL DYSFUNCTION. DEPRESSIVE NEUROSES ......................... NEUROSES EXCEPT DEPRESSIVE .......... DISORDERS OF PERSONALITY & IMPULSE CONTROL. ORGANIC DISTURBANCES & MENTAL RETARDATION. PSYCHOSES ............................................... CHILDHOOD MENTAL DISORDERS .......... OTHER MENTAL DISORDER DIAGNOSES ALCOHOL/DRUG ABUSE OR DEPENDENCE, LEFT AMA. NO LONGER VALID .................................... NO LONGER VALID .................................... NO LONGER VALID .................................... NO LONGER VALID .................................... NO LONGER VALID .................................... SKIN GRAFTS FOR INJURIES ................... WOUND DEBRIDEMENTS FOR INJURIES HAND PROCEDURES FOR INJURIES ...... OTHER O.R. PROCEDURES FOR INJURIES W CC. OTHER O.R. PROCEDURES FOR INJURIES W/O CC. TRAUMATIC INJURY AGE >17 W CC ....... TRAUMATIC INJURY AGE >17 W/O CC .... TRAUMATIC INJURY AGE 0–17 ................ ALLERGIC REACTIONS AGE >17 ............. ALLERGIC REACTIONS AGE 0–17 ............ POISONING & TOXIC EFFECTS OF DRUGS AGE >17 W CC. POISONING & TOXIC EFFECTS OF DRUGS AGE >17 W/O CC. POISONING & TOXIC EFFECTS OF DRUGS AGE 0–17. COMPLICATIONS OF TREATMENT W CC COMPLICATIONS OF TREATMENT W/O CC. OTHER INJURY, POISONING & TOXIC EFFECT DIAG W CC. OTHER INJURY, POISONING & TOXIC EFFECT DIAG W/O CC. NO LONGER VALID .................................... NO LONGER VALID .................................... NO LONGER VALID .................................... NO LONGER VALID .................................... NO LONGER VALID .................................... O.R. PROC W DIAGNOSES OF OTHER CONTACT W HEALTH SERVICES. REHABILITATION ........................................ SIGNS & SYMPTOMS W CC ...................... SIGNS & SYMPTOMS W/O CC .................. AFTERCARE W HISTORY OF MALIGNANCY AS SECONDARY DIAGNOSIS. AFTERCARE W/O HISTORY OF MALIGNANCY AS SECONDARY DIAGNOSIS. VerDate Aug<31>2005 17:10 Apr 24, 2006 Jkt 208001 PO 00000 ......... ......... ......... ......... ......... ......... ......... ......... Frm 00289 Fmt 4701 Sfmt 4702 E:\FR\FM\25APP2.SGM Geometric mean LOS Arithmetic mean LOS 0.8951 3.4 4.4 0.6263 2.6 3.2 0.8210 0.8240 3.1 2.6 4.0 3.7 1.9053 5.9 8.2 2.3978 7.4 11.4 0.7075 2.6 3.5 0.7464 0.8104 1.1577 3.2 3.2 4.5 4.5 4.7 7.3 0.9614 4.4 5.8 1.2316 1.0504 0.7280 0.4017 5.9 4.3 2.7 2.1 8.0 6.8 4.0 2.8 0.0000 0.0000 0.0000 0.0000 0.0000 2.0857 2.0128 1.0682 2.6213 0.0 0.0 0.0 0.0 0.0 5.4 5.6 2.3 5.9 0.0 0.0 0.0 0.0 0.0 8.4 8.5 3.5 8.9 1.0919 2.7 3.5 0.8329 0.5792 0.5792 0.6470 0.6470 0.9882 3.2 2.3 * 1.9 * 2.7 4.1 2.8 * 2.6 * 3.7 0.5741 1.6 2.0 0.5741 10.2 10.5 1.1377 0.5867 3.5 2.2 4.9 2.8 0.9136 3.0 4.1 0.5053 1.8 2.3 0.0000 0.0000 0.0000 0.0000 0.0000 1.5386 0.0 0.0 0.0 0.0 0.0 3.3 0.0 0.0 0.0 0.0 0.0 5.6 1.5753 0.7661 0.5663 0.6205 8.4 3.1 2.4 2.5 9.9 3.9 2.9 3.6 0.7848 2.7 5.0 Weights 25APP2 24284 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules TABLE 5.—LIST OF DIAGNOSIS-RELATED GROUPS, RELATIVE WEIGHTING FACTORS, AND GEOMETRIC AND ARITHMETIC MEAN LENGTH OF STAY (LOS)—Continued DRG FY 07 proposed rule post-acute care DRG FY 07 proposed rule special pay DRG MDC 467 ...... No ............ No ............ 468 ...... Yes .......... 469 ...... DRG title 23 MED ......... No ............ .......... SURG ...... No ............ No ............ .......... ** .............. 470 ...... 471 ...... No ............ Yes .......... No ............ Yes .......... .......... 08 ** .............. SURG ...... 472 ...... 473 ...... No ............ No ............ No ............ No ............ 22 17 SURG ...... MED ......... 474 ...... 475 ...... No ............ Yes .......... No ............ No ............ 04 04 SURG ...... MED ......... 476 ...... No ............ No ............ .......... SURG ...... 477 ...... Yes .......... No ............ .......... SURG ...... 478 ...... 479 ...... Yes .......... No ............ No ............ No ............ 05 05 SURG ...... SURG ...... 480 ...... No ............ No ............ PRE SURG ...... 481 ...... 482 ...... No ............ Yes .......... No ............ No ............ PRE PRE SURG ...... SURG ...... 483 ...... 484 ...... No ............ No ............ No ............ No ............ PRE 24 SURG ...... SURG ...... 485 ...... Yes .......... No ............ 24 SURG ...... 486 ...... No ............ No ............ 24 SURG ...... 487 ...... Yes .......... No ............ 24 MED ......... 488 ...... 489 ...... 490 ...... No ............ No ............ No ............ No ............ No ............ No ............ 25 25 25 SURG ...... MED ......... MED ......... 491 ...... No ............ No ............ 08 SURG ...... 492 ...... No ............ No ............ 17 MED ......... 493 ...... No ............ No ............ 07 SURG ...... 494 ...... No ............ No ............ 07 SURG ...... 495 ...... 496 ...... No ............ No ............ No ............ No ............ PRE 08 SURG ...... SURG ...... 497 ...... Yes .......... Yes .......... 08 SURG ...... 498 ...... Yes .......... Yes .......... 08 SURG ...... 499 ...... wwhite on PROD1PC61 with PROPOSALS2 Type No ............ No ............ 08 SURG ...... 500 ...... No ............ No ............ 08 SURG ...... 501 ...... Yes .......... No ............ 08 SURG ...... 502 ...... Yes .......... No ............ 08 SURG ...... 503 ...... No ............ No ............ 08 SURG ...... OTHER FACTORS INFLUENCING HEALTH STATUS. EXTENSIVE O.R. PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS. PRINCIPAL DIAGNOSIS INVALID AS DISCHARGE DIAGNOSIS. UNGROUPABLE .......................................... BILATERAL OR MULTIPLE MAJOR JOINT PROCS OF LOWER EXTREMITY. NO LONGER VALID .................................... ACUTE LEUKEMIA W/O MAJOR O.R. PROCEDURE AGE >17. NO LONGER VALID .................................... RESPIRATORY SYSTEM DIAGNOSIS WITH VENTILATOR SUPPORT. PROSTATIC O.R. PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS. NON-EXTENSIVE O.R. PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS. NO LONGER VALID .................................... OTHER VASCULAR PROCEDURES W/O CC. LIVER TRANSPLANT AND/OR INTESTINAL TRANSPLANT. BONE MARROW TRANSPLANT ................ TRACHEOSTOMY FOR FACE,MOUTH & NECK DIAGNOSES. NO LONGER VALID .................................... CRANIOTOMY FOR MULTIPLE SIGNIFICANT TRAUMA. LIMB REATTACHMENT, HIP AND FEMUR PROC FOR MULTIPLE SIGNIFICANT TRAUMA. OTHER O.R. PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA. OTHER MULTIPLE SIGNIFICANT TRAUMA. HIV W EXTENSIVE O.R. PROCEDURE ..... HIV W MAJOR RELATED CONDITION ...... HIV W OR W/O OTHER RELATED CONDITION. MAJOR JOINT & LIMB REATTACHMENT PROCEDURES OF UPPER EXTREMITY. CHEMOTHERAPY W ACUTE LEUKEMIA OR W USE OF HI DOSE CHEMOAGENT. LAPAROSCOPIC CHOLECYSTECTOMY W/O C.D.E. W CC. LAPAROSCOPIC CHOLECYSTECTOMY W/O C.D.E. W/O CC. LUNG TRANSPLANT ................................... COMBINED ANTERIOR/POSTERIOR SPINAL FUSION. SPINAL FUSION EXCEPT CERVICAL W CC. SPINAL FUSION EXCEPT CERVICAL W/O CC. BACK & NECK PROCEDURES EXCEPT SPINAL FUSION W CC. BACK & NECK PROCEDURES DEXCEPT SPINAL FUSION W/O CC. KNEE PROCEDURES W PDX OF INFECTION W CC. KNEE PROCEDURES W PDX OF INFECTION W/O CC. KNEE PROCEDURES W/O PDX OF INFECTION. VerDate Aug<31>2005 17:10 Apr 24, 2006 Jkt 208001 PO 00000 Frm 00290 Fmt 4701 Sfmt 4702 E:\FR\FM\25APP2.SGM Geometric mean LOS Arithmetic mean LOS 0.5408 1.9 2.7 3.8122 9.6 12.9 0.0000 0.0 0.0 0.0000 2.7365 0.0 4.2 0.0 4.6 0.0000 3.4703 0.0 7.3 0.0 12.7 0.0000 3.8279 0.0 7.9 0.0 10.9 2.1079 6.9 10.0 2.0694 5.9 8.6 0.0000 1.2715 0.0 1.9 0.0 2.6 11.7482 14.0 19.2 7.1983 3.5956 18.7 9.4 22.0 11.8 0.0000 5.3652 0.0 8.6 0.0 12.8 3.5846 8.1 9.9 5.1310 8.5 12.3 2.1184 5.2 7.1 4.8181 1.7760 1.0808 12.2 5.8 3.8 17.5 8.2 5.3 1.5997 2.5 3.0 3.6663 8.9 13.8 1.7812 4.6 6.0 0.9795 2.1 2.7 10.0630 5.3926 14.2 6.4 17.0 8.8 3.3300 4.8 5.7 2.5267 3.3 3.7 1.3408 3.0 4.2 0.8707 1.8 2.2 2.7150 8.4 10.4 1.5598 5.0 5.8 1.2375 3.0 3.9 Weights 25APP2 24285 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules TABLE 5.—LIST OF DIAGNOSIS-RELATED GROUPS, RELATIVE WEIGHTING FACTORS, AND GEOMETRIC AND ARITHMETIC MEAN LENGTH OF STAY (LOS)—Continued DRG FY 07 proposed rule post-acute care DRG FY 07 proposed rule special pay DRG MDC 504 ...... No ............ No ............ 505 ...... No ............ 506 ...... DRG title 22 SURG ...... No ............ 22 MED ......... No ............ No ............ 22 SURG ...... 507 ...... No ............ No ............ 22 SURG ...... 508 ...... No ............ No ............ 22 MED ......... 509 ...... No ............ No ............ 22 MED ......... 510 ...... No ............ No ............ 22 MED ......... 511 ...... No ............ No ............ 22 MED ......... 512 ...... No ............ No ............ PRE SURG ...... 513 ...... 514 ...... 515 ...... No ............ No ............ No ............ No ............ No ............ No ............ PRE 05 05 SURG ...... SURG ...... SURG ...... 516 ...... 517 ...... 518 ...... No ............ No ............ No ............ No ............ No ............ No ............ 05 05 05 SURG ...... SURG ...... SURG ...... 519 ...... 520 ...... 521 ...... No ............ No ............ Yes .......... No ............ No ............ No ............ 08 08 20 SURG ...... SURG ...... MED ......... 522 ...... Yes .......... No ............ 20 MED ......... 523 ...... No ............ No ............ 20 MED ......... 524 ...... 525 ...... No ............ No ............ No ............ No ............ 01 05 MED ......... SURG ...... 526 ...... 527 ...... 528 ...... No ............ No ............ No ............ No ............ No ............ No ............ 05 05 01 SURG ...... SURG ...... SURG ...... 529 ...... Yes .......... No ............ 01 SURG ...... 530 ...... Yes .......... No ............ 01 SURG ...... 531 532 533 534 535 ...... ...... ...... ...... ...... Yes .......... Yes .......... No ............ No ............ No ............ No No No No No ............ ............ ............ ............ ............ 01 01 01 01 05 SURG SURG SURG SURG SURG 536 ...... No ............ No ............ 05 SURG ...... 537 ...... Yes .......... No ............ 08 SURG ...... 538 ...... Yes .......... No ............ 08 SURG ...... 539 ...... wwhite on PROD1PC61 with PROPOSALS2 Type No ............ No ............ 17 SURG ...... 540 ...... No ............ No ............ 17 SURG ...... 541 ...... Yes .......... No ............ PRE SURG ...... 542 ...... Yes .......... No ............ PRE SURG ...... EXTEN. BURNS OR FULL THICKNESS BURN W/MV 96+HRS W/SKIN GFT. EXTEN. BURNS OR FULL THICKNESS BURN W/MV 96+HRS W/O SKIN GFT. FULL THICKNESS BURN W DSKIN GRAFT OR INHAL INJ W CC OR SIG TRAUMA. FULL THICKNESS BURN W SKIN GRFT OR INHAL INJ W/O CC OR SIG TRAUMA. FULL THICKNESS BURN W/O SKIN GRFT OR INHAL INJ W CC OR SIG TRAUMA. FULL THICKNESS BURN W/O SKIN GRFT OR INH INJ W/O CC OR SIG TRAUMA. NON-EXTENSIVE BURNS W CC OR SIGNIFICANT TRAUMA. NON-EXTENSIVE BURNS W/O CC OR SIGNIFICANT DTRAUMA. SIMULTANEOUS PANCREAS/KIDNEY TRANSPLANT. PANCREAS TRANSPLANT ......................... NO LONGER VALID .................................... CARDIAC DEFIBRILLATOR IMPLANT W/O CARDIAC CATH. NO LONGER VALID .................................... NO LONGER VALID .................................... PERC CARDIO PROC W/O CORONARY ARTERY STENT OR AMI. CERVICAL SPINAL FUSION W CC ............ CERVICAL SPINAL FUSION W/O CC ........ ALCOHOL/DRUG ABUSE OR DEPENDENCE W CC. ALC/DRUG ABUSE OR DEPEND W REHABILITATION THERAPY W/O CC. ALC/DRUG ABUSE OR DEPEND W/O REHABILITATION THERAPY W/O CC. TRANSIENT ISCHEMIA ............................... OTHER HEART ASSIST SYSTEM IMPLANT. NO LONGER VALID .................................... NO LONGER VALID .................................... INTRACRANIAL VASCULAR PROC W PDX HEMORRHAGE. VENTRICULAR SHUNT PROCEDURES W CC. VENTRICULAR SHUNT PROCEDURES W/ O CC. SPINAL PROCEDURES W CC ................... SPINAL PROCEDURES W/O CC ............... EXTRACRANIAL PROCEDURES W CC .... EXTRACRANIAL PROCEDURES W/O CC CARDIAC DEFIB IMPLANT W CARDIAC CATH W AMI/HF/SHOCK. CARDIAC DEFIB IMPLANT W CARDIAC CATH W/O AMI/HF/SHOCK. LOCAL EXCIS & REMOV OF INT FIX DEV EXCEPT HIP & FEMUR W CC. LOCAL EXCIS & REMOV OF INT FIX DEV EXCEPT HIP & FEMUR W/O CC. LYMPHOMA & LEUKEMIA W MAJOR OR PROCEDURE W CC. LYMPHOMA & LEUKEMIA W MAJOR OR PROCEDURE W/O CC. ECMO OR TRACH W MV 96+HRS OR PDX EXC FACE, MOUTH & NECK W MAJ O.R.. TRACH W MV 96+HRS OR PDX EXC FACE, MOUTH & NECK W/O MAJ O.R.. VerDate Aug<31>2005 17:10 Apr 24, 2006 Jkt 208001 PO 00000 ...... ...... ...... ...... ...... Frm 00291 Fmt 4701 Sfmt 4702 E:\FR\FM\25APP2.SGM Geometric mean LOS Arithmetic mean LOS 13.2723 21.0 28.3 3.0532 2.8 6.4 4.7246 10.9 15.2 2.2603 5.5 7.8 1.6171 5.3 7.5 1.1338 3.7 5.3 1.4467 4.1 6.1 0.8610 2.6 3.7 9.9384 11.1 13.5 6.5546 0.0000 4.1471 8.8 0.0 2.2 10.0 0.0 3.8 0.0000 0.0000 1.1424 0.0 0.0 1.8 0.0 0.0 2.5 2.2859 1.4721 0.9157 2.9 1.6 4.0 4.7 1.9 5.4 1.0575 8.1 10.5 0.5474 3.2 3.8 0.6913 12.0673 2.6 7.7 3.1 14.5 0.0000 0.0000 7.3829 0.0 0.0 13.3 0.0 0.0 16.4 2.2423 4.7 7.5 1.1697 2.3 3.0 3.0552 1.3777 1.4911 0.9668 5.8951 6.3 2.8 2.3 1.4 6.9 9.1 3.6 3.7 1.7 9.2 5.2199 5.5 7.3 1.8568 4.7 6.6 1.0223 2.2 2.9 3.1235 6.8 10.5 1.1837 2.6 3.5 19.9990 36.9 44.1 12.5966 27.2 32.6 Weights 25APP2 24286 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules TABLE 5.—LIST OF DIAGNOSIS-RELATED GROUPS, RELATIVE WEIGHTING FACTORS, AND GEOMETRIC AND ARITHMETIC MEAN LENGTH OF STAY (LOS)—Continued DRG FY 07 proposed rule post-acute care DRG FY 07 proposed rule special pay DRG MDC 543 ...... Yes .......... No ............ 544 ...... Yes .......... 545 ...... Type 01 SURG ...... No ............ 08 SURG ...... Yes .......... Yes .......... 08 SURG ...... 546 ...... No ............ No ............ 08 SURG ...... 547 ...... Yes .......... No ............ 05 SURG ...... 548 ...... Yes .......... No ............ 05 SURG ...... 549 ...... Yes .......... Yes .......... 05 SURG ...... 550 ...... Yes .......... Yes .......... 05 SURG ...... 551 ...... No ............ No ............ 05 SURG ...... 552 ...... No ............ No ............ 05 SURG ...... 553 ...... Yes .......... No ............ 05 SURG ...... 554 ...... Yes .......... No ............ 05 SURG ...... 555 ...... No ............ No ............ 05 SURG ...... 556 ...... No ............ No ............ 05 SURG ...... 557 ...... No ............ No ............ 05 SURG ...... 558 ...... No ............ No ............ 05 SURG ...... 559 ...... No ............ No ............ 08 MED ......... Arithmetic mean LOS 8.4 12.0 1.8941 4.0 4.4 2.4127 4.5 5.2 4.8421 6.9 8.7 5.6862 10.9 12.4 4.1762 8.1 8.9 4.8829 8.7 10.3 3.4598 6.2 6.8 2.6339 4.2 6.1 1.7670 2.5 3.5 2.8371 6.3 9.3 1.9483 3.7 5.6 1.8654 3.4 4.8 1.2241 1.6 2.0 2.1323 3.0 4.1 1.4299 1.5 1.8 2.2370 CRANIOTOMY W/IMPLANT OF CHEMO AGENT OR ACUTE COMPLX CNS PDX. MAJOR JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY. REVISION OF HIP OR KNEE REPLACEMENT. SPINAL FUSION EXC CERV WITH CURVATURE OF THE SPINE OR MALIG. CORONARY BYPASS W CARDIAC CATH W MAJOR CV DX. CORONARY BYPASS W CARDIAC CATH W/O MAJOR CV DX. CORONARY BYPASS W/O CARDIAC CATH W MAJOR CV DX. CORONARY BYPASS W/O CARDIAC CATH W/O MAJOR CV DX. PERMANENT CARDIAC PACEMAKER IMPL W MAJ CV DX OR AICD LEAD OR GNRTR. OTHER PERMANENT CARDIAC PACEMAKER IMPLANT W/O MAJOR CV DX. OTHER VASCULAR PROCEDURES W CC W MAJOR CV DX. OTHER VASCULAR PROCEDURES W CC W/O MAJOR CV DX. PERCUTANEOUS CARDIOVASCULAR PROC W MAJOR CV DX. PERCUTANEOUS CARDIOVASC PROC W NON-DRUG-ELUTING STENT W/O MAJ CV DX. PERCUTANEOUS CARDIOVASCULAR PROC W DRUG-ELUTING STENT W MAJOR CV DX. PERCUTANEOUS CARDIOVASCULAR PROC W DRUG-ELUTING STENT W/O MAJ CV DX. ACUTE ISCHEMIC STROKE WITH USE OF THROMBOLYTIC AGENT. Geometric mean LOS 4.6474 DRG title 5.4 6.9 Weights DRGS 469 and 470 contain cases which could not be assigned to valid drgs. Note: An asterisk in the gmlos or amlos column indicates there is no data to compute. Note: Arithmetic mean is presented for informational purposes only. Note: Geometric mean is used only to determine payment for transfer cases. Note: Relative weights are based on medicare patient data and may not be appropriate for other patients. TABLE 6A.—NEW DIAGNOSIS CODES Description 052.2 ........ 053.14 ...... 054.74 ...... 238.71 ...... 238.72 ...... 238.73 ...... 238.74 ...... 238.75 ...... 238.76 ...... wwhite on PROD1PC61 with PROPOSALS2 Diagnosis code Postvaricella myelitis .................................................................................................................... Herpes zoster myelitis ................................................................................................................. Herpes simplex myelitis ............................................................................................................... Essential thrombocythemia .......................................................................................................... Low grade myelodysplastic syndrome lesions ............................................................................ High grade myelodysplastic syndrome lesions ........................................................................... Myelodysplastic syndrome with 5q deletion ................................................................................ Myelodysplastic syndrome, unspecified ...................................................................................... Myelofibrosis with myeloid Metaplasia ........................................................................................ Y Y Y N N N N N N 1 1 1 16 16 16 16 16 17 238.79 ...... Other lymphatic and Hematopoietic tissues ................................................................................ N 17 277.30 ...... 277.31 ...... 277.39 ...... 284.01 ...... 284.09 ...... 284.1 ........ Amyloidosis, unspecified .............................................................................................................. Familial Mediterranean fever ....................................................................................................... Other amyloidosis ........................................................................................................................ Constitutional red blood cell aplasia ............................................................................................ Other constitutional aplastic anemia ............................................................................................ Pancytopenia ............................................................................................................................... N N N N N N 8 8 8 16 16 16 VerDate Aug<31>2005 17:10 Apr 24, 2006 Jkt 208001 PO 00000 Frm 00292 Fmt 4701 CC Sfmt 4702 E:\FR\FM\25APP2.SGM 25APP2 MDC DRG 20, 543 20, 543 20, 543 398, 399 395, 396 395, 396 395, 396 395, 396 401, 402, 403, 404, 539, 540 401, 402, 403, 404, 539, 540 240, 241 240, 241 240, 241 395, 396 395, 396 395, 396 24287 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules TABLE 6A.—NEW DIAGNOSIS CODES—Continued Description 284.2 ........ Myelophthisis ............................................................................................................................... N 17 288.00 ...... Neutropenia, unspecified ............................................................................................................. N 288.01 ...... Congenital neutropenia ................................................................................................................ N 288.02 ...... Cyclic neutropenia ....................................................................................................................... N 288.03 ...... Drug induced neutropenia ........................................................................................................... N 288.04 ...... Neutropenia due to infection ........................................................................................................ N 288.09 ...... Other neutropenia ........................................................................................................................ N 288.4 ........ 288.50 ...... 288.51 ...... 288.59 ...... 288.60 ...... 288.61 ...... 288.62 ...... 288.63 ...... 288.64 ...... 288.65 ...... 288.69 ...... 289.53 ...... 289.83 ...... Hemophagocytic syndromes ........................................................................................................ Leukocytopenia, unspecified ........................................................................................................ Lymphocytopenia ......................................................................................................................... Other decreased white blood cell count ...................................................................................... Leukocytosis, unspecified ............................................................................................................ Lymphocytosis (symptomatic) ...................................................................................................... Leukemoid reaction ...................................................................................................................... Monocytosis (symptomatic) ......................................................................................................... Plasmacytosis .............................................................................................................................. Basophilia ..................................................................................................................................... Other elevated white blood cell count ......................................................................................... Neutropenic splenomegaly .......................................................................................................... Myelofibrosis ................................................................................................................................ N N N N N N N N N N N N N 16 25 16 25 16 25 16 25 16 25 16 25 16 16 16 16 16 16 16 16 16 16 16 16 17 323.01 323.02 323.41 323.42 323.51 323.52 323.61 323.62 323.63 323.71 323.72 323.81 ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... Encephalitis and encephalomyelitis in viral diseases classified elsewhere ................................ Myelitis in viral diseases classified elsewhere ............................................................................ Other encephalitis and encephalomyelitis due to infection classified elsewhere ....................... Other myelitis due to infection classified elsewhere ................................................................... Encephalitis and encephalomyelitis following immunization procedures .................................... Myelitis following immunization procedures ................................................................................ Infectious acute disseminated encephalomyelitis (ADEM) .......................................................... Other postinfectious encephalitis and encephalomyelitis ............................................................ Postinfectious myelitis .................................................................................................................. Toxic encephalitis and encephalomyelitis ................................................................................... Toxic myelitis ............................................................................................................................... Other causes of encephalitis and encephalomyelitis .................................................................. N N N N N N N N N N N N 323.82 ...... wwhite on PROD1PC61 with PROPOSALS2 Diagnosis code Other causes of myelitis .............................................................................................................. N 331.83 ...... 333.71 ...... 333.72 ...... 333.79 ...... 333.85 ...... 338.0 ........ 338.11 ...... 338.12 ...... 338.18 ...... 338.19 ...... 338.21 ...... 338.22 ...... 338.28 ...... 338.29 ...... 338.3 ........ 338.4 ........ 341.20 ...... 341.21 ...... 341.22 ...... 377.43 ...... 379.60 ...... 379.61 ...... 379.62 ...... 379.63 ...... 389.15 ...... 389.16 ...... 429.83 ...... Mild cognitive impairment, so stated ........................................................................................... Athetoid cerebral palsy ................................................................................................................ Acute dystonia due to drugs ........................................................................................................ Other acquired torsion dystonia ................................................................................................... Subacute dyskinesia due to drugs .............................................................................................. Central pain syndrome ................................................................................................................. Acute pain due to trauma ............................................................................................................ Acute post-thoracotomy pain ....................................................................................................... Other acute postoperative pain ................................................................................................... Other acute pain .......................................................................................................................... Chronic pain due to trauma ......................................................................................................... Chronic post-thoracotomy pain .................................................................................................... Other chronic postoperative pain ................................................................................................. Other chronic pain ....................................................................................................................... Neoplasm related pain (acute) (chronic) ..................................................................................... Chronic pain syndrome ................................................................................................................ Acute (transverse) myelitis NOS ................................................................................................. Acute (transverse) myelitis in conditions classified elsewhere ................................................... Idiopathic transverse myelitis ....................................................................................................... Optic nerve hypoplasia ................................................................................................................ Inflammation (infection) of postprocedural bleb, unspecified ...................................................... Inflammation (infection) of postprocedural bleb, stage 1 ............................................................ Inflammation (infection) of postprocedural bleb, stage 2 ............................................................ Inflammation (infection) of postprocedural bleb, stage 3 ............................................................ Sensorineural hearing loss, unilateral ......................................................................................... Sensorineural hearing loss, asymmetrical ................................................................................... Takotsubo syndrome ................................................................................................................... N N N N N N N N N N N N N N N N N N N N N N N N N N N VerDate Aug<31>2005 17:10 Apr 24, 2006 Jkt 208001 PO 00000 Frm 00293 Fmt 4701 CC Sfmt 4702 E:\FR\FM\25APP2.SGM 25APP2 MDC 1 1 1 1 1 1 1 1 1 1 1 1 25 1 25 1 1 1 1 1 23 23 23 23 23 23 23 23 23 23 23 1 1 1 2 2 2 2 2 3 3 5 DRG 401, 402, 403, 404, 539, 540 398, 399 490 398, 399 490 398, 399 490 398, 399 490 398, 399 490 398, 399 490 398, 399 398, 399 398, 399 398, 399 398, 399 398, 399 398, 399 398, 399 398, 399 398, 399 398, 399 398, 399 401, 402, 403, 404, 539, 540 20, 543 20, 543 20, 543 20, 543 20, 543 20, 543 20, 543 20, 543 20, 543 34, 35, 543 34, 35, 543 20, 543 489 20, 543 489 12 12 34, 35 34, 35 34, 35 463, 464 463, 464 463, 464 463, 464 463, 464 463, 464 463, 464 463, 464 463, 464 463, 464 463, 464 20, 543 20, 543 20, 543 45 46, 47, 48 46, 47, 48 46, 47, 48 46, 47, 48 73, 74 73, 74 144, 145 24288 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules TABLE 6A.—NEW DIAGNOSIS CODES—Continued Description 478.11 ...... Nasal mucositis (ulcerative) ......................................................................................................... N 3 478.19 ...... Other disease of nasal cavity and sinuses .................................................................................. N 518.7 ........ 519.11 ...... Transfusion related acute lung injury (TRALI) ............................................................................. Acute bronchospasm ................................................................................................................... Y N 519.19 ...... Other diseases of trachea and bronchus .................................................................................... N 521.81 ...... Cracked tooth ............................................................................................................................... N 521.89 ...... Other specific diseases of hard tissues of teeth ......................................................................... N 523.00 ...... Acute gingivitis, plaque induced .................................................................................................. N 523.01 ...... Acute gingivitis, non-plaque induced ........................................................................................... N 523.10 ...... Chronic gingivitis, plaque induced ............................................................................................... N 523.11 ...... Chronic gingivitis, non-plaque induced ........................................................................................ N 523.30 ...... Aggressive periodontitis, unspecified .......................................................................................... N 523.31 ...... Aggressive periodontitis, localized ............................................................................................... N 523.32 ...... Aggressive periodontitis, generalized .......................................................................................... N 523.33 ...... Acute periodontitis ....................................................................................................................... N 523.40 ...... Chronic periodontitis, unspecified ................................................................................................ N 523.41 ...... Chronic periodontitis, localized .................................................................................................... N 523.42 ...... Chronic periodontitis,generalized ................................................................................................. N 525.60 ...... Unspecified unsatisfactory restoration of tooth ........................................................................... N 525.61 ...... Open restoration margins ............................................................................................................ N 525.62 ...... Unrepairable overhanging of dental restorative materials ........................................................... N 525.63 ...... Fractured dental restorative material without loss of material .................................................... N 525.64 ...... Fractured dental restorative material with loss of material ......................................................... N 525.65 ...... Contour of existing restoration of tooth biologically incompatible with oral health ..................... N 525.66 ...... Allergy to existing dental restorative material .............................................................................. N 525.67 ...... Poor aesthetics of existing restoration ........................................................................................ N 525.69 ...... Other unsatisfactory restoration of existing tooth ........................................................................ N 526.61 ...... Perforation of root canal space ................................................................................................... N 526.62 ...... Endodontic overfill ........................................................................................................................ N 526.63 ...... Endodontic underfill ..................................................................................................................... N 526.69 ...... Other periradicular pathology associated with previous endodontic treatment .......................... N 528.00 ...... wwhite on PROD1PC61 with PROPOSALS2 Diagnosis code Stomatitis and mucositis, unspecified .......................................................................................... N 528.01 ...... Mucositis (ulcerative) due to antineoplastic therapy ................................................................... N 528.02 ...... Mucositis (ulcerative) due to other drugs .................................................................................... N 528.09 ...... Other stomatitis and mucositis (ulcerative) ................................................................................. N 538 ........... 608.20 ...... Gastrointestinal mucositis (ulcerative) ......................................................................................... Torsion of testis, unspecified ....................................................................................................... N N 3 15 4 PRE 4 PRE 4 PRE 3 PRE 3 PRE 3 PRE 3 PRE 3 PRE 3 PRE 3 PRE 3 PRE 3 PRE 3 PRE 3 PRE 3 PRE 3 PRE 3 PRE 3 PRE 3 PRE 3 PRE 3 PRE 3 PRE 3 PRE 3 PRE 3 PRE 3 PRE 3 PRE 3 PRE 3 PRE 3 PRE 3 PRE 3 PRE 3 6 12 VerDate Aug<31>2005 17:10 Apr 24, 2006 Jkt 208001 PO 00000 Frm 00294 Fmt 4701 CC Sfmt 4702 E:\FR\FM\25APP2.SGM 25APP2 MDC DRG 15, 73, 74 391 1 73, 74 391 1 101, 102 482 96, 97, 98 482 96, 97, 98 482 185, 186, 187 482 185, 186, 187 482 185, 186, 187 482 185, 186, 187 482 185, 186, 187 482 185, 186, 187 482 185, 186, 187 482 185, 186, 187 482 185, 186, 187 482 185, 186, 187 482 185, 186, 187 482 185, 186, 187 482 185, 186, 187 482 185, 186, 187 482 185, 186, 187 482 185, 186, 187 482 185, 186, 187 482 185, 186, 187 482 185, 186, 187 482 185, 186, 187 482 185, 186, 187 482 185, 186, 187 482 185, 186, 187 482 185, 186, 187 482 185, 186, 187 482 185, 186, 187 482 185, 186, 187 482 185, 186, 187 482 185, 186, 187 482 185, 186, 187 182, 183, 184 352 24289 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules TABLE 6A.—NEW DIAGNOSIS CODES—Continued Diagnosis code 608.21 608.22 608.23 608.24 616.81 616.89 618.84 629.29 629.81 629.89 649.00 ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... Description CC MDC DRG N N N N N N N N N N N 12 12 12 12 13 13 13 13 13 13 14 352 352 352 352 358, 358, 358, 358, 358, 358, 469 N 14 N 14 N 14 370, 371, 372, 373, 374, 375 370, 371, 372, 373, 374, 375 383, 384 N 14 376, 377 N 14 469 N 14 N 14 N 14 370, 371, 372, 373, 374, 375 370, 371, 372, 373, 374, 375 383, 384 N 14 376, 377 N 14 469 N 14 N 14 N 14 370, 371, 372, 373, 374, 375 370, 371, 372, 373, 374, 375 383, 384 N 14 376, 377 N 14 469 N 14 N 14 N 14 370, 371, 372, 373, 374, 375 370, 371, 372, 373, 374, 375 383, 384 N 14 376, 377 N 14 469 N 14 N 14 N 14 370, 371, 372, 373, 374, 375 370, 371, 372, 373, 374, 375 383, 384 N 14 376, 377 649.50 ...... 649.51 ...... Extravaginal torsion of spermatic cord ........................................................................................ Intravaginal torsion of spermatic cord ......................................................................................... Torsion of appendix testis ............................................................................................................ Torsion of appendix epididymis ................................................................................................... Mucositis (ulcerative) of cervix, vagina, and vulva ...................................................................... Other inflammatory disease of cervix, vagina and vulva ............................................................ Cervical stump prolapse .............................................................................................................. Other female genital mutilation status ......................................................................................... Habitual aborter without current pregnancy ................................................................................ Other specified disorders of female genital organs ..................................................................... Tobacco use disorder complicating pregnancy, childbirth, or the puerperium, unspecified as to episode of care or not applicable. Tobacco use disorder complicating pregnancy, childbirth, or the puerperium, delivered, with or without mention of antepartum condition. Tobacco use disorder complicating pregnancy, childbirth, or the puerperium, delivered, with mention of postpartum complication. Tobacco use disorder complicating pregnancy, childbirth, or the puerperium, antepartum condition or complication. Tobacco use disorder complicating pregnancy, childbirth, or the puerperium, postpartum condition or complication. Obesity complicating pregnancy, childbirth, or the puerperium, unspecified as to episode of care or not applicable. Obesity complicating pregnancy, childbirth, or the puerperium, delivered, with or without mention of antepartum condition. Obesity complicating pregnancy, childbirth, or the puerperium, delivered, with mention of postpartum complication. Obesity complicating pregnancy, childbirth, or the puerperium, antepartum condition or complication. Obesity complicating pregnancy, childbirth, or the puerperium, postpartum condition or complication. Bariatric surgery status complicating pregnancy, childbirth, or the puerperium, unspecified as to episode of care or not applicable. Bariatric surgery status complicating pregnancy, childbirth, or the puerperium, delivered, with or without mention of antepartum condition. Bariatric surgery status complicating pregnancy, childbirth, or the puerperium, delivered, with mention of postpartum complication. Bariatric surgery status complicating pregnancy, childbirth, or the puerperium, antepartum condition or complication. Bariatric surgery status complicating pregnancy, childbirth, or the puerperium, postpartum condition or complication. Coagulation defects complicating pregnancy, childbirth, or the puerperium, unspecified as to episode of care or not applicable. Coagulation defects complicating pregnancy, childbirth, or the puerperium, delivered, with or without mention of antepartum condition. Coagulation defects complicating pregnancy, childbirth, or the puerperium, delivered, with mention of postpartum complication. Coagulation defects complicating pregnancy, childbirth, or the puerperium, antepartum condition or complication. Coagulation defects complicating pregnancy, childbirth, or the puerperium, postpartum condition or complication. Epilepsy complicating pregnancy, childbirth, or the puerperium, unspecified as to episode of care or not applicable. Epilepsy complicating pregnancy, childbirth, or the puerperium, delivered, with or without mention of antepartum condition. Epilepsy complicating pregnancy, childbirth, or the puerperium, delivered, with mention of postpartum complication. Epilepsy complicating pregnancy, childbirth, or the puerperium, antepartum condition or complication. Epilepsy complicating pregnancy, childbirth, or the puerperium, postpartum condition or complication. Spotting complicating pregnancy, unspecified as to episode of care or not applicable ............. Spotting complicating pregnancy, delivered, with or without mention of antepartum condition N N 14 14 649.53 ...... 649.60 ...... 649.61 ...... Spotting complicating pregnancy, antepartum condition or complication ................................... Uterine size date discrepancy, unspecified as to episode of care or not applicable .................. Uterine size date discrepancy, delivered, with or without mention of antepartum condition ...... N N N 14 14 14 649.62 ...... Uterine size date discrepancy, delivered, with mention of postpartum complication ................. N 14 649.63 ...... 649.64 ...... Uterine size date discrepancy, antepartum condition or complication ........................................ Uterine size date discrepancy, postpartum condition or complication ........................................ N N 14 14 469 370, 371, 372, 373, 374, 375 383, 384 469 370, 371, 372, 373, 374, 375 370, 371, 372, 373, 374, 375 383, 384 376, 377 649.01 ...... 649.02 ...... 649.03 ...... 649.04 ...... 649.10 ...... 649.11 ...... 649.12 ...... 649.13 ...... 649.14 ...... 649.20 ...... 649.21 ...... 649.22 ...... 649.23 ...... 649.24 ...... 649.30 ...... 649.31 ...... 649.32 ...... 649.33 ...... 649.34 ...... 649.40 ...... 649.41 ...... 649.42 ...... 649.43 ...... wwhite on PROD1PC61 with PROPOSALS2 649.44 ...... VerDate Aug<31>2005 17:10 Apr 24, 2006 Jkt 208001 PO 00000 Frm 00295 Fmt 4701 Sfmt 4702 E:\FR\FM\25APP2.SGM 25APP2 359, 359, 359, 359, 359, 359, 368 368 369 369 368 368 24290 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules TABLE 6A.—NEW DIAGNOSIS CODES—Continued Diagnosis code Description 729.71 ...... 729.72 ...... 729.73 ...... 729.79 ...... 731.3 ........ 780.32 ...... 780.96 ...... 780.97 ...... 784.91 ...... 784.99 ...... 788.64 ...... 788.65 ...... 793.91 ...... 793.99 ...... 795.06 ...... 795.81 ...... 795.82 ...... 795.89 ...... 958.90 ...... 958.91 ...... 958.92 ...... 958.93 ...... 958.99 ...... 995.20 ...... Nontraumatic compartment syndrome of upper extremity .......................................................... Nontraumatic compartment syndrome of lower extremity ........................................................... Nontraumatic compartment syndrome of abdomen .................................................................... Nontraumatic compartment syndrome of other sites .................................................................. Major osseous defects ................................................................................................................. Complex febrile convulsions ........................................................................................................ Generalized pain .......................................................................................................................... Altered mental status ................................................................................................................... Postnasal drip .............................................................................................................................. Other symptoms involving head and neck .................................................................................. Urinary hesitancy ......................................................................................................................... Straining on urination ................................................................................................................... Image test inconclusive due to excess body fat ......................................................................... Other nonspecific abnormal findings on radiological and other examinations of body structure Papanicolaou smear of cervix with cytologic evidence of malignancy ....................................... Elevated carcinoembryonic antigen [CEA] .................................................................................. Elevated cancer antigen 125 [CA 125] ........................................................................................ Other abnormal tumor markers ................................................................................................... Compartment syndrome, unspecified .......................................................................................... Traumatic compartment syndrome of upper extremity ................................................................ Traumatic compartment syndrome of lower extremity ................................................................ Traumatic compartment syndrome of abdomen .......................................................................... Traumatic compartment syndrome of other sites ........................................................................ Unspecified adverse effect of unspecified drug, medicinal and biological substance ................ N N N N N Y N N N N N N N N N N N N N N N N N N 995.21 ...... Arthus phenomenon ..................................................................................................................... N 995.22 ...... Unspecified adverse effect of anesthesia .................................................................................... N 995.23 ...... Unspecified adverse effect of insulin ........................................................................................... N 995.27 ...... Other drug allergy ........................................................................................................................ N 995.29 ...... Unspecified adverse effect of other drug, medicinal and biological substance .......................... N V18.51 V18.59 V26.34 V26.35 V26.39 V45.86 V58.30 V58.31 V58.32 V72.11 ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... Family history, Colonic polyps ..................................................................................................... Family history, Other digestive disorders .................................................................................... Testing of male for genetic disease carrier status ...................................................................... Encounter for testing of male partner of habitual aborter ........................................................... Other genetic testing of male ...................................................................................................... Bariatric surgery status ................................................................................................................ Encounter for change or removal of nonsurgical wound dressing .............................................. Encounter for change or removal of surgical wound dressing .................................................... Encounter for removal of sutures ................................................................................................ Encounter for hearing examinationfollowing failed hearing screening ........................................ N N N N N N N N N N V72.19 ..... Other examination of ears and hearing ....................................................................................... N V82.71 ..... V82.79 ..... V85.51 ..... V85.52 ..... V85.53 ..... V85.54 ..... V86.0 ....... V86.1 ....... Screening for genetic disease carrier status ............................................................................... Other genetic screening ............................................................................................................... Body Mass Index, pediatric, less than 5th percentile for age ..................................................... Body Mass Index, pediatric, 5th percentile to less than 85th percentile for age ........................ Body Mass Index, pediatric, 85th percentile to less than 95th percentile for age ...................... Body Mass Index, pediatric, greater than or equal to 95th percentile for age ........................... Estrogen receptor positive status [ER+] ...................................................................................... Estrogen receptor negative status [ER-] ..................................................................................... N N N N N N N N 1 On CC MDC DRG 8 8 8 8 8 1 23 23 3 3 11 11 23 23 13 23 23 23 21 21 21 21 21 15 21 15 21 15 21 15 21 15 21 15 21 23 23 23 23 23 23 23 23 23 23 15 23 15 23 23 23 23 23 23 23 23 248 248 248 248 244, 245 24, 25, 26 463, 464 463, 464 73, 74 73, 74 325, 326, 327 325, 326, 327 463, 464 463, 464 358, 359, 369 463, 464 463, 464 463, 464 454, 455 454, 455 454, 455 454, 455 454, 455 387 2, 389 2 449, 450, 451 387 2, 389 2 449, 450, 451 387 2, 389 2 449, 450, 451 387 2, 389 2 449, 450, 451 387 2, 389 2 449, 450, 451 387 2, 389 2 449, 450, 451 467 467 467 467 467 467 467 467 467 467 391 1 467 391 1 467 467 467 467 467 467 467 467 ‘‘Only secondary diagnosis’’ list. or secondary diagnosis of major problem. 2 Principal wwhite on PROD1PC61 with PROPOSALS2 TABLE 6B.—NEW PROCEDURE CODES Procedure code Description 00.44 ........ 00.56 ........ Procedure on vessel bifurcation .................................................................................................. Insertion or replacement of implantable pressure sensor (lead) for intracardiac hemodynamic monitoring. Implantation or replacement of subcutaneous device for intracardiac hemodynamic monitoring. Noninvasive programmed electrical stimulation [NIPS] ............................................................... 00.57 ........ 37.20 ........ VerDate Aug<31>2005 17:10 Apr 24, 2006 Jkt 208001 PO 00000 Frm 00296 Fmt 4701 O.R. Sfmt 4702 E:\FR\FM\25APP2.SGM MDC DRG N Y 5 117,120 1 Y 5 118,120 1 N 25APP2 24291 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules TABLE 6B.—NEW PROCEDURE CODES—Continued Procedure code Description 39.74 ........ Endovascular removal of obstruction from head and neck vessel(s) ......................................... Y 68.41 ........ Laparoscopic total abdominal hysterectomy ............................................................................... Y 68.49 ........ Other and unspecified total abdominal hysterectomy ................................................................. Y 13 14 68.61 ........ Laparoscopic radical abdominal hysterectomy ............................................................................ Y 68.69 ........ Other and unspecified radical abdominal hysterectomy ............................................................. Y 68.71 ........ Laparoscopic radical vaginal hysterectomy [LRVH] .................................................................... Y 68.79 ........ Other and unspecified radical vaginal hysterectomy ................................................................... Y 13 14 13 14 13 14 13 14 1 Assigned O.R. MDC 1 21 24 13 14 DRG 1, 2, 3, 543 442, 443 486 354, 355, 357, 358, 359 375 354, 355, 357,358, 359 375 353 375 353 375 353 375 353 375 to DRG 120 when both Code 00.56 and Code 00.57 are reported. TABLE 6C.—INVALID DIAGNOSIS CODES Description 238.7 ........ Other lymphatic and hematopoietic tissues ................................................................................. N 17 277.3 ........ 284.0 ........ 288.0 ........ Amyloidosis .................................................................................................................................. Constitutional aplastic anemia ..................................................................................................... Agranulocytosis ............................................................................................................................ N Y Y 323.0 323.4 323.5 323.6 323.7 323.8 ........ ........ ........ ........ ........ ........ Encephalitis in viral diseases classified elsewhere ..................................................................... Other encephalitis due to infection classified elsewhere ............................................................ Encephalitis following immunization procedures ......................................................................... Postinfectious encephalitis ........................................................................................................... Toxic encephalitis ........................................................................................................................ Other causes of encephalitis ....................................................................................................... N N N N N N 333.7 ........ 478.1 ........ Symptomatic torsion dystonia ...................................................................................................... Other diseases of nasal cavity and sinuses ................................................................................ N N 519.1 ........ Other diseases of trachea and bronchus, not elsewhere classified ........................................... N 521.8 ........ Other specific diseases of hard tissues of teeth ......................................................................... N 523.0 ........ Acute gingivitis ............................................................................................................................. N 523.1 ........ Chronic gingivitis .......................................................................................................................... N 523.3 ........ Acute periodontitis ....................................................................................................................... N 523.4 ........ Chronic periodontitis .................................................................................................................... N 528.0 ........ Stomatitis ..................................................................................................................................... N 608.2 616.8 629.8 784.9 793.9 995.2 wwhite on PROD1PC61 with PROPOSALS2 Diagnosis code ........ ........ ........ ........ ........ ........ Torsion of testis ........................................................................................................................... Other specified inflammatory diseases of cervix, vagina, and vulva .......................................... Other specified disorders of female genital organs ..................................................................... Other symptoms involving head and neck .................................................................................. Other nonspecific abnormal findings on radiological and other examinations of body structure Unspecified adverse effect of drug, medicinal and biological substance ................................... N N N N N N V18.5 ....... V58.3 ....... V72.1 ....... Family history, Digestive disorders .............................................................................................. Attention to surgical dressings and sutures ................................................................................ Examination of ears and hearing ................................................................................................. N N N 8 16 16 25 1 1 1 1 1 1 25 1 3 15 PRE 4 PRE 3 PRE 3 PRE 3 PRE 3 PRE 3 PRE 3 12 13 13 3 23 15 21 23 23 15 23 1 On CC ‘‘Only secondary diagnosis’’ list. or secondary diagnosis of major problem. 2 Principal VerDate Aug<31>2005 17:10 Apr 24, 2006 Jkt 208001 PO 00000 Frm 00297 Fmt 4701 Sfmt 4702 E:\FR\FM\25APP2.SGM 25APP2 MDC DRG 401, 402, 403, 404, 539, 540 240, 241 395, 396 398, 399 490 20, 20, 20, 20, 34, 20, 543 543 543 543 35, 543 543 489 12 73, 74 391 1 482 96, 97, 98 482 185, 186, 187 482 185, 186, 187 482 185, 186, 187 482 185, 186, 187 482 185, 186, 187 482 185, 186, 187 352 358, 359, 368 358, 359, 369 73, 74 463, 464 387 2, 389 2 449, 450, 451 467 467 391 1 467 24292 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules TABLE 6D.—INVALID PROCEDURE CODES Procedure code Description 68.4 .......... Total abdominal hysterectomy ..................................................................................................... Y 13 14 68.6 .......... Radical abdominal hysterectomy ................................................................................................. Y 68.7 .......... Radical vaginal hysterectomy ...................................................................................................... Y 13 14 13 14 O.R. MDC DRG 354, 355, 357, 358, 359 375 353 375 353 375 TABLE 6E.—REVISED DIAGNOSIS CODES Diagnosis code Description 255.10 ...... 285.29 ...... 323.1 ........ 323.2 ........ 323.9 ........ Hyperaldosteronism, unspecified .............................................................................................. Anemia of other chronic disease .............................................................................................. Encephalitis, myelitis, and encephalomyelitis in rickettsial diseases classified elsewhere ...... Encephalitis, myelitis, and encephalomyelitis in protozoal diseases classified elsewhere ...... Unspecified causes of encephalitis, myelitis, and encephalomyelitis ...................................... N N N N N 333.6 ........ 345.40 ...... Genetic torsion dystonia ........................................................................................................... Localization-related (focal) (partial) epilepsy and epileptic syndromes with complex partial seizures, without mention of intractable epilepsy. Localization-related (focal) (partial) epilepsy and epileptic syndromes with complex partial seizures, with intractable epilepsy. Localization-related (focal) (partial) epilepsy and epileptic syndromes with simple partial seizures, without mention of intractable epilepsy. Localization-related (focal) (partial) epilepsy and epileptic syndromes with simple partial seizures, with intractable epilepsy. Other forms of epilepsy and recurrent seizures, without mention of intractable epilepsy ....... Other forms of epilepsy and recurrent seizures, with intractable epilepsy ............................... Sensory hearing loss, bilateral .................................................................................................. Neural hearing loss, bilateral .................................................................................................... Central hearing loss, bilateral ................................................................................................... Sensorineural hearing loss of combined types, bilateral .......................................................... Hypertensive chronic kidney disease, malignant, with chronic kidney disease stage I through stage IV, or unspecified. Hypertensive chronic kidney disease, malignant, with chronic kidney disease stage V or end stage renal disease. Hypertensive chronic kidney disease, benign, with chronic kidney disease stage I through stage IV, or unspecified. Hypertensive chronic kidney disease, benign, with chronic kidney disease stage V or end stage renal disease. Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified. Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease. Hypertensive heart and chronic kidney disease, malignant, without heart failure and with chronic kidney disease stage I through stage IV, or unspecified. Hypertensive heart and chronic kidney disease, malignant, with heart failure and with chronic kidney disease stage I through stage IV, or unspecified. Y 404.03 ...... Hypertensive heart and chronic kidney disease, malignant, without heart failure and with chronic kidney disease stage V or end stage renal disease. Hypertensive heart and chronic kidney disease, malignant, with heart failure and with chronic kidney disease stage V or end stage renal disease. 404.10 ...... Hypertensive heart and chronic kidney disease, benign, without heart failure and with chronic kidney disease stage I through stage IV, or unspecified. N 345.41 ...... 345.50 ...... 345.51 ...... 345.80 345.81 389.11 389.12 389.14 389.18 403.00 ...... ...... ...... ...... ...... ...... ...... 403.01 ...... 403.10 ...... 403.11 ...... 403.90 ...... 403.91 ...... 404.00 ...... 404.01 ...... wwhite on PROD1PC61 with PROPOSALS2 404.02 ...... VerDate Aug<31>2005 17:10 Apr 24, 2006 Jkt 208001 PO 00000 Frm 00298 Fmt 4701 CC Sfmt 4702 E:\FR\FM\25APP2.SGM MDC DRG N N 10 16 1 1 1 25 1 1 300, 301 395, 396 20, 543 20, 543 20, 543 489 12 24, 25, 26 Y 1 24, 25, 26 N 1 24, 25, 26 Y 1 24, 25, 26 N Y N N N N Y 1 1 3 3 3 3 11 24, 25, 26 24, 25, 26 73, 74 73, 74 73, 74 73, 74 331, 332, 333 Y PRE 11 11 512 1, 513 1 315, 316 331, 332, 333 PRE 11 11 512 1, 513 1 315, 316 331, 332, 333 Y PRE 11 5 512 1, 513 1 315, 316 134 Y 5 121 2, 124 3, 127, 535, 547 4, 549 4, 551 4, 553 4, 555 4, 557 4 387 5, 389 5 512 1, 513 1 315, 316 512 1, 513 1 121 2, 124 3, 127, 535, 547 4, 549 4, 551 4, 553 4, 555 4, 557 4 387 5, 389 5 134 N Y N Y Y 25APP2 15 PRE 11 PRE 5 15 5 24293 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules TABLE 6E.—REVISED DIAGNOSIS CODES—Continued Diagnosis code Description 404.11 ...... Hypertensive heart and chronic kidney disease, benign, with heart failure and with chronic kidney disease stage I through stage IV, or unspecified. Y 404.12 ...... Hypertensive heart and chronic kidney disease, benign, without heart failure and with chronic kidney disease stage V or end stage renal disease. Hypertensive heart and chronic kidney disease, benign, with heart failure and chronic kidney disease stage V or end stage renal disease. Y Hypertensive heart and chronic kidney disease, unspecified, without heart failure and with chronic kidney disease stage I through stage IV, or unspecified. Hypertensive heart and chronic kidney disease, unspecified, with heart failure and with chronic kidney disease stage I through stage IV, or unspecified. N 15 5 Y 5 Y 404.93 ...... Hypertensive heart and chronic kidney disease, unspecified, without heart failure and with chronic kidney disease stage V or end stage renal disease. Hypertensive heart and chronic kidney disease, unspecified, with heart failure and chronic kidney disease stage V or end stage renal disease. 524.21 ...... Malocclusion, Angle’s class I .................................................................................................... N 524.22 ...... Malocclusion, Angle’s class II ................................................................................................... N 524.23 ...... Malocclusion, Angle’s class III .................................................................................................. N 524.35 ...... Rotation of tooth/teeth ............................................................................................................... N 600.00 ...... N N 12 348, 349 N 12 348, 349 N 12 348, 349 N 12 348, 349 N 12 348, 349 780.31 ...... Hypertrophy (benign) of prostate withouturinary obstruction and other lower urinary tract (LUTS)symptoms (LUTS). Hypertrophy (benign) of prostate with urinary obstruction and other lower urinary tract symptoms (LUTS). Benign localized hyperplasia of prostate without urinary obstruction and other lower urinary tract symptoms (LUTS). Benign localized hyperplasia of prostate with urinary obstruction and other lower urinary tract symptoms (LUTS). Hyperplasia of prostate, unspecified, without urinary obstruction and other lower urinary symptoms (LUTS). Hyperplasia of prostate, unspecified, with urinary obstruction and other lower urinary symptoms (LUTS). Febrile convulsions (simple), unspecified ................................................................................. 15 PRE 3 PRE 3 PRE 3 PRE 3 12 Y 1 780.95 ...... 790.93 ...... 873.63 ...... Excessive crying of child, adolescent, or adult ......................................................................... Elevated prostate specific antigen [PSA] .................................................................................. Tooth (broken) (fractured) (due to trauma), without mention of complication .......................... N N N 873.73 ...... Tooth (broken) (fractured) (due to trauma), complicated ......................................................... N 995.91 ...... 995.92 ...... 995.93 ...... Sepsis ........................................................................................................................................ Severe sepsis ............................................................................................................................ Systemic inflammatory response syndrome due to noninfectious process without acute organ dysfunction. Systemic inflammatory response syndrome due to noninfectious process with acute organ dysfunction. Testing of female for genetic disease carrier status ................................................................ Other genetic testing of female ................................................................................................. Y Y Y 23 23 3 24 3 24 18 18 18 15 24, 25, 26 387 5, 389 5 463, 464 463, 464 185, 186, 187 487 185, 186, 187 487 416, 417 416, 417 416, 417 Y 18 416, 417 N N 23 23 467 467 404.13 ...... 404.90 ...... 404.91 ...... 404.92 ...... 600.01 ...... 600.20 ...... 600.21 ...... 600.90 ...... wwhite on PROD1PC61 with PROPOSALS2 600.91 ...... 995.94 ...... V26.31 ..... V26.32 ..... 1 Principal 2 Principal CC Y Y or secondary diagnosis. or secondary diagnosis of major complication. VerDate Aug<31>2005 17:10 Apr 24, 2006 Jkt 208001 PO 00000 Frm 00299 Fmt 4701 Sfmt 4702 E:\FR\FM\25APP2.SGM 25APP2 MDC DRG 5 15 PRE 11 PRE 5 15 PRE 11 PRE 5 121 2, 124 3, 127, 535, 547 4, 549 4, 551 4, 553 4, 555 4, 557 4 387 5, 389 5 512 1, 513 1 315, 316 512 1, 513 1 121 2, 124 3, 127, 535, 547 4, 549 4, 551 4, 553 4, 5554, 557 4 387 5, 389 5 134 121 2, 124 3, 127, 535, 547 4, 549 4, 551 4, 553 4, 555 4, 557 4 387 5, 389 5 512 1, 513 1 315, 316 512 1, 513 1 121 2, 124 3, 127, 535, 547 4, 549 4, 551 4, 553 4, 555 4, 557 4 387 5, 389 5 482 185, 186, 187 482 185, 186, 187 482 185, 186, 187 482 185, 186, 187 348, 349 24294 3 Principal 4 Principal 5 Principal Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules or secondary diagnosis of complex diagnosis. or secondary diagnosis of major cardiovascular. or secondary diagnosis of major problem. TABLE 6F.—REVISED PROCEDURE CODE TITLES Procedure code Description 37.26 ........ Catheter based invasive electrophysiologic testing ..................................................................... O.R. N* MDC DRG 5 104, 518, 555, 556, 557, 558 *Non-O.R. code that affects DRG assignment. TABLE 6G.—ADDITIONS TO THE CC EXCLUSIONS LIST—Continued TABLE 6G.—ADDITIONS TO THE CC EXCLUSIONS LIST—Continued [CCs that are added to the list, effective October 1, 2006, are included in this table. Each of the principal diagnoses is shown with an asterisk, and the revisions to the CC Exclusions List are provided in an indented column immediately following the affected principal diagnosis.] wwhite on PROD1PC61 with PROPOSALS2 TABLE 6G.—ADDITIONS TO THE CC EXCLUSIONS LIST [CCs that are added to the list, effective October 1, 2006, are included in this table. Each of the principal diagnoses is shown with an asterisk, and the revisions to the CC Exclusions List are provided in an indented column immediately following the affected principal diagnosis.] [CCs that are added to the list, effective October 1, 2006, are included in this table. Each of the principal diagnoses is shown with an asterisk, and the revisions to the CC Exclusions List are provided in an indented column immediately following the affected principal diagnosis.] *0519 0522 *0522 0520 0521 0522 0527 0528 0529 05314 05474 *0527 0522 *0528 0522 *0529 0522 *0530 05314 *05310 05314 *05311 05314 *05312 05314 *05313 05314 *05314 0522 0530 05310 05311 05312 05313 05314 05319 05379 0538 05474 *05319 05314 *05379 05314 *0538 05314 *0539 05314 *05472 05314 *05474 0522 0530 05310 05311 05312 05313 05314 05319 05379 0538 0543 0545 05471 05472 05474 05479 0548 *05479 05314 05474 *0548 05314 05474 *0549 05314 05474 *07888 0522 05314 05474 *07889 0522 05314 05474 *07981 0522 05314 05474 *07988 0522 05314 05474 *07989 0522 05314 05474 *07998 0522 05314 05474 *07999 0522 05314 05474 *1398 0522 05314 05474 *28401 2800 2814 2818 28241 28242 28249 28260 28261 28262 28263 28264 28268 28269 2830 28310 28311 28319 2832 2839 2848 2849 2850 2851 *28409 2800 2814 2818 28241 28242 28249 28260 28261 28262 28263 28264 28268 28269 2830 28310 28311 28319 2832 2839 2848 2849 2850 2851 *2841 2800 2814 VerDate Aug<31>2005 17:10 Apr 24, 2006 Jkt 208001 PO 00000 Frm 00300 Fmt 4701 Sfmt 4702 E:\FR\FM\25APP2.SGM 25APP2 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules 24295 TABLE 6G.—ADDITIONS TO THE CC EXCLUSIONS LIST—Continued TABLE 6G.—ADDITIONS TO THE CC EXCLUSIONS LIST—Continued [CCs that are added to the list, effective October 1, 2006, are included in this table. Each of the principal diagnoses is shown with an asterisk, and the revisions to the CC Exclusions List are provided in an indented column immediately following the affected principal diagnosis.] wwhite on PROD1PC61 with PROPOSALS2 TABLE 6G.—ADDITIONS TO THE CC EXCLUSIONS LIST—Continued [CCs that are added to the list, effective October 1, 2006, are included in this table. Each of the principal diagnoses is shown with an asterisk, and the revisions to the CC Exclusions List are provided in an indented column immediately following the affected principal diagnosis.] [CCs that are added to the list, effective October 1, 2006, are included in this table. Each of the principal diagnoses is shown with an asterisk, and the revisions to the CC Exclusions List are provided in an indented column immediately following the affected principal diagnosis.] 2818 28241 28242 28249 28260 28261 28262 28263 28264 28268 28269 2830 28310 28311 28319 2832 2839 2848 2849 2850 2851 *2842 2800 2814 2818 28241 28242 28249 28260 28261 28262 28263 28264 28268 28269 2830 28310 28311 28319 2832 2839 2848 2849 2850 2851 *28800 2881 28981 28982 *28801 2881 28981 28982 *28802 2881 28981 28982 *28803 2881 28981 28982 *28804 2881 28981 28982 *28809 2881 28981 28982 *2884 2881 28981 28982 *28850 2881 28981 28982 *28851 2881 28981 28982 *28859 2881 28981 28982 *28860 2881 28981 28982 *28861 2881 28981 28982 *28862 2881 28981 28982 *28863 2881 28981 28982 *28864 2881 28981 28982 *28865 2881 28981 28982 *28869 2881 28981 28982 *28953 2881 28981 28982 *28983 2800 2814 2818 28241 28242 28249 28260 28261 28262 28263 28264 28268 28269 2830 28310 28311 28319 2832 2839 2848 2849 2850 2851 2860 2861 2862 2863 2864 2865 2866 2867 2869 2870 2871 2872 28730 28731 28732 28733 28739 2874 2875 2878 2879 2881 28981 28982 *32301 0522 05314 05474 34982 *32302 0522 05314 05474 34982 *32341 0522 05314 05474 34982 *32342 0522 05314 05474 34982 *32351 0522 05314 05474 34982 *32352 0522 05314 05474 34982 *32361 0522 05314 VerDate Aug<31>2005 17:10 Apr 24, 2006 Jkt 208001 PO 00000 Frm 00301 Fmt 4701 Sfmt 4702 E:\FR\FM\25APP2.SGM 25APP2 24296 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules TABLE 6G.—ADDITIONS TO THE CC EXCLUSIONS LIST—Continued TABLE 6G.—ADDITIONS TO THE CC EXCLUSIONS LIST—Continued [CCs that are added to the list, effective October 1, 2006, are included in this table. Each of the principal diagnoses is shown with an asterisk, and the revisions to the CC Exclusions List are provided in an indented column immediately following the affected principal diagnosis.] wwhite on PROD1PC61 with PROPOSALS2 TABLE 6G.—ADDITIONS TO THE CC EXCLUSIONS LIST—Continued [CCs that are added to the list, effective October 1, 2006, are included in this table. Each of the principal diagnoses is shown with an asterisk, and the revisions to the CC Exclusions List are provided in an indented column immediately following the affected principal diagnosis.] [CCs that are added to the list, effective October 1, 2006, are included in this table. Each of the principal diagnoses is shown with an asterisk, and the revisions to the CC Exclusions List are provided in an indented column immediately following the affected principal diagnosis.] 05474 34982 *32362 0522 05314 05474 34982 *32363 0522 05314 05474 34982 *32371 0522 05314 05474 34982 *32372 0522 05314 05474 34982 *32381 0522 05314 05474 34982 *32382 0522 05314 05474 34982 *33183 3314 *33371 7817 *33372 7817 *33379 7817 *33385 7817 *3380 04082 44024 78001 78003 7801 78031 78032 78039 7817 7854 78550 78551 78552 78559 7863 78820 78829 7895 7907 7911 7913 79901 79902 7991 7994 *33811 04082 44024 78001 78003 7801 78031 78032 78039 7817 7854 78550 78551 78552 78559 7863 78820 78829 7895 7907 7911 7913 79901 79902 7991 7994 *33812 04082 44024 78001 78003 7801 78031 78032 78039 7817 7854 78550 78551 78552 78559 7863 78820 78829 7895 7907 7911 7913 79901 79902 7991 7994 *33818 04082 44024 78001 78003 7801 78031 78032 78039 7817 7854 78550 78551 78552 78559 7863 78820 78829 7895 7907 7911 7913 79901 79902 7991 7994 *33819 04082 44024 78001 78003 7801 78031 78032 78039 7817 7854 78550 78551 78552 78559 7863 78820 78829 7895 7907 7911 7913 79901 79902 7991 7994 *33821 04082 44024 78001 78003 7801 78031 78032 78039 7817 7854 78550 78551 78552 78559 7863 78820 78829 7895 7907 7911 7913 79901 79902 7991 7994 VerDate Aug<31>2005 17:10 Apr 24, 2006 Jkt 208001 PO 00000 Frm 00302 Fmt 4701 Sfmt 4702 E:\FR\FM\25APP2.SGM 25APP2 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules 24297 TABLE 6G.—ADDITIONS TO THE CC EXCLUSIONS LIST—Continued TABLE 6G.—ADDITIONS TO THE CC EXCLUSIONS LIST—Continued [CCs that are added to the list, effective October 1, 2006, are included in this table. Each of the principal diagnoses is shown with an asterisk, and the revisions to the CC Exclusions List are provided in an indented column immediately following the affected principal diagnosis.] wwhite on PROD1PC61 with PROPOSALS2 TABLE 6G.—ADDITIONS TO THE CC EXCLUSIONS LIST—Continued [CCs that are added to the list, effective October 1, 2006, are included in this table. Each of the principal diagnoses is shown with an asterisk, and the revisions to the CC Exclusions List are provided in an indented column immediately following the affected principal diagnosis.] [CCs that are added to the list, effective October 1, 2006, are included in this table. Each of the principal diagnoses is shown with an asterisk, and the revisions to the CC Exclusions List are provided in an indented column immediately following the affected principal diagnosis.] *33822 04082 44024 78001 78003 7801 78031 78032 78039 7817 7854 78550 78551 78552 78559 7863 78820 78829 7895 7907 7911 7913 79901 79902 7991 7994 *33828 04082 44024 78001 78003 7801 78031 78032 78039 7817 7854 78550 78551 78552 78559 7863 78820 78829 7895 7907 7911 7913 79901 79902 7991 7994 *33829 04082 44024 78001 78003 7801 78031 78032 78039 7817 7854 78550 78551 78552 78559 7863 78820 78829 7895 7907 7911 7913 79901 79902 7991 7994 *3383 04082 44024 78001 78003 7801 78031 78032 78039 7817 7854 78550 78551 78552 78559 7863 78820 78829 7895 7907 7911 7913 79901 79902 7991 7994 *3384 04082 44024 78001 78003 7801 78031 78032 78039 7817 7854 78550 78551 78552 78559 7863 78820 78829 7895 7907 7911 7913 79901 79902 7991 7994 *34120 0522 05314 05474 34982 *34121 0522 05314 05474 34982 *34122 0522 05314 05474 34982 *34500 78032 *34501 78032 *34510 78032 *34511 78032 *3452 78032 *3453 78032 *34540 78032 *34541 78032 *34550 78032 *34551 78032 *34560 78032 *34561 78032 *34570 78032 *34571 78032 *34580 78032 *34581 78032 *34590 78032 *34591 78032 *3488 78032 *3489 78032 *34989 78032 *3499 78032 *37960 37700 37701 37702 *37961 37700 37701 37702 *37962 VerDate Aug<31>2005 17:10 Apr 24, 2006 Jkt 208001 PO 00000 Frm 00303 Fmt 4701 Sfmt 4702 E:\FR\FM\25APP2.SGM 25APP2 24298 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules TABLE 6G.—ADDITIONS TO THE CC EXCLUSIONS LIST—Continued TABLE 6G.—ADDITIONS TO THE CC EXCLUSIONS LIST—Continued [CCs that are added to the list, effective October 1, 2006, are included in this table. Each of the principal diagnoses is shown with an asterisk, and the revisions to the CC Exclusions List are provided in an indented column immediately following the affected principal diagnosis.] wwhite on PROD1PC61 with PROPOSALS2 TABLE 6G.—ADDITIONS TO THE CC EXCLUSIONS LIST—Continued [CCs that are added to the list, effective October 1, 2006, are included in this table. Each of the principal diagnoses is shown with an asterisk, and the revisions to the CC Exclusions List are provided in an indented column immediately following the affected principal diagnosis.] [CCs that are added to the list, effective October 1, 2006, are included in this table. Each of the principal diagnoses is shown with an asterisk, and the revisions to the CC Exclusions List are provided in an indented column immediately following the affected principal diagnosis.] 37700 37701 37702 *37963 37700 37701 37702 *5187 5187 9973 *51911 51900 51901 51902 51909 *51919 51900 51901 51902 51909 *52800 5283 *52801 5283 *52802 5283 *52809 5283 *538 5273 5274 53021 53100 53101 53110 53111 53120 53121 53131 53140 53141 53150 53151 53160 53161 53171 53191 53200 53201 53210 53211 53220 53221 53231 53240 53241 53250 53251 53260 53261 53271 53291 53300 53301 53310 53311 53320 53321 53331 53340 53341 53350 53351 53360 53361 53371 53391 53400 53401 53410 53411 53420 53421 53431 53440 53441 53450 53451 53460 53461 53471 53491 5400 5401 5409 55000 55001 55002 55003 55010 55011 55012 55013 55100 55101 55102 55103 5511 55120 55121 55129 5518 5519 55200 55201 55202 55203 *61681 6140 6143 6145 6150 6163 6164 *61689 6140 6143 6145 6150 6163 6164 *62929 6140 6143 6145 6150 6163 6164 6207 *62981 6140 6143 6145 6150 6163 6164 6207 *62989 6140 6143 6145 6150 6163 6164 6207 *64900 63400 63401 63402 63410 63411 63412 63420 63421 63422 63430 63431 63432 63440 63441 63442 63450 63451 63452 63460 63461 63462 63470 63471 63472 63480 63481 63482 63490 63491 63492 6390 6391 6392 6393 6394 6395 6396 6398 6399 64000 64001 64003 VerDate Aug<31>2005 17:10 Apr 24, 2006 Jkt 208001 PO 00000 Frm 00304 Fmt 4701 Sfmt 4702 E:\FR\FM\25APP2.SGM 25APP2 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules 24299 TABLE 6G.—ADDITIONS TO THE CC EXCLUSIONS LIST—Continued TABLE 6G.—ADDITIONS TO THE CC EXCLUSIONS LIST—Continued [CCs that are added to the list, effective October 1, 2006, are included in this table. Each of the principal diagnoses is shown with an asterisk, and the revisions to the CC Exclusions List are provided in an indented column immediately following the affected principal diagnosis.] wwhite on PROD1PC61 with PROPOSALS2 TABLE 6G.—ADDITIONS TO THE CC EXCLUSIONS LIST—Continued [CCs that are added to the list, effective October 1, 2006, are included in this table. Each of the principal diagnoses is shown with an asterisk, and the revisions to the CC Exclusions List are provided in an indented column immediately following the affected principal diagnosis.] [CCs that are added to the list, effective October 1, 2006, are included in this table. Each of the principal diagnoses is shown with an asterisk, and the revisions to the CC Exclusions List are provided in an indented column immediately following the affected principal diagnosis.] 64080 64081 64083 64090 64091 64093 64100 64101 64103 64110 64111 64113 64130 64131 64133 64180 64181 64183 64190 64191 64193 64240 64241 64242 64243 64244 64250 64251 64252 64253 64254 64260 64261 64262 64263 64264 64270 64271 64272 64273 64274 64400 64403 64410 64413 64660 64661 64662 64663 64664 64670 64671 64673 64730 64731 64732 64733 64734 64740 64741 64742 64743 64744 64800 64801 64802 VerDate Aug<31>2005 64803 64804 64820 64821 64822 64823 64824 64830 64831 64832 64833 64834 64850 64851 64852 64853 64854 64860 64861 64862 64863 64864 65930 65931 65933 66500 66501 66503 66510 66511 66632 66634 66800 66801 66802 66803 66804 66810 66811 66812 66813 66814 66820 66821 66822 66823 66824 66880 66881 66882 66883 66884 66890 66891 66892 66893 66894 66910 66911 66912 66913 66914 66930 66932 66934 67000 17:10 Apr 24, 2006 Jkt 208001 PO 00000 Frm 00305 67002 67004 67120 67121 67122 67123 67124 67130 67131 67133 67140 67142 67144 67300 67301 67302 67303 67304 67310 67311 67312 67313 67314 67320 67321 67322 67323 67324 67330 67331 67332 67333 67334 67380 67381 67382 67383 67384 67400 67401 67402 67403 67404 67410 67412 67420 67422 67424 67450 67451 67452 67453 67454 67510 67511 67512 *64901 63400 63401 63402 63410 63411 63412 63420 63421 63422 Fmt 4701 Sfmt 4702 E:\FR\FM\25APP2.SGM 25APP2 24300 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules TABLE 6G.—ADDITIONS TO THE CC EXCLUSIONS LIST—Continued TABLE 6G.—ADDITIONS TO THE CC EXCLUSIONS LIST—Continued [CCs that are added to the list, effective October 1, 2006, are included in this table. Each of the principal diagnoses is shown with an asterisk, and the revisions to the CC Exclusions List are provided in an indented column immediately following the affected principal diagnosis.] wwhite on PROD1PC61 with PROPOSALS2 TABLE 6G.—ADDITIONS TO THE CC EXCLUSIONS LIST—Continued [CCs that are added to the list, effective October 1, 2006, are included in this table. Each of the principal diagnoses is shown with an asterisk, and the revisions to the CC Exclusions List are provided in an indented column immediately following the affected principal diagnosis.] [CCs that are added to the list, effective October 1, 2006, are included in this table. Each of the principal diagnoses is shown with an asterisk, and the revisions to the CC Exclusions List are provided in an indented column immediately following the affected principal diagnosis.] 63430 63431 63432 63440 63441 63442 63450 63451 63452 63460 63461 63462 63470 63471 63472 63480 63481 63482 63490 63491 63492 6390 6391 6392 6393 6394 6395 6396 6398 6399 64000 64001 64003 64080 64081 64083 64090 64091 64093 64100 64101 64103 64110 64111 64113 64130 64131 64133 64180 64181 64183 64190 64191 64193 64240 64241 64242 64243 64244 64250 64251 64252 64253 64254 64260 64261 VerDate Aug<31>2005 64262 64263 64264 64270 64271 64272 64273 64274 64400 64403 64410 64413 64660 64661 64662 64663 64664 64670 64671 64673 64730 64731 64732 64733 64734 64740 64741 64742 64743 64744 64800 64801 64802 64803 64804 64820 64821 64822 64823 64824 64830 64831 64832 64833 64834 64850 64851 64852 64853 64854 64860 64861 64862 64863 64864 65930 65931 65933 66500 66501 66503 66510 66511 66632 66634 66800 17:10 Apr 24, 2006 Jkt 208001 PO 00000 Frm 00306 66801 66802 66803 66804 66810 66811 66812 66813 66814 66820 66821 66822 66823 66824 66880 66881 66882 66883 66884 66890 66891 66892 66893 66894 66910 66911 66912 66913 66914 66930 66932 66934 67000 67002 67004 67120 67121 67122 67123 67124 67130 67131 67133 67140 67142 67144 67300 67301 67302 67303 67304 67310 67311 67312 67313 67314 67320 67321 67322 67323 67324 67330 67331 67332 67333 67334 Fmt 4701 Sfmt 4702 E:\FR\FM\25APP2.SGM 25APP2 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules 24301 TABLE 6G.—ADDITIONS TO THE CC EXCLUSIONS LIST—Continued TABLE 6G.—ADDITIONS TO THE CC EXCLUSIONS LIST—Continued [CCs that are added to the list, effective October 1, 2006, are included in this table. Each of the principal diagnoses is shown with an asterisk, and the revisions to the CC Exclusions List are provided in an indented column immediately following the affected principal diagnosis.] wwhite on PROD1PC61 with PROPOSALS2 TABLE 6G.—ADDITIONS TO THE CC EXCLUSIONS LIST—Continued [CCs that are added to the list, effective October 1, 2006, are included in this table. Each of the principal diagnoses is shown with an asterisk, and the revisions to the CC Exclusions List are provided in an indented column immediately following the affected principal diagnosis.] [CCs that are added to the list, effective October 1, 2006, are included in this table. Each of the principal diagnoses is shown with an asterisk, and the revisions to the CC Exclusions List are provided in an indented column immediately following the affected principal diagnosis.] 67380 67381 67382 67383 67384 67400 67401 67402 67403 67404 67410 67412 67420 67422 67424 67450 67451 67452 67453 67454 67510 67511 67512 *64902 63400 63401 63402 63410 63411 63412 63420 63421 63422 63430 63431 63432 63440 63441 63442 63450 63451 63452 63460 63461 63462 63470 63471 63472 63480 63481 63482 63490 63491 63492 6390 6391 6392 6393 6394 6395 6396 6398 6399 64000 64001 64003 VerDate Aug<31>2005 64080 64081 64083 64090 64091 64093 64100 64101 64103 64110 64111 64113 64130 64131 64133 64180 64181 64183 64190 64191 64193 64240 64241 64242 64243 64244 64250 64251 64252 64253 64254 64260 64261 64262 64263 64264 64270 64271 64272 64273 64274 64400 64403 64410 64413 64660 64661 64662 64663 64664 64670 64671 64673 64730 64731 64732 64733 64734 64740 64741 64742 64743 64744 64800 64801 64802 17:10 Apr 24, 2006 Jkt 208001 PO 00000 Frm 00307 64803 64804 64820 64821 64822 64823 64824 64830 64831 64832 64833 64834 64850 64851 64852 64853 64854 64860 64861 64862 64863 64864 65930 65931 65933 66500 66501 66503 66510 66511 66632 66634 66800 66801 66802 66803 66804 66810 66811 66812 66813 66814 66820 66821 66822 66823 66824 66880 66881 66882 66883 66884 66890 66891 66892 66893 66894 66910 66911 66912 66913 66914 66930 66932 66934 67000 Fmt 4701 Sfmt 4702 E:\FR\FM\25APP2.SGM 25APP2 24302 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules TABLE 6G.—ADDITIONS TO THE CC EXCLUSIONS LIST—Continued TABLE 6G.—ADDITIONS TO THE CC EXCLUSIONS LIST—Continued [CCs that are added to the list, effective October 1, 2006, are included in this table. Each of the principal diagnoses is shown with an asterisk, and the revisions to the CC Exclusions List are provided in an indented column immediately following the affected principal diagnosis.] wwhite on PROD1PC61 with PROPOSALS2 TABLE 6G.—ADDITIONS TO THE CC EXCLUSIONS LIST—Continued [CCs that are added to the list, effective October 1, 2006, are included in this table. Each of the principal diagnoses is shown with an asterisk, and the revisions to the CC Exclusions List are provided in an indented column immediately following the affected principal diagnosis.] [CCs that are added to the list, effective October 1, 2006, are included in this table. Each of the principal diagnoses is shown with an asterisk, and the revisions to the CC Exclusions List are provided in an indented column immediately following the affected principal diagnosis.] 67002 67004 67120 67121 67122 67123 67124 67130 67131 67133 67140 67142 67144 67300 67301 67302 67303 67304 67310 67311 67312 67313 67314 67320 67321 67322 67323 67324 67330 67331 67332 67333 67334 67380 67381 67382 67383 67384 67400 67401 67402 67403 67404 67410 67412 67420 67422 67424 67450 67451 67452 67453 67454 67510 67511 67512 *64903 63400 63401 63402 63410 63411 63412 63420 63421 63422 VerDate Aug<31>2005 63430 63431 63432 63440 63441 63442 63450 63451 63452 63460 63461 63462 63470 63471 63472 63480 63481 63482 63490 63491 63492 6390 6391 6392 6393 6394 6395 6396 6398 6399 64000 64001 64003 64080 64081 64083 64090 64091 64093 64100 64101 64103 64110 64111 64113 64130 64131 64133 64180 64181 64183 64190 64191 64193 64240 64241 64242 64243 64244 64250 64251 64252 64253 64254 64260 64261 17:10 Apr 24, 2006 Jkt 208001 PO 00000 Frm 00308 64262 64263 64264 64270 64271 64272 64273 64274 64400 64403 64410 64413 64660 64661 64662 64663 64664 64670 64671 64673 64730 64731 64732 64733 64734 64740 64741 64742 64743 64744 64800 64801 64802 64803 64804 64820 64821 64822 64823 64824 64830 64831 64832 64833 64834 64850 64851 64852 64853 64854 64860 64861 64862 64863 64864 65930 65931 65933 66500 66501 66503 66510 66511 66632 66634 66800 Fmt 4701 Sfmt 4702 E:\FR\FM\25APP2.SGM 25APP2 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules 24303 TABLE 6G.—ADDITIONS TO THE CC EXCLUSIONS LIST—Continued TABLE 6G.—ADDITIONS TO THE CC EXCLUSIONS LIST—Continued [CCs that are added to the list, effective October 1, 2006, are included in this table. Each of the principal diagnoses is shown with an asterisk, and the revisions to the CC Exclusions List are provided in an indented column immediately following the affected principal diagnosis.] wwhite on PROD1PC61 with PROPOSALS2 TABLE 6G.—ADDITIONS TO THE CC EXCLUSIONS LIST—Continued [CCs that are added to the list, effective October 1, 2006, are included in this table. Each of the principal diagnoses is shown with an asterisk, and the revisions to the CC Exclusions List are provided in an indented column immediately following the affected principal diagnosis.] [CCs that are added to the list, effective October 1, 2006, are included in this table. Each of the principal diagnoses is shown with an asterisk, and the revisions to the CC Exclusions List are provided in an indented column immediately following the affected principal diagnosis.] 66801 66802 66803 66804 66810 66811 66812 66813 66814 66820 66821 66822 66823 66824 66880 66881 66882 66883 66884 66890 66891 66892 66893 66894 66910 66911 66912 66913 66914 66930 66932 66934 67000 67002 67004 67120 67121 67122 67123 67124 67130 67131 67133 67140 67142 67144 67300 67301 67302 67303 67304 67310 67311 67312 67313 67314 67320 67321 67322 67323 67324 67330 67331 67332 67333 67334 VerDate Aug<31>2005 67380 67381 67382 67383 67384 67400 67401 67402 67403 67404 67410 67412 67420 67422 67424 67450 67451 67452 67453 67454 67510 67511 67512 *64904 63400 63401 63402 63410 63411 63412 63420 63421 63422 63430 63431 63432 63440 63441 63442 63450 63451 63452 63460 63461 63462 63470 63471 63472 63480 63481 63482 63490 63491 63492 6390 6391 6392 6393 6394 6395 6396 6398 6399 64000 64001 64003 17:10 Apr 24, 2006 Jkt 208001 PO 00000 Frm 00309 64080 64081 64083 64090 64091 64093 64100 64101 64103 64110 64111 64113 64130 64131 64133 64180 64181 64183 64190 64191 64193 64240 64241 64242 64243 64244 64250 64251 64252 64253 64254 64260 64261 64262 64263 64264 64270 64271 64272 64273 64274 64400 64403 64410 64413 64660 64661 64662 64663 64664 64670 64671 64673 64730 64731 64732 64733 64734 64740 64741 64742 64743 64744 64800 64801 64802 Fmt 4701 Sfmt 4702 E:\FR\FM\25APP2.SGM 25APP2 24304 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules TABLE 6G.—ADDITIONS TO THE CC EXCLUSIONS LIST—Continued TABLE 6G.—ADDITIONS TO THE CC EXCLUSIONS LIST—Continued [CCs that are added to the list, effective October 1, 2006, are included in this table. Each of the principal diagnoses is shown with an asterisk, and the revisions to the CC Exclusions List are provided in an indented column immediately following the affected principal diagnosis.] wwhite on PROD1PC61 with PROPOSALS2 TABLE 6G.—ADDITIONS TO THE CC EXCLUSIONS LIST—Continued [CCs that are added to the list, effective October 1, 2006, are included in this table. Each of the principal diagnoses is shown with an asterisk, and the revisions to the CC Exclusions List are provided in an indented column immediately following the affected principal diagnosis.] [CCs that are added to the list, effective October 1, 2006, are included in this table. Each of the principal diagnoses is shown with an asterisk, and the revisions to the CC Exclusions List are provided in an indented column immediately following the affected principal diagnosis.] 64803 64804 64820 64821 64822 64823 64824 64830 64831 64832 64833 64834 64850 64851 64852 64853 64854 64860 64861 64862 64863 64864 65930 65931 65933 66500 66501 66503 66510 66511 66632 66634 66800 66801 66802 66803 66804 66810 66811 66812 66813 66814 66820 66821 66822 66823 66824 66880 66881 66882 66883 66884 66890 66891 66892 66893 66894 66910 66911 66912 66913 66914 66930 66932 66934 67000 VerDate Aug<31>2005 67002 67004 67120 67121 67122 67123 67124 67130 67131 67133 67140 67142 67144 67300 67301 67302 67303 67304 67310 67311 67312 67313 67314 67320 67321 67322 67323 67324 67330 67331 67332 67333 67334 67380 67381 67382 67383 67384 67400 67401 67402 67403 67404 67410 67412 67420 67422 67424 67450 67451 67452 67453 67454 67510 67511 67512 *64910 63400 63401 63402 63410 63411 63412 63420 63421 63422 17:10 Apr 24, 2006 Jkt 208001 PO 00000 Frm 00310 63430 63431 63432 63440 63441 63442 63450 63451 63452 63460 63461 63462 63470 63471 63472 63480 63481 63482 63490 63491 63492 6390 6391 6392 6393 6394 6395 6396 6398 6399 64000 64001 64003 64080 64081 64083 64090 64091 64093 64100 64101 64103 64110 64111 64113 64130 64131 64133 64180 64181 64183 64190 64191 64193 64240 64241 64242 64243 64244 64250 64251 64252 64253 64254 64260 64261 Fmt 4701 Sfmt 4702 E:\FR\FM\25APP2.SGM 25APP2 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules 24305 TABLE 6G.—ADDITIONS TO THE CC EXCLUSIONS LIST—Continued TABLE 6G.—ADDITIONS TO THE CC EXCLUSIONS LIST—Continued [CCs that are added to the list, effective October 1, 2006, are included in this table. Each of the principal diagnoses is shown with an asterisk, and the revisions to the CC Exclusions List are provided in an indented column immediately following the affected principal diagnosis.] wwhite on PROD1PC61 with PROPOSALS2 TABLE 6G.—ADDITIONS TO THE CC EXCLUSIONS LIST—Continued [CCs that are added to the list, effective October 1, 2006, are included in this table. Each of the principal diagnoses is shown with an asterisk, and the revisions to the CC Exclusions List are provided in an indented column immediately following the affected principal diagnosis.] [CCs that are added to the list, effective October 1, 2006, are included in this table. Each of the principal diagnoses is shown with an asterisk, and the revisions to the CC Exclusions List are provided in an indented column immediately following the affected principal diagnosis.] 64262 64263 64264 64270 64271 64272 64273 64274 64400 64403 64410 64413 64660 64661 64662 64663 64664 64670 64671 64673 64730 64731 64732 64733 64734 64740 64741 64742 64743 64744 64800 64801 64802 64803 64804 64820 64821 64822 64823 64824 64830 64831 64832 64833 64834 64850 64851 64852 64853 64854 64860 64861 64862 64863 64864 65930 65931 65933 66500 66501 66503 66510 66511 66632 66634 66800 VerDate Aug<31>2005 66801 66802 66803 66804 66810 66811 66812 66813 66814 66820 66821 66822 66823 66824 66880 66881 66882 66883 66884 66890 66891 66892 66893 66894 66910 66911 66912 66913 66914 66930 66932 66934 67000 67002 67004 67120 67121 67122 67123 67124 67130 67131 67133 67140 67142 67144 67300 67301 67302 67303 67304 67310 67311 67312 67313 67314 67320 67321 67322 67323 67324 67330 67331 67332 67333 67334 17:10 Apr 24, 2006 Jkt 208001 PO 00000 Frm 00311 67380 67381 67382 67383 67384 67400 67401 67402 67403 67404 67410 67412 67420 67422 67424 67450 67451 67452 67453 67454 67510 67511 67512 *64911 63400 63401 63402 63410 63411 63412 63420 63421 63422 63430 63431 63432 63440 63441 63442 63450 63451 63452 63460 63461 63462 63470 63471 63472 63480 63481 63482 63490 63491 63492 6390 6391 6392 6393 6394 6395 6396 6398 6399 64000 64001 64003 Fmt 4701 Sfmt 4702 E:\FR\FM\25APP2.SGM 25APP2 24306 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules TABLE 6G.—ADDITIONS TO THE CC EXCLUSIONS LIST—Continued TABLE 6G.—ADDITIONS TO THE CC EXCLUSIONS LIST—Continued [CCs that are added to the list, effective October 1, 2006, are included in this table. Each of the principal diagnoses is shown with an asterisk, and the revisions to the CC Exclusions List are provided in an indented column immediately following the affected principal diagnosis.] wwhite on PROD1PC61 with PROPOSALS2 TABLE 6G.—ADDITIONS TO THE CC EXCLUSIONS LIST—Continued [CCs that are added to the list, effective October 1, 2006, are included in this table. Each of the principal diagnoses is shown with an asterisk, and the revisions to the CC Exclusions List are provided in an indented column immediately following the affected principal diagnosis.] [CCs that are added to the list, effective October 1, 2006, are included in this table. Each of the principal diagnoses is shown with an asterisk, and the revisions to the CC Exclusions List are provided in an indented column immediately following the affected principal diagnosis.] 64080 64081 64083 64090 64091 64093 64100 64101 64103 64110 64111 64113 64130 64131 64133 64180 64181 64183 64190 64191 64193 64240 64241 64242 64243 64244 64250 64251 64252 64253 64254 64260 64261 64262 64263 64264 64270 64271 64272 64273 64274 64400 64403 64410 64413 64660 64661 64662 64663 64664 64670 64671 64673 64730 64731 64732 64733 64734 64740 64741 64742 64743 64744 64800 64801 64802 VerDate Aug<31>2005 64803 64804 64820 64821 64822 64823 64824 64830 64831 64832 64833 64834 64850 64851 64852 64853 64854 64860 64861 64862 64863 64864 65930 65931 65933 66500 66501 66503 66510 66511 66632 66634 66800 66801 66802 66803 66804 66810 66811 66812 66813 66814 66820 66821 66822 66823 66824 66880 66881 66882 66883 66884 66890 66891 66892 66893 66894 66910 66911 66912 66913 66914 66930 66932 66934 67000 17:10 Apr 24, 2006 Jkt 208001 PO 00000 Frm 00312 67002 67004 67120 67121 67122 67123 67124 67130 67131 67133 67140 67142 67144 67300 67301 67302 67303 67304 67310 67311 67312 67313 67314 67320 67321 67322 67323 67324 67330 67331 67332 67333 67334 67380 67381 67382 67383 67384 67400 67401 67402 67403 67404 67410 67412 67420 67422 67424 67450 67451 67452 67453 67454 67510 67511 67512 *64912 63400 63401 63402 63410 63411 63412 63420 63421 63422 Fmt 4701 Sfmt 4702 E:\FR\FM\25APP2.SGM 25APP2 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules 24307 TABLE 6G.—ADDITIONS TO THE CC EXCLUSIONS LIST—Continued TABLE 6G.—ADDITIONS TO THE CC EXCLUSIONS LIST—Continued [CCs that are added to the list, effective October 1, 2006, are included in this table. Each of the principal diagnoses is shown with an asterisk, and the revisions to the CC Exclusions List are provided in an indented column immediately following the affected principal diagnosis.] wwhite on PROD1PC61 with PROPOSALS2 TABLE 6G.—ADDITIONS TO THE CC EXCLUSIONS LIST—Continued [CCs that are added to the list, effective October 1, 2006, are included in this table. Each of the principal diagnoses is shown with an asterisk, and the revisions to the CC Exclusions List are provided in an indented column immediately following the affected principal diagnosis.] [CCs that are added to the list, effective October 1, 2006, are included in this table. Each of the principal diagnoses is shown with an asterisk, and the revisions to the CC Exclusions List are provided in an indented column immediately following the affected principal diagnosis.] 63430 63431 63432 63440 63441 63442 63450 63451 63452 63460 63461 63462 63470 63471 63472 63480 63481 63482 63490 63491 63492 6390 6391 6392 6393 6394 6395 6396 6398 6399 64000 64001 64003 64080 64081 64083 64090 64091 64093 64100 64101 64103 64110 64111 64113 64130 64131 64133 64180 64181 64183 64190 64191 64193 64240 64241 64242 64243 64244 64250 64251 64252 64253 64254 64260 64261 VerDate Aug<31>2005 64262 64263 64264 64270 64271 64272 64273 64274 64400 64403 64410 64413 64660 64661 64662 64663 64664 64670 64671 64673 64730 64731 64732 64733 64734 64740 64741 64742 64743 64744 64800 64801 64802 64803 64804 64820 64821 64822 64823 64824 64830 64831 64832 64833 64834 64850 64851 64852 64853 64854 64860 64861 64862 64863 64864 65930 65931 65933 66500 66501 66503 66510 66511 66632 66634 66800 17:10 Apr 24, 2006 Jkt 208001 PO 00000 Frm 00313 66801 66802 66803 66804 66810 66811 66812 66813 66814 66820 66821 66822 66823 66824 66880 66881 66882 66883 66884 66890 66891 66892 66893 66894 66910 66911 66912 66913 66914 66930 66932 66934 67000 67002 67004 67120 67121 67122 67123 67124 67130 67131 67133 67140 67142 67144 67300 67301 67302 67303 67304 67310 67311 67312 67313 67314 67320 67321 67322 67323 67324 67330 67331 67332 67333 67334 Fmt 4701 Sfmt 4702 E:\FR\FM\25APP2.SGM 25APP2 24308 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules TABLE 6G.—ADDITIONS TO THE CC EXCLUSIONS LIST—Continued TABLE 6G.—ADDITIONS TO THE CC EXCLUSIONS LIST—Continued [CCs that are added to the list, effective October 1, 2006, are included in this table. Each of the principal diagnoses is shown with an asterisk, and the revisions to the CC Exclusions List are provided in an indented column immediately following the affected principal diagnosis.] wwhite on PROD1PC61 with PROPOSALS2 TABLE 6G.—ADDITIONS TO THE CC EXCLUSIONS LIST—Continued [CCs that are added to the list, effective October 1, 2006, are included in this table. Each of the principal diagnoses is shown with an asterisk, and the revisions to the CC Exclusions List are provided in an indented column immediately following the affected principal diagnosis.] [CCs that are added to the list, effective October 1, 2006, are included in this table. Each of the principal diagnoses is shown with an asterisk, and the revisions to the CC Exclusions List are provided in an indented column immediately following the affected principal diagnosis.] 67380 67381 67382 67383 67384 67400 67401 67402 67403 67404 67410 67412 67420 67422 67424 67450 67451 67452 67453 67454 67510 67511 67512 *64913 63400 63401 63402 63410 63411 63412 63420 63421 63422 63430 63431 63432 63440 63441 63442 63450 63451 63452 63460 63461 63462 63470 63471 63472 63480 63481 63482 63490 63491 63492 6390 6391 6392 6393 6394 6395 6396 6398 6399 64000 64001 64003 VerDate Aug<31>2005 64080 64081 64083 64090 64091 64093 64100 64101 64103 64110 64111 64113 64130 64131 64133 64180 64181 64183 64190 64191 64193 64240 64241 64242 64243 64244 64250 64251 64252 64253 64254 64260 64261 64262 64263 64264 64270 64271 64272 64273 64274 64400 64403 64410 64413 64660 64661 64662 64663 64664 64670 64671 64673 64730 64731 64732 64733 64734 64740 64741 64742 64743 64744 64800 64801 64802 17:10 Apr 24, 2006 Jkt 208001 PO 00000 Frm 00314 64803 64804 64820 64821 64822 64823 64824 64830 64831 64832 64833 64834 64850 64851 64852 64853 64854 64860 64861 64862 64863 64864 65930 65931 65933 66500 66501 66503 66510 66511 66632 66634 66800 66801 66802 66803 66804 66810 66811 66812 66813 66814 66820 66821 66822 66823 66824 66880 66881 66882 66883 66884 66890 66891 66892 66893 66894 66910 66911 66912 66913 66914 66930 66932 66934 67000 Fmt 4701 Sfmt 4702 E:\FR\FM\25APP2.SGM 25APP2 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules 24309 TABLE 6G.—ADDITIONS TO THE CC EXCLUSIONS LIST—Continued TABLE 6G.—ADDITIONS TO THE CC EXCLUSIONS LIST—Continued [CCs that are added to the list, effective October 1, 2006, are included in this table. Each of the principal diagnoses is shown with an asterisk, and the revisions to the CC Exclusions List are provided in an indented column immediately following the affected principal diagnosis.] wwhite on PROD1PC61 with PROPOSALS2 TABLE 6G.—ADDITIONS TO THE CC EXCLUSIONS LIST—Continued [CCs that are added to the list, effective October 1, 2006, are included in this table. Each of the principal diagnoses is shown with an asterisk, and the revisions to the CC Exclusions List are provided in an indented column immediately following the affected principal diagnosis.] [CCs that are added to the list, effective October 1, 2006, are included in this table. Each of the principal diagnoses is shown with an asterisk, and the revisions to the CC Exclusions List are provided in an indented column immediately following the affected principal diagnosis.] 67002 67004 67120 67121 67122 67123 67124 67130 67131 67133 67140 67142 67144 67300 67301 67302 67303 67304 67310 67311 67312 67313 67314 67320 67321 67322 67323 67324 67330 67331 67332 67333 67334 67380 67381 67382 67383 67384 67400 67401 67402 67403 67404 67410 67412 67420 67422 67424 67450 67451 67452 67453 67454 67510 67511 67512 *64914 63400 63401 63402 63410 63411 63412 63420 63421 63422 VerDate Aug<31>2005 63430 63431 63432 63440 63441 63442 63450 63451 63452 63460 63461 63462 63470 63471 63472 63480 63481 63482 63490 63491 63492 6390 6391 6392 6393 6394 6395 6396 6398 6399 64000 64001 64003 64080 64081 64083 64090 64091 64093 64100 64101 64103 64110 64111 64113 64130 64131 64133 64180 64181 64183 64190 64191 64193 64240 64241 64242 64243 64244 64250 64251 64252 64253 64254 64260 64261 17:10 Apr 24, 2006 Jkt 208001 PO 00000 Frm 00315 64262 64263 64264 64270 64271 64272 64273 64274 64400 64403 64410 64413 64660 64661 64662 64663 64664 64670 64671 64673 64730 64731 64732 64733 64734 64740 64741 64742 64743 64744 64800 64801 64802 64803 64804 64820 64821 64822 64823 64824 64830 64831 64832 64833 64834 64850 64851 64852 64853 64854 64860 64861 64862 64863 64864 65930 65931 65933 66500 66501 66503 66510 66511 66632 66634 66800 Fmt 4701 Sfmt 4702 E:\FR\FM\25APP2.SGM 25APP2 24310 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules TABLE 6G.—ADDITIONS TO THE CC EXCLUSIONS LIST—Continued TABLE 6G.—ADDITIONS TO THE CC EXCLUSIONS LIST—Continued [CCs that are added to the list, effective October 1, 2006, are included in this table. Each of the principal diagnoses is shown with an asterisk, and the revisions to the CC Exclusions List are provided in an indented column immediately following the affected principal diagnosis.] wwhite on PROD1PC61 with PROPOSALS2 TABLE 6G.—ADDITIONS TO THE CC EXCLUSIONS LIST—Continued [CCs that are added to the list, effective October 1, 2006, are included in this table. Each of the principal diagnoses is shown with an asterisk, and the revisions to the CC Exclusions List are provided in an indented column immediately following the affected principal diagnosis.] [CCs that are added to the list, effective October 1, 2006, are included in this table. Each of the principal diagnoses is shown with an asterisk, and the revisions to the CC Exclusions List are provided in an indented column immediately following the affected principal diagnosis.] 66801 66802 66803 66804 66810 66811 66812 66813 66814 66820 66821 66822 66823 66824 66880 66881 66882 66883 66884 66890 66891 66892 66893 66894 66910 66911 66912 66913 66914 66930 66932 66934 67000 67002 67004 67120 67121 67122 67123 67124 67130 67131 67133 67140 67142 67144 67300 67301 67302 67303 67304 67310 67311 67312 67313 67314 67320 67321 67322 67323 67324 67330 67331 67332 67333 67334 VerDate Aug<31>2005 67380 67381 67382 67383 67384 67400 67401 67402 67403 67404 67410 67412 67420 67422 67424 67450 67451 67452 67453 67454 67510 67511 67512 *64920 63400 63401 63402 63410 63411 63412 63420 63421 63422 63430 63431 63432 63440 63441 63442 63450 63451 63452 63460 63461 63462 63470 63471 63472 63480 63481 63482 63490 63491 63492 6390 6391 6392 6393 6394 6395 6396 6398 6399 64000 64001 64003 17:10 Apr 24, 2006 Jkt 208001 PO 00000 Frm 00316 64080 64081 64083 64090 64091 64093 64100 64101 64103 64110 64111 64113 64130 64131 64133 64180 64181 64183 64190 64191 64193 64240 64241 64242 64243 64244 64250 64251 64252 64253 64254 64260 64261 64262 64263 64264 64270 64271 64272 64273 64274 64400 64403 64410 64413 64660 64661 64662 64663 64664 64670 64671 64673 64730 64731 64732 64733 64734 64740 64741 64742 64743 64744 64800 64801 64802 Fmt 4701 Sfmt 4702 E:\FR\FM\25APP2.SGM 25APP2 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules 24311 TABLE 6G.—ADDITIONS TO THE CC EXCLUSIONS LIST—Continued TABLE 6G.—ADDITIONS TO THE CC EXCLUSIONS LIST—Continued [CCs that are added to the list, effective October 1, 2006, are included in this table. Each of the principal diagnoses is shown with an asterisk, and the revisions to the CC Exclusions List are provided in an indented column immediately following the affected principal diagnosis.] wwhite on PROD1PC61 with PROPOSALS2 TABLE 6G.—ADDITIONS TO THE CC EXCLUSIONS LIST—Continued [CCs that are added to the list, effective October 1, 2006, are included in this table. Each of the principal diagnoses is shown with an asterisk, and the revisions to the CC Exclusions List are provided in an indented column immediately following the affected principal diagnosis.] [CCs that are added to the list, effective October 1, 2006, are included in this table. Each of the principal diagnoses is shown with an asterisk, and the revisions to the CC Exclusions List are provided in an indented column immediately following the affected principal diagnosis.] 64803 64804 64820 64821 64822 64823 64824 64830 64831 64832 64833 64834 64850 64851 64852 64853 64854 64860 64861 64862 64863 64864 65930 65931 65933 66500 66501 66503 66510 66511 66632 66634 66800 66801 66802 66803 66804 66810 66811 66812 66813 66814 66820 66821 66822 66823 66824 66880 66881 66882 66883 66884 66890 66891 66892 66893 66894 66910 66911 66912 66913 66914 66930 66932 66934 67000 VerDate Aug<31>2005 67002 67004 67120 67121 67122 67123 67124 67130 67131 67133 67140 67142 67144 67300 67301 67302 67303 67304 67310 67311 67312 67313 67314 67320 67321 67322 67323 67324 67330 67331 67332 67333 67334 67380 67381 67382 67383 67384 67400 67401 67402 67403 67404 67410 67412 67420 67422 67424 67450 67451 67452 67453 67454 67510 67511 67512 *64921 63400 63401 63402 63410 63411 63412 63420 63421 63422 17:10 Apr 24, 2006 Jkt 208001 PO 00000 Frm 00317 63430 63431 63432 63440 63441 63442 63450 63451 63452 63460 63461 63462 63470 63471 63472 63480 63481 63482 63490 63491 63492 6390 6391 6392 6393 6394 6395 6396 6398 6399 64000 64001 64003 64080 64081 64083 64090 64091 64093 64100 64101 64103 64110 64111 64113 64130 64131 64133 64180 64181 64183 64190 64191 64193 64240 64241 64242 64243 64244 64250 64251 64252 64253 64254 64260 64261 Fmt 4701 Sfmt 4702 E:\FR\FM\25APP2.SGM 25APP2 24312 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules TABLE 6G.—ADDITIONS TO THE CC EXCLUSIONS LIST—Continued TABLE 6G.—ADDITIONS TO THE CC EXCLUSIONS LIST—Continued [CCs that are added to the list, effective October 1, 2006, are included in this table. Each of the principal diagnoses is shown with an asterisk, and the revisions to the CC Exclusions List are provided in an indented column immediately following the affected principal diagnosis.] wwhite on PROD1PC61 with PROPOSALS2 TABLE 6G.—ADDITIONS TO THE CC EXCLUSIONS LIST—Continued [CCs that are added to the list, effective October 1, 2006, are included in this table. Each of the principal diagnoses is shown with an asterisk, and the revisions to the CC Exclusions List are provided in an indented column immediately following the affected principal diagnosis.] [CCs that are added to the list, effective October 1, 2006, are included in this table. Each of the principal diagnoses is shown with an asterisk, and the revisions to the CC Exclusions List are provided in an indented column immediately following the affected principal diagnosis.] 64262 64263 64264 64270 64271 64272 64273 64274 64400 64403 64410 64413 64660 64661 64662 64663 64664 64670 64671 64673 64730 64731 64732 64733 64734 64740 64741 64742 64743 64744 64800 64801 64802 64803 64804 64820 64821 64822 64823 64824 64830 64831 64832 64833 64834 64850 64851 64852 64853 64854 64860 64861 64862 64863 64864 65930 65931 65933 66500 66501 66503 66510 66511 66632 66634 66800 VerDate Aug<31>2005 66801 66802 66803 66804 66810 66811 66812 66813 66814 66820 66821 66822 66823 66824 66880 66881 66882 66883 66884 66890 66891 66892 66893 66894 66910 66911 66912 66913 66914 66930 66932 66934 67000 67002 67004 67120 67121 67122 67123 67124 67130 67131 67133 67140 67142 67144 67300 67301 67302 67303 67304 67310 67311 67312 67313 67314 67320 67321 67322 67323 67324 67330 67331 67332 67333 67334 17:10 Apr 24, 2006 Jkt 208001 PO 00000 Frm 00318 67380 67381 67382 67383 67384 67400 67401 67402 67403 67404 67410 67412 67420 67422 67424 67450 67451 67452 67453 67454 67510 67511 67512 *64922 63400 63401 63402 63410 63411 63412 63420 63421 63422 63430 63431 63432 63440 63441 63442 63450 63451 63452 63460 63461 63462 63470 63471 63472 63480 63481 63482 63490 63491 63492 6390 6391 6392 6393 6394 6395 6396 6398 6399 64000 64001 64003 Fmt 4701 Sfmt 4702 E:\FR\FM\25APP2.SGM 25APP2 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules 24313 TABLE 6G.—ADDITIONS TO THE CC EXCLUSIONS LIST—Continued TABLE 6G.—ADDITIONS TO THE CC EXCLUSIONS LIST—Continued [CCs that are added to the list, effective October 1, 2006, are included in this table. Each of the principal diagnoses is shown with an asterisk, and the revisions to the CC Exclusions List are provided in an indented column immediately following the affected principal diagnosis.] wwhite on PROD1PC61 with PROPOSALS2 TABLE 6G.—ADDITIONS TO THE CC EXCLUSIONS LIST—Continued [CCs that are added to the list, effective October 1, 2006, are included in this table. Each of the principal diagnoses is shown with an asterisk, and the revisions to the CC Exclusions List are provided in an indented column immediately following the affected principal diagnosis.] [CCs that are added to the list, effective October 1, 2006, are included in this table. Each of the principal diagnoses is shown with an asterisk, and the revisions to the CC Exclusions List are provided in an indented column immediately following the affected principal diagnosis.] 64080 64081 64083 64090 64091 64093 64100 64101 64103 64110 64111 64113 64130 64131 64133 64180 64181 64183 64190 64191 64193 64240 64241 64242 64243 64244 64250 64251 64252 64253 64254 64260 64261 64262 64263 64264 64270 64271 64272 64273 64274 64400 64403 64410 64413 64660 64661 64662 64663 64664 64670 64671 64673 64730 64731 64732 64733 64734 64740 64741 64742 64743 64744 64800 64801 64802 VerDate Aug<31>2005 64803 64804 64820 64821 64822 64823 64824 64830 64831 64832 64833 64834 64850 64851 64852 64853 64854 64860 64861 64862 64863 64864 65930 65931 65933 66500 66501 66503 66510 66511 66632 66634 66800 66801 66802 66803 66804 66810 66811 66812 66813 66814 66820 66821 66822 66823 66824 66880 66881 66882 66883 66884 66890 66891 66892 66893 66894 66910 66911 66912 66913 66914 66930 66932 66934 67000 17:10 Apr 24, 2006 Jkt 208001 PO 00000 Frm 00319 67002 67004 67120 67121 67122 67123 67124 67130 67131 67133 67140 67142 67144 67300 67301 67302 67303 67304 67310 67311 67312 67313 67314 67320 67321 67322 67323 67324 67330 67331 67332 67333 67334 67380 67381 67382 67383 67384 67400 67401 67402 67403 67404 67410 67412 67420 67422 67424 67450 67451 67452 67453 67454 67510 67511 67512 *64923 63400 63401 63402 63410 63411 63412 63420 63421 63422 Fmt 4701 Sfmt 4702 E:\FR\FM\25APP2.SGM 25APP2 24314 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules TABLE 6G.—ADDITIONS TO THE CC EXCLUSIONS LIST—Continued TABLE 6G.—ADDITIONS TO THE CC EXCLUSIONS LIST—Continued [CCs that are added to the list, effective October 1, 2006, are included in this table. Each of the principal diagnoses is shown with an asterisk, and the revisions to the CC Exclusions List are provided in an indented column immediately following the affected principal diagnosis.] wwhite on PROD1PC61 with PROPOSALS2 TABLE 6G.—ADDITIONS TO THE CC EXCLUSIONS LIST—Continued [CCs that are added to the list, effective October 1, 2006, are included in this table. Each of the principal diagnoses is shown with an asterisk, and the revisions to the CC Exclusions List are provided in an indented column immediately following the affected principal diagnosis.] [CCs that are added to the list, effective October 1, 2006, are included in this table. Each of the principal diagnoses is shown with an asterisk, and the revisions to the CC Exclusions List are provided in an indented column immediately following the affected principal diagnosis.] 63430 63431 63432 63440 63441 63442 63450 63451 63452 63460 63461 63462 63470 63471 63472 63480 63481 63482 63490 63491 63492 6390 6391 6392 6393 6394 6395 6396 6398 6399 64000 64001 64003 64080 64081 64083 64090 64091 64093 64100 64101 64103 64110 64111 64113 64130 64131 64133 64180 64181 64183 64190 64191 64193 64240 64241 64242 64243 64244 64250 64251 64252 64253 64254 64260 64261 VerDate Aug<31>2005 64262 64263 64264 64270 64271 64272 64273 64274 64400 64403 64410 64413 64660 64661 64662 64663 64664 64670 64671 64673 64730 64731 64732 64733 64734 64740 64741 64742 64743 64744 64800 64801 64802 64803 64804 64820 64821 64822 64823 64824 64830 64831 64832 64833 64834 64850 64851 64852 64853 64854 64860 64861 64862 64863 64864 65930 65931 65933 66500 66501 66503 66510 66511 66632 66634 66800 17:10 Apr 24, 2006 Jkt 208001 PO 00000 Frm 00320 66801 66802 66803 66804 66810 66811 66812 66813 66814 66820 66821 66822 66823 66824 66880 66881 66882 66883 66884 66890 66891 66892 66893 66894 66910 66911 66912 66913 66914 66930 66932 66934 67000 67002 67004 67120 67121 67122 67123 67124 67130 67131 67133 67140 67142 67144 67300 67301 67302 67303 67304 67310 67311 67312 67313 67314 67320 67321 67322 67323 67324 67330 67331 67332 67333 67334 Fmt 4701 Sfmt 4702 E:\FR\FM\25APP2.SGM 25APP2 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules 24315 TABLE 6G.—ADDITIONS TO THE CC EXCLUSIONS LIST—Continued TABLE 6G.—ADDITIONS TO THE CC EXCLUSIONS LIST—Continued [CCs that are added to the list, effective October 1, 2006, are included in this table. Each of the principal diagnoses is shown with an asterisk, and the revisions to the CC Exclusions List are provided in an indented column immediately following the affected principal diagnosis.] wwhite on PROD1PC61 with PROPOSALS2 TABLE 6G.—ADDITIONS TO THE CC EXCLUSIONS LIST—Continued [CCs that are added to the list, effective October 1, 2006, are included in this table. Each of the principal diagnoses is shown with an asterisk, and the revisions to the CC Exclusions List are provided in an indented column immediately following the affected principal diagnosis.] [CCs that are added to the list, effective October 1, 2006, are included in this table. Each of the principal diagnoses is shown with an asterisk, and the revisions to the CC Exclusions List are provided in an indented column immediately following the affected principal diagnosis.] 67380 67381 67382 67383 67384 67400 67401 67402 67403 67404 67410 67412 67420 67422 67424 67450 67451 67452 67453 67454 67510 67511 67512 *64924 63400 63401 63402 63410 63411 63412 63420 63421 63422 63430 63431 63432 63440 63441 63442 63450 63451 63452 63460 63461 63462 63470 63471 63472 63480 63481 63482 63490 63491 63492 6390 6391 6392 6393 6394 6395 6396 6398 6399 64000 64001 64003 VerDate Aug<31>2005 64080 64081 64083 64090 64091 64093 64100 64101 64103 64110 64111 64113 64130 64131 64133 64180 64181 64183 64190 64191 64193 64240 64241 64242 64243 64244 64250 64251 64252 64253 64254 64260 64261 64262 64263 64264 64270 64271 64272 64273 64274 64400 64403 64410 64413 64660 64661 64662 64663 64664 64670 64671 64673 64730 64731 64732 64733 64734 64740 64741 64742 64743 64744 64800 64801 64802 17:10 Apr 24, 2006 Jkt 208001 PO 00000 Frm 00321 64803 64804 64820 64821 64822 64823 64824 64830 64831 64832 64833 64834 64850 64851 64852 64853 64854 64860 64861 64862 64863 64864 65930 65931 65933 66500 66501 66503 66510 66511 66632 66634 66800 66801 66802 66803 66804 66810 66811 66812 66813 66814 66820 66821 66822 66823 66824 66880 66881 66882 66883 66884 66890 66891 66892 66893 66894 66910 66911 66912 66913 66914 66930 66932 66934 67000 Fmt 4701 Sfmt 4702 E:\FR\FM\25APP2.SGM 25APP2 24316 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules TABLE 6G.—ADDITIONS TO THE CC EXCLUSIONS LIST—Continued TABLE 6G.—ADDITIONS TO THE CC EXCLUSIONS LIST—Continued [CCs that are added to the list, effective October 1, 2006, are included in this table. Each of the principal diagnoses is shown with an asterisk, and the revisions to the CC Exclusions List are provided in an indented column immediately following the affected principal diagnosis.] wwhite on PROD1PC61 with PROPOSALS2 TABLE 6G.—ADDITIONS TO THE CC EXCLUSIONS LIST—Continued [CCs that are added to the list, effective October 1, 2006, are included in this table. Each of the principal diagnoses is shown with an asterisk, and the revisions to the CC Exclusions List are provided in an indented column immediately following the affected principal diagnosis.] [CCs that are added to the list, effective October 1, 2006, are included in this table. Each of the principal diagnoses is shown with an asterisk, and the revisions to the CC Exclusions List are provided in an indented column immediately following the affected principal diagnosis.] 67002 67004 67120 67121 67122 67123 67124 67130 67131 67133 67140 67142 67144 67300 67301 67302 67303 67304 67310 67311 67312 67313 67314 67320 67321 67322 67323 67324 67330 67331 67332 67333 67334 67380 67381 67382 67383 67384 67400 67401 67402 67403 67404 67410 67412 67420 67422 67424 67450 67451 67452 67453 67454 67510 67511 67512 *64930 63400 63401 63402 63410 63411 63412 63420 63421 63422 VerDate Aug<31>2005 63430 63431 63432 63440 63441 63442 63450 63451 63452 63460 63461 63462 63470 63471 63472 63480 63481 63482 63490 63491 63492 6390 6391 6392 6393 6394 6395 6396 6398 6399 64000 64001 64003 64080 64081 64083 64090 64091 64093 64100 64101 64103 64110 64111 64113 64130 64131 64133 64180 64181 64183 64190 64191 64193 64240 64241 64242 64243 64244 64250 64251 64252 64253 64254 64260 64261 17:10 Apr 24, 2006 Jkt 208001 PO 00000 Frm 00322 64262 64263 64264 64270 64271 64272 64273 64274 64400 64403 64410 64413 64660 64661 64662 64663 64664 64670 64671 64673 64730 64731 64732 64733 64734 64740 64741 64742 64743 64744 64800 64801 64802 64803 64804 64820 64821 64822 64823 64824 64830 64831 64832 64833 64834 64850 64851 64852 64853 64854 64860 64861 64862 64863 64864 65930 65931 65933 66500 66501 66503 66510 66511 66632 66634 66800 Fmt 4701 Sfmt 4702 E:\FR\FM\25APP2.SGM 25APP2 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules 24317 TABLE 6G.—ADDITIONS TO THE CC EXCLUSIONS LIST—Continued TABLE 6G.—ADDITIONS TO THE CC EXCLUSIONS LIST—Continued [CCs that are added to the list, effective October 1, 2006, are included in this table. Each of the principal diagnoses is shown with an asterisk, and the revisions to the CC Exclusions List are provided in an indented column immediately following the affected principal diagnosis.] wwhite on PROD1PC61 with PROPOSALS2 TABLE 6G.—ADDITIONS TO THE CC EXCLUSIONS LIST—Continued [CCs that are added to the list, effective October 1, 2006, are included in this table. Each of the principal diagnoses is shown with an asterisk, and the revisions to the CC Exclusions List are provided in an indented column immediately following the affected principal diagnosis.] [CCs that are added to the list, effective October 1, 2006, are included in this table. Each of the principal diagnoses is shown with an asterisk, and the revisions to the CC Exclusions List are provided in an indented column immediately following the affected principal diagnosis.] 66801 66802 66803 66804 66810 66811 66812 66813 66814 66820 66821 66822 66823 66824 66880 66881 66882 66883 66884 66890 66891 66892 66893 66894 66910 66911 66912 66913 66914 66930 66932 66934 67000 67002 67004 67120 67121 67122 67123 67124 67130 67131 67133 67140 67142 67144 67300 67301 67302 67303 67304 67310 67311 67312 67313 67314 67320 67321 67322 67323 67324 67330 67331 67332 67333 67334 VerDate Aug<31>2005 67380 67381 67382 67383 67384 67400 67401 67402 67403 67404 67410 67412 67420 67422 67424 67450 67451 67452 67453 67454 67510 67511 67512 *64931 63400 63401 63402 63410 63411 63412 63420 63421 63422 63430 63431 63432 63440 63441 63442 63450 63451 63452 63460 63461 63462 63470 63471 63472 63480 63481 63482 63490 63491 63492 6390 6391 6392 6393 6394 6395 6396 6398 6399 64000 64001 64003 17:10 Apr 24, 2006 Jkt 208001 PO 00000 Frm 00323 64080 64081 64083 64090 64091 64093 64100 64101 64103 64110 64111 64113 64130 64131 64133 64180 64181 64183 64190 64191 64193 64240 64241 64242 64243 64244 64250 64251 64252 64253 64254 64260 64261 64262 64263 64264 64270 64271 64272 64273 64274 64400 64403 64410 64413 64660 64661 64662 64663 64664 64670 64671 64673 64730 64731 64732 64733 64734 64740 64741 64742 64743 64744 64800 64801 64802 Fmt 4701 Sfmt 4702 E:\FR\FM\25APP2.SGM 25APP2 24318 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules TABLE 6G.—ADDITIONS TO THE CC EXCLUSIONS LIST—Continued TABLE 6G.—ADDITIONS TO THE CC EXCLUSIONS LIST—Continued [CCs that are added to the list, effective October 1, 2006, are included in this table. Each of the principal diagnoses is shown with an asterisk, and the revisions to the CC Exclusions List are provided in an indented column immediately following the affected principal diagnosis.] wwhite on PROD1PC61 with PROPOSALS2 TABLE 6G.—ADDITIONS TO THE CC EXCLUSIONS LIST—Continued [CCs that are added to the list, effective October 1, 2006, are included in this table. Each of the principal diagnoses is shown with an asterisk, and the revisions to the CC Exclusions List are provided in an indented column immediately following the affected principal diagnosis.] [CCs that are added to the list, effective October 1, 2006, are included in this table. Each of the principal diagnoses is shown with an asterisk, and the revisions to the CC Exclusions List are provided in an indented column immediately following the affected principal diagnosis.] 64803 64804 64820 64821 64822 64823 64824 64830 64831 64832 64833 64834 64850 64851 64852 64853 64854 64860 64861 64862 64863 64864 65930 65931 65933 66500 66501 66503 66510 66511 66632 66634 66800 66801 66802 66803 66804 66810 66811 66812 66813 66814 66820 66821 66822 66823 66824 66880 66881 66882 66883 66884 66890 66891 66892 66893 66894 66910 66911 66912 66913 66914 66930 66932 66934 67000 VerDate Aug<31>2005 67002 67004 67120 67121 67122 67123 67124 67130 67131 67133 67140 67142 67144 67300 67301 67302 67303 67304 67310 67311 67312 67313 67314 67320 67321 67322 67323 67324 67330 67331 67332 67333 67334 67380 67381 67382 67383 67384 67400 67401 67402 67403 67404 67410 67412 67420 67422 67424 67450 67451 67452 67453 67454 67510 67511 67512 *64932 63400 63401 63402 63410 63411 63412 63420 63421 63422 17:10 Apr 24, 2006 Jkt 208001 PO 00000 Frm 00324 63430 63431 63432 63440 63441 63442 63450 63451 63452 63460 63461 63462 63470 63471 63472 63480 63481 63482 63490 63491 63492 6390 6391 6392 6393 6394 6395 6396 6398 6399 64000 64001 64003 64080 64081 64083 64090 64091 64093 64100 64101 64103 64110 64111 64113 64130 64131 64133 64180 64181 64183 64190 64191 64193 64240 64241 64242 64243 64244 64250 64251 64252 64253 64254 64260 64261 Fmt 4701 Sfmt 4702 E:\FR\FM\25APP2.SGM 25APP2 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules 24319 TABLE 6G.—ADDITIONS TO THE CC EXCLUSIONS LIST—Continued TABLE 6G.—ADDITIONS TO THE CC EXCLUSIONS LIST—Continued [CCs that are added to the list, effective October 1, 2006, are included in this table. Each of the principal diagnoses is shown with an asterisk, and the revisions to the CC Exclusions List are provided in an indented column immediately following the affected principal diagnosis.] wwhite on PROD1PC61 with PROPOSALS2 TABLE 6G.—ADDITIONS TO THE CC EXCLUSIONS LIST—Continued [CCs that are added to the list, effective October 1, 2006, are included in this table. Each of the principal diagnoses is shown with an asterisk, and the revisions to the CC Exclusions List are provided in an indented column immediately following the affected principal diagnosis.] [CCs that are added to the list, effective October 1, 2006, are included in this table. Each of the principal diagnoses is shown with an asterisk, and the revisions to the CC Exclusions List are provided in an indented column immediately following the affected principal diagnosis.] 64262 64263 64264 64270 64271 64272 64273 64274 64400 64403 64410 64413 64660 64661 64662 64663 64664 64670 64671 64673 64730 64731 64732 64733 64734 64740 64741 64742 64743 64744 64800 64801 64802 64803 64804 64820 64821 64822 64823 64824 64830 64831 64832 64833 64834 64850 64851 64852 64853 64854 64860 64861 64862 64863 64864 65930 65931 65933 66500 66501 66503 66510 66511 66632 66634 66800 VerDate Aug<31>2005 66801 66802 66803 66804 66810 66811 66812 66813 66814 66820 66821 66822 66823 66824 66880 66881 66882 66883 66884 66890 66891 66892 66893 66894 66910 66911 66912 66913 66914 66930 66932 66934 67000 67002 67004 67120 67121 67122 67123 67124 67130 67131 67133 67140 67142 67144 67300 67301 67302 67303 67304 67310 67311 67312 67313 67314 67320 67321 67322 67323 67324 67330 67331 67332 67333 67334 17:10 Apr 24, 2006 Jkt 208001 PO 00000 Frm 00325 67380 67381 67382 67383 67384 67400 67401 67402 67403 67404 67410 67412 67420 67422 67424 67450 67451 67452 67453 67454 67510 67511 67512 *64933 63400 63401 63402 63410 63411 63412 63420 63421 63422 63430 63431 63432 63440 63441 63442 63450 63451 63452 63460 63461 63462 63470 63471 63472 63480 63481 63482 63490 63491 63492 6390 6391 6392 6393 6394 6395 6396 6398 6399 64000 64001 64003 Fmt 4701 Sfmt 4702 E:\FR\FM\25APP2.SGM 25APP2 24320 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules TABLE 6G.—ADDITIONS TO THE CC EXCLUSIONS LIST—Continued TABLE 6G.—ADDITIONS TO THE CC EXCLUSIONS LIST—Continued [CCs that are added to the list, effective October 1, 2006, are included in this table. Each of the principal diagnoses is shown with an asterisk, and the revisions to the CC Exclusions List are provided in an indented column immediately following the affected principal diagnosis.] wwhite on PROD1PC61 with PROPOSALS2 TABLE 6G.—ADDITIONS TO THE CC EXCLUSIONS LIST—Continued [CCs that are added to the list, effective October 1, 2006, are included in this table. Each of the principal diagnoses is shown with an asterisk, and the revisions to the CC Exclusions List are provided in an indented column immediately following the affected principal diagnosis.] [CCs that are added to the list, effective October 1, 2006, are included in this table. Each of the principal diagnoses is shown with an asterisk, and the revisions to the CC Exclusions List are provided in an indented column immediately following the affected principal diagnosis.] 64080 64081 64083 64090 64091 64093 64100 64101 64103 64110 64111 64113 64130 64131 64133 64180 64181 64183 64190 64191 64193 64240 64241 64242 64243 64244 64250 64251 64252 64253 64254 64260 64261 64262 64263 64264 64270 64271 64272 64273 64274 64400 64403 64410 64413 64660 64661 64662 64663 64664 64670 64671 64673 64730 64731 64732 64733 64734 64740 64741 64742 64743 64744 64800 64801 64802 VerDate Aug<31>2005 64803 64804 64820 64821 64822 64823 64824 64830 64831 64832 64833 64834 64850 64851 64852 64853 64854 64860 64861 64862 64863 64864 65930 65931 65933 66500 66501 66503 66510 66511 66632 66634 66800 66801 66802 66803 66804 66810 66811 66812 66813 66814 66820 66821 66822 66823 66824 66880 66881 66882 66883 66884 66890 66891 66892 66893 66894 66910 66911 66912 66913 66914 66930 66932 66934 67000 17:10 Apr 24, 2006 Jkt 208001 PO 00000 Frm 00326 67002 67004 67120 67121 67122 67123 67124 67130 67131 67133 67140 67142 67144 67300 67301 67302 67303 67304 67310 67311 67312 67313 67314 67320 67321 67322 67323 67324 67330 67331 67332 67333 67334 67380 67381 67382 67383 67384 67400 67401 67402 67403 67404 67410 67412 67420 67422 67424 67450 67451 67452 67453 67454 67510 67511 67512 *64934 63400 63401 63402 63410 63411 63412 63420 63421 63422 Fmt 4701 Sfmt 4702 E:\FR\FM\25APP2.SGM 25APP2 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules 24321 TABLE 6G.—ADDITIONS TO THE CC EXCLUSIONS LIST—Continued TABLE 6G.—ADDITIONS TO THE CC EXCLUSIONS LIST—Continued [CCs that are added to the list, effective October 1, 2006, are included in this table. Each of the principal diagnoses is shown with an asterisk, and the revisions to the CC Exclusions List are provided in an indented column immediately following the affected principal diagnosis.] wwhite on PROD1PC61 with PROPOSALS2 TABLE 6G.—ADDITIONS TO THE CC EXCLUSIONS LIST—Continued [CCs that are added to the list, effective October 1, 2006, are included in this table. Each of the principal diagnoses is shown with an asterisk, and the revisions to the CC Exclusions List are provided in an indented column immediately following the affected principal diagnosis.] [CCs that are added to the list, effective October 1, 2006, are included in this table. Each of the principal diagnoses is shown with an asterisk, and the revisions to the CC Exclusions List are provided in an indented column immediately following the affected principal diagnosis.] 63430 63431 63432 63440 63441 63442 63450 63451 63452 63460 63461 63462 63470 63471 63472 63480 63481 63482 63490 63491 63492 6390 6391 6392 6393 6394 6395 6396 6398 6399 64000 64001 64003 64080 64081 64083 64090 64091 64093 64100 64101 64103 64110 64111 64113 64130 64131 64133 64180 64181 64183 64190 64191 64193 64240 64241 64242 64243 64244 64250 64251 64252 64253 64254 64260 64261 VerDate Aug<31>2005 64262 64263 64264 64270 64271 64272 64273 64274 64400 64403 64410 64413 64660 64661 64662 64663 64664 64670 64671 64673 64730 64731 64732 64733 64734 64740 64741 64742 64743 64744 64800 64801 64802 64803 64804 64820 64821 64822 64823 64824 64830 64831 64832 64833 64834 64850 64851 64852 64853 64854 64860 64861 64862 64863 64864 65930 65931 65933 66500 66501 66503 66510 66511 66632 66634 66800 17:10 Apr 24, 2006 Jkt 208001 PO 00000 Frm 00327 66801 66802 66803 66804 66810 66811 66812 66813 66814 66820 66821 66822 66823 66824 66880 66881 66882 66883 66884 66890 66891 66892 66893 66894 66910 66911 66912 66913 66914 66930 66932 66934 67000 67002 67004 67120 67121 67122 67123 67124 67130 67131 67133 67140 67142 67144 67300 67301 67302 67303 67304 67310 67311 67312 67313 67314 67320 67321 67322 67323 67324 67330 67331 67332 67333 67334 Fmt 4701 Sfmt 4702 E:\FR\FM\25APP2.SGM 25APP2 24322 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules TABLE 6G.—ADDITIONS TO THE CC EXCLUSIONS LIST—Continued TABLE 6G.—ADDITIONS TO THE CC EXCLUSIONS LIST—Continued [CCs that are added to the list, effective October 1, 2006, are included in this table. Each of the principal diagnoses is shown with an asterisk, and the revisions to the CC Exclusions List are provided in an indented column immediately following the affected principal diagnosis.] wwhite on PROD1PC61 with PROPOSALS2 TABLE 6G.—ADDITIONS TO THE CC EXCLUSIONS LIST—Continued [CCs that are added to the list, effective October 1, 2006, are included in this table. Each of the principal diagnoses is shown with an asterisk, and the revisions to the CC Exclusions List are provided in an indented column immediately following the affected principal diagnosis.] [CCs that are added to the list, effective October 1, 2006, are included in this table. Each of the principal diagnoses is shown with an asterisk, and the revisions to the CC Exclusions List are provided in an indented column immediately following the affected principal diagnosis.] 67380 67381 67382 67383 67384 67400 67401 67402 67403 67404 67410 67412 67420 67422 67424 67450 67451 67452 67453 67454 67510 67511 67512 *64940 63400 63401 63402 63410 63411 63412 63420 63421 63422 63430 63431 63432 63440 63441 63442 63450 63451 63452 63460 63461 63462 63470 63471 63472 63480 63481 63482 63490 63491 63492 6390 6391 6392 6393 6394 6395 6396 6398 6399 64000 64001 64003 VerDate Aug<31>2005 64080 64081 64083 64090 64091 64093 64100 64101 64103 64110 64111 64113 64130 64131 64133 64180 64181 64183 64190 64191 64193 64240 64241 64242 64243 64244 64250 64251 64252 64253 64254 64260 64261 64262 64263 64264 64270 64271 64272 64273 64274 64400 64403 64410 64413 64660 64661 64662 64663 64664 64670 64671 64673 64730 64731 64732 64733 64734 64740 64741 64742 64743 64744 64800 64801 64802 17:10 Apr 24, 2006 Jkt 208001 PO 00000 Frm 00328 64803 64804 64820 64821 64822 64823 64824 64830 64831 64832 64833 64834 64850 64851 64852 64853 64854 64860 64861 64862 64863 64864 65930 65931 65933 66500 66501 66503 66510 66511 66632 66634 66800 66801 66802 66803 66804 66810 66811 66812 66813 66814 66820 66821 66822 66823 66824 66880 66881 66882 66883 66884 66890 66891 66892 66893 66894 66910 66911 66912 66913 66914 66930 66932 66934 67000 Fmt 4701 Sfmt 4702 E:\FR\FM\25APP2.SGM 25APP2 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules 24323 TABLE 6G.—ADDITIONS TO THE CC EXCLUSIONS LIST—Continued TABLE 6G.—ADDITIONS TO THE CC EXCLUSIONS LIST—Continued [CCs that are added to the list, effective October 1, 2006, are included in this table. Each of the principal diagnoses is shown with an asterisk, and the revisions to the CC Exclusions List are provided in an indented column immediately following the affected principal diagnosis.] wwhite on PROD1PC61 with PROPOSALS2 TABLE 6G.—ADDITIONS TO THE CC EXCLUSIONS LIST—Continued [CCs that are added to the list, effective October 1, 2006, are included in this table. Each of the principal diagnoses is shown with an asterisk, and the revisions to the CC Exclusions List are provided in an indented column immediately following the affected principal diagnosis.] [CCs that are added to the list, effective October 1, 2006, are included in this table. Each of the principal diagnoses is shown with an asterisk, and the revisions to the CC Exclusions List are provided in an indented column immediately following the affected principal diagnosis.] 67002 67004 67120 67121 67122 67123 67124 67130 67131 67133 67140 67142 67144 67300 67301 67302 67303 67304 67310 67311 67312 67313 67314 67320 67321 67322 67323 67324 67330 67331 67332 67333 67334 67380 67381 67382 67383 67384 67400 67401 67402 67403 67404 67410 67412 67420 67422 67424 67450 67451 67452 67453 67454 67510 67511 67512 *64941 63400 63401 63402 63410 63411 63412 63420 63421 63422 VerDate Aug<31>2005 63430 63431 63432 63440 63441 63442 63450 63451 63452 63460 63461 63462 63470 63471 63472 63480 63481 63482 63490 63491 63492 6390 6391 6392 6393 6394 6395 6396 6398 6399 64000 64001 64003 64080 64081 64083 64090 64091 64093 64100 64101 64103 64110 64111 64113 64130 64131 64133 64180 64181 64183 64190 64191 64193 64240 64241 64242 64243 64244 64250 64251 64252 64253 64254 64260 64261 17:10 Apr 24, 2006 Jkt 208001 PO 00000 Frm 00329 64262 64263 64264 64270 64271 64272 64273 64274 64400 64403 64410 64413 64660 64661 64662 64663 64664 64670 64671 64673 64730 64731 64732 64733 64734 64740 64741 64742 64743 64744 64800 64801 64802 64803 64804 64820 64821 64822 64823 64824 64830 64831 64832 64833 64834 64850 64851 64852 64853 64854 64860 64861 64862 64863 64864 65930 65931 65933 66500 66501 66503 66510 66511 66632 66634 66800 Fmt 4701 Sfmt 4702 E:\FR\FM\25APP2.SGM 25APP2 24324 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules TABLE 6G.—ADDITIONS TO THE CC EXCLUSIONS LIST—Continued TABLE 6G.—ADDITIONS TO THE CC EXCLUSIONS LIST—Continued [CCs that are added to the list, effective October 1, 2006, are included in this table. Each of the principal diagnoses is shown with an asterisk, and the revisions to the CC Exclusions List are provided in an indented column immediately following the affected principal diagnosis.] wwhite on PROD1PC61 with PROPOSALS2 TABLE 6G.—ADDITIONS TO THE CC EXCLUSIONS LIST—Continued [CCs that are added to the list, effective October 1, 2006, are included in this table. Each of the principal diagnoses is shown with an asterisk, and the revisions to the CC Exclusions List are provided in an indented column immediately following the affected principal diagnosis.] [CCs that are added to the list, effective October 1, 2006, are included in this table. Each of the principal diagnoses is shown with an asterisk, and the revisions to the CC Exclusions List are provided in an indented column immediately following the affected principal diagnosis.] 66801 66802 66803 66804 66810 66811 66812 66813 66814 66820 66821 66822 66823 66824 66880 66881 66882 66883 66884 66890 66891 66892 66893 66894 66910 66911 66912 66913 66914 66930 66932 66934 67000 67002 67004 67120 67121 67122 67123 67124 67130 67131 67133 67140 67142 67144 67300 67301 67302 67303 67304 67310 67311 67312 67313 67314 67320 67321 67322 67323 67324 67330 67331 67332 67333 67334 VerDate Aug<31>2005 67380 67381 67382 67383 67384 67400 67401 67402 67403 67404 67410 67412 67420 67422 67424 67450 67451 67452 67453 67454 67510 67511 67512 *64942 63400 63401 63402 63410 63411 63412 63420 63421 63422 63430 63431 63432 63440 63441 63442 63450 63451 63452 63460 63461 63462 63470 63471 63472 63480 63481 63482 63490 63491 63492 6390 6391 6392 6393 6394 6395 6396 6398 6399 64000 64001 64003 17:10 Apr 24, 2006 Jkt 208001 PO 00000 Frm 00330 64080 64081 64083 64090 64091 64093 64100 64101 64103 64110 64111 64113 64130 64131 64133 64180 64181 64183 64190 64191 64193 64240 64241 64242 64243 64244 64250 64251 64252 64253 64254 64260 64261 64262 64263 64264 64270 64271 64272 64273 64274 64400 64403 64410 64413 64660 64661 64662 64663 64664 64670 64671 64673 64730 64731 64732 64733 64734 64740 64741 64742 64743 64744 64800 64801 64802 Fmt 4701 Sfmt 4702 E:\FR\FM\25APP2.SGM 25APP2 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules 24325 TABLE 6G.—ADDITIONS TO THE CC EXCLUSIONS LIST—Continued TABLE 6G.—ADDITIONS TO THE CC EXCLUSIONS LIST—Continued [CCs that are added to the list, effective October 1, 2006, are included in this table. Each of the principal diagnoses is shown with an asterisk, and the revisions to the CC Exclusions List are provided in an indented column immediately following the affected principal diagnosis.] wwhite on PROD1PC61 with PROPOSALS2 TABLE 6G.—ADDITIONS TO THE CC EXCLUSIONS LIST—Continued [CCs that are added to the list, effective October 1, 2006, are included in this table. Each of the principal diagnoses is shown with an asterisk, and the revisions to the CC Exclusions List are provided in an indented column immediately following the affected principal diagnosis.] [CCs that are added to the list, effective October 1, 2006, are included in this table. Each of the principal diagnoses is shown with an asterisk, and the revisions to the CC Exclusions List are provided in an indented column immediately following the affected principal diagnosis.] 64803 64804 64820 64821 64822 64823 64824 64830 64831 64832 64833 64834 64850 64851 64852 64853 64854 64860 64861 64862 64863 64864 65930 65931 65933 66500 66501 66503 66510 66511 66632 66634 66800 66801 66802 66803 66804 66810 66811 66812 66813 66814 66820 66821 66822 66823 66824 66880 66881 66882 66883 66884 66890 66891 66892 66893 66894 66910 66911 66912 66913 66914 66930 66932 66934 67000 VerDate Aug<31>2005 67002 67004 67120 67121 67122 67123 67124 67130 67131 67133 67140 67142 67144 67300 67301 67302 67303 67304 67310 67311 67312 67313 67314 67320 67321 67322 67323 67324 67330 67331 67332 67333 67334 67380 67381 67382 67383 67384 67400 67401 67402 67403 67404 67410 67412 67420 67422 67424 67450 67451 67452 67453 67454 67510 67511 67512 *64943 63400 63401 63402 63410 63411 63412 63420 63421 63422 17:10 Apr 24, 2006 Jkt 208001 PO 00000 Frm 00331 63430 63431 63432 63440 63441 63442 63450 63451 63452 63460 63461 63462 63470 63471 63472 63480 63481 63482 63490 63491 63492 6390 6391 6392 6393 6394 6395 6396 6398 6399 64000 64001 64003 64080 64081 64083 64090 64091 64093 64100 64101 64103 64110 64111 64113 64130 64131 64133 64180 64181 64183 64190 64191 64193 64240 64241 64242 64243 64244 64250 64251 64252 64253 64254 64260 64261 Fmt 4701 Sfmt 4702 E:\FR\FM\25APP2.SGM 25APP2 24326 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules TABLE 6G.—ADDITIONS TO THE CC EXCLUSIONS LIST—Continued TABLE 6G.—ADDITIONS TO THE CC EXCLUSIONS LIST—Continued [CCs that are added to the list, effective October 1, 2006, are included in this table. Each of the principal diagnoses is shown with an asterisk, and the revisions to the CC Exclusions List are provided in an indented column immediately following the affected principal diagnosis.] wwhite on PROD1PC61 with PROPOSALS2 TABLE 6G.—ADDITIONS TO THE CC EXCLUSIONS LIST—Continued [CCs that are added to the list, effective October 1, 2006, are included in this table. Each of the principal diagnoses is shown with an asterisk, and the revisions to the CC Exclusions List are provided in an indented column immediately following the affected principal diagnosis.] [CCs that are added to the list, effective October 1, 2006, are included in this table. Each of the principal diagnoses is shown with an asterisk, and the revisions to the CC Exclusions List are provided in an indented column immediately following the affected principal diagnosis.] 64262 64263 64264 64270 64271 64272 64273 64274 64400 64403 64410 64413 64660 64661 64662 64663 64664 64670 64671 64673 64730 64731 64732 64733 64734 64740 64741 64742 64743 64744 64800 64801 64802 64803 64804 64820 64821 64822 64823 64824 64830 64831 64832 64833 64834 64850 64851 64852 64853 64854 64860 64861 64862 64863 64864 65930 65931 65933 66500 66501 66503 66510 66511 66632 66634 66800 VerDate Aug<31>2005 66801 66802 66803 66804 66810 66811 66812 66813 66814 66820 66821 66822 66823 66824 66880 66881 66882 66883 66884 66890 66891 66892 66893 66894 66910 66911 66912 66913 66914 66930 66932 66934 67000 67002 67004 67120 67121 67122 67123 67124 67130 67131 67133 67140 67142 67144 67300 67301 67302 67303 67304 67310 67311 67312 67313 67314 67320 67321 67322 67323 67324 67330 67331 67332 67333 67334 17:10 Apr 24, 2006 Jkt 208001 PO 00000 Frm 00332 67380 67381 67382 67383 67384 67400 67401 67402 67403 67404 67410 67412 67420 67422 67424 67450 67451 67452 67453 67454 67510 67511 67512 *64944 63400 63401 63402 63410 63411 63412 63420 63421 63422 63430 63431 63432 63440 63441 63442 63450 63451 63452 63460 63461 63462 63470 63471 63472 63480 63481 63482 63490 63491 63492 6390 6391 6392 6393 6394 6395 6396 6398 6399 64000 64001 64003 Fmt 4701 Sfmt 4702 E:\FR\FM\25APP2.SGM 25APP2 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules 24327 TABLE 6G.—ADDITIONS TO THE CC EXCLUSIONS LIST—Continued TABLE 6G.—ADDITIONS TO THE CC EXCLUSIONS LIST—Continued [CCs that are added to the list, effective October 1, 2006, are included in this table. Each of the principal diagnoses is shown with an asterisk, and the revisions to the CC Exclusions List are provided in an indented column immediately following the affected principal diagnosis.] wwhite on PROD1PC61 with PROPOSALS2 TABLE 6G.—ADDITIONS TO THE CC EXCLUSIONS LIST—Continued [CCs that are added to the list, effective October 1, 2006, are included in this table. Each of the principal diagnoses is shown with an asterisk, and the revisions to the CC Exclusions List are provided in an indented column immediately following the affected principal diagnosis.] [CCs that are added to the list, effective October 1, 2006, are included in this table. Each of the principal diagnoses is shown with an asterisk, and the revisions to the CC Exclusions List are provided in an indented column immediately following the affected principal diagnosis.] 64080 64081 64083 64090 64091 64093 64100 64101 64103 64110 64111 64113 64130 64131 64133 64180 64181 64183 64190 64191 64193 64240 64241 64242 64243 64244 64250 64251 64252 64253 64254 64260 64261 64262 64263 64264 64270 64271 64272 64273 64274 64400 64403 64410 64413 64660 64661 64662 64663 64664 64670 64671 64673 64730 64731 64732 64733 64734 64740 64741 64742 64743 64744 64800 64801 64802 VerDate Aug<31>2005 64803 64804 64820 64821 64822 64823 64824 64830 64831 64832 64833 64834 64850 64851 64852 64853 64854 64860 64861 64862 64863 64864 65930 65931 65933 66500 66501 66503 66510 66511 66632 66634 66800 66801 66802 66803 66804 66810 66811 66812 66813 66814 66820 66821 66822 66823 66824 66880 66881 66882 66883 66884 66890 66891 66892 66893 66894 66910 66911 66912 66913 66914 66930 66932 66934 67000 17:10 Apr 24, 2006 Jkt 208001 PO 00000 Frm 00333 67002 67004 67120 67121 67122 67123 67124 67130 67131 67133 67140 67142 67144 67300 67301 67302 67303 67304 67310 67311 67312 67313 67314 67320 67321 67322 67323 67324 67330 67331 67332 67333 67334 67380 67381 67382 67383 67384 67400 67401 67402 67403 67404 67410 67412 67420 67422 67424 67450 67451 67452 67453 67454 67510 67511 67512 *64950 63400 63401 63402 63410 63411 63412 63420 63421 63422 Fmt 4701 Sfmt 4702 E:\FR\FM\25APP2.SGM 25APP2 24328 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules TABLE 6G.—ADDITIONS TO THE CC EXCLUSIONS LIST—Continued TABLE 6G.—ADDITIONS TO THE CC EXCLUSIONS LIST—Continued [CCs that are added to the list, effective October 1, 2006, are included in this table. Each of the principal diagnoses is shown with an asterisk, and the revisions to the CC Exclusions List are provided in an indented column immediately following the affected principal diagnosis.] wwhite on PROD1PC61 with PROPOSALS2 TABLE 6G.—ADDITIONS TO THE CC EXCLUSIONS LIST—Continued [CCs that are added to the list, effective October 1, 2006, are included in this table. Each of the principal diagnoses is shown with an asterisk, and the revisions to the CC Exclusions List are provided in an indented column immediately following the affected principal diagnosis.] [CCs that are added to the list, effective October 1, 2006, are included in this table. Each of the principal diagnoses is shown with an asterisk, and the revisions to the CC Exclusions List are provided in an indented column immediately following the affected principal diagnosis.] 63430 63431 63432 63440 63441 63442 63450 63451 63452 63460 63461 63462 63470 63471 63472 63480 63481 63482 63490 63491 63492 6390 6391 6392 6393 6394 6395 6396 6398 6399 64000 64001 64003 64080 64081 64083 64090 64091 64093 64100 64101 64103 64110 64111 64113 64130 64131 64133 64180 64181 64183 64190 64191 64193 64240 64241 64242 64243 64244 64250 64251 64252 64253 64254 64260 64261 VerDate Aug<31>2005 64262 64263 64264 64270 64271 64272 64273 64274 64400 64403 64410 64413 64660 64661 64662 64663 64664 64670 64671 64673 64730 64731 64732 64733 64734 64740 64741 64742 64743 64744 64800 64801 64802 64803 64804 64820 64821 64822 64823 64824 64830 64831 64832 64833 64834 64850 64851 64852 64853 64854 64860 64861 64862 64863 64864 65930 65931 65933 66500 66501 66503 66510 66511 66632 66634 66800 17:10 Apr 24, 2006 Jkt 208001 PO 00000 Frm 00334 66801 66802 66803 66804 66810 66811 66812 66813 66814 66820 66821 66822 66823 66824 66880 66881 66882 66883 66884 66890 66891 66892 66893 66894 66910 66911 66912 66913 66914 66930 66932 66934 67000 67002 67004 67120 67121 67122 67123 67124 67130 67131 67133 67140 67142 67144 67300 67301 67302 67303 67304 67310 67311 67312 67313 67314 67320 67321 67322 67323 67324 67330 67331 67332 67333 67334 Fmt 4701 Sfmt 4702 E:\FR\FM\25APP2.SGM 25APP2 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules 24329 TABLE 6G.—ADDITIONS TO THE CC EXCLUSIONS LIST—Continued TABLE 6G.—ADDITIONS TO THE CC EXCLUSIONS LIST—Continued [CCs that are added to the list, effective October 1, 2006, are included in this table. Each of the principal diagnoses is shown with an asterisk, and the revisions to the CC Exclusions List are provided in an indented column immediately following the affected principal diagnosis.] wwhite on PROD1PC61 with PROPOSALS2 TABLE 6G.—ADDITIONS TO THE CC EXCLUSIONS LIST—Continued [CCs that are added to the list, effective October 1, 2006, are included in this table. Each of the principal diagnoses is shown with an asterisk, and the revisions to the CC Exclusions List are provided in an indented column immediately following the affected principal diagnosis.] [CCs that are added to the list, effective October 1, 2006, are included in this table. Each of the principal diagnoses is shown with an asterisk, and the revisions to the CC Exclusions List are provided in an indented column immediately following the affected principal diagnosis.] 67380 67381 67382 67383 67384 67400 67401 67402 67403 67404 67410 67412 67420 67422 67424 67450 67451 67452 67453 67454 67510 67511 67512 *64951 63400 63401 63402 63410 63411 63412 63420 63421 63422 63430 63431 63432 63440 63441 63442 63450 63451 63452 63460 63461 63462 63470 63471 63472 63480 63481 63482 63490 63491 63492 6390 6391 6392 6393 6394 6395 6396 6398 6399 64000 64001 64003 VerDate Aug<31>2005 64080 64081 64083 64090 64091 64093 64100 64101 64103 64110 64111 64113 64130 64131 64133 64180 64181 64183 64190 64191 64193 64240 64241 64242 64243 64244 64250 64251 64252 64253 64254 64260 64261 64262 64263 64264 64270 64271 64272 64273 64274 64400 64403 64410 64413 64660 64661 64662 64663 64664 64670 64671 64673 64730 64731 64732 64733 64734 64740 64741 64742 64743 64744 64800 64801 64802 17:10 Apr 24, 2006 Jkt 208001 PO 00000 Frm 00335 64803 64804 64820 64821 64822 64823 64824 64830 64831 64832 64833 64834 64850 64851 64852 64853 64854 64860 64861 64862 64863 64864 65930 65931 65933 66500 66501 66503 66510 66511 66632 66634 66800 66801 66802 66803 66804 66810 66811 66812 66813 66814 66820 66821 66822 66823 66824 66880 66881 66882 66883 66884 66890 66891 66892 66893 66894 66910 66911 66912 66913 66914 66930 66932 66934 67000 Fmt 4701 Sfmt 4702 E:\FR\FM\25APP2.SGM 25APP2 24330 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules TABLE 6G.—ADDITIONS TO THE CC EXCLUSIONS LIST—Continued TABLE 6G.—ADDITIONS TO THE CC EXCLUSIONS LIST—Continued [CCs that are added to the list, effective October 1, 2006, are included in this table. Each of the principal diagnoses is shown with an asterisk, and the revisions to the CC Exclusions List are provided in an indented column immediately following the affected principal diagnosis.] wwhite on PROD1PC61 with PROPOSALS2 TABLE 6G.—ADDITIONS TO THE CC EXCLUSIONS LIST—Continued [CCs that are added to the list, effective October 1, 2006, are included in this table. Each of the principal diagnoses is shown with an asterisk, and the revisions to the CC Exclusions List are provided in an indented column immediately following the affected principal diagnosis.] [CCs that are added to the list, effective October 1, 2006, are included in this table. Each of the principal diagnoses is shown with an asterisk, and the revisions to the CC Exclusions List are provided in an indented column immediately following the affected principal diagnosis.] 67002 67004 67120 67121 67122 67123 67124 67130 67131 67133 67140 67142 67144 67300 67301 67302 67303 67304 67310 67311 67312 67313 67314 67320 67321 67322 67323 67324 67330 67331 67332 67333 67334 67380 67381 67382 67383 67384 67400 67401 67402 67403 67404 67410 67412 67420 67422 67424 67450 67451 67452 67453 67454 67510 67511 67512 *64953 63400 63401 63402 63410 63411 63412 63420 63421 63422 VerDate Aug<31>2005 63430 63431 63432 63440 63441 63442 63450 63451 63452 63460 63461 63462 63470 63471 63472 63480 63481 63482 63490 63491 63492 6390 6391 6392 6393 6394 6395 6396 6398 6399 64000 64001 64003 64080 64081 64083 64090 64091 64093 64100 64101 64103 64110 64111 64113 64130 64131 64133 64180 64181 64183 64190 64191 64193 64240 64241 64242 64243 64244 64250 64251 64252 64253 64254 64260 64261 17:10 Apr 24, 2006 Jkt 208001 PO 00000 Frm 00336 64262 64263 64264 64270 64271 64272 64273 64274 64400 64403 64410 64413 64660 64661 64662 64663 64664 64670 64671 64673 64730 64731 64732 64733 64734 64740 64741 64742 64743 64744 64800 64801 64802 64803 64804 64820 64821 64822 64823 64824 64830 64831 64832 64833 64834 64850 64851 64852 64853 64854 64860 64861 64862 64863 64864 65930 65931 65933 66500 66501 66503 66510 66511 66632 66634 66800 Fmt 4701 Sfmt 4702 E:\FR\FM\25APP2.SGM 25APP2 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules 24331 TABLE 6G.—ADDITIONS TO THE CC EXCLUSIONS LIST—Continued TABLE 6G.—ADDITIONS TO THE CC EXCLUSIONS LIST—Continued [CCs that are added to the list, effective October 1, 2006, are included in this table. Each of the principal diagnoses is shown with an asterisk, and the revisions to the CC Exclusions List are provided in an indented column immediately following the affected principal diagnosis.] wwhite on PROD1PC61 with PROPOSALS2 TABLE 6G.—ADDITIONS TO THE CC EXCLUSIONS LIST—Continued [CCs that are added to the list, effective October 1, 2006, are included in this table. Each of the principal diagnoses is shown with an asterisk, and the revisions to the CC Exclusions List are provided in an indented column immediately following the affected principal diagnosis.] [CCs that are added to the list, effective October 1, 2006, are included in this table. Each of the principal diagnoses is shown with an asterisk, and the revisions to the CC Exclusions List are provided in an indented column immediately following the affected principal diagnosis.] 66801 66802 66803 66804 66810 66811 66812 66813 66814 66820 66821 66822 66823 66824 66880 66881 66882 66883 66884 66890 66891 66892 66893 66894 66910 66911 66912 66913 66914 66930 66932 66934 67000 67002 67004 67120 67121 67122 67123 67124 67130 67131 67133 67140 67142 67144 67300 67301 67302 67303 67304 67310 67311 67312 67313 67314 67320 67321 67322 67323 67324 67330 67331 67332 67333 67334 VerDate Aug<31>2005 67380 67381 67382 67383 67384 67400 67401 67402 67403 67404 67410 67412 67420 67422 67424 67450 67451 67452 67453 67454 67510 67511 67512 *64960 63400 63401 63402 63410 63411 63412 63420 63421 63422 63430 63431 63432 63440 63441 63442 63450 63451 63452 63460 63461 63462 63470 63471 63472 63480 63481 63482 63490 63491 63492 6390 6391 6392 6393 6394 6395 6396 6398 6399 64000 64001 64003 17:10 Apr 24, 2006 Jkt 208001 PO 00000 Frm 00337 64080 64081 64083 64090 64091 64093 64100 64101 64103 64110 64111 64113 64130 64131 64133 64180 64181 64183 64190 64191 64193 64240 64241 64242 64243 64244 64250 64251 64252 64253 64254 64260 64261 64262 64263 64264 64270 64271 64272 64273 64274 64400 64403 64410 64413 64660 64661 64662 64663 64664 64670 64671 64673 64730 64731 64732 64733 64734 64740 64741 64742 64743 64744 64800 64801 64802 Fmt 4701 Sfmt 4702 E:\FR\FM\25APP2.SGM 25APP2 24332 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules TABLE 6G.—ADDITIONS TO THE CC EXCLUSIONS LIST—Continued TABLE 6G.—ADDITIONS TO THE CC EXCLUSIONS LIST—Continued [CCs that are added to the list, effective October 1, 2006, are included in this table. Each of the principal diagnoses is shown with an asterisk, and the revisions to the CC Exclusions List are provided in an indented column immediately following the affected principal diagnosis.] wwhite on PROD1PC61 with PROPOSALS2 TABLE 6G.—ADDITIONS TO THE CC EXCLUSIONS LIST—Continued [CCs that are added to the list, effective October 1, 2006, are included in this table. Each of the principal diagnoses is shown with an asterisk, and the revisions to the CC Exclusions List are provided in an indented column immediately following the affected principal diagnosis.] [CCs that are added to the list, effective October 1, 2006, are included in this table. Each of the principal diagnoses is shown with an asterisk, and the revisions to the CC Exclusions List are provided in an indented column immediately following the affected principal diagnosis.] 64803 64804 64820 64821 64822 64823 64824 64830 64831 64832 64833 64834 64850 64851 64852 64853 64854 64860 64861 64862 64863 64864 65930 65931 65933 66500 66501 66503 66510 66511 66632 66634 66800 66801 66802 66803 66804 66810 66811 66812 66813 66814 66820 66821 66822 66823 66824 66880 66881 66882 66883 66884 66890 66891 66892 66893 66894 66910 66911 66912 66913 66914 66930 66932 66934 67000 VerDate Aug<31>2005 67002 67004 67120 67121 67122 67123 67124 67130 67131 67133 67140 67142 67144 67300 67301 67302 67303 67304 67310 67311 67312 67313 67314 67320 67321 67322 67323 67324 67330 67331 67332 67333 67334 67380 67381 67382 67383 67384 67400 67401 67402 67403 67404 67410 67412 67420 67422 67424 67450 67451 67452 67453 67454 67510 67511 67512 *64961 63400 63401 63402 63410 63411 63412 63420 63421 63422 17:10 Apr 24, 2006 Jkt 208001 PO 00000 Frm 00338 63430 63431 63432 63440 63441 63442 63450 63451 63452 63460 63461 63462 63470 63471 63472 63480 63481 63482 63490 63491 63492 6390 6391 6392 6393 6394 6395 6396 6398 6399 64000 64001 64003 64080 64081 64083 64090 64091 64093 64100 64101 64103 64110 64111 64113 64130 64131 64133 64180 64181 64183 64190 64191 64193 64240 64241 64242 64243 64244 64250 64251 64252 64253 64254 64260 64261 Fmt 4701 Sfmt 4702 E:\FR\FM\25APP2.SGM 25APP2 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules 24333 TABLE 6G.—ADDITIONS TO THE CC EXCLUSIONS LIST—Continued TABLE 6G.—ADDITIONS TO THE CC EXCLUSIONS LIST—Continued [CCs that are added to the list, effective October 1, 2006, are included in this table. Each of the principal diagnoses is shown with an asterisk, and the revisions to the CC Exclusions List are provided in an indented column immediately following the affected principal diagnosis.] wwhite on PROD1PC61 with PROPOSALS2 TABLE 6G.—ADDITIONS TO THE CC EXCLUSIONS LIST—Continued [CCs that are added to the list, effective October 1, 2006, are included in this table. Each of the principal diagnoses is shown with an asterisk, and the revisions to the CC Exclusions List are provided in an indented column immediately following the affected principal diagnosis.] [CCs that are added to the list, effective October 1, 2006, are included in this table. Each of the principal diagnoses is shown with an asterisk, and the revisions to the CC Exclusions List are provided in an indented column immediately following the affected principal diagnosis.] 64262 64263 64264 64270 64271 64272 64273 64274 64400 64403 64410 64413 64660 64661 64662 64663 64664 64670 64671 64673 64730 64731 64732 64733 64734 64740 64741 64742 64743 64744 64800 64801 64802 64803 64804 64820 64821 64822 64823 64824 64830 64831 64832 64833 64834 64850 64851 64852 64853 64854 64860 64861 64862 64863 64864 65930 65931 65933 66500 66501 66503 66510 66511 66632 66634 66800 VerDate Aug<31>2005 66801 66802 66803 66804 66810 66811 66812 66813 66814 66820 66821 66822 66823 66824 66880 66881 66882 66883 66884 66890 66891 66892 66893 66894 66910 66911 66912 66913 66914 66930 66932 66934 67000 67002 67004 67120 67121 67122 67123 67124 67130 67131 67133 67140 67142 67144 67300 67301 67302 67303 67304 67310 67311 67312 67313 67314 67320 67321 67322 67323 67324 67330 67331 67332 67333 67334 17:10 Apr 24, 2006 Jkt 208001 PO 00000 Frm 00339 67380 67381 67382 67383 67384 67400 67401 67402 67403 67404 67410 67412 67420 67422 67424 67450 67451 67452 67453 67454 67510 67511 67512 *64962 63400 63401 63402 63410 63411 63412 63420 63421 63422 63430 63431 63432 63440 63441 63442 63450 63451 63452 63460 63461 63462 63470 63471 63472 63480 63481 63482 63490 63491 63492 6390 6391 6392 6393 6394 6395 6396 6398 6399 64000 64001 64003 Fmt 4701 Sfmt 4702 E:\FR\FM\25APP2.SGM 25APP2 24334 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules TABLE 6G.—ADDITIONS TO THE CC EXCLUSIONS LIST—Continued TABLE 6G.—ADDITIONS TO THE CC EXCLUSIONS LIST—Continued [CCs that are added to the list, effective October 1, 2006, are included in this table. Each of the principal diagnoses is shown with an asterisk, and the revisions to the CC Exclusions List are provided in an indented column immediately following the affected principal diagnosis.] wwhite on PROD1PC61 with PROPOSALS2 TABLE 6G.—ADDITIONS TO THE CC EXCLUSIONS LIST—Continued [CCs that are added to the list, effective October 1, 2006, are included in this table. Each of the principal diagnoses is shown with an asterisk, and the revisions to the CC Exclusions List are provided in an indented column immediately following the affected principal diagnosis.] [CCs that are added to the list, effective October 1, 2006, are included in this table. Each of the principal diagnoses is shown with an asterisk, and the revisions to the CC Exclusions List are provided in an indented column immediately following the affected principal diagnosis.] 64080 64081 64083 64090 64091 64093 64100 64101 64103 64110 64111 64113 64130 64131 64133 64180 64181 64183 64190 64191 64193 64240 64241 64242 64243 64244 64250 64251 64252 64253 64254 64260 64261 64262 64263 64264 64270 64271 64272 64273 64274 64400 64403 64410 64413 64660 64661 64662 64663 64664 64670 64671 64673 64730 64731 64732 64733 64734 64740 64741 64742 64743 64744 64800 64801 64802 VerDate Aug<31>2005 64803 64804 64820 64821 64822 64823 64824 64830 64831 64832 64833 64834 64850 64851 64852 64853 64854 64860 64861 64862 64863 64864 65930 65931 65933 66500 66501 66503 66510 66511 66632 66634 66800 66801 66802 66803 66804 66810 66811 66812 66813 66814 66820 66821 66822 66823 66824 66880 66881 66882 66883 66884 66890 66891 66892 66893 66894 66910 66911 66912 66913 66914 66930 66932 66934 67000 17:10 Apr 24, 2006 Jkt 208001 PO 00000 Frm 00340 67002 67004 67120 67121 67122 67123 67124 67130 67131 67133 67140 67142 67144 67300 67301 67302 67303 67304 67310 67311 67312 67313 67314 67320 67321 67322 67323 67324 67330 67331 67332 67333 67334 67380 67381 67382 67383 67384 67400 67401 67402 67403 67404 67410 67412 67420 67422 67424 67450 67451 67452 67453 67454 67510 67511 67512 *64963 63400 63401 63402 63410 63411 63412 63420 63421 63422 Fmt 4701 Sfmt 4702 E:\FR\FM\25APP2.SGM 25APP2 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules 24335 TABLE 6G.—ADDITIONS TO THE CC EXCLUSIONS LIST—Continued TABLE 6G.—ADDITIONS TO THE CC EXCLUSIONS LIST—Continued [CCs that are added to the list, effective October 1, 2006, are included in this table. Each of the principal diagnoses is shown with an asterisk, and the revisions to the CC Exclusions List are provided in an indented column immediately following the affected principal diagnosis.] wwhite on PROD1PC61 with PROPOSALS2 TABLE 6G.—ADDITIONS TO THE CC EXCLUSIONS LIST—Continued [CCs that are added to the list, effective October 1, 2006, are included in this table. Each of the principal diagnoses is shown with an asterisk, and the revisions to the CC Exclusions List are provided in an indented column immediately following the affected principal diagnosis.] [CCs that are added to the list, effective October 1, 2006, are included in this table. Each of the principal diagnoses is shown with an asterisk, and the revisions to the CC Exclusions List are provided in an indented column immediately following the affected principal diagnosis.] 63430 63431 63432 63440 63441 63442 63450 63451 63452 63460 63461 63462 63470 63471 63472 63480 63481 63482 63490 63491 63492 6390 6391 6392 6393 6394 6395 6396 6398 6399 64000 64001 64003 64080 64081 64083 64090 64091 64093 64100 64101 64103 64110 64111 64113 64130 64131 64133 64180 64181 64183 64190 64191 64193 64240 64241 64242 64243 64244 64250 64251 64252 64253 64254 64260 64261 VerDate Aug<31>2005 64262 64263 64264 64270 64271 64272 64273 64274 64400 64403 64410 64413 64660 64661 64662 64663 64664 64670 64671 64673 64730 64731 64732 64733 64734 64740 64741 64742 64743 64744 64800 64801 64802 64803 64804 64820 64821 64822 64823 64824 64830 64831 64832 64833 64834 64850 64851 64852 64853 64854 64860 64861 64862 64863 64864 65930 65931 65933 66500 66501 66503 66510 66511 66632 66634 66800 17:10 Apr 24, 2006 Jkt 208001 PO 00000 Frm 00341 66801 66802 66803 66804 66810 66811 66812 66813 66814 66820 66821 66822 66823 66824 66880 66881 66882 66883 66884 66890 66891 66892 66893 66894 66910 66911 66912 66913 66914 66930 66932 66934 67000 67002 67004 67120 67121 67122 67123 67124 67130 67131 67133 67140 67142 67144 67300 67301 67302 67303 67304 67310 67311 67312 67313 67314 67320 67321 67322 67323 67324 67330 67331 67332 67333 67334 Fmt 4701 Sfmt 4702 E:\FR\FM\25APP2.SGM 25APP2 24336 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules TABLE 6G.—ADDITIONS TO THE CC EXCLUSIONS LIST—Continued TABLE 6G.—ADDITIONS TO THE CC EXCLUSIONS LIST—Continued [CCs that are added to the list, effective October 1, 2006, are included in this table. Each of the principal diagnoses is shown with an asterisk, and the revisions to the CC Exclusions List are provided in an indented column immediately following the affected principal diagnosis.] wwhite on PROD1PC61 with PROPOSALS2 TABLE 6G.—ADDITIONS TO THE CC EXCLUSIONS LIST—Continued [CCs that are added to the list, effective October 1, 2006, are included in this table. Each of the principal diagnoses is shown with an asterisk, and the revisions to the CC Exclusions List are provided in an indented column immediately following the affected principal diagnosis.] [CCs that are added to the list, effective October 1, 2006, are included in this table. Each of the principal diagnoses is shown with an asterisk, and the revisions to the CC Exclusions List are provided in an indented column immediately following the affected principal diagnosis.] 67380 67381 67382 67383 67384 67400 67401 67402 67403 67404 67410 67412 67420 67422 67424 67450 67451 67452 67453 67454 67510 67511 67512 *64964 63400 63401 63402 63410 63411 63412 63420 63421 63422 63430 63431 63432 63440 63441 63442 63450 63451 63452 63460 63461 63462 63470 63471 63472 63480 63481 63482 63490 63491 63492 6390 6391 6392 6393 6394 6395 6396 6398 6399 64000 64001 64003 VerDate Aug<31>2005 64080 64081 64083 64090 64091 64093 64100 64101 64103 64110 64111 64113 64130 64131 64133 64180 64181 64183 64190 64191 64193 64240 64241 64242 64243 64244 64250 64251 64252 64253 64254 64260 64261 64262 64263 64264 64270 64271 64272 64273 64274 64400 64403 64410 64413 64660 64661 64662 64663 64664 64670 64671 64673 64730 64731 64732 64733 64734 64740 64741 64742 64743 64744 64800 64801 64802 17:10 Apr 24, 2006 Jkt 208001 PO 00000 Frm 00342 64803 64804 64820 64821 64822 64823 64824 64830 64831 64832 64833 64834 64850 64851 64852 64853 64854 64860 64861 64862 64863 64864 65930 65931 65933 66500 66501 66503 66510 66511 66632 66634 66800 66801 66802 66803 66804 66810 66811 66812 66813 66814 66820 66821 66822 66823 66824 66880 66881 66882 66883 66884 66890 66891 66892 66893 66894 66910 66911 66912 66913 66914 66930 66932 66934 67000 Fmt 4701 Sfmt 4702 E:\FR\FM\25APP2.SGM 25APP2 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules 24337 TABLE 6G.—ADDITIONS TO THE CC EXCLUSIONS LIST—Continued TABLE 6G.—ADDITIONS TO THE CC EXCLUSIONS LIST—Continued [CCs that are added to the list, effective October 1, 2006, are included in this table. Each of the principal diagnoses is shown with an asterisk, and the revisions to the CC Exclusions List are provided in an indented column immediately following the affected principal diagnosis.] wwhite on PROD1PC61 with PROPOSALS2 TABLE 6G.—ADDITIONS TO THE CC EXCLUSIONS LIST—Continued [CCs that are added to the list, effective October 1, 2006, are included in this table. Each of the principal diagnoses is shown with an asterisk, and the revisions to the CC Exclusions List are provided in an indented column immediately following the affected principal diagnosis.] [CCs that are added to the list, effective October 1, 2006, are included in this table. Each of the principal diagnoses is shown with an asterisk, and the revisions to the CC Exclusions List are provided in an indented column immediately following the affected principal diagnosis.] 67002 67004 67120 67121 67122 67123 67124 67130 67131 67133 67140 67142 67144 67300 67301 67302 67303 67304 67310 67311 67312 67313 67314 67320 67321 67322 67323 67324 67330 67331 67332 67333 67334 67380 67381 67382 67383 67384 67400 67401 67402 67403 67404 67410 67412 67420 67422 67424 67450 67451 67452 67453 67454 67510 67511 67512 *7790 78032 *7791 78032 *78031 78032 *78032 78031 78032 78039 *78039 78032 *78091 78032 *78092 78032 *78093 78032 *78094 78032 *78095 78032 *78096 04082 44024 78001 78003 7801 78031 78032 78039 7817 7854 78550 78551 78552 78559 7863 78820 78829 7895 7907 7911 7913 79901 79902 7991 7994 *78097 04082 44024 78001 78003 7801 78031 78032 78039 7817 7854 78550 78551 78552 78559 7863 78820 78829 7895 7907 7911 7913 79901 79902 7991 7994 *78099 78032 *78864 78820 78829 *78865 78820 78829 *79981 78032 *79989 78032 *95890 80000 80001 80002 80003 80004 80005 80006 80009 80010 80011 80012 80013 80014 80015 80016 80019 80020 80021 80022 80023 80024 80025 80026 80029 80030 80031 80032 80033 80034 80035 80036 80039 80040 80041 80042 80043 80044 80045 80046 80049 80050 80051 80052 80053 80054 80055 80056 80059 80060 80061 80062 80063 80064 80065 80066 VerDate Aug<31>2005 17:10 Apr 24, 2006 Jkt 208001 PO 00000 Frm 00343 Fmt 4701 Sfmt 4702 E:\FR\FM\25APP2.SGM 25APP2 24338 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules TABLE 6G.—ADDITIONS TO THE CC EXCLUSIONS LIST—Continued TABLE 6G.—ADDITIONS TO THE CC EXCLUSIONS LIST—Continued [CCs that are added to the list, effective October 1, 2006, are included in this table. Each of the principal diagnoses is shown with an asterisk, and the revisions to the CC Exclusions List are provided in an indented column immediately following the affected principal diagnosis.] wwhite on PROD1PC61 with PROPOSALS2 TABLE 6G.—ADDITIONS TO THE CC EXCLUSIONS LIST—Continued [CCs that are added to the list, effective October 1, 2006, are included in this table. Each of the principal diagnoses is shown with an asterisk, and the revisions to the CC Exclusions List are provided in an indented column immediately following the affected principal diagnosis.] [CCs that are added to the list, effective October 1, 2006, are included in this table. Each of the principal diagnoses is shown with an asterisk, and the revisions to the CC Exclusions List are provided in an indented column immediately following the affected principal diagnosis.] 80069 80070 80071 80072 80073 80074 80075 80076 80079 80080 80081 80082 80083 80084 80085 80086 80089 80090 80091 80092 80093 80094 80095 80096 80099 80100 80101 80102 80103 80104 80105 80106 80109 80110 80111 80112 80113 80114 80115 80116 80119 80120 80121 80122 80123 80124 80125 80126 80129 80130 80131 80132 80133 80134 80135 80136 80139 80140 80141 80142 80143 80144 80145 80146 80149 80150 VerDate Aug<31>2005 80151 80152 80153 80154 80155 80156 80159 80160 80161 80162 80163 80164 80165 80166 80169 80170 80171 80172 80173 80174 80175 80176 80179 80180 80181 80182 80183 80184 80185 80186 80189 80190 80191 80192 80193 80194 80195 80196 80199 8021 80220 80221 80222 80223 80224 80225 80226 80227 80228 80229 80230 80231 80232 80233 80234 80235 80236 80237 80238 80239 8024 8025 8026 8027 8028 8029 17:10 Apr 24, 2006 Jkt 208001 PO 00000 Frm 00344 80300 80301 80302 80303 80304 80305 80306 80309 80310 80311 80312 80313 80314 80315 80316 80319 80320 80321 80322 80323 80324 80325 80326 80329 80330 80331 80332 80333 80334 80335 80336 80339 80340 80341 80342 80343 80344 80345 80346 80349 80350 80351 80352 80353 80354 80355 80356 80359 80360 80361 80362 80363 80364 80365 80366 80369 80370 80371 80372 80373 80374 80375 80376 80379 80380 80381 Fmt 4701 Sfmt 4702 E:\FR\FM\25APP2.SGM 25APP2 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules 24339 TABLE 6G.—ADDITIONS TO THE CC EXCLUSIONS LIST—Continued TABLE 6G.—ADDITIONS TO THE CC EXCLUSIONS LIST—Continued [CCs that are added to the list, effective October 1, 2006, are included in this table. Each of the principal diagnoses is shown with an asterisk, and the revisions to the CC Exclusions List are provided in an indented column immediately following the affected principal diagnosis.] wwhite on PROD1PC61 with PROPOSALS2 TABLE 6G.—ADDITIONS TO THE CC EXCLUSIONS LIST—Continued [CCs that are added to the list, effective October 1, 2006, are included in this table. Each of the principal diagnoses is shown with an asterisk, and the revisions to the CC Exclusions List are provided in an indented column immediately following the affected principal diagnosis.] [CCs that are added to the list, effective October 1, 2006, are included in this table. Each of the principal diagnoses is shown with an asterisk, and the revisions to the CC Exclusions List are provided in an indented column immediately following the affected principal diagnosis.] 80382 80383 80384 80385 80386 80389 80390 80391 80392 80393 80394 80395 80396 80399 80400 80401 80402 80403 80404 80405 80406 80409 80410 80411 80412 80413 80414 80415 80416 80419 80420 80421 80422 80423 80424 80425 80426 80429 80430 80431 80432 80433 80434 80435 80436 80439 80440 80441 80442 80443 80444 80445 80446 80449 80450 80451 80452 80453 80454 80455 80456 80459 80460 80461 80462 80463 VerDate Aug<31>2005 80464 80465 80466 80469 80470 80471 80472 80473 80474 80475 80476 80479 80480 80481 80482 80483 80484 80485 80486 80489 80490 80491 80492 80493 80494 80495 80496 80499 80500 80501 80502 80503 80504 80505 80506 80507 80508 80510 80511 80512 80513 80514 80515 80516 80517 80518 8052 8053 8054 8055 8056 8057 8058 8059 80600 80601 80602 80603 80604 80605 80606 80607 80608 80609 80610 80611 17:10 Apr 24, 2006 Jkt 208001 PO 00000 Frm 00345 80612 80613 80614 80615 80616 80617 80618 80619 80620 80621 80622 80623 80624 80625 80626 80627 80628 80629 80630 80631 80632 80633 80634 80635 80636 80637 80638 80639 8064 8065 80660 80661 80662 80669 80670 80671 80672 80679 8068 8069 80704 80705 80706 80707 80708 80709 80710 80711 80712 80713 80714 80715 80716 80717 80718 80719 8072 8073 8074 8075 8076 8080 8081 8082 8083 80843 Fmt 4701 Sfmt 4702 E:\FR\FM\25APP2.SGM 25APP2 24340 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules TABLE 6G.—ADDITIONS TO THE CC EXCLUSIONS LIST—Continued TABLE 6G.—ADDITIONS TO THE CC EXCLUSIONS LIST—Continued [CCs that are added to the list, effective October 1, 2006, are included in this table. Each of the principal diagnoses is shown with an asterisk, and the revisions to the CC Exclusions List are provided in an indented column immediately following the affected principal diagnosis.] wwhite on PROD1PC61 with PROPOSALS2 TABLE 6G.—ADDITIONS TO THE CC EXCLUSIONS LIST—Continued [CCs that are added to the list, effective October 1, 2006, are included in this table. Each of the principal diagnoses is shown with an asterisk, and the revisions to the CC Exclusions List are provided in an indented column immediately following the affected principal diagnosis.] [CCs that are added to the list, effective October 1, 2006, are included in this table. Each of the principal diagnoses is shown with an asterisk, and the revisions to the CC Exclusions List are provided in an indented column immediately following the affected principal diagnosis.] 80849 80851 80852 80853 80859 8088 8089 82000 82001 82002 82003 82009 82010 82011 82012 82013 82019 82020 82021 82022 82030 82031 82032 8208 8209 82100 82101 82110 82111 83900 83901 83902 83903 83904 83905 83906 83907 83908 83910 83911 83912 83913 83914 83915 83916 83917 83918 8500 85011 85012 8502 8503 8504 8505 8509 85100 85101 85102 85103 85104 85105 85106 85109 85110 85111 85112 VerDate Aug<31>2005 85113 85114 85115 85116 85119 85120 85121 85122 85123 85124 85125 85126 85129 85130 85131 85132 85133 85134 85135 85136 85139 85140 85141 85142 85143 85144 85145 85146 85149 85150 85151 85152 85153 85154 85155 85156 85159 85160 85161 85162 85163 85164 85165 85166 85169 85170 85171 85172 85173 85174 85175 85176 85179 85180 85181 85182 85183 85184 85185 85186 85189 85190 85191 85192 85193 85194 17:10 Apr 24, 2006 Jkt 208001 PO 00000 Frm 00346 85195 85196 85199 85200 85201 85202 85203 85204 85205 85206 85209 85210 85211 85212 85213 85214 85215 85216 85219 85220 85221 85222 85223 85224 85225 85226 85229 85230 85231 85232 85233 85234 85235 85236 85239 85240 85241 85242 85243 85244 85245 85246 85249 85250 85251 85252 85253 85254 85255 85256 85259 85300 85301 85302 85303 85304 85305 85306 85309 85310 85311 85312 85313 85314 85315 85316 Fmt 4701 Sfmt 4702 E:\FR\FM\25APP2.SGM 25APP2 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules 24341 TABLE 6G.—ADDITIONS TO THE CC EXCLUSIONS LIST—Continued TABLE 6G.—ADDITIONS TO THE CC EXCLUSIONS LIST—Continued [CCs that are added to the list, effective October 1, 2006, are included in this table. Each of the principal diagnoses is shown with an asterisk, and the revisions to the CC Exclusions List are provided in an indented column immediately following the affected principal diagnosis.] wwhite on PROD1PC61 with PROPOSALS2 TABLE 6G.—ADDITIONS TO THE CC EXCLUSIONS LIST—Continued [CCs that are added to the list, effective October 1, 2006, are included in this table. Each of the principal diagnoses is shown with an asterisk, and the revisions to the CC Exclusions List are provided in an indented column immediately following the affected principal diagnosis.] [CCs that are added to the list, effective October 1, 2006, are included in this table. Each of the principal diagnoses is shown with an asterisk, and the revisions to the CC Exclusions List are provided in an indented column immediately following the affected principal diagnosis.] 85319 85400 85401 85402 85403 85404 85405 85406 85409 85410 85411 85412 85413 85414 85415 85416 85419 8600 8601 8602 8603 8604 8605 86101 86102 86103 86110 86111 86112 86113 86122 86130 86131 86132 8621 86221 86222 86229 86231 86232 86239 8629 8631 86330 86331 86339 86350 86351 86352 86353 86354 86355 86356 86359 86390 86391 86392 86393 86394 86395 86399 86400 86401 86402 86403 86404 VerDate Aug<31>2005 86405 86409 86410 86411 86412 86413 86414 86415 86419 86500 86501 86502 86503 86504 86509 86510 86511 86512 86513 86514 86519 86600 86601 86602 86603 86610 86611 86612 86613 8670 8671 8672 8673 8674 8675 8676 8677 8678 8679 86800 86801 86802 86803 86804 86809 86810 86811 86812 86813 86814 86819 8690 8691 8703 8704 8708 8709 8710 8711 8712 8713 8714 8719 87272 87273 87274 17:10 Apr 24, 2006 Jkt 208001 PO 00000 Frm 00347 87333 8739 87400 87401 87402 87410 87411 87412 8743 8745 8750 8751 8870 8871 8872 8873 8874 8875 8876 8877 8960 8961 8962 8963 8970 8971 8972 8973 8974 8975 8976 8977 90000 90001 90002 90003 9001 90081 90082 90089 9009 9010 9011 9012 9013 90141 90142 90183 9020 90210 90211 90219 90220 90222 90223 90224 90225 90226 90227 90229 90231 90232 90233 90234 90239 90240 Fmt 4701 Sfmt 4702 E:\FR\FM\25APP2.SGM 25APP2 24342 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules TABLE 6G.—ADDITIONS TO THE CC EXCLUSIONS LIST—Continued TABLE 6G.—ADDITIONS TO THE CC EXCLUSIONS LIST—Continued [CCs that are added to the list, effective October 1, 2006, are included in this table. Each of the principal diagnoses is shown with an asterisk, and the revisions to the CC Exclusions List are provided in an indented column immediately following the affected principal diagnosis.] wwhite on PROD1PC61 with PROPOSALS2 TABLE 6G.—ADDITIONS TO THE CC EXCLUSIONS LIST—Continued [CCs that are added to the list, effective October 1, 2006, are included in this table. Each of the principal diagnoses is shown with an asterisk, and the revisions to the CC Exclusions List are provided in an indented column immediately following the affected principal diagnosis.] [CCs that are added to the list, effective October 1, 2006, are included in this table. Each of the principal diagnoses is shown with an asterisk, and the revisions to the CC Exclusions List are provided in an indented column immediately following the affected principal diagnosis.] 90241 90242 90249 90250 90251 90252 90253 90254 90259 90287 9251 9252 9290 95200 95201 95202 95203 95204 95205 95206 95207 95208 95209 95210 95211 95212 95213 95214 95215 95216 95217 95218 95219 9522 9523 9524 9528 9529 9530 9531 9532 9533 9534 9535 9538 9539 9580 9581 9582 9583 9584 9585 9587 *95891 80000 80001 80002 80003 80004 80005 80006 80009 80010 80011 80012 80013 VerDate Aug<31>2005 80014 80015 80016 80019 80020 80021 80022 80023 80024 80025 80026 80029 80030 80031 80032 80033 80034 80035 80036 80039 80040 80041 80042 80043 80044 80045 80046 80049 80050 80051 80052 80053 80054 80055 80056 80059 80060 80061 80062 80063 80064 80065 80066 80069 80070 80071 80072 80073 80074 80075 80076 80079 80080 80081 80082 80083 80084 80085 80086 80089 80090 80091 80092 80093 80094 80095 17:10 Apr 24, 2006 Jkt 208001 PO 00000 Frm 00348 80096 80099 80100 80101 80102 80103 80104 80105 80106 80109 80110 80111 80112 80113 80114 80115 80116 80119 80120 80121 80122 80123 80124 80125 80126 80129 80130 80131 80132 80133 80134 80135 80136 80139 80140 80141 80142 80143 80144 80145 80146 80149 80150 80151 80152 80153 80154 80155 80156 80159 80160 80161 80162 80163 80164 80165 80166 80169 80170 80171 80172 80173 80174 80175 80176 80179 Fmt 4701 Sfmt 4702 E:\FR\FM\25APP2.SGM 25APP2 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules 24343 TABLE 6G.—ADDITIONS TO THE CC EXCLUSIONS LIST—Continued TABLE 6G.—ADDITIONS TO THE CC EXCLUSIONS LIST—Continued [CCs that are added to the list, effective October 1, 2006, are included in this table. Each of the principal diagnoses is shown with an asterisk, and the revisions to the CC Exclusions List are provided in an indented column immediately following the affected principal diagnosis.] wwhite on PROD1PC61 with PROPOSALS2 TABLE 6G.—ADDITIONS TO THE CC EXCLUSIONS LIST—Continued [CCs that are added to the list, effective October 1, 2006, are included in this table. Each of the principal diagnoses is shown with an asterisk, and the revisions to the CC Exclusions List are provided in an indented column immediately following the affected principal diagnosis.] [CCs that are added to the list, effective October 1, 2006, are included in this table. Each of the principal diagnoses is shown with an asterisk, and the revisions to the CC Exclusions List are provided in an indented column immediately following the affected principal diagnosis.] 80180 80181 80182 80183 80184 80185 80186 80189 80190 80191 80192 80193 80194 80195 80196 80199 8021 80220 80221 80222 80223 80224 80225 80226 80227 80228 80229 80230 80231 80232 80233 80234 80235 80236 80237 80238 80239 8024 8025 8026 8027 8028 8029 80300 80301 80302 80303 80304 80305 80306 80309 80310 80311 80312 80313 80314 80315 80316 80319 80320 80321 80322 80323 80324 80325 80326 VerDate Aug<31>2005 80329 80330 80331 80332 80333 80334 80335 80336 80339 80340 80341 80342 80343 80344 80345 80346 80349 80350 80351 80352 80353 80354 80355 80356 80359 80360 80361 80362 80363 80364 80365 80366 80369 80370 80371 80372 80373 80374 80375 80376 80379 80380 80381 80382 80383 80384 80385 80386 80389 80390 80391 80392 80393 80394 80395 80396 80399 80400 80401 80402 80403 80404 80405 80406 80409 80410 17:10 Apr 24, 2006 Jkt 208001 PO 00000 Frm 00349 80411 80412 80413 80414 80415 80416 80419 80420 80421 80422 80423 80424 80425 80426 80429 80430 80431 80432 80433 80434 80435 80436 80439 80440 80441 80442 80443 80444 80445 80446 80449 80450 80451 80452 80453 80454 80455 80456 80459 80460 80461 80462 80463 80464 80465 80466 80469 80470 80471 80472 80473 80474 80475 80476 80479 80480 80481 80482 80483 80484 80485 80486 80489 80490 80491 80492 Fmt 4701 Sfmt 4702 E:\FR\FM\25APP2.SGM 25APP2 24344 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules TABLE 6G.—ADDITIONS TO THE CC EXCLUSIONS LIST—Continued TABLE 6G.—ADDITIONS TO THE CC EXCLUSIONS LIST—Continued [CCs that are added to the list, effective October 1, 2006, are included in this table. Each of the principal diagnoses is shown with an asterisk, and the revisions to the CC Exclusions List are provided in an indented column immediately following the affected principal diagnosis.] wwhite on PROD1PC61 with PROPOSALS2 TABLE 6G.—ADDITIONS TO THE CC EXCLUSIONS LIST—Continued [CCs that are added to the list, effective October 1, 2006, are included in this table. Each of the principal diagnoses is shown with an asterisk, and the revisions to the CC Exclusions List are provided in an indented column immediately following the affected principal diagnosis.] [CCs that are added to the list, effective October 1, 2006, are included in this table. Each of the principal diagnoses is shown with an asterisk, and the revisions to the CC Exclusions List are provided in an indented column immediately following the affected principal diagnosis.] 80493 80494 80495 80496 80499 80500 80501 80502 80503 80504 80505 80506 80507 80508 80510 80511 80512 80513 80514 80515 80516 80517 80518 8052 8053 8054 8055 8056 8057 8058 8059 80600 80601 80602 80603 80604 80605 80606 80607 80608 80609 80610 80611 80612 80613 80614 80615 80616 80617 80618 80619 80620 80621 80622 80623 80624 80625 80626 80627 80628 80629 80630 80631 80632 80633 80634 VerDate Aug<31>2005 80635 80636 80637 80638 80639 8064 8065 80660 80661 80662 80669 80670 80671 80672 80679 8068 8069 80704 80705 80706 80707 80708 80709 80710 80711 80712 80713 80714 80715 80716 80717 80718 80719 8072 8073 8074 8075 8076 8080 8081 8082 8083 80843 80849 80851 80852 80853 80859 8088 8089 82000 82001 82002 82003 82009 82010 82011 82012 82013 82019 82020 82021 82022 82030 82031 82032 17:10 Apr 24, 2006 Jkt 208001 PO 00000 Frm 00350 8208 8209 82100 82101 82110 82111 83900 83901 83902 83903 83904 83905 83906 83907 83908 83910 83911 83912 83913 83914 83915 83916 83917 83918 8500 85011 85012 8502 8503 8504 8505 8509 85100 85101 85102 85103 85104 85105 85106 85109 85110 85111 85112 85113 85114 85115 85116 85119 85120 85121 85122 85123 85124 85125 85126 85129 85130 85131 85132 85133 85134 85135 85136 85139 85140 85141 Fmt 4701 Sfmt 4702 E:\FR\FM\25APP2.SGM 25APP2 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules 24345 TABLE 6G.—ADDITIONS TO THE CC EXCLUSIONS LIST—Continued TABLE 6G.—ADDITIONS TO THE CC EXCLUSIONS LIST—Continued [CCs that are added to the list, effective October 1, 2006, are included in this table. Each of the principal diagnoses is shown with an asterisk, and the revisions to the CC Exclusions List are provided in an indented column immediately following the affected principal diagnosis.] wwhite on PROD1PC61 with PROPOSALS2 TABLE 6G.—ADDITIONS TO THE CC EXCLUSIONS LIST—Continued [CCs that are added to the list, effective October 1, 2006, are included in this table. Each of the principal diagnoses is shown with an asterisk, and the revisions to the CC Exclusions List are provided in an indented column immediately following the affected principal diagnosis.] [CCs that are added to the list, effective October 1, 2006, are included in this table. Each of the principal diagnoses is shown with an asterisk, and the revisions to the CC Exclusions List are provided in an indented column immediately following the affected principal diagnosis.] 85142 85143 85144 85145 85146 85149 85150 85151 85152 85153 85154 85155 85156 85159 85160 85161 85162 85163 85164 85165 85166 85169 85170 85171 85172 85173 85174 85175 85176 85179 85180 85181 85182 85183 85184 85185 85186 85189 85190 85191 85192 85193 85194 85195 85196 85199 85200 85201 85202 85203 85204 85205 85206 85209 85210 85211 85212 85213 85214 85215 85216 85219 85220 85221 85222 85223 VerDate Aug<31>2005 85224 85225 85226 85229 85230 85231 85232 85233 85234 85235 85236 85239 85240 85241 85242 85243 85244 85245 85246 85249 85250 85251 85252 85253 85254 85255 85256 85259 85300 85301 85302 85303 85304 85305 85306 85309 85310 85311 85312 85313 85314 85315 85316 85319 85400 85401 85402 85403 85404 85405 85406 85409 85410 85411 85412 85413 85414 85415 85416 85419 8600 8601 8602 8603 8604 8605 17:10 Apr 24, 2006 Jkt 208001 PO 00000 Frm 00351 86101 86102 86103 86110 86111 86112 86113 86122 86130 86131 86132 8621 86221 86222 86229 86231 86232 86239 8629 8631 86330 86331 86339 86350 86351 86352 86353 86354 86355 86356 86359 86390 86391 86392 86393 86394 86395 86399 86400 86401 86402 86403 86404 86405 86409 86410 86411 86412 86413 86414 86415 86419 86500 86501 86502 86503 86504 86509 86510 86511 86512 86513 86514 86519 86600 86601 Fmt 4701 Sfmt 4702 E:\FR\FM\25APP2.SGM 25APP2 24346 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules TABLE 6G.—ADDITIONS TO THE CC EXCLUSIONS LIST—Continued TABLE 6G.—ADDITIONS TO THE CC EXCLUSIONS LIST—Continued [CCs that are added to the list, effective October 1, 2006, are included in this table. Each of the principal diagnoses is shown with an asterisk, and the revisions to the CC Exclusions List are provided in an indented column immediately following the affected principal diagnosis.] wwhite on PROD1PC61 with PROPOSALS2 TABLE 6G.—ADDITIONS TO THE CC EXCLUSIONS LIST—Continued [CCs that are added to the list, effective October 1, 2006, are included in this table. Each of the principal diagnoses is shown with an asterisk, and the revisions to the CC Exclusions List are provided in an indented column immediately following the affected principal diagnosis.] [CCs that are added to the list, effective October 1, 2006, are included in this table. Each of the principal diagnoses is shown with an asterisk, and the revisions to the CC Exclusions List are provided in an indented column immediately following the affected principal diagnosis.] 86602 86603 86610 86611 86612 86613 8670 8671 8672 8673 8674 8675 8676 8677 8678 8679 86800 86801 86802 86803 86804 86809 86810 86811 86812 86813 86814 86819 8690 8691 8703 8704 8708 8709 8710 8711 8712 8713 8714 8719 87272 87273 87274 87333 8739 87400 87401 87402 87410 87411 87412 8743 8745 8750 8751 8870 8871 8872 8873 8874 8875 8876 8877 8960 8961 8962 VerDate Aug<31>2005 8963 8970 8971 8972 8973 8974 8975 8976 8977 90000 90001 90002 90003 9001 90081 90082 90089 9009 9010 9011 9012 9013 90141 90142 90183 9020 90210 90211 90219 90220 90222 90223 90224 90225 90226 90227 90229 90231 90232 90233 90234 90239 90240 90241 90242 90249 90250 90251 90252 90253 90254 90259 90287 9251 9252 9290 95200 95201 95202 95203 95204 95205 95206 95207 95208 95209 17:10 Apr 24, 2006 Jkt 208001 PO 00000 Frm 00352 95210 95211 95212 95213 95214 95215 95216 95217 95218 95219 9522 9523 9524 9528 9529 9530 9531 9532 9533 9534 9535 9538 9539 9580 9581 9582 9583 9584 9585 9587 *95892 80000 80001 80002 80003 80004 80005 80006 80009 80010 80011 80012 80013 80014 80015 80016 80019 80020 80021 80022 80023 80024 80025 80026 80029 80030 80031 80032 80033 80034 80035 80036 80039 80040 80041 80042 Fmt 4701 Sfmt 4702 E:\FR\FM\25APP2.SGM 25APP2 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules 24347 TABLE 6G.—ADDITIONS TO THE CC EXCLUSIONS LIST—Continued TABLE 6G.—ADDITIONS TO THE CC EXCLUSIONS LIST—Continued [CCs that are added to the list, effective October 1, 2006, are included in this table. Each of the principal diagnoses is shown with an asterisk, and the revisions to the CC Exclusions List are provided in an indented column immediately following the affected principal diagnosis.] wwhite on PROD1PC61 with PROPOSALS2 TABLE 6G.—ADDITIONS TO THE CC EXCLUSIONS LIST—Continued [CCs that are added to the list, effective October 1, 2006, are included in this table. Each of the principal diagnoses is shown with an asterisk, and the revisions to the CC Exclusions List are provided in an indented column immediately following the affected principal diagnosis.] [CCs that are added to the list, effective October 1, 2006, are included in this table. Each of the principal diagnoses is shown with an asterisk, and the revisions to the CC Exclusions List are provided in an indented column immediately following the affected principal diagnosis.] 80043 80044 80045 80046 80049 80050 80051 80052 80053 80054 80055 80056 80059 80060 80061 80062 80063 80064 80065 80066 80069 80070 80071 80072 80073 80074 80075 80076 80079 80080 80081 80082 80083 80084 80085 80086 80089 80090 80091 80092 80093 80094 80095 80096 80099 80100 80101 80102 80103 80104 80105 80106 80109 80110 80111 80112 80113 80114 80115 80116 80119 80120 80121 80122 80123 80124 VerDate Aug<31>2005 80125 80126 80129 80130 80131 80132 80133 80134 80135 80136 80139 80140 80141 80142 80143 80144 80145 80146 80149 80150 80151 80152 80153 80154 80155 80156 80159 80160 80161 80162 80163 80164 80165 80166 80169 80170 80171 80172 80173 80174 80175 80176 80179 80180 80181 80182 80183 80184 80185 80186 80189 80190 80191 80192 80193 80194 80195 80196 80199 8021 80220 80221 80222 80223 80224 80225 17:10 Apr 24, 2006 Jkt 208001 PO 00000 Frm 00353 80226 80227 80228 80229 80230 80231 80232 80233 80234 80235 80236 80237 80238 80239 8024 8025 8026 8027 8028 8029 80300 80301 80302 80303 80304 80305 80306 80309 80310 80311 80312 80313 80314 80315 80316 80319 80320 80321 80322 80323 80324 80325 80326 80329 80330 80331 80332 80333 80334 80335 80336 80339 80340 80341 80342 80343 80344 80345 80346 80349 80350 80351 80352 80353 80354 80355 Fmt 4701 Sfmt 4702 E:\FR\FM\25APP2.SGM 25APP2 24348 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules TABLE 6G.—ADDITIONS TO THE CC EXCLUSIONS LIST—Continued TABLE 6G.—ADDITIONS TO THE CC EXCLUSIONS LIST—Continued [CCs that are added to the list, effective October 1, 2006, are included in this table. Each of the principal diagnoses is shown with an asterisk, and the revisions to the CC Exclusions List are provided in an indented column immediately following the affected principal diagnosis.] wwhite on PROD1PC61 with PROPOSALS2 TABLE 6G.—ADDITIONS TO THE CC EXCLUSIONS LIST—Continued [CCs that are added to the list, effective October 1, 2006, are included in this table. Each of the principal diagnoses is shown with an asterisk, and the revisions to the CC Exclusions List are provided in an indented column immediately following the affected principal diagnosis.] [CCs that are added to the list, effective October 1, 2006, are included in this table. Each of the principal diagnoses is shown with an asterisk, and the revisions to the CC Exclusions List are provided in an indented column immediately following the affected principal diagnosis.] 80356 80359 80360 80361 80362 80363 80364 80365 80366 80369 80370 80371 80372 80373 80374 80375 80376 80379 80380 80381 80382 80383 80384 80385 80386 80389 80390 80391 80392 80393 80394 80395 80396 80399 80400 80401 80402 80403 80404 80405 80406 80409 80410 80411 80412 80413 80414 80415 80416 80419 80420 80421 80422 80423 80424 80425 80426 80429 80430 80431 80432 80433 80434 80435 80436 80439 VerDate Aug<31>2005 80440 80441 80442 80443 80444 80445 80446 80449 80450 80451 80452 80453 80454 80455 80456 80459 80460 80461 80462 80463 80464 80465 80466 80469 80470 80471 80472 80473 80474 80475 80476 80479 80480 80481 80482 80483 80484 80485 80486 80489 80490 80491 80492 80493 80494 80495 80496 80499 80500 80501 80502 80503 80504 80505 80506 80507 80508 80510 80511 80512 80513 80514 80515 80516 80517 80518 17:10 Apr 24, 2006 Jkt 208001 PO 00000 Frm 00354 8052 8053 8054 8055 8056 8057 8058 8059 80600 80601 80602 80603 80604 80605 80606 80607 80608 80609 80610 80611 80612 80613 80614 80615 80616 80617 80618 80619 80620 80621 80622 80623 80624 80625 80626 80627 80628 80629 80630 80631 80632 80633 80634 80635 80636 80637 80638 80639 8064 8065 80660 80661 80662 80669 80670 80671 80672 80679 8068 8069 80704 80705 80706 80707 80708 80709 Fmt 4701 Sfmt 4702 E:\FR\FM\25APP2.SGM 25APP2 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules 24349 TABLE 6G.—ADDITIONS TO THE CC EXCLUSIONS LIST—Continued TABLE 6G.—ADDITIONS TO THE CC EXCLUSIONS LIST—Continued [CCs that are added to the list, effective October 1, 2006, are included in this table. Each of the principal diagnoses is shown with an asterisk, and the revisions to the CC Exclusions List are provided in an indented column immediately following the affected principal diagnosis.] wwhite on PROD1PC61 with PROPOSALS2 TABLE 6G.—ADDITIONS TO THE CC EXCLUSIONS LIST—Continued [CCs that are added to the list, effective October 1, 2006, are included in this table. Each of the principal diagnoses is shown with an asterisk, and the revisions to the CC Exclusions List are provided in an indented column immediately following the affected principal diagnosis.] [CCs that are added to the list, effective October 1, 2006, are included in this table. Each of the principal diagnoses is shown with an asterisk, and the revisions to the CC Exclusions List are provided in an indented column immediately following the affected principal diagnosis.] 80710 80711 80712 80713 80714 80715 80716 80717 80718 80719 8072 8073 8074 8075 8076 8080 8081 8082 8083 80843 80849 80851 80852 80853 80859 8088 8089 82000 82001 82002 82003 82009 82010 82011 82012 82013 82019 82020 82021 82022 82030 82031 82032 8208 8209 82100 82101 82110 82111 83900 83901 83902 83903 83904 83905 83906 83907 83908 83910 83911 83912 83913 83914 83915 83916 83917 VerDate Aug<31>2005 83918 8500 85011 85012 8502 8503 8504 8505 8509 85100 85101 85102 85103 85104 85105 85106 85109 85110 85111 85112 85113 85114 85115 85116 85119 85120 85121 85122 85123 85124 85125 85126 85129 85130 85131 85132 85133 85134 85135 85136 85139 85140 85141 85142 85143 85144 85145 85146 85149 85150 85151 85152 85153 85154 85155 85156 85159 85160 85161 85162 85163 85164 85165 85166 85169 85170 17:10 Apr 24, 2006 Jkt 208001 PO 00000 Frm 00355 85171 85172 85173 85174 85175 85176 85179 85180 85181 85182 85183 85184 85185 85186 85189 85190 85191 85192 85193 85194 85195 85196 85199 85200 85201 85202 85203 85204 85205 85206 85209 85210 85211 85212 85213 85214 85215 85216 85219 85220 85221 85222 85223 85224 85225 85226 85229 85230 85231 85232 85233 85234 85235 85236 85239 85240 85241 85242 85243 85244 85245 85246 85249 85250 85251 85252 Fmt 4701 Sfmt 4702 E:\FR\FM\25APP2.SGM 25APP2 24350 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules TABLE 6G.—ADDITIONS TO THE CC EXCLUSIONS LIST—Continued TABLE 6G.—ADDITIONS TO THE CC EXCLUSIONS LIST—Continued [CCs that are added to the list, effective October 1, 2006, are included in this table. Each of the principal diagnoses is shown with an asterisk, and the revisions to the CC Exclusions List are provided in an indented column immediately following the affected principal diagnosis.] wwhite on PROD1PC61 with PROPOSALS2 TABLE 6G.—ADDITIONS TO THE CC EXCLUSIONS LIST—Continued [CCs that are added to the list, effective October 1, 2006, are included in this table. Each of the principal diagnoses is shown with an asterisk, and the revisions to the CC Exclusions List are provided in an indented column immediately following the affected principal diagnosis.] [CCs that are added to the list, effective October 1, 2006, are included in this table. Each of the principal diagnoses is shown with an asterisk, and the revisions to the CC Exclusions List are provided in an indented column immediately following the affected principal diagnosis.] 85253 85254 85255 85256 85259 85300 85301 85302 85303 85304 85305 85306 85309 85310 85311 85312 85313 85314 85315 85316 85319 85400 85401 85402 85403 85404 85405 85406 85409 85410 85411 85412 85413 85414 85415 85416 85419 8600 8601 8602 8603 8604 8605 86101 86102 86103 86110 86111 86112 86113 86122 86130 86131 86132 8621 86221 86222 86229 86231 86232 86239 8629 8631 86330 86331 86339 VerDate Aug<31>2005 86350 86351 86352 86353 86354 86355 86356 86359 86390 86391 86392 86393 86394 86395 86399 86400 86401 86402 86403 86404 86405 86409 86410 86411 86412 86413 86414 86415 86419 86500 86501 86502 86503 86504 86509 86510 86511 86512 86513 86514 86519 86600 86601 86602 86603 86610 86611 86612 86613 8670 8671 8672 8673 8674 8675 8676 8677 8678 8679 86800 86801 86802 86803 86804 86809 86810 17:10 Apr 24, 2006 Jkt 208001 PO 00000 Frm 00356 86811 86812 86813 86814 86819 8690 8691 8703 8704 8708 8709 8710 8711 8712 8713 8714 8719 87272 87273 87274 87333 8739 87400 87401 87402 87410 87411 87412 8743 8745 8750 8751 8870 8871 8872 8873 8874 8875 8876 8877 8960 8961 8962 8963 8970 8971 8972 8973 8974 8975 8976 8977 90000 90001 90002 90003 9001 90081 90082 90089 9009 9010 9011 9012 9013 90141 Fmt 4701 Sfmt 4702 E:\FR\FM\25APP2.SGM 25APP2 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules 24351 TABLE 6G.—ADDITIONS TO THE CC EXCLUSIONS LIST—Continued TABLE 6G.—ADDITIONS TO THE CC EXCLUSIONS LIST—Continued [CCs that are added to the list, effective October 1, 2006, are included in this table. Each of the principal diagnoses is shown with an asterisk, and the revisions to the CC Exclusions List are provided in an indented column immediately following the affected principal diagnosis.] wwhite on PROD1PC61 with PROPOSALS2 TABLE 6G.—ADDITIONS TO THE CC EXCLUSIONS LIST—Continued [CCs that are added to the list, effective October 1, 2006, are included in this table. Each of the principal diagnoses is shown with an asterisk, and the revisions to the CC Exclusions List are provided in an indented column immediately following the affected principal diagnosis.] [CCs that are added to the list, effective October 1, 2006, are included in this table. Each of the principal diagnoses is shown with an asterisk, and the revisions to the CC Exclusions List are provided in an indented column immediately following the affected principal diagnosis.] 90142 90183 9020 90210 90211 90219 90220 90222 90223 90224 90225 90226 90227 90229 90231 90232 90233 90234 90239 90240 90241 90242 90249 90250 90251 90252 90253 90254 90259 90287 9251 9252 9290 95200 95201 95202 95203 95204 95205 95206 95207 95208 95209 95210 95211 95212 95213 95214 95215 95216 95217 95218 95219 9522 9523 9524 9528 9529 9530 9531 9532 9533 9534 9535 9538 9539 VerDate Aug<31>2005 9580 9581 9582 9583 9584 9585 9587 *95893 80000 80001 80002 80003 80004 80005 80006 80009 80010 80011 80012 80013 80014 80015 80016 80019 80020 80021 80022 80023 80024 80025 80026 80029 80030 80031 80032 80033 80034 80035 80036 80039 80040 80041 80042 80043 80044 80045 80046 80049 80050 80051 80052 80053 80054 80055 80056 80059 80060 80061 80062 80063 80064 80065 80066 80069 80070 80071 17:10 Apr 24, 2006 Jkt 208001 PO 00000 Frm 00357 80072 80073 80074 80075 80076 80079 80080 80081 80082 80083 80084 80085 80086 80089 80090 80091 80092 80093 80094 80095 80096 80099 80100 80101 80102 80103 80104 80105 80106 80109 80110 80111 112 80113 80114 80115 80116 80119 80120 80121 80122 80123 80124 80125 80126 80129 80130 80131 80132 80133 80134 80135 80136 80139 80140 80141 80142 80143 80144 80145 80146 80149 80150 80151 80152 80153 Fmt 4701 Sfmt 4702 E:\FR\FM\25APP2.SGM 25APP2 24352 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules TABLE 6G.—ADDITIONS TO THE CC EXCLUSIONS LIST—Continued TABLE 6G.—ADDITIONS TO THE CC EXCLUSIONS LIST—Continued [CCs that are added to the list, effective October 1, 2006, are included in this table. Each of the principal diagnoses is shown with an asterisk, and the revisions to the CC Exclusions List are provided in an indented column immediately following the affected principal diagnosis.] wwhite on PROD1PC61 with PROPOSALS2 TABLE 6G.—ADDITIONS TO THE CC EXCLUSIONS LIST—Continued [CCs that are added to the list, effective October 1, 2006, are included in this table. Each of the principal diagnoses is shown with an asterisk, and the revisions to the CC Exclusions List are provided in an indented column immediately following the affected principal diagnosis.] [CCs that are added to the list, effective October 1, 2006, are included in this table. Each of the principal diagnoses is shown with an asterisk, and the revisions to the CC Exclusions List are provided in an indented column immediately following the affected principal diagnosis.] 80154 80155 80156 80159 80160 80161 80162 80163 80164 80165 80166 80169 80170 80171 80172 80173 80174 80175 80176 80179 80180 80181 80182 80183 80184 80185 80186 80189 80190 80191 80192 80193 80194 80195 80196 80199 8021 80220 80221 80222 80223 80224 80225 80226 80227 80228 80229 80230 80231 80232 80233 80234 80235 80236 80237 80238 80239 8024 8025 8026 8027 8028 8029 80300 80301 80302 VerDate Aug<31>2005 80303 80304 80305 80306 80309 80310 80311 80312 80313 80314 80315 80316 80319 80320 80321 80322 80323 80324 80325 80326 80329 80330 80331 80332 80333 80334 80335 80336 80339 80340 80341 80342 80343 80344 80345 80346 80349 80350 80351 80352 80353 80354 80355 80356 80359 80360 80361 80362 80363 80364 80365 80366 80369 80370 80371 80372 80373 80374 80375 80376 80379 80380 80381 80382 80383 80384 17:10 Apr 24, 2006 Jkt 208001 PO 00000 Frm 00358 80385 80386 80389 80390 80391 80392 80393 80394 80395 80396 80399 80400 80401 80402 80403 80404 80405 80406 80409 80410 80411 80412 80413 80414 80415 80416 80419 80420 80421 80422 80423 80424 80425 80426 80429 80430 80431 80432 80433 80434 80435 80436 80439 80440 80441 80442 80443 80444 80445 80446 80449 80450 80451 80452 80453 80454 80455 80456 80459 80460 80461 80462 80463 80464 80465 80466 Fmt 4701 Sfmt 4702 E:\FR\FM\25APP2.SGM 25APP2 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules 24353 TABLE 6G.—ADDITIONS TO THE CC EXCLUSIONS LIST—Continued TABLE 6G.—ADDITIONS TO THE CC EXCLUSIONS LIST—Continued [CCs that are added to the list, effective October 1, 2006, are included in this table. Each of the principal diagnoses is shown with an asterisk, and the revisions to the CC Exclusions List are provided in an indented column immediately following the affected principal diagnosis.] wwhite on PROD1PC61 with PROPOSALS2 TABLE 6G.—ADDITIONS TO THE CC EXCLUSIONS LIST—Continued [CCs that are added to the list, effective October 1, 2006, are included in this table. Each of the principal diagnoses is shown with an asterisk, and the revisions to the CC Exclusions List are provided in an indented column immediately following the affected principal diagnosis.] [CCs that are added to the list, effective October 1, 2006, are included in this table. Each of the principal diagnoses is shown with an asterisk, and the revisions to the CC Exclusions List are provided in an indented column immediately following the affected principal diagnosis.] 80469 80470 80471 80472 80473 80474 80475 80476 80479 80480 80481 80482 80483 80484 80485 80486 80489 80490 80491 80492 80493 80494 80495 80496 80499 80500 80501 80502 80503 80504 80505 80506 80507 80508 80510 80511 80512 80513 80514 80515 80516 80517 80518 8052 8053 8054 8055 8056 8057 8058 8059 80600 80601 80602 80603 80604 80605 80606 80607 80608 80609 80610 80611 80612 80613 80614 VerDate Aug<31>2005 80615 80616 80617 80618 80619 80620 80621 80622 80623 80624 80625 80626 80627 80628 80629 80630 80631 80632 80633 80634 80635 80636 80637 80638 80639 8064 8065 80660 80661 80662 80669 80670 80671 80672 80679 8068 8069 80704 80705 80706 80707 80708 80709 80710 80711 80712 80713 80714 80715 80716 80717 80718 80719 8072 8073 8074 8075 8076 8080 8081 8082 8083 80843 80849 80851 80852 17:10 Apr 24, 2006 Jkt 208001 PO 00000 Frm 00359 80853 80859 8088 8089 82000 82001 82002 82003 82009 82010 82011 82012 82013 82019 82020 82021 82022 82030 82031 82032 8208 8209 82100 82101 82110 82111 83900 83901 83902 83903 83904 83905 83906 83907 83908 83910 83911 83912 83913 83914 83915 83916 83917 83918 8500 85011 85012 8502 8503 8504 8505 8509 85100 85101 85102 85103 85104 85105 85106 85109 85110 85111 85112 85113 85114 85115 Fmt 4701 Sfmt 4702 E:\FR\FM\25APP2.SGM 25APP2 24354 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules TABLE 6G.—ADDITIONS TO THE CC EXCLUSIONS LIST—Continued TABLE 6G.—ADDITIONS TO THE CC EXCLUSIONS LIST—Continued [CCs that are added to the list, effective October 1, 2006, are included in this table. Each of the principal diagnoses is shown with an asterisk, and the revisions to the CC Exclusions List are provided in an indented column immediately following the affected principal diagnosis.] wwhite on PROD1PC61 with PROPOSALS2 TABLE 6G.—ADDITIONS TO THE CC EXCLUSIONS LIST—Continued [CCs that are added to the list, effective October 1, 2006, are included in this table. Each of the principal diagnoses is shown with an asterisk, and the revisions to the CC Exclusions List are provided in an indented column immediately following the affected principal diagnosis.] [CCs that are added to the list, effective October 1, 2006, are included in this table. Each of the principal diagnoses is shown with an asterisk, and the revisions to the CC Exclusions List are provided in an indented column immediately following the affected principal diagnosis.] 85116 85119 85120 85121 85122 85123 85124 85125 85126 85129 85130 85131 85132 85133 85134 85135 85136 85139 85140 85141 85142 85143 85144 85145 85146 85149 85150 85151 85152 85153 85154 85155 85156 85159 85160 85161 85162 85163 85164 85165 85166 85169 85170 85171 85172 85173 85174 85175 85176 85179 85180 85181 85182 85183 85184 85185 85186 85189 85190 85191 85192 85193 85194 85195 85196 85199 VerDate Aug<31>2005 85200 85201 85202 85203 85204 85205 85206 85209 85210 85211 85212 85213 85214 85215 85216 85219 85220 85221 85222 85223 85224 85225 85226 85229 85230 85231 85232 85233 85234 85235 85236 85239 85240 85241 85242 85243 85244 85245 85246 85249 85250 85251 85252 85253 85254 85255 85256 85259 85300 85301 85302 85303 85304 85305 85306 85309 85310 85311 85312 85313 85314 85315 85316 85319 85400 85401 17:10 Apr 24, 2006 Jkt 208001 PO 00000 Frm 00360 85402 85403 85404 85405 85406 85409 85410 85411 85412 85413 85414 85415 85416 85419 8600 8601 8602 8603 8604 8605 86101 86102 86103 86110 86111 86112 86113 86122 86130 86131 86132 8621 86221 86222 86229 86231 86232 86239 8629 8631 86330 86331 86339 86350 86351 86352 86353 86354 86355 86356 86359 86390 86391 86392 86393 86394 86395 86399 86400 86401 86402 86403 86404 86405 86409 86410 Fmt 4701 Sfmt 4702 E:\FR\FM\25APP2.SGM 25APP2 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules 24355 TABLE 6G.—ADDITIONS TO THE CC EXCLUSIONS LIST—Continued TABLE 6G.—ADDITIONS TO THE CC EXCLUSIONS LIST—Continued [CCs that are added to the list, effective October 1, 2006, are included in this table. Each of the principal diagnoses is shown with an asterisk, and the revisions to the CC Exclusions List are provided in an indented column immediately following the affected principal diagnosis.] wwhite on PROD1PC61 with PROPOSALS2 TABLE 6G.—ADDITIONS TO THE CC EXCLUSIONS LIST—Continued [CCs that are added to the list, effective October 1, 2006, are included in this table. Each of the principal diagnoses is shown with an asterisk, and the revisions to the CC Exclusions List are provided in an indented column immediately following the affected principal diagnosis.] [CCs that are added to the list, effective October 1, 2006, are included in this table. Each of the principal diagnoses is shown with an asterisk, and the revisions to the CC Exclusions List are provided in an indented column immediately following the affected principal diagnosis.] 86411 86412 86413 86414 86415 86419 86500 86501 86502 86503 86504 86509 86510 86511 86512 86513 86514 86519 86600 86601 86602 86603 86610 86611 86612 86613 8670 8671 8672 8673 8674 8675 8676 8677 8678 8679 86800 86801 86802 86803 86804 86809 86810 86811 86812 86813 86814 86819 8690 8691 8703 8704 8708 8709 8710 8711 8712 8713 8714 8719 87272 87273 87274 87333 8739 87400 VerDate Aug<31>2005 87401 87402 87410 87411 87412 8743 8745 8750 8751 8870 8871 8872 8873 8874 8875 8876 8877 8960 8961 8962 8963 8970 8971 8972 8973 8974 8975 8976 8977 90000 90001 90002 90003 9001 90081 90082 90089 9009 9010 9011 9012 9013 90141 90142 90183 9020 90210 90211 90219 90220 90222 90223 90224 90225 90226 90227 90229 90231 90232 90233 90234 90239 90240 90241 90242 90249 17:10 Apr 24, 2006 Jkt 208001 PO 00000 Frm 00361 90250 90251 90252 90253 90254 90259 90287 9251 9252 9290 95200 95201 95202 95203 95204 95205 95206 95207 95208 95209 95210 95211 95212 95213 95214 95215 95216 95217 95218 95219 9522 9523 9524 9528 9529 9530 9531 9532 9533 9534 9535 9538 9539 9580 9581 9582 9583 9584 9585 9587 *95899 80000 80001 80002 80003 80004 80005 80006 80009 80010 80011 80012 80013 80014 80015 80016 Fmt 4701 Sfmt 4702 E:\FR\FM\25APP2.SGM 25APP2 24356 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules TABLE 6G.—ADDITIONS TO THE CC EXCLUSIONS LIST—Continued TABLE 6G.—ADDITIONS TO THE CC EXCLUSIONS LIST—Continued [CCs that are added to the list, effective October 1, 2006, are included in this table. Each of the principal diagnoses is shown with an asterisk, and the revisions to the CC Exclusions List are provided in an indented column immediately following the affected principal diagnosis.] wwhite on PROD1PC61 with PROPOSALS2 TABLE 6G.—ADDITIONS TO THE CC EXCLUSIONS LIST—Continued [CCs that are added to the list, effective October 1, 2006, are included in this table. Each of the principal diagnoses is shown with an asterisk, and the revisions to the CC Exclusions List are provided in an indented column immediately following the affected principal diagnosis.] [CCs that are added to the list, effective October 1, 2006, are included in this table. Each of the principal diagnoses is shown with an asterisk, and the revisions to the CC Exclusions List are provided in an indented column immediately following the affected principal diagnosis.] 80019 80020 80021 80022 80023 80024 80025 80026 80029 80030 80031 80032 80033 80034 80035 80036 80039 80040 80041 80042 80043 80044 80045 80046 80049 80050 80051 80052 80053 80054 80055 80056 80059 80060 80061 80062 80063 80064 80065 80066 80069 80070 80071 80072 80073 80074 80075 80076 80079 80080 80081 80082 80083 80084 80085 80086 80089 80090 80091 80092 80093 80094 80095 80096 80099 80100 VerDate Aug<31>2005 80101 80102 80103 80104 80105 80106 80109 80110 80111 80112 80113 80114 80115 80116 80119 80120 80121 80122 80123 80124 80125 80126 80129 80130 80131 80132 80133 80134 80135 80136 80139 80140 80141 80142 80143 80144 80145 80146 80149 80150 80151 80152 80153 80154 80155 80156 80159 80160 80161 80162 80163 80164 80165 80166 80169 80170 80171 80172 80173 80174 80175 80176 80179 80180 80181 80182 17:10 Apr 24, 2006 Jkt 208001 PO 00000 Frm 00362 80183 80184 80185 80186 80189 80190 80191 80192 80193 80194 80195 80196 80199 8021 80220 80221 80222 80223 80224 80225 80226 80227 80228 80229 80230 80231 80232 80233 80234 80235 80236 80237 80238 80239 8024 8025 8026 8027 8028 8029 80300 80301 80302 80303 80304 80305 80306 80309 80310 80311 80312 80313 80314 80315 80316 80319 80320 80321 80322 80323 80324 80325 80326 80329 80330 80331 Fmt 4701 Sfmt 4702 E:\FR\FM\25APP2.SGM 25APP2 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules 24357 TABLE 6G.—ADDITIONS TO THE CC EXCLUSIONS LIST—Continued TABLE 6G.—ADDITIONS TO THE CC EXCLUSIONS LIST—Continued [CCs that are added to the list, effective October 1, 2006, are included in this table. Each of the principal diagnoses is shown with an asterisk, and the revisions to the CC Exclusions List are provided in an indented column immediately following the affected principal diagnosis.] wwhite on PROD1PC61 with PROPOSALS2 TABLE 6G.—ADDITIONS TO THE CC EXCLUSIONS LIST—Continued [CCs that are added to the list, effective October 1, 2006, are included in this table. Each of the principal diagnoses is shown with an asterisk, and the revisions to the CC Exclusions List are provided in an indented column immediately following the affected principal diagnosis.] [CCs that are added to the list, effective October 1, 2006, are included in this table. Each of the principal diagnoses is shown with an asterisk, and the revisions to the CC Exclusions List are provided in an indented column immediately following the affected principal diagnosis.] 80332 80333 80334 80335 80336 80339 80340 80341 80342 80343 80344 80345 80346 80349 80350 80351 80352 80353 80354 80355 80356 80359 80360 80361 80362 80363 80364 80365 80366 80369 80370 80371 80372 80373 80374 80375 80376 80379 80380 80381 80382 80383 80384 80385 80386 80389 80390 80391 80392 80393 80394 80395 80396 80399 80400 80401 80402 80403 80404 80405 80406 80409 80410 80411 80412 80413 VerDate Aug<31>2005 80414 80415 80416 80419 80420 80421 80422 80423 80424 80425 80426 80429 80430 80431 80432 80433 80434 80435 80436 80439 80440 80441 80442 80443 80444 80445 80446 80449 80450 80451 80452 80453 80454 80455 80456 80459 80460 80461 80462 80463 80464 80465 80466 80469 80470 80471 80472 80473 80474 80475 80476 80479 80480 80481 80482 80483 80484 80485 80486 80489 80490 80491 80492 80493 80494 80495 17:10 Apr 24, 2006 Jkt 208001 PO 00000 Frm 00363 80496 80499 80500 80501 80502 80503 80504 80505 80506 80507 80508 80510 80511 80512 80513 80514 80515 80516 80517 80518 8052 8053 8054 8055 8056 8057 8058 8059 80600 80601 80602 80603 80604 80605 80606 80607 80608 80609 80610 80611 80612 80613 80614 80615 80616 80617 80618 80619 80620 80621 80622 80623 80624 80625 80626 80627 80628 80629 80630 80631 80632 80633 80634 80635 80636 80637 Fmt 4701 Sfmt 4702 E:\FR\FM\25APP2.SGM 25APP2 24358 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules TABLE 6G.—ADDITIONS TO THE CC EXCLUSIONS LIST—Continued TABLE 6G.—ADDITIONS TO THE CC EXCLUSIONS LIST—Continued [CCs that are added to the list, effective October 1, 2006, are included in this table. Each of the principal diagnoses is shown with an asterisk, and the revisions to the CC Exclusions List are provided in an indented column immediately following the affected principal diagnosis.] wwhite on PROD1PC61 with PROPOSALS2 TABLE 6G.—ADDITIONS TO THE CC EXCLUSIONS LIST—Continued [CCs that are added to the list, effective October 1, 2006, are included in this table. Each of the principal diagnoses is shown with an asterisk, and the revisions to the CC Exclusions List are provided in an indented column immediately following the affected principal diagnosis.] [CCs that are added to the list, effective October 1, 2006, are included in this table. Each of the principal diagnoses is shown with an asterisk, and the revisions to the CC Exclusions List are provided in an indented column immediately following the affected principal diagnosis.] 80638 80639 8064 8065 80660 80661 80662 80669 80670 80671 80672 80679 8068 8069 80704 80705 80706 80707 80708 80709 80710 80711 80712 80713 80714 80715 80716 80717 80718 80719 8072 8073 8074 8075 8076 8080 8081 8082 8083 80843 80849 80851 80852 80853 80859 8088 8089 82000 82001 82002 82003 82009 82010 82011 82012 82013 82019 82020 82021 82022 82030 82031 82032 8208 8209 82100 VerDate Aug<31>2005 82101 82110 82111 83900 83901 83902 83903 83904 83905 83906 83907 83908 83910 83911 83912 83913 83914 83915 83916 83917 83918 8500 85011 85012 8502 8503 8504 8505 8509 85100 85101 85102 85103 85104 85105 85106 85109 85110 85111 85112 85113 85114 85115 85116 85119 85120 85121 85122 85123 85124 85125 85126 85129 85130 85131 85132 85133 85134 85135 85136 85139 85140 85141 85142 85143 85144 17:10 Apr 24, 2006 Jkt 208001 PO 00000 Frm 00364 85145 85146 85149 85150 85151 85152 85153 85154 85155 85156 85159 85160 85161 85162 85163 85164 85165 85166 85169 85170 85171 85172 85173 85174 85175 85176 85179 85180 85181 85182 85183 85184 85185 85186 85189 85190 85191 85192 85193 85194 85195 85196 85199 85200 85201 85202 85203 85204 85205 85206 85209 85210 85211 85212 85213 85214 85215 85216 85219 85220 85221 85222 85223 85224 85225 85226 Fmt 4701 Sfmt 4702 E:\FR\FM\25APP2.SGM 25APP2 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules 24359 TABLE 6G.—ADDITIONS TO THE CC EXCLUSIONS LIST—Continued TABLE 6G.—ADDITIONS TO THE CC EXCLUSIONS LIST—Continued [CCs that are added to the list, effective October 1, 2006, are included in this table. Each of the principal diagnoses is shown with an asterisk, and the revisions to the CC Exclusions List are provided in an indented column immediately following the affected principal diagnosis.] wwhite on PROD1PC61 with PROPOSALS2 TABLE 6G.—ADDITIONS TO THE CC EXCLUSIONS LIST—Continued [CCs that are added to the list, effective October 1, 2006, are included in this table. Each of the principal diagnoses is shown with an asterisk, and the revisions to the CC Exclusions List are provided in an indented column immediately following the affected principal diagnosis.] [CCs that are added to the list, effective October 1, 2006, are included in this table. Each of the principal diagnoses is shown with an asterisk, and the revisions to the CC Exclusions List are provided in an indented column immediately following the affected principal diagnosis.] 85229 85230 85231 85232 85233 85234 85235 85236 85239 85240 85241 85242 85243 85244 85245 85246 85249 85250 85251 85252 85253 85254 85255 85256 85259 85300 85301 85302 85303 85304 85305 85306 85309 85310 85311 85312 85313 85314 85315 85316 85319 85400 85401 85402 85403 85404 85405 85406 85409 85410 85411 85412 85413 85414 85415 85416 85419 8600 8601 8602 8603 8604 8605 86101 86102 86103 VerDate Aug<31>2005 86110 86111 86112 86113 86122 86130 86131 86132 8621 86221 86222 86229 86231 86232 86239 8629 8631 86330 86331 86339 86350 86351 86352 86353 86354 86355 86356 86359 86390 86391 86392 86393 86394 86395 86399 86400 86401 86402 86403 86404 86405 86409 86410 86411 86412 86413 86414 86415 86419 86500 86501 86502 86503 86504 86509 86510 86511 86512 86513 86514 86519 86600 86601 86602 86603 86610 17:10 Apr 24, 2006 Jkt 208001 PO 00000 Frm 00365 86611 86612 86613 8670 8671 8672 8673 8674 8675 8676 8677 8678 8679 86800 86801 86802 86803 86804 86809 86810 86811 86812 86813 86814 86819 8690 8691 8703 8704 8708 8709 8710 8711 8712 8713 8714 8719 87272 87273 87274 87333 8739 87400 87401 87402 87410 87411 87412 8743 8745 8750 8751 8870 8871 8872 8873 8874 8875 8876 8877 8960 8961 8962 8963 8970 8971 Fmt 4701 Sfmt 4702 E:\FR\FM\25APP2.SGM 25APP2 24360 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules TABLE 6G.—ADDITIONS TO THE CC EXCLUSIONS LIST—Continued TABLE 6H.—DELETIONS FROM THE CC EXCLUSIONS LIST—Continued [CCs that are added to the list, effective October 1, 2006, are included in this table. Each of the principal diagnoses is shown with an asterisk, and the revisions to the CC Exclusions List are provided in an indented column immediately following the affected principal diagnosis.] wwhite on PROD1PC61 with PROPOSALS2 TABLE 6G.—ADDITIONS TO THE CC EXCLUSIONS LIST—Continued [CCs that are added to the list, effective October 1, 2006, are included in this table. Each of the principal diagnoses is shown with an asterisk, and the revisions to the CC Exclusions List are provided in an indented column immediately following the affected principal diagnosis.] [CCs that are deleted from the list, effective October 1, 2006, are included in this table. Each of the principal diagnoses is shown with an asterisk, and the revisions to the CC Exclusions List are provided in an indented column immediately following the affected principal diagnosis.] 8972 8973 8974 8975 8976 8977 90000 90001 90002 90003 9001 90081 90082 90089 9009 9010 9011 9012 9013 90141 90142 90183 9020 90210 90211 90219 90220 90222 90223 90224 90225 90226 90227 90229 90231 90232 90233 90234 90239 90240 90241 90242 90249 90250 90251 90252 90253 90254 90259 90287 9251 9252 9290 95200 95201 95202 95203 95204 95205 95206 95207 95208 95209 95210 95211 95212 VerDate Aug<31>2005 95213 95214 95215 95216 95217 95218 95219 9522 9523 9524 9528 9529 9530 9531 9532 9533 9534 9535 9538 9539 9580 9581 9582 9583 9584 9585 9587 *9973 5187 *99791 5187 *99799 5187 *99881 5187 *99883 5187 *99889 5187 *9989 5187 TABLE 6H.—DELETIONS FROM THE CC EXCLUSIONS LIST [CCs that are deleted from the list, effective October 1, 2006, are included in this table. Each of the principal diagnoses is shown with an asterisk, and the revisions to the CC Exclusions List are provided in an indented column immediately following the affected principal diagnosis.] *2800 2840 *2801 2840 *2808 2840 *2809 2840 *2810 2840 *2811 2840 *2812 17:10 Apr 24, 2006 Jkt 208001 PO 00000 Frm 00366 Fmt 4701 Sfmt 4702 2840 *2813 2840 *2814 2840 *2818 2840 *2819 2840 *2820 2840 *2821 2840 *2822 2840 *2823 2840 *28241 2840 *28242 2840 *28249 2840 *2825 2840 *28260 2840 *28261 2840 *28262 2840 *28263 2840 *28264 2840 *28268 2840 *28269 2840 *2827 2840 *2828 2840 *2829 2840 *2830 2840 *28310 2840 *28311 2840 *28319 2840 *2832 2840 *2839 2840 *2840 2800 2814 2818 28241 28242 28249 28260 28261 E:\FR\FM\25APP2.SGM 25APP2 24361 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules TABLE 6H.—DELETIONS FROM THE CC TABLE 6H.—DELETIONS FROM THE CC TABLE 6H.—DELETIONS FROM THE CC EXCLUSIONS LIST—Continued EXCLUSIONS LIST—Continued EXCLUSIONS LIST—Continued [CCs that are deleted from the list, effective October 1, 2006, are included in this table. Each of the principal diagnoses is shown with an asterisk, and the revisions to the CC Exclusions List are provided in an indented column immediately following the affected principal diagnosis.] 28262 28263 28264 28268 28269 2830 28310 28311 28319 2832 2839 2840 2848 2849 2850 2851 *2848 2840 *2849 2840 *2850 2840 *2851 2840 *28521 2840 *28522 2840 *28529 2840 *2858 2840 *2859 2840 [CCs that are deleted from the list, effective October 1, 2006, are included in this table. Each of the principal diagnoses is shown with an asterisk, and the revisions to the CC Exclusions List are provided in an indented column immediately following the affected principal diagnosis.] *2880 2880 2881 28981 28982 *2881 2880 *2882 2880 *2883 2880 *2888 2880 *2889 2880 *28981 2840 2880 *28982 2840 2880 *28989 2840 2880 *2899 2840 2880 *3230 34982 *3234 34982 *3235 34982 *3236 [CCs that are deleted from the list, effective October 1, 2006, are included in this table. Each of the principal diagnoses is shown with an asterisk, and the revisions to the CC Exclusions List are provided in an indented column immediately following the affected principal diagnosis.] 34982 *3237 34982 *3238 34982 *3337 7817 *5173 2840 *5191 51900 51901 51902 51909 *5280 5283 *6168 6140 6143 6145 6150 6163 6164 *6298 6140 6143 6145 6150 6163 6164 6207 TABLE 7A.—MEDICARE PROSPECTIVE PAYMENT SYSTEM SELECTED PERCENTILE LENGTHS OF STAY FY 2005 MEDPAR UPDATE DECEMBER 2005 GROUPER V23.0 Number of discharges wwhite on PROD1PC61 with PROPOSALS2 DRG 1 ................................... 2 ................................... 3 ................................... 6 ................................... 7 ................................... 8 ................................... 9 ................................... 10 ................................. 11 ................................. 12 ................................. 13 ................................. 14 ................................. 15 ................................. 16 ................................. 17 ................................. 18 ................................. 19 ................................. 20 ................................. 21 ................................. 22 ................................. 23 ................................. 24 ................................. 25 ................................. 26 ................................. 27 ................................. VerDate Aug<31>2005 17:10 Apr 24, 2006 24,336 10,279 2 291 14,913 3,415 1,761 19,577 3,075 56,255 7,499 278,220 20,045 17,338 2,968 33,376 8,423 6,408 2,205 3,151 10,668 63,283 27,276 24 5,925 Jkt 208001 Arithmetic mean length-of-stay 10th percentile 9.6056 4.3955 12.5000 3.0619 9.2679 2.7628 6.0023 5.9190 3.5463 5.3867 4.8481 5.3760 4.0130 6.2840 3.0387 5.1560 3.3765 9.8262 6.2036 5.0232 3.8978 4.6436 3.1226 3.7917 4.7406 PO 00000 Frm 00367 25th percentile 2 1 4 1 2 1 1 2 1 2 2 2 1 2 1 2 1 3 2 2 1 1 1 1 1 Fmt 4701 Sfmt 4702 50th percentile 4 2 4 1 4 1 3 3 2 3 3 3 2 3 1 3 2 5 3 2 2 2 2 1 1 E:\FR\FM\25APP2.SGM 75th percentile 7 4 21 2 7 2 4 4 3 4 4 4 3 5 2 4 3 8 5 4 3 3 3 2 3 25APP2 90th percentile 12 6 21 4 12 3 7 7 5 6 6 7 5 8 4 6 4 13 8 6 5 6 4 5 6 19 8 21 7 19 6 11 12 7 10 8 10 8 12 6 10 6 19 12 10 7 9 6 9 10 24362 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules TABLE 7A.—MEDICARE PROSPECTIVE PAYMENT SYSTEM SELECTED PERCENTILE LENGTHS OF STAY FY 2005 MEDPAR UPDATE DECEMBER 2005 GROUPER V23.0—Continued Number of discharges wwhite on PROD1PC61 with PROPOSALS2 DRG 28 ................................. 29 ................................. 31 ................................. 32 ................................. 34 ................................. 35 ................................. 36 ................................. 37 ................................. 38 ................................. 39 ................................. 40 ................................. 42 ................................. 43 ................................. 44 ................................. 45 ................................. 46 ................................. 47 ................................. 49 ................................. 50 ................................. 51 ................................. 52 ................................. 53 ................................. 55 ................................. 56 ................................. 57 ................................. 59 ................................. 60 ................................. 61 ................................. 62 ................................. 63 ................................. 64 ................................. 65 ................................. 66 ................................. 67 ................................. 68 ................................. 69 ................................. 70 ................................. 71 ................................. 72 ................................. 73 ................................. 74 ................................. 75 ................................. 76 ................................. 77 ................................. 78 ................................. 79 ................................. 80 ................................. 81 ................................. 82 ................................. 83 ................................. 84 ................................. 85 ................................. 86 ................................. 87 ................................. 88 ................................. 89 ................................. 90 ................................. 91 ................................. 92 ................................. 93 ................................. 94 ................................. 95 ................................. 96 ................................. 97 ................................. 98 ................................. 99 ................................. 100 ............................... 101 ............................... 102 ............................... VerDate Aug<31>2005 17:10 Apr 24, 2006 19,839 6,500 4,967 1,857 27,466 7,830 1,207 1,233 49 362 1,252 941 123 1,311 2,766 3,942 1,322 2,415 2,025 192 317 2,138 1,367 450 881 127 3 222 4 2,826 3,252 40,702 8,210 379 19,066 5,201 23 71 1,341 9,967 3 46,673 47,942 2,086 49,512 160,409 7,190 6 63,099 7,053 1,379 22,193 1,726 96,631 427,997 555,221 43,748 53 16,534 1,446 13,561 1,568 60,151 27,006 13 21,448 6,432 23,374 4,920 Jkt 208001 Arithmetic mean length-of-stay 10th percentile 5.5783 3.2209 3.9088 2.2752 4.7076 3.0425 1.6694 4.0706 2.8367 2.0193 4.1262 3.0595 2.9431 4.7414 3.0387 4.1870 3.0242 4.5172 1.8652 2.6979 1.7003 3.9995 2.8983 2.6800 3.1510 2.3780 1.6667 6.0541 1.5000 4.5467 6.2232 2.7629 3.1097 3.6992 3.8447 2.9435 2.3478 4.3380 3.3057 4.2892 3.3333 9.5853 10.4748 4.5005 6.0951 8.0438 5.2405 6.1667 6.6687 5.1999 3.1407 6.1053 3.4936 6.3599 4.8483 5.5216 3.7105 3.4151 5.9330 3.7420 5.8975 3.3846 4.2912 3.3549 3.0769 3.1000 2.1206 4.1844 2.5317 PO 00000 Frm 00368 25th percentile 1 1 1 1 1 1 1 1 1 1 1 1 1 2 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 3 3 3 1 2 3 2 2 2 2 1 2 1 2 2 2 2 1 2 1 2 1 2 1 2 1 1 1 1 Fmt 4701 Sfmt 4702 50th percentile 2 1 2 1 2 1 1 1 1 1 1 1 1 3 2 2 1 2 1 1 1 1 1 1 1 1 1 1 1 1 2 1 1 2 2 2 1 2 2 2 3 5 5 2 4 4 3 3 3 3 2 3 2 3 3 3 2 1 3 2 3 2 2 2 2 1 1 2 1 E:\FR\FM\25APP2.SGM 75th percentile 4 3 3 2 4 3 1 3 2 1 4 2 2 4 2 3 2 3 1 1 1 2 2 2 2 2 1 4 1 3 4 2 2 3 3 3 2 3 3 3 3 7 8 4 5 7 4 5 5 4 3 5 3 5 4 5 3 2 5 3 5 3 4 3 2 2 2 3 2 25APP2 90th percentile 7 4 5 3 6 4 1 5 3 2 5 4 4 6 4 5 4 5 2 3 2 5 3 3 3 3 3 8 1 6 8 3 4 5 5 4 3 5 4 5 4 12 13 6 7 10 7 8 9 6 4 8 5 8 6 7 5 4 7 5 8 4 5 4 4 4 3 5 3 11 6 7 4 9 6 3 9 6 4 7 7 5 9 6 8 6 9 3 6 3 9 6 5 7 5 3 13 3 10 13 5 6 8 7 5 4 8 6 8 4 19 19 9 10 15 10 8 13 10 6 12 7 12 9 10 6 6 11 7 12 6 8 6 6 6 4 8 5 24363 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules TABLE 7A.—MEDICARE PROSPECTIVE PAYMENT SYSTEM SELECTED PERCENTILE LENGTHS OF STAY FY 2005 MEDPAR UPDATE DECEMBER 2005 GROUPER V23.0—Continued Number of discharges wwhite on PROD1PC61 with PROPOSALS2 DRG 103 104 105 106 108 110 111 113 114 117 118 119 120 121 122 123 124 125 126 127 128 129 130 131 132 133 134 135 136 138 139 140 141 142 143 144 145 146 147 148 149 150 151 152 153 154 155 156 157 158 159 160 161 162 163 164 165 166 167 168 169 170 171 172 173 174 175 176 177 ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... VerDate Aug<31>2005 17:10 Apr 24, 2006 859 20,084 32,527 3,427 8,740 57,543 10,746 34,591 7,940 5,332 7,631 965 33,340 150,106 54,557 29,530 120,235 92,072 5,417 668,008 4,229 3,511 87,632 22,947 101,483 5,883 40,294 7,172 936 206,196 74,082 31,544 123,475 49,367 238,376 104,952 5,728 10,226 2,608 132,689 19,473 22,894 5,368 5,000 1,947 26,973 5,995 4 8,294 3,710 19,181 11,929 10,141 4,954 4 5,972 2,447 5,128 4,877 1,532 772 17,895 1,404 33,137 2,230 261,063 29,906 14,599 7,657 Jkt 208001 Arithmetic mean length-of-stay 10th percentile 34.9488 14.6532 9.9333 10.9311 10.7237 8.0134 3.1084 12.5649 8.3304 4.2815 3.0250 5.3751 8.9613 6.2060 3.3059 4.7386 4.3915 2.7033 10.6799 5.0818 5.1726 2.5483 5.3553 3.6999 2.7988 2.1321 3.0936 4.2876 2.6880 3.8775 2.4272 2.4063 3.4314 2.4888 2.0951 5.8085 2.5513 9.7570 5.5498 11.9313 5.6473 10.7215 5.0183 7.9332 4.8639 12.9702 3.9585 9.2500 5.6907 2.6447 5.0884 2.6554 4.5089 2.0838 2.7500 7.6911 4.0016 4.3235 2.1300 4.8570 2.3964 10.7070 4.1695 6.7936 3.5309 4.6851 2.8557 5.0884 4.4324 PO 00000 Frm 00369 25th percentile 8 6 4 5 4 1 1 4 2 1 1 1 1 2 1 1 1 1 3 2 2 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 4 2 5 3 4 1 3 2 3 1 7 1 1 1 1 1 1 1 3 2 1 1 1 1 2 1 2 1 2 1 2 2 Fmt 4701 Sfmt 4702 50th percentile 11 8 6 7 6 3 1 6 4 1 1 1 3 3 1 1 2 1 6 3 3 1 3 2 1 1 2 2 1 2 1 1 2 1 1 2 1 6 4 6 4 6 2 5 3 6 2 7 2 1 2 1 2 1 1 4 2 2 1 2 1 5 2 3 1 3 2 3 2 E:\FR\FM\25APP2.SGM 75th percentile 22 12 8 9 9 6 2 10 7 2 2 3 6 5 3 3 3 2 9 4 5 1 4 3 2 2 2 3 2 3 2 2 3 2 2 4 2 8 5 9 5 9 4 7 5 10 3 8 4 2 4 2 3 2 2 7 4 3 2 3 2 8 3 5 3 4 2 4 4 25APP2 90th percentile 45 18 11 13 13 10 5 15 11 5 4 7 12 8 4 6 6 3 13 6 6 2 7 5 3 3 4 5 3 5 3 3 4 3 3 7 3 11 7 15 7 13 7 9 6 16 6 8 7 3 6 3 6 3 3 9 5 5 3 6 3 13 5 8 4 6 4 6 5 76 26 18 18 20 16 6 24 16 9 7 13 19 12 6 11 9 5 20 9 9 5 10 6 5 4 6 8 5 7 4 4 6 5 4 12 5 17 9 22 8 19 9 14 7 25 8 14 11 5 10 5 9 4 5 13 7 8 4 10 5 21 8 13 7 8 5 9 8 24364 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules TABLE 7A.—MEDICARE PROSPECTIVE PAYMENT SYSTEM SELECTED PERCENTILE LENGTHS OF STAY FY 2005 MEDPAR UPDATE DECEMBER 2005 GROUPER V23.0—Continued Number of discharges wwhite on PROD1PC61 with PROPOSALS2 DRG 178 179 180 181 182 183 184 185 186 187 188 189 190 191 192 193 194 195 196 197 198 199 200 201 202 203 204 205 206 207 208 210 211 212 213 216 217 218 219 220 223 224 225 226 227 228 229 230 232 233 234 235 236 237 238 239 240 241 242 243 244 245 246 247 248 249 250 251 252 ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... VerDate Aug<31>2005 17:10 Apr 24, 2006 2,550 14,661 91,338 25,241 297,097 81,861 76 6,243 7 645 93,582 13,160 63 10,550 1,376 4,039 463 2,835 595 16,352 4,110 1,478 1,014 2,707 27,516 32,333 69,207 32,741 2,042 38,339 9,538 126,376 25,712 10 9,459 19,928 15,593 29,975 21,059 2 12,649 9,937 6,246 6,736 4,868 2,680 1,123 2,459 568 18,412 9,074 4,753 41,727 1,918 9,766 40,272 12,903 2,833 2,729 100,743 17,027 5,905 1,407 21,432 16,495 13,445 4,144 2,068 1 Jkt 208001 Arithmetic mean length-of-stay 10th percentile 3.0761 5.7827 5.2551 3.3112 4.4814 2.8942 4.3421 4.4810 3.1429 4.2016 5.4542 3.0575 4.8730 12.3736 5.5094 12.5519 6.3672 10.5661 5.3647 9.0237 4.3275 9.0068 10.3156 13.5670 6.1369 6.4419 5.3851 5.8448 3.7958 5.2460 2.9494 6.6274 4.5900 2.5000 8.9875 5.3145 12.1150 5.3809 3.1663 4.0000 3.2641 1.9359 5.2730 6.3550 2.6313 4.1981 2.4880 5.4254 2.7394 6.3241 2.6676 4.6749 4.4100 3.7873 8.0468 6.0349 6.4095 3.6287 6.4723 4.4942 4.4384 3.1160 3.5586 3.2912 4.8125 3.9212 3.8446 2.7964 1.0000 PO 00000 Frm 00370 25th percentile 1 2 2 1 1 1 1 1 1 1 1 1 1 3 1 5 2 4 2 3 2 2 1 3 2 2 2 2 1 1 1 3 3 1 2 1 3 2 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 2 2 2 1 2 1 1 1 1 1 2 1 1 1 1 Fmt 4701 Sfmt 4702 50th percentile 2 3 3 2 2 1 2 2 2 2 2 1 2 6 3 7 4 6 3 5 3 4 3 6 3 3 3 3 2 2 1 4 3 2 4 1 5 3 2 1 1 1 2 3 1 1 1 2 1 2 1 2 3 2 4 3 3 2 3 2 2 1 2 2 3 1 2 1 1 E:\FR\FM\25APP2.SGM 75th percentile 3 4 4 3 3 2 3 3 2 3 4 2 3 9 5 10 6 9 5 7 4 7 7 10 5 5 4 4 3 4 2 5 4 2 7 3 8 4 3 7 2 1 4 4 2 3 2 4 2 5 1 4 4 3 6 5 5 3 5 4 4 3 3 3 4 3 3 3 1 25APP2 90th percentile 4 7 6 4 6 4 4 6 3 6 7 4 6 15 7 15 8 13 7 11 5 12 13 17 8 8 6 7 5 7 4 8 5 4 11 7 15 7 4 7 4 2 7 8 3 5 3 7 3 8 3 6 5 5 10 7 8 4 8 6 6 4 4 4 6 5 5 3 1 5 11 10 6 8 5 8 9 5 8 11 6 8 25 9 23 11 18 10 16 7 19 21 27 12 13 10 12 7 10 6 11 7 4 18 13 24 10 5 7 7 3 11 13 5 9 5 11 6 13 6 8 8 7 15 11 12 6 12 8 8 6 7 6 9 8 7 5 1 24365 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules TABLE 7A.—MEDICARE PROSPECTIVE PAYMENT SYSTEM SELECTED PERCENTILE LENGTHS OF STAY FY 2005 MEDPAR UPDATE DECEMBER 2005 GROUPER V23.0—Continued Number of discharges wwhite on PROD1PC61 with PROPOSALS2 DRG 253 254 255 256 257 258 259 260 261 262 263 264 265 266 267 268 269 270 271 272 273 274 275 276 277 278 279 280 281 283 284 285 286 287 288 289 290 291 292 293 294 295 296 297 298 299 300 301 302 303 304 305 306 307 308 309 310 311 312 313 314 315 316 317 318 319 320 321 322 ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... VerDate Aug<31>2005 17:10 Apr 24, 2006 24,751 9,993 1 7,608 13,094 11,391 2,658 2,432 1,570 599 22,466 3,905 4,011 2,221 273 994 11,015 2,568 21,705 6,079 1,267 2,242 180 1,623 119,318 33,958 6 19,321 6,560 6,782 1,870 8,034 2,859 5,418 11,270 6,334 11,872 59 7,563 319 97,793 4,360 247,607 42,717 110 1,544 21,677 3,920 10,267 24,561 14,043 3,003 5,792 1,943 6,673 3,268 25,310 5,873 1,322 502 2 34,708 204,595 2,698 5,901 386 225,362 32,132 67 Jkt 208001 Arithmetic mean length-of-stay 10th percentile 4.5342 3.0679 1.0000 4.9628 2.5466 1.6969 2.8503 1.4030 2.1949 4.6194 10.4537 6.2453 6.5410 3.0360 4.2125 3.6579 7.9966 3.5927 6.7812 5.8138 3.7119 6.1704 3.2056 4.6161 5.4224 3.9963 4.1667 3.9877 2.8002 4.5823 2.9128 9.8114 5.1784 9.5314 3.7031 2.3892 2.0299 1.4915 10.0186 4.6865 4.2386 3.6961 4.6431 3.0296 3.5545 5.1101 5.8069 3.3571 7.9781 7.2806 8.3545 3.1052 5.5830 2.0314 6.1560 1.9819 4.4992 1.8502 4.9448 2.3845 89.0000 6.7296 6.1566 3.4959 5.9548 2.5466 4.9903 3.5412 3.5821 PO 00000 Frm 00371 25th percentile 2 1 1 1 1 1 1 1 1 1 3 2 1 1 1 1 2 1 2 2 1 1 1 1 2 2 2 1 1 1 1 3 2 3 1 1 1 1 2 1 1 1 1 1 1 1 2 1 4 3 2 1 1 1 1 1 1 1 1 1 5 1 2 1 1 1 2 1 2 Fmt 4701 Sfmt 4702 50th percentile 3 2 1 2 1 1 1 1 1 2 5 3 2 1 1 1 3 1 3 3 2 3 1 2 3 2 3 2 1 2 1 5 2 5 2 1 1 1 4 2 2 2 2 2 1 2 3 2 5 4 3 2 2 1 2 1 2 1 2 1 5 1 3 1 3 1 3 2 2 E:\FR\FM\25APP2.SGM 4 3 1 4 2 1 1 1 1 3 7 5 4 2 3 2 6 3 5 4 3 5 2 4 4 3 5 3 2 3 2 8 4 7 3 1 1 1 8 3 3 3 4 3 2 4 5 3 6 6 6 3 3 2 4 1 3 1 3 2 173 4 5 2 4 2 4 3 3 25APP2 75th percentile 5 4 1 6 3 2 3 1 2 6 13 7 8 4 5 4 10 5 8 7 5 8 4 6 7 5 5 5 4 6 4 12 6 11 4 2 2 1 12 6 5 4 6 4 4 6 7 4 9 8 10 4 8 2 8 2 6 2 6 3 173 9 8 4 8 3 6 4 4 90th percentile 8 5 1 9 5 3 7 2 4 9 20 11 14 6 9 7 15 7 12 11 7 12 7 8 10 7 5 7 5 9 5 18 10 17 6 5 3 2 19 9 8 7 9 5 6 10 11 6 14 14 17 6 13 3 14 4 10 3 11 5 173 16 12 7 12 5 9 6 6 24366 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules TABLE 7A.—MEDICARE PROSPECTIVE PAYMENT SYSTEM SELECTED PERCENTILE LENGTHS OF STAY FY 2005 MEDPAR UPDATE DECEMBER 2005 GROUPER V23.0—Continued Number of discharges wwhite on PROD1PC61 with PROPOSALS2 DRG 323 324 325 326 327 328 329 331 332 333 334 335 336 337 338 339 340 341 342 344 345 346 347 348 349 350 352 353 354 355 356 357 358 359 360 361 362 363 364 365 366 367 368 369 370 371 372 373 374 375 376 377 378 379 380 381 382 383 384 387 389 392 394 395 396 397 398 399 401 ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... VerDate Aug<31>2005 17:10 Apr 24, 2006 20,435 4,625 9,915 2,596 11 574 55 56,928 4,148 242 9,483 12,125 28,106 21,429 670 1,226 1 3,118 455 2,346 1,393 4,007 247 4,275 556 7,277 1,176 3,076 7,559 4,995 22,243 5,525 20,877 28,606 14,265 288 2 1,979 1,367 1,607 4,664 449 4,156 3,783 2,212 2,662 1,355 5,213 153 13 474 111 204 486 111 172 51 2,816 147 1 3 2,121 2,760 115,737 20 16,460 18,608 1,644 6,443 Jkt 208001 Arithmetic mean length-of-stay 10th percentile 3.1085 1.8461 3.7382 2.5559 2.0000 3.3885 1.6727 5.4050 3.0668 5.3719 4.0363 2.4941 3.2238 1.8439 5.7910 5.1835 2.0000 3.2049 3.0440 2.7289 5.4113 5.8982 2.7126 4.0044 2.6529 4.5139 4.1896 6.0039 5.5536 3.0162 1.8699 8.0443 3.8586 2.3498 2.5481 2.9688 1.0000 4.0889 4.1895 7.8363 6.2281 3.0356 6.3780 3.2495 5.0190 3.3933 3.4635 2.2486 2.9739 6.2308 3.2911 4.4414 2.1716 3.1914 1.9910 2.4186 1.4510 3.6364 2.4966 9.0000 2.0000 8.8237 7.2779 4.2702 2.9500 5.1170 5.7065 3.3802 11.0118 PO 00000 Frm 00372 25th percentile 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 2 1 1 1 1 2 1 1 1 2 1 2 2 2 1 3 2 1 1 1 1 1 1 2 2 1 2 1 2 2 2 1 2 1 1 1 1 1 1 1 1 1 1 9 1 2 1 1 1 1 2 1 2 Fmt 4701 Sfmt 4702 50th percentile 1 1 2 1 1 1 1 2 1 2 2 2 1 1 2 2 2 1 1 1 2 3 1 2 1 2 2 3 3 2 1 4 2 2 1 1 1 2 2 3 3 1 3 1 3 3 2 2 2 2 2 2 1 1 1 1 1 1 1 9 1 4 2 2 2 2 3 2 5 E:\FR\FM\25APP2.SGM 75th percentile 2 1 3 2 2 3 1 4 2 4 3 2 2 2 4 3 2 1 2 1 3 4 2 3 2 4 3 4 4 3 2 6 3 2 2 2 1 2 3 5 5 2 5 2 4 3 2 2 2 3 2 3 2 2 1 1 1 2 1 9 2 6 5 3 3 4 4 3 8 25APP2 90th percentile 4 2 5 3 2 4 2 7 4 6 5 3 4 2 8 7 2 3 3 3 7 7 4 5 3 6 5 7 6 3 2 10 4 3 3 3 1 4 5 10 8 4 8 4 5 4 3 3 3 7 4 6 3 3 2 2 1 4 3 9 3 11 9 5 3 6 7 4 14 6 3 7 5 3 7 3 10 6 10 7 4 7 3 13 11 2 7 6 7 12 11 6 8 5 8 9 11 10 4 3 15 7 3 4 7 1 9 8 16 12 6 12 6 7 4 5 3 4 15 7 9 4 6 4 5 3 7 4 9 3 19 16 8 4 10 11 6 22 24367 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules TABLE 7A.—MEDICARE PROSPECTIVE PAYMENT SYSTEM SELECTED PERCENTILE LENGTHS OF STAY FY 2005 MEDPAR UPDATE DECEMBER 2005 GROUPER V23.0—Continued Number of discharges wwhite on PROD1PC61 with PROPOSALS2 DRG 402 403 404 406 407 408 409 410 411 412 413 414 415 416 417 418 419 420 421 422 423 424 425 426 427 428 429 430 431 432 433 439 440 441 442 443 444 445 447 449 450 451 452 453 454 455 461 462 463 464 465 466 467 468 471 473 475 476 477 479 480 481 482 484 485 486 487 488 489 ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... VerDate Aug<31>2005 17:10 Apr 24, 2006 1,341 31,520 3,629 2,301 608 1,941 1,735 29,030 5 8 5,728 481 55,707 287,777 33 29,900 17,739 3,054 13,253 77 9,078 1,034 13,110 4,246 1,575 831 24,106 75,207 338 401 5,146 1,750 5,181 687 18,533 3,572 6,005 2,261 6,342 40,821 7,412 2 28,666 5,381 4,755 885 2,271 7,873 32,987 7,681 171 1,250 1,037 51,814 16,680 8,558 119,967 2,841 28,081 27,608 884 1,183 5,078 456 3,658 2,607 4,878 823 13,668 Jkt 208001 Arithmetic mean length-of-stay 10th percentile 3.8926 7.8447 3.9862 9.4198 3.5049 8.1891 5.9873 3.7625 2.0000 1.5000 6.7263 4.0520 14.0947 7.4539 6.5455 6.0648 4.3418 3.1673 4.0073 3.6753 8.0063 11.3598 3.4657 4.3243 4.6387 7.2972 5.5073 7.7972 6.8402 4.0449 2.9195 8.5280 8.1670 3.4731 8.6498 3.5269 4.0206 2.8178 2.5732 3.6926 1.9899 10.5000 4.9275 2.7640 4.1085 2.3017 5.5685 9.5382 3.8751 2.9046 3.6023 4.7560 2.6914 12.5399 4.8562 12.4167 10.6391 9.9335 8.5088 2.5529 19.1618 22.0211 11.2115 12.7741 9.4672 12.1952 6.8569 17.4836 8.1512 PO 00000 Frm 00373 25th percentile 1 2 1 2 1 1 2 1 1 1 2 1 4 2 2 2 1 1 1 1 2 2 1 1 1 1 2 2 1 1 1 1 2 1 2 1 1 1 1 1 1 8 1 1 1 1 1 4 1 1 1 1 1 3 3 2 2 1 1 1 6 12 4 2 4 2 1 4 2 Fmt 4701 Sfmt 4702 50th percentile 1 3 2 4 2 2 3 2 1 1 3 2 6 3 3 3 2 2 2 2 3 4 1 2 2 2 3 3 2 1 1 3 3 1 3 1 2 1 1 1 1 8 2 1 2 1 1 5 2 1 1 1 1 6 3 3 5 4 3 1 8 16 6 5 5 5 3 7 3 E:\FR\FM\25APP2.SGM 75th percentile 3 6 3 7 3 5 4 3 1 1 5 3 11 6 5 5 3 3 3 2 6 8 3 3 3 4 4 6 4 3 2 5 5 2 6 3 3 2 2 3 1 13 3 2 3 2 3 7 3 2 2 2 2 10 4 7 9 8 7 2 13 20 9 10 7 10 5 13 6 25APP2 90th percentile 5 10 5 12 5 11 6 5 3 2 9 5 17 9 8 7 5 4 5 4 10 14 4 5 5 7 6 9 7 4 3 10 9 4 10 5 5 4 3 4 2 13 6 3 5 3 7 10 5 4 5 5 3 16 5 17 14 14 11 3 23 24 13 17 11 16 9 21 10 9 16 8 20 6 19 12 6 4 2 13 7 27 14 12 11 8 6 7 7 16 23 7 8 8 13 10 14 12 8 6 17 16 7 18 7 7 5 5 7 4 13 10 5 8 4 12 12 7 5 8 8 6 24 8 32 20 19 17 5 39 33 20 26 17 25 14 35 16 24368 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules TABLE 7A.—MEDICARE PROSPECTIVE PAYMENT SYSTEM SELECTED PERCENTILE LENGTHS OF STAY FY 2005 MEDPAR UPDATE DECEMBER 2005 GROUPER V23.0—Continued Number of discharges wwhite on PROD1PC61 with PROPOSALS2 DRG 490 491 492 493 494 495 496 497 498 499 500 501 502 503 504 505 506 507 508 509 510 511 512 513 515 518 519 520 521 522 523 524 525 528 529 530 531 532 533 534 535 536 537 538 539 540 541 542 543 544 545 546 547 548 549 550 551 552 553 554 555 556 557 558 559 ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... VerDate Aug<31>2005 5,341 22,698 3,897 60,917 24,482 336 3,710 31,247 21,409 35,214 46,705 3,172 756 5,863 191 180 964 323 663 157 1,798 636 530 213 58,194 23,656 12,546 16,538 32,469 5,805 15,604 109,168 203 1,841 5,110 3,374 4,874 2,832 46,528 42,555 8,766 8,191 8,953 5,456 4,954 1,493 25,010 23,224 5,478 445,170 43,505 2,348 32,613 32,131 13,102 34,474 53,809 81,920 39,195 77,181 37,296 18,962 123,883 192,407 2,889 12,149,409 17:10 Apr 24, 2006 Jkt 208001 Arithmetic mean length-of-stay 10th percentile 5.3026 3.0177 13.8111 6.0332 2.6885 17.0417 8.7685 5.6724 3.6627 4.1547 2.1886 9.8373 5.7315 3.9168 28.1885 6.3611 15.2656 7.7895 7.4087 5.2038 6.0801 3.6840 13.5491 10.0235 3.8449 2.4643 4.6720 1.9346 5.4433 9.2951 3.8646 3.1419 13.8719 16.2960 7.2626 2.9452 8.9241 3.6335 3.6527 1.7237 9.2450 7.2792 6.4996 2.9041 10.5365 3.5050 41.5518 30.4308 11.7158 4.3989 5.0296 8.7709 12.1280 8.7786 10.1125 6.7767 6.0733 3.4753 9.0732 5.5751 4.8187 2.0159 4.1057 1.8118 6.8463 PO 00000 Frm 00374 25th percentile 1 1 3 2 1 8 3 3 2 1 1 4 2 1 8 1 3 1 1 1 1 1 6 5 1 1 1 1 2 4 1 1 1 6 1 1 2 1 1 1 2 2 1 1 2 1 16 11 2 3 3 3 6 5 5 4 1 1 1 1 1 1 1 1 2 Fmt 4701 Sfmt 4702 50th percentile 2 2 5 3 1 10 4 3 3 2 1 5 3 2 13 1 7 3 3 2 2 1 8 7 1 1 1 1 3 4 2 2 3 9 2 1 4 1 1 1 4 3 3 1 4 1 23 17 5 3 3 4 8 6 6 5 2 1 3 2 2 1 2 1 3 E:\FR\FM\25APP2.SGM 75th percentile 4 2 6 5 2 13 6 5 3 3 2 8 5 3 24 2 12 6 5 3 4 2 10 8 2 1 3 1 4 7 3 3 7 14 4 2 7 3 2 1 8 6 5 2 7 3 34 25 9 4 4 7 10 8 8 6 5 2 7 4 3 1 3 1 5 25APP2 90th percentile 7 3 23 8 4 20 10 6 4 5 3 12 7 5 36 7 20 10 9 6 7 5 14 11 5 3 6 2 7 12 5 4 17 21 9 3 11 5 4 2 12 9 8 4 14 4 50 37 16 5 6 10 14 10 12 8 8 5 12 7 6 2 5 2 8 10 5 32 11 5 33 18 9 6 8 4 18 10 7 51 15 30 15 15 11 12 8 25 17 9 5 11 4 11 17 6 6 35 29 16 6 18 7 8 3 17 14 13 6 23 7 73 53 24 7 8 16 20 13 18 10 12 7 19 12 10 4 8 4 13 24369 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules TABLE 7B.—MEDICARE PROSPECTIVE PAYMENT SYSTEM SELECTED PERCENTILE LENGTHS OF STAY FY 2005 MEDPAR UPDATE DECEMBER 2005 GROUPER V24.0 Number of discharges wwhite on PROD1PC61 with PROPOSALS2 DRG 1 ................................... 2 ................................... 3 ................................... 6 ................................... 7 ................................... 8 ................................... 9 ................................... 10 ................................. 11 ................................. 12 ................................. 13 ................................. 14 ................................. 15 ................................. 16 ................................. 17 ................................. 18 ................................. 19 ................................. 20 ................................. 21 ................................. 22 ................................. 23 ................................. 24 ................................. 25 ................................. 26 ................................. 27 ................................. 28 ................................. 29 ................................. 31 ................................. 32 ................................. 34 ................................. 35 ................................. 36 ................................. 37 ................................. 38 ................................. 39 ................................. 40 ................................. 42 ................................. 43 ................................. 44 ................................. 45 ................................. 46 ................................. 47 ................................. 49 ................................. 50 ................................. 51 ................................. 52 ................................. 53 ................................. 55 ................................. 56 ................................. 57 ................................. 59 ................................. 60 ................................. 61 ................................. 62 ................................. 63 ................................. 64 ................................. 65 ................................. 66 ................................. 67 ................................. 68 ................................. 69 ................................. 70 ................................. 71 ................................. 72 ................................. 73 ................................. 74 ................................. 75 ................................. 76 ................................. 77 ................................. VerDate Aug<31>2005 17:10 Apr 24, 2006 24,342 10,268 2 291 14,937 3,419 1,762 19,573 3,070 57,060 7,489 278,444 19,998 17,374 2,960 33,407 8,413 6,389 2,204 3,158 10,736 63,274 27,221 24 5,910 19,811 6,491 4,963 1,854 27,481 7,817 1,207 1,228 49 361 1,251 943 123 1,298 2,761 3,930 1,310 2,417 2,024 191 316 2,144 1,365 451 882 127 3 222 4 2,819 3,237 40,692 8,202 378 19,016 5,160 23 70 1,338 9,943 3 46,669 48,046 2,086 Jkt 208001 Arithmetic mean length-of-stay 10th percentile 9.6035 4.3919 12.5000 3.0619 9.2561 2.7640 6.0335 5.9187 3.5476 5.4770 4.8484 5.3747 4.0114 6.2850 3.0372 5.1537 3.3808 9.8455 6.1892 5.0130 3.9275 4.6447 3.1235 3.7917 4.7389 5.5762 3.2169 3.9079 2.2681 4.7113 3.0380 1.6827 4.0847 2.8367 2.0305 4.1431 3.0403 2.9512 4.7473 3.0315 4.1880 3.0069 4.5122 1.8656 2.6859 1.7025 4.0005 2.8864 2.6674 3.1610 2.3780 1.6667 6.0541 1.5000 4.5413 6.2252 2.7630 3.1099 3.6958 3.8478 2.9453 2.3478 4.3429 3.3169 4.2956 3.3333 9.5793 10.4814 4.4971 PO 00000 Frm 00375 25th percentile 2 1 4 1 2 1 1 2 1 2 2 2 1 2 1 2 1 3 2 2 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 2 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 3 3 3 1 Fmt 4701 Sfmt 4702 50th percentile 4 2 4 1 4 1 3 3 2 3 3 3 2 3 1 3 2 5 3 2 2 2 2 1 1 2 1 2 1 2 1 1 1 1 1 1 1 1 3 2 2 1 2 1 1 1 1 1 1 1 1 1 1 1 1 2 1 1 2 2 2 1 2 2 2 3 5 5 2 E:\FR\FM\25APP2.SGM 75th percentile 7 4 21 2 7 2 4 4 3 4 4 4 3 5 2 4 3 8 5 4 3 3 3 2 3 4 3 3 2 4 3 1 3 2 1 4 2 2 4 2 3 2 3 1 1 1 2 2 2 2 2 1 4 1 3 4 2 2 3 3 3 2 3 3 3 3 7 8 4 25APP2 90th percentile 12 6 21 4 12 3 7 7 5 6 6 7 5 8 4 6 4 12 8 6 5 6 4 5 6 7 4 5 3 6 4 1 5 3 2 5 4 4 6 4 5 4 5 2 3 2 5 3 3 3 3 3 8 1 6 8 3 4 5 5 4 3 5 4 5 4 12 13 6 19 8 21 7 19 6 11 12 7 10 8 10 7 12 6 10 6 18 12 10 7 9 6 9 10 11 6 7 4 9 6 3 9 6 4 7 7 5 8 6 8 6 9 3 6 3 9 6 5 7 5 3 13 3 10 13 5 6 8 7 5 4 7 6 8 4 19 20 9 24370 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules TABLE 7B.—MEDICARE PROSPECTIVE PAYMENT SYSTEM SELECTED PERCENTILE LENGTHS OF STAY FY 2005 MEDPAR UPDATE DECEMBER 2005 GROUPER V24.0—Continued Number of discharges wwhite on PROD1PC61 with PROPOSALS2 DRG 78 ................................. 79 ................................. 80 ................................. 81 ................................. 82 ................................. 83 ................................. 84 ................................. 85 ................................. 86 ................................. 87 ................................. 88 ................................. 89 ................................. 90 ................................. 91 ................................. 92 ................................. 93 ................................. 94 ................................. 95 ................................. 96 ................................. 97 ................................. 98 ................................. 99 ................................. 100 ............................... 101 ............................... 102 ............................... 103 ............................... 104 ............................... 105 ............................... 106 ............................... 108 ............................... 110 ............................... 111 ............................... 113 ............................... 114 ............................... 117 ............................... 118 ............................... 119 ............................... 120 ............................... 121 ............................... 122 ............................... 123 ............................... 124 ............................... 125 ............................... 126 ............................... 127 ............................... 128 ............................... 129 ............................... 130 ............................... 131 ............................... 132 ............................... 133 ............................... 134 ............................... 135 ............................... 136 ............................... 138 ............................... 139 ............................... 140 ............................... 141 ............................... 142 ............................... 143 ............................... 144 ............................... 145 ............................... 146 ............................... 147 ............................... 148 ............................... 149 ............................... 150 ............................... 151 ............................... 152 ............................... VerDate Aug<31>2005 17:10 Apr 24, 2006 49,542 160,422 7,151 6 63,105 7,054 1,379 22,190 1,719 96,722 428,131 554,927 143,397 53 16,515 1,431 13,559 1,567 60,067 26,938 13 21,398 6,411 23,326 4,896 859 20,062 32,513 3,425 8,715 57,507 10,723 34,611 7,947 5,333 7,615 964 33,418 150,021 54,501 29,532 120,245 92,047 5,419 668,127 4,228 3,516 87,532 22,847 101,519 5,861 40,204 7,152 934 206,178 73,962 31,440 123,506 49,357 238,140 105,005 5,713 10,240 2,600 132,760 19,451 22,923 5,379 5,000 Jkt 208001 Arithmetic mean length-of-stay 10th percentile 6.0974 8.0472 5.2225 6.1667 6.6705 5.2007 3.1378 6.1035 3.4607 6.3636 4.8522 5.5242 3.7046 3.4151 5.9398 3.7519 5.9001 3.3854 4.2943 3.3583 3.0769 3.0985 2.1093 4.1821 2.5353 34.9488 14.6431 9.9310 10.9323 10.7177 8.0074 3.1038 12.5574 8.3434 4.2738 3.0223 5.3932 8.9638 6.2025 3.3056 4.7330 4.3891 2.7024 10.7123 5.0831 5.1824 2.5444 5.3515 3.7023 2.8000 2.1435 3.0925 4.2875 2.6938 3.8766 2.4279 2.4072 3.4313 2.4907 2.0969 5.8109 2.5452 9.7635 5.5485 11.9306 5.6456 10.7178 5.0134 7.9154 PO 00000 Frm 00376 25th percentile 2 3 2 2 2 2 1 2 1 2 2 2 2 1 2 1 2 1 2 1 2 1 1 1 1 8 6 4 5 4 1 1 4 2 1 1 1 1 2 1 1 1 1 3 2 2 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 4 2 5 3 4 1 3 Fmt 4701 Sfmt 4702 50th percentile 4 4 3 3 3 3 2 3 2 3 3 3 2 1 3 2 3 2 2 2 2 1 1 2 1 11 8 6 7 6 3 1 6 4 1 1 1 3 3 1 1 2 1 6 3 3 1 3 2 1 1 2 2 1 2 1 1 2 1 1 2 1 6 4 6 4 6 2 5 E:\FR\FM\25APP2.SGM 75th percentile 5 7 4 5 5 4 3 5 3 5 4 5 3 2 5 3 5 3 4 3 2 2 2 3 2 22 12 8 9 9 6 2 10 7 2 2 3 6 5 3 3 3 2 9 4 5 1 4 3 2 2 2 3 2 3 2 2 3 2 2 4 2 8 5 9 5 9 4 7 25APP2 90th percentile 7 10 6 8 9 6 4 8 5 8 6 7 5 4 7 5 8 4 5 4 4 4 3 5 3 45 18 11 13 13 10 4 15 11 5 4 7 12 8 4 6 6 3 13 6 6 2 7 5 3 3 4 5 3 5 3 3 4 3 3 7 3 11 7 15 7 13 7 9 10 15 9 8 13 10 6 12 7 12 9 10 6 6 11 7 12 6 8 6 6 6 4 8 5 76 26 18 18 19 16 6 24 16 9 7 13 19 12 6 11 9 5 20 9 9 5 10 6 5 4 6 8 5 7 4 4 6 4 4 12 5 17 8 22 8 19 9 14 24371 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules TABLE 7B.—MEDICARE PROSPECTIVE PAYMENT SYSTEM SELECTED PERCENTILE LENGTHS OF STAY FY 2005 MEDPAR UPDATE DECEMBER 2005 GROUPER V24.0—Continued Number of discharges wwhite on PROD1PC61 with PROPOSALS2 DRG 153 154 155 156 157 158 159 160 161 162 163 164 165 166 167 168 169 170 171 172 173 174 175 176 177 178 179 180 181 182 183 184 185 186 187 188 189 190 191 192 193 194 195 196 197 198 199 200 201 202 203 204 205 206 207 208 210 211 212 213 216 217 218 219 220 223 224 225 226 ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... VerDate Aug<31>2005 17:10 Apr 24, 2006 1,943 26,986 5,993 4 8,303 3,703 19,177 11,919 10,150 4,955 4 5,979 2,445 5,128 4,888 1,531 771 17,892 1,402 33,088 2,201 261,230 29,881 14,624 7,655 2,554 14,667 91,385 25,208 297,098 81,695 76 6,238 7 640 93,553 13,057 63 10,552 1,376 4,034 463 2,835 594 16,367 4,102 1,473 1,013 2,713 27,472 32,349 69,238 32,709 2,040 38,281 9,447 126,388 25,730 10 9,465 19,942 15,610 30,001 21,067 2 12,657 9,940 6,246 6,748 Jkt 208001 Arithmetic mean length-of-stay 10th percentile 4.8636 12.9751 3.9580 9.2500 5.6904 2.6425 5.0870 2.6539 4.5100 2.0852 2.7500 7.6887 4.0045 4.3249 2.1291 4.8537 2.3904 10.6930 4.1676 6.7832 3.4993 4.6845 2.8559 5.0844 4.4286 3.0779 5.7799 5.2542 3.3076 4.4827 2.8952 4.3421 4.4833 3.1429 4.1984 5.4513 3.0531 4.8730 12.3500 5.4964 12.5473 6.3672 10.5686 5.3468 9.0180 4.3206 8.9885 10.3416 13.5584 6.1313 6.4399 5.3850 5.8510 3.8103 5.2408 2.9451 6.6248 4.5898 2.5000 8.9718 5.3156 12.0976 5.3765 3.1625 4.0000 3.2634 1.9360 5.2789 6.3594 PO 00000 Frm 00377 25th percentile 2 3 1 7 1 1 1 1 1 1 1 3 2 1 1 1 1 2 1 2 1 2 1 2 2 1 2 2 1 1 1 1 1 1 1 1 1 1 3 1 5 2 4 2 3 2 2 1 3 2 2 2 2 1 1 1 3 3 1 2 1 3 2 1 1 1 1 1 1 Fmt 4701 Sfmt 4702 50th percentile 3 6 2 7 2 1 2 1 2 1 1 4 2 2 1 2 1 5 2 3 1 3 2 3 2 2 3 3 2 2 1 2 2 2 2 2 1 2 6 3 7 4 6 3 5 3 4 3 6 3 3 3 3 2 2 1 4 3 2 4 1 5 3 2 1 1 1 2 3 E:\FR\FM\25APP2.SGM 75th percentile 5 10 3 8 4 2 4 2 3 2 2 7 4 3 2 3 2 8 3 5 3 4 2 4 4 3 4 4 3 3 2 3 3 2 3 4 2 3 9 5 10 6 9 5 7 4 7 7 10 5 5 4 4 3 4 2 6 4 2 7 3 8 4 3 7 2 1 4 4 25APP2 90th percentile 6 16 6 8 7 3 6 3 6 3 3 9 5 5 3 6 3 13 5 8 4 6 4 6 5 4 7 6 4 6 4 4 6 3 6 7 4 6 15 7 15 8 13 7 11 5 12 13 17 8 8 6 7 5 7 4 8 5 4 11 7 15 7 4 7 4 2 7 8 7 25 8 14 11 5 10 5 9 4 5 14 7 8 4 10 5 21 8 13 7 8 5 9 8 5 11 10 6 8 5 8 9 5 8 11 6 8 25 9 23 11 18 10 16 7 19 21 27 12 13 10 11 7 10 5 11 7 4 18 13 24 10 5 7 7 3 11 13 24372 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules TABLE 7B.—MEDICARE PROSPECTIVE PAYMENT SYSTEM SELECTED PERCENTILE LENGTHS OF STAY FY 2005 MEDPAR UPDATE DECEMBER 2005 GROUPER V24.0—Continued Number of discharges wwhite on PROD1PC61 with PROPOSALS2 DRG 227 228 229 230 232 233 234 235 236 237 238 239 240 241 242 243 244 245 246 247 248 249 250 251 252 253 254 255 256 257 258 259 260 261 262 263 264 265 266 267 268 269 270 271 272 273 274 275 276 277 278 279 280 281 283 284 285 286 287 288 289 290 291 292 293 294 295 296 297 ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... VerDate Aug<31>2005 17:10 Apr 24, 2006 4,864 2,673 1,118 2,464 569 18,441 9,076 4,745 41,690 1,918 9,728 40,288 12,888 2,812 2,724 100,724 16,990 5,860 1,400 21,406 16,433 13,453 4,139 2,049 1 24,733 9,965 1 7,577 13,101 11,379 2,656 2,435 1,573 596 22,506 3,901 4,014 2,220 272 992 11,031 2,565 21,624 6,071 1,263 2,223 173 1,615 119,112 33,788 6 19,291 6,530 6,765 1,856 8,029 2,853 5,440 11,290 6,337 11,858 59 7,564 316 97,541 4,362 247,608 42,673 Jkt 208001 Arithmetic mean length-of-stay 10th percentile 2.6301 4.1968 2.4875 5.4180 2.7346 6.3221 2.6644 4.6565 4.4064 3.7904 8.0118 6.0331 6.4250 3.6348 6.4589 4.4958 4.4383 3.1056 3.5536 3.2872 4.8139 3.9550 3.8425 2.8019 1.0000 4.5276 3.0711 1.0000 4.9555 2.5513 1.6977 2.8407 1.4049 2.1933 4.6393 10.4499 6.2153 6.5399 3.0171 4.2132 3.6563 7.9837 3.5977 6.7865 5.8122 3.7126 6.1858 3.3064 4.6136 5.4229 3.9930 4.1667 3.9889 2.8018 4.5808 2.9230 9.8162 5.1854 9.5362 3.7006 2.3926 2.0279 1.4915 10.0071 4.7089 4.2412 3.6997 4.6432 3.0303 PO 00000 Frm 00378 25th percentile 1 1 1 1 1 1 1 1 1 1 2 2 2 1 2 1 1 1 1 1 2 1 1 1 1 2 1 1 1 1 1 1 1 1 1 3 2 1 1 1 1 2 1 2 2 1 1 1 1 2 2 2 1 1 1 1 3 2 3 1 1 1 1 2 1 1 1 1 1 Fmt 4701 Sfmt 4702 50th percentile 1 1 1 2 1 2 1 2 3 2 4 3 3 2 3 2 2 1 2 2 3 1 2 1 1 3 2 1 2 1 1 1 1 1 2 5 3 2 1 1 1 3 1 3 3 2 3 1 2 3 2 3 2 1 2 1 5 2 5 2 1 1 1 4 2 2 2 2 2 E:\FR\FM\25APP2.SGM 75th percentile 2 3 2 4 2 5 1 4 4 3 6 5 5 3 5 4 4 3 3 3 4 3 3 3 1 4 3 1 4 2 1 1 1 1 3 7 5 4 2 3 2 6 3 5 4 3 5 2 4 4 3 5 3 2 3 2 8 4 7 3 1 1 1 8 3 3 3 4 3 25APP2 90th percentile 3 5 3 7 3 8 3 6 5 5 10 7 8 4 8 6 5 4 4 4 6 5 5 3 1 5 4 1 6 3 2 3 1 2 6 13 7 8 4 5 4 10 5 8 7 5 8 4 6 7 5 5 5 4 6 4 12 6 11 4 2 2 1 12 6 5 4 6 4 5 9 5 11 6 13 6 8 8 7 15 11 12 6 12 8 8 6 7 6 9 8 7 5 1 8 5 1 9 5 3 7 2 4 9 20 11 14 6 8 7 15 7 12 11 7 12 6 8 10 7 5 7 5 9 5 18 10 18 6 5 3 2 19 8 8 7 9 5 24373 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules TABLE 7B.—MEDICARE PROSPECTIVE PAYMENT SYSTEM SELECTED PERCENTILE LENGTHS OF STAY FY 2005 MEDPAR UPDATE DECEMBER 2005 GROUPER V24.0—Continued Number of discharges wwhite on PROD1PC61 with PROPOSALS2 DRG 298 299 300 301 302 303 304 305 306 307 308 309 310 311 312 313 314 315 316 317 318 319 320 321 322 323 324 325 326 327 328 329 331 332 333 334 335 336 337 338 339 340 341 342 344 345 346 347 348 349 350 352 353 354 355 356 357 358 359 360 361 362 363 364 365 366 367 368 369 ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... VerDate Aug<31>2005 17:10 Apr 24, 2006 110 1,541 21,697 3,912 10,255 24,546 14,020 2,996 5,804 1,942 6,675 3,267 25,304 5,872 1,320 501 12 34,750 204,504 2,696 5,891 382 225,245 31,997 67 20,408 4,621 9,909 2,596 11 573 54 56,851 4,131 242 9,503 12,142 28,146 21,461 674 1,230 1 3,120 456 2,342 1,387 3,983 240 4,273 555 7,266 1,176 3,082 7,554 4,988 22,223 5,519 20,865 28,581 14,256 287 2 1,979 1,377 1,605 4,644 437 4,150 3,727 Jkt 208001 Arithmetic mean length-of-stay 10th percentile 3.5545 5.1304 5.8067 3.3566 7.9757 7.2813 8.3536 3.1031 5.5829 2.0391 6.1486 1.9773 4.4981 1.8551 4.9356 2.3852 89.0000 6.7385 6.1586 3.4970 5.9701 2.5733 4.9895 3.5392 3.5821 3.1059 1.8455 3.7375 2.5632 2.0000 3.3805 1.6852 5.4046 3.0690 5.3719 4.0414 2.4975 3.2243 1.8444 5.7908 5.1976 2.0000 3.2032 3.0395 2.7331 5.4232 5.8943 2.6917 4.0059 2.6396 4.5140 4.1820 6.0039 5.5586 3.0158 1.8694 8.0364 3.8574 2.3500 2.5446 2.9756 1.0000 4.0859 4.1888 7.8517 6.2351 3.0092 6.4051 3.2667 PO 00000 Frm 00379 25th percentile 1 1 2 1 4 3 2 1 1 1 1 1 1 1 1 1 5 1 2 1 1 1 2 1 2 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 2 1 1 1 1 2 1 1 1 2 1 2 2 2 1 3 2 1 1 1 1 1 1 2 2 1 2 1 Fmt 4701 Sfmt 4702 50th percentile 1 2 3 2 5 4 3 2 2 1 2 1 2 1 2 1 5 1 3 1 3 1 3 2 2 1 1 2 1 1 1 1 2 1 2 2 2 1 1 2 2 2 1 1 1 2 3 1 2 1 2 2 3 3 2 1 4 2 2 1 1 1 2 2 3 3 1 3 1 E:\FR\FM\25APP2.SGM 2 4 5 3 6 6 6 3 3 2 4 1 3 1 3 2 173 4 5 2 4 2 4 3 3 2 1 3 2 2 3 1 4 2 4 3 2 2 2 4 3 2 1 2 1 3 4 2 3 2 4 3 4 4 3 2 6 3 2 2 2 1 2 3 5 5 2 5 2 25APP2 75th percentile 4 6 7 4 9 8 10 4 8 2 8 2 6 2 6 3 173 9 8 4 8 3 6 4 4 4 2 5 3 2 4 2 7 4 6 5 3 4 2 8 7 2 3 3 3 7 7 3 5 3 6 5 7 6 3 2 10 4 3 3 3 1 4 5 10 8 4 8 4 90th percentile 6 10 11 6 13 14 17 6 13 3 14 4 10 3 10 5 173 16 12 7 12 5 9 6 6 6 3 7 5 3 6 3 10 6 10 7 4 7 3 13 12 2 7 6 7 12 11 5 8 5 8 9 11 10 4 3 15 7 3 4 6 1 9 9 16 12 5 12 6 24374 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules TABLE 7B.—MEDICARE PROSPECTIVE PAYMENT SYSTEM SELECTED PERCENTILE LENGTHS OF STAY FY 2005 MEDPAR UPDATE DECEMBER 2005 GROUPER V24.0—Continued Number of discharges wwhite on PROD1PC61 with PROPOSALS2 DRG 370 371 372 373 374 375 376 377 378 379 380 381 382 383 384 387 389 392 394 395 396 397 398 399 401 402 403 404 406 407 408 409 410 411 412 413 414 415 416 417 418 419 420 421 422 423 424 425 426 427 428 429 430 431 432 433 439 440 441 442 443 444 445 447 449 450 451 452 453 ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... VerDate Aug<31>2005 17:10 Apr 24, 2006 2,209 2,663 1,349 5,186 153 13 473 109 203 484 110 170 49 2,780 147 1 3 2,120 2,758 115,655 20 16,459 18,615 1,633 6,439 1,340 31,515 3,614 2,300 610 1,943 1,740 29,094 5 8 5,728 478 55,770 288,297 33 29,873 17,681 3,029 13,246 77 9,067 1,033 13,142 4,389 1,603 855 24,588 76,498 339 400 4,640 1,751 5,187 685 18,537 3,580 5,993 2,240 6,355 40,805 7,411 2 28,672 5,363 Jkt 208001 Arithmetic mean length-of-stay 10th percentile 5.0023 3.3924 3.4633 2.2443 2.9739 6.2308 3.2939 4.4495 2.1773 3.2004 2.0273 2.4294 1.4694 3.6439 2.4966 9.0000 2.0000 8.8330 7.2708 4.2739 2.9500 5.1109 5.7086 3.3791 11.0110 3.8955 7.8539 3.9801 9.4235 3.5049 8.2203 5.9891 3.7690 2.0000 1.5000 6.7243 4.0146 14.0714 7.4530 6.5455 6.0664 4.3426 3.1700 4.0091 3.6753 8.0275 11.3679 3.4810 4.5129 4.7324 7.3111 5.6295 7.8309 6.8171 4.0400 2.8390 8.3501 8.1656 3.4730 8.6463 3.5260 4.0310 2.8210 2.5769 3.6894 1.9873 10.5000 4.9315 2.7583 PO 00000 Frm 00380 25th percentile 2 2 2 1 2 1 1 1 1 1 1 1 1 1 1 9 1 2 1 1 1 1 2 1 2 1 2 1 2 1 1 2 1 1 1 2 1 4 2 2 2 1 1 1 1 2 2 1 1 1 1 2 2 1 1 1 1 2 1 2 1 1 1 1 1 1 8 1 1 Fmt 4701 Sfmt 4702 50th percentile 3 3 2 2 2 2 2 2 1 1 1 1 1 1 1 9 1 4 2 2 2 2 3 2 5 1 3 2 4 2 2 3 2 1 1 3 2 6 4 3 3 2 2 2 2 3 4 1 2 2 2 3 3 2 1 1 3 3 1 3 1 2 1 1 1 1 8 2 1 E:\FR\FM\25APP2.SGM 75th percentile 4 3 2 2 2 3 2 3 2 2 1 1 1 2 1 9 2 6 5 3 3 4 4 3 8 3 6 3 7 3 5 4 3 1 1 5 3 11 6 5 5 3 3 3 2 6 8 3 3 3 4 4 6 4 3 2 5 5 2 6 3 3 2 2 3 1 13 3 2 25APP2 90th percentile 5 4 3 3 3 7 4 6 3 3 2 2 1 4 3 9 3 11 9 5 3 6 7 4 14 5 10 5 12 5 11 6 5 3 2 9 5 17 9 8 7 5 4 5 4 10 14 4 5 6 8 7 9 7 4 3 10 9 4 10 5 5 4 3 4 2 13 6 3 7 4 5 3 4 15 7 8 4 6 4 4 2 7 4 9 3 19 16 8 4 10 11 6 22 8 16 8 20 7 19 12 6 4 2 13 7 28 14 12 11 8 6 7 7 16 23 7 9 9 14 10 15 12 8 4 17 17 7 18 7 7 5 5 7 4 13 10 5 24375 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules TABLE 7B.—MEDICARE PROSPECTIVE PAYMENT SYSTEM SELECTED PERCENTILE LENGTHS OF STAY FY 2005 MEDPAR UPDATE DECEMBER 2005 GROUPER V24.0—Continued Number of discharges wwhite on PROD1PC61 with PROPOSALS2 DRG 454 455 461 462 463 464 465 466 467 468 471 473 475 476 477 479 480 481 482 484 485 486 487 488 489 490 491 492 493 494 495 496 497 498 499 500 501 502 503 504 505 506 507 508 509 510 511 512 513 515 518 519 520 521 522 523 524 525 528 529 530 531 532 533 534 535 536 537 538 ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... VerDate Aug<31>2005 17:10 Apr 24, 2006 4,747 885 2,273 8,971 32,939 7,650 165 1,205 1,028 51,844 15,609 8,557 120,026 2,847 28,111 27,545 884 1,183 5,072 455 3,660 2,600 4,866 820 13,634 5,299 22,716 3,906 60,947 24,474 336 3,715 31,285 21,475 35,262 46,802 3,178 756 5,879 190 177 960 322 658 156 1,779 626 530 213 58,196 23,688 12,559 16,572 29,820 3,580 14,736 109,259 203 1,838 5,103 3,371 4,884 2,838 46,516 42,526 8,772 8,193 8,952 5,452 Jkt 208001 Arithmetic mean length-of-stay 10th percentile 4.1062 2.2814 5.5794 9.5207 3.8728 2.8997 3.6182 4.9842 2.6625 12.5282 4.5466 12.4122 10.6390 9.9424 8.5004 2.5522 19.1618 22.0211 11.1808 12.7560 9.4104 12.1862 6.8531 17.4744 8.1556 5.3025 3.0154 13.7983 6.0341 2.6904 17.0417 8.7505 5.6682 3.6630 4.1552 2.1900 9.8420 5.7116 3.9160 28.2789 6.3503 15.2063 7.7702 7.3708 5.2179 6.0438 3.6773 13.5491 10.0235 3.8438 2.4604 4.6661 1.9340 5.2943 10.3455 3.8210 3.1436 13.9458 16.2927 7.2536 2.9436 8.9378 3.6350 3.6549 1.7237 9.2410 7.2754 6.4947 2.9057 PO 00000 Frm 00381 25th percentile 1 1 1 4 1 1 1 1 1 3 3 2 2 1 1 1 6 12 4 2 4 2 1 4 2 1 1 3 2 1 8 3 3 2 1 1 4 2 1 8 1 3 1 1 1 1 1 6 5 1 1 1 1 1 3 1 1 1 6 1 1 2 1 1 1 2 2 1 1 Fmt 4701 Sfmt 4702 50th percentile 2 1 1 6 2 1 1 1 1 6 3 3 5 4 3 1 8 16 6 5 5 5 3 7 3 2 2 5 3 1 10 4 3 3 2 1 5 3 2 13 1 7 3 3 2 2 1 8 7 1 1 1 1 2 4 2 2 3 9 2 1 4 1 1 1 4 3 3 1 E:\FR\FM\25APP2.SGM 75th percentile 3 2 3 8 3 2 2 2 2 10 4 7 9 8 7 2 13 20 9 10 7 10 5 13 6 4 2 6 5 2 13 6 5 3 3 2 8 5 3 24 2 12 6 5 3 4 2 10 8 2 1 3 1 4 5 3 3 7 14 4 2 7 3 2 1 8 6 5 2 25APP2 90th percentile 5 3 7 11 5 4 4 5 3 16 5 17 14 14 11 3 23 24 13 17 11 16 9 21 10 6 3 23 8 4 20 10 6 4 5 3 12 7 5 36 6 20 10 9 6 7 4 14 11 5 3 6 2 6 7 4 4 17 21 9 3 11 5 4 2 12 9 8 4 8 4 13 16 7 5 6 7 5 24 7 32 21 20 17 5 39 33 20 26 17 25 14 34 16 10 5 32 11 5 33 18 9 6 8 4 18 10 7 51 13 30 15 14 11 12 7 25 17 9 5 11 4 8 8 6 6 35 29 16 6 18 7 8 3 18 14 13 6 24376 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules TABLE 7B.—MEDICARE PROSPECTIVE PAYMENT SYSTEM SELECTED PERCENTILE LENGTHS OF STAY FY 2005 MEDPAR UPDATE DECEMBER 2005 GROUPER V24.0—Continued 539 540 541 542 543 544 545 546 547 548 549 550 551 552 553 554 555 556 557 558 559 Arithmetic mean length-of-stay Number of discharges DRG ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... ............................... 4,962 1,495 24,941 23,183 5,475 445,895 44,700 2,349 32,600 32,135 13,107 34,471 53,828 81,945 39,190 77,166 37,283 18,925 123,799 192,346 2,886 12,144,751 10.5316 3.5010 41.4444 30.3714 11.7145 4.3971 5.1342 8.7292 12.1272 8.7775 10.1157 6.7739 6.0746 3.4779 9.0613 5.5699 4.8161 2.0092 4.1037 1.8113 6.8257 TABLE 8A.—STATEWIDE AVERAGE OPERATING COST-TO-CHARGE RATIOS—MARCH 2006 wwhite on PROD1PC61 with PROPOSALS2 State Urban Alabama .................... Alaska ....................... Arizona ...................... Arkansas ................... California ................... Colorado ................... Connecticut ............... Delaware ................... District of Columbia .. Florida ....................... Georgia ..................... Hawaii ....................... Idaho ......................... Illinois ........................ Indiana ...................... Iowa .......................... Kansas ...................... Kentucky ................... Louisiana .................. Maine ........................ Maryland ................... Massachusetts .......... Michigan ................... Minnesota ................. Mississippi ................ Missouri .................... Montana .................... Nebraska .................. Nevada ..................... New Hampshire ........ New Jersey ............... New Mexico .............. New York .................. North Carolina .......... North Dakota ............ Ohio .......................... Oklahoma ................. Oregon ...................... Pennsylvania ............ VerDate Aug<31>2005 50th percentile 4 1 23 17 5 3 3 4 8 6 6 5 2 1 3 2 2 1 2 1 3 TABLE 8A.—STATEWIDE AVERAGE OPERATING COST-TO-CHARGE RATIOS—MARCH 2006—Continued State 0.334 0.719 0.37 0.357 0.347 0.486 0.5 0.508 ................ 0.3 0.404 0.432 0.528 0.418 0.454 0.467 0.454 0.394 0.374 0.475 0.882 ................ 0.474 0.52 0.38 0.387 0.478 0.475 0.477 0.463 ................ 0.39 0.526 0.433 0.455 0.549 0.405 0.475 0.444 Puerto Rico ............... Rhode Island ............ South Carolina .......... South Dakota ............ Tennessee ................ Texas ........................ Utah .......................... Vermont .................... Virginia ...................... Washington ............... West Virginia ............ Wisconsin ................. Wyoming ................... Jkt 208001 25th percentile 2 1 16 11 2 3 3 3 6 5 5 4 1 1 1 1 1 1 1 1 2 Rural 0.265 0.423 0.285 0.34 0.24 0.314 0.428 0.528 0.397 0.252 0.355 0.384 0.48 0.326 0.424 0.39 0.299 0.386 0.308 0.496 0.763 0.472 0.376 0.391 0.331 0.333 0.431 0.361 0.24 0.463 0.18 0.385 0.365 0.439 0.43 0.376 0.321 0.474 0.282 17:10 Apr 24, 2006 10th percentile Urban 0.461 0.409 0.294 0.375 0.324 0.282 0.423 0.555 0.366 0.427 0.488 0.442 0.4 PO 00000 Frm 00382 Fmt 4701 Sfmt 4702 14 4 50 37 16 5 6 10 14 10 12 8 8 5 12 7 6 2 5 2 8 ................ ................ 0.297 0.461 0.386 0.369 0.589 0.627 0.378 0.469 0.454 0.481 0.561 Kentucky ....................................... Louisiana ...................................... Maine ............................................ Maryland ....................................... Massachusetts .............................. Michigan ....................................... Minnesota ..................................... Mississippi .................................... Missouri ........................................ Montana ........................................ Nebraska ...................................... Nevada ......................................... New Hampshire ............................ New Jersey ................................... New Mexico .................................. New York ...................................... North Carolina .............................. North Dakota ................................ Ohio .............................................. Oklahoma ..................................... Oregon .......................................... Pennsylvania ................................ Puerto Rico ................................... Rhode Island ................................ South Carolina .............................. South Dakota ................................ Tennessee .................................... Texas ............................................ Utah .............................................. Vermont ........................................ Virginia .......................................... Washington ................................... West Virginia ................................ Wisconsin ..................................... Wyoming ....................................... 0.026 0.042 0.026 0.027 0.016 0.03 0.03 0.042 0.027 0.024 0.032 0.033 0.037 0.027 0.038 0.03 0.032 23 7 72 53 24 7 9 16 20 13 18 10 12 7 19 12 10 4 8 4 13 TABLE 8B.—STATEWIDE AVERAGE CAPITAL COST-TO-CHARGE RATIOS—MARCH 2006—Continued State Ratio Alabama ........................................ Alaska ........................................... Arizona .......................................... Arkansas ....................................... California ....................................... Colorado ....................................... Connecticut ................................... Delaware ....................................... District of Columbia ...................... Florida ........................................... Georgia ......................................... Hawaii ........................................... Idaho ............................................. Illinois ............................................ Indiana .......................................... Iowa .............................................. Kansas .......................................... 7 3 34 25 9 4 4 7 10 8 8 6 5 2 7 4 3 1 3 1 5 90th percentile Rural TABLE 8B.—STATEWIDE AVERAGE CAPITAL COST-TO-CHARGE RATIOS—MARCH 2006 State 75th percentile E:\FR\FM\25APP2.SGM 25APP2 Ratio 0.031 0.031 0.035 0.013 0.034 0.032 0.029 0.03 0.027 0.039 0.038 0.021 0.037 0.013 0.034 0.03 0.037 0.04 0.031 0.031 0.032 0.023 0.035 0.023 0.027 0.037 0.033 0.028 0.039 0.043 0.037 0.035 0.034 0.038 0.047 24377 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules TABLE 8C.—STATEWIDE AVERAGE TOTAL COST-TO-CHARGE RATIOS FOR LTCHS—MARCH 2006 State Urban Alabama .................... Alaska ....................... Arizona ...................... Arkansas ................... California ................... Colorado ................... Connecticut ............... Delaware ................... District of Columbia* Florida ....................... Georgia ..................... Hawaii ....................... Idaho ......................... Illinois ........................ Indiana ...................... Iowa .......................... Kansas ...................... Kentucky ................... Louisiana .................. Maine ........................ Maryland** ................ TABLE 8C.—STATEWIDE AVERAGE TOTAL COST-TO-CHARGE RATIOS FOR LTCHS—MARCH 2006—Continued Rural 0.291 0.458 0.307 0.368 0.254 0.350 0.454 0.567 0.436 0.276 0.384 0.417 0.516 0.351 0.462 0.412 0.326 0.418 0.340 0.533 0.361 0.365 0.788 0.407 0.390 0.368 0.531 0.538 0.558 ................ 0.343 0.439 0.465 0.573 0.457 0.499 0.506 0.495 0.423 0.402 0.507 0.458 State Urban Massachusetts* ........ Michigan ................... Minnesota ................. Mississippi ................ Missouri .................... Montana .................... Nebraska .................. Nevada ..................... New Hampshire ........ New Jersey* ............. New Mexico .............. New York .................. North Carolina .......... North Dakota ............ Ohio .......................... Oklahoma ................. Oregon ...................... Pennsylvania ............ Puerto Rico* ............. Rhode Island* ........... TABLE 8C.—STATEWIDE AVERAGE TOTAL COST-TO-CHARGE RATIOS FOR LTCHS—MARCH 2006—Continued Rural ................ 0.510 0.550 0.407 0.430 0.522 0.523 0.550 0.498 ................ 0.415 0.561 0.476 0.504 0.595 0.441 0.513 0.479 ................ ................ 0.501 0.410 0.419 0.360 0.357 0.467 0.395 0.259 0.501 0.194 0.418 0.393 0.478 0.467 0.404 0.351 0.507 0.299 0.493 0.432 State South Carolina .......... South Dakota ............ Tennessee ................ Texas ........................ Utah .......................... Vermont .................... Virginia ...................... Washington ............... West Virginia ............ Wisconsin ................. Wyoming ................... Urban Rural 0.320 0.410 0.360 0.307 0.460 0.601 0.399 0.462 0.515 0.483 0.440 0.326 0.506 0.421 0.404 0.649 0.667 0.419 0.516 0.487 0.519 0.614 * All counties in the State or Territory are classified as urban, with the exception of Massachusetts, which has areas designated as rural. However, no short-term acute care IPPS hospitals or LTCHs are located in those areas as of March 2005. ** National average IPPS total cost-tocharge ratios, as discussed in section II.F.5. of this proposed rule. TABLE 9A.—HOSPITAL RECLASSIFICATIONS AND REDESIGNATIONS BY INDIVIDUAL HOSPITAL AND CBSA—FY2007 Geographic CBSA wwhite on PROD1PC61 with PROPOSALS2 Provider No. 010005 010008 010009 010012 010022 010025 010029 010035 010044 010045 010054 010059 010065 010072 010083 010085 010100 010101 010118 010126 010143 010150 010158 010164 020008 030007 030033 040014 040017 040019 040020 040027 040039 040041 040047 040069 040071 040076 040080 040088 040091 ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ VerDate Aug<31>2005 17:10 Apr 24, 2006 Jkt 208001 PO 00000 Frm 00383 Fmt 4701 01 01 19460 01 01 01 12220 01 01 01 19460 19460 01 01 01 19460 01 01 01 01 01 01 01 01 02 03 03 04 04 04 27860 04 04 04 04 04 38220 04 04 04 04 Sfmt 4702 Reclassified CBSA 10/1/2006–3/31/ 2007 Reclassified CBSA 4/1/2007–9/30/ 2007 13820 33860 26620 16860 40660 17980 17980 13820 13820 13820 26620 26620 33860 11500 37860 26620 37860 11500 46220 33860 13820 33860 19460 11500 11260 22380 22380 30780 22220 32820 32820 44180 26 30780 26 32820 30780 30780 27860 43340 45500 E:\FR\FM\25APP2.SGM 25APP2 13820 33860 26620 16860 40660 17980 17980 13820 13820 13820 26620 26620 33860 11500 37860 26620 37860 11500 46220 33860 13820 33860 19460 11500 11260 22380 22380 30780 22220 32820 32820 44180 26 30780 26 32820 30780 30780 27860 43340 45500 LUGAR LUGAR LUGAR LUGAR LUGAR 24378 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules TABLE 9A.—HOSPITAL RECLASSIFICATIONS AND REDESIGNATIONS BY INDIVIDUAL HOSPITAL AND CBSA—FY2007— Continued Geographic CBSA wwhite on PROD1PC61 with PROPOSALS2 Provider No. 040100 040119 050006 050009 050013 050014 050022 050042 050046 050054 050065 050069 050071 050073 050076 050082 050089 050090 050099 050101 050102 050118 050129 050136 050140 050150 050159 050168 050173 050174 050193 050197 050224 050226 050228 050230 050236 050243 050245 050251 050272 050279 050291 050292 050298 050300 050327 050329 050348 050367 050385 050390 050394 050423 050426 050430 050510 050517 050526 050534 050535 050541 050543 050547 050548 050549 050550 050551 ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ VerDate Aug<31>2005 17:10 Apr 24, 2006 Jkt 208001 PO 00000 Frm 00384 Fmt 4701 04 04 05 34900 34900 05 40140 05 37100 40 42044 42044 41940 46700 41884 37100 40 42220 40 46700 40 44700 40 42220 40 05 37100 42044 42044 42220 42044 41884 42044 42044 41884 42044 37100 40 40 05 40 40 42220 40 40 40 40 40 42044 46700 42220 40 37100 40 42044 05 41884 40 42044 40 42044 41884 42044 42220 42044 37100 42044 42044 Sfmt 4702 Reclassified CBSA 10/1/2006–3/31/ 2007 Reclassified CBSA 4/1/2007–9/30/ 2007 30780 30780 39820 46700 46700 40900 42044 39820 ............................ 42044 31084 31084 36084 36084 36084 ............................ 31084 41884 31084 36084 42044 33700 31084 41884 31084 40900 ............................ 31084 31084 41884 31084 36084 31084 31084 36084 31084 ............................ 42044 31084 39900 31084 31084 41884 42044 31084 31084 31084 42044 31084 36084 41884 42044 ............................ 42044 31084 39900 36084 31084 31084 42044 31084 36084 31084 41884 31084 ............................ 31084 31084 E:\FR\FM\25APP2.SGM 25APP2 30780 30780 39820 46700 46700 40900 42044 39820 31084 42044 31084 31084 36084 36084 36084 31084 31084 41884 31084 36084 42044 33700 31084 41884 31084 40900 31084 31084 31084 41884 31084 36084 31084 31084 36084 31084 31084 42044 31084 39900 31084 31084 41884 42044 31084 31084 31084 42044 31084 36084 41884 42044 31084 42044 31084 39900 36084 31084 31084 42044 31084 36084 31084 41884 31084 31084 31084 31084 LUGAR Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules 24379 TABLE 9A.—HOSPITAL RECLASSIFICATIONS AND REDESIGNATIONS BY INDIVIDUAL HOSPITAL AND CBSA—FY2007— Continued Geographic CBSA wwhite on PROD1PC61 with PROPOSALS2 Provider No. 050567 050569 050570 050573 050580 050584 050585 050586 050589 050592 050594 050603 050609 050616 050667 050678 050680 050684 050686 050690 050693 050694 050701 050709 050718 050720 050728 050749 060003 060023 060027 060044 060049 060075 060096 060103 070001 070003 070005 070006 070010 070016 070017 070018 070019 070021 070022 070028 070031 070033 070034 070036 070038 070039 080004 080004 080006 090001 100022 100023 100024 100045 100049 100081 100109 100118 100139 100150 ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ VerDate Aug<31>2005 17:10 Apr 24, 2006 Jkt 208001 PO 00000 Frm 00385 Fmt 4701 42044 05 42044 40 42044 40 42044 40 42044 42044 42044 42044 42044 37100 34900 42044 46700 40 40 42220 42044 40 40 40 40 42044 42220 37100 14500 24300 14500 06 06 06 06 14500 35300 07 35300 14860 14860 35300 35300 14860 35300 07 35300 14860 35300 14860 14860 25540 35300 35300 20100 08 08 47894 33124 10 10 19660 10 10 10 10 10 10 Sfmt 4702 Reclassified CBSA 10/1/2006–3/31/ 2007 Reclassified CBSA 4/1/2007–9/30/ 2007 31084 42220 31084 42044 31084 31084 31084 31084 31084 31084 31084 31084 31084 ............................ 46700 31084 36084 42044 42044 41884 31084 42044 42044 31084 42044 31084 41884 ............................ 19740 19740 19740 19740 22660 24300 19740 19740 ............................ 25540 ............................ ............................ ............................ ............................ ............................ ............................ ............................ 25540 ............................ ............................ ............................ 35644 ............................ 35300 ............................ ............................ 48864 20100 36140 13644 22744 36740 33124 36740 29460 23020 36740 27260 23540 33124 E:\FR\FM\25APP2.SGM 25APP2 31084 42220 31084 42044 31084 31084 31084 31084 31084 31084 31084 31084 31084 31084 46700 31084 36084 42044 42044 41884 31084 42044 42044 31084 42044 31084 41884 31084 19740 19740 19740 19740 22660 24300 19740 19740 35004 25540 35004 35644 35644 35004 35004 35644 35004 25540 35004 35644 35004 35644 35644 35300 35004 35004 48864 20100 36140 13644 22744 36740 33124 36740 29460 23020 36740 27260 23540 33124 LUGAR LUGAR LUGAR LUGAR LUGAR 24380 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules TABLE 9A.—HOSPITAL RECLASSIFICATIONS AND REDESIGNATIONS BY INDIVIDUAL HOSPITAL AND CBSA—FY2007— Continued Geographic CBSA wwhite on PROD1PC61 with PROPOSALS2 Provider No. 100157 100176 100217 100232 100239 100249 100252 100258 100292 110001 110002 110003 110023 110025 110029 110038 110040 110041 110052 110054 110069 110075 110088 110095 110117 110122 110125 110128 110150 110153 110168 110187 110189 110205 120028 130002 130003 130018 130049 130067 140012 140015 140032 140033 140034 140040 140043 140046 140058 140064 140084 140093 140100 140110 140130 140143 140160 140161 140164 140167 140189 140202 140233 140234 140236 140291 150002 150004 ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ VerDate Aug<31>2005 17:10 Apr 24, 2006 Jkt 208001 PO 00000 Frm 00386 Fmt 4701 29460 48424 42680 10 45300 10 10 48424 10 19140 11 11 11 15260 23580 11 11 11 11 40660 47580 11 11 11 11 46660 11 11 11 47580 40660 11 11 11 12 13 30300 13 17660 13 14 14 14 29404 14 14 14 14 14 14 29404 19180 29404 14 29404 14 14 14 14 14 14 29404 40420 14 14 29404 23844 23844 Sfmt 4702 Reclassified CBSA 10/1/2006–3/31/ 2007 Reclassified CBSA 4/1/2007–9/30/ 2007 45300 38940 38940 27260 42260 45300 38940 22744 23020 12060 12060 27260 12060 27260 12060 46660 12060 12020 16860 12060 31420 42340 12060 46660 12060 45220 31420 42340 12060 31420 12060 12060 12060 12060 26180 29 28420 38540 44060 26820 16974 41180 41180 16974 41180 37900 40420 41180 41180 37900 16974 16580 16974 16974 16974 37900 40420 16974 41180 28100 16580 16974 16974 37900 28100 16974 16974 16974 E:\FR\FM\25APP2.SGM 25APP2 45300 38940 38940 27260 42260 45300 38940 22744 23020 12060 12060 27260 12060 27260 12060 46660 12060 12020 16860 12060 31420 42340 12060 46660 12060 45220 31420 42340 12060 31420 12060 12060 12060 12060 26180 29 28420 38540 44060 26820 16974 41180 41180 16974 41180 37900 40420 41180 41180 37900 16974 16580 16974 16974 16974 37900 40420 16974 41180 28100 16580 16974 16974 37900 28100 16974 16974 16974 LUGAR LUGAR LUGAR LUGAR LUGAR LUGAR LUGAR LUGAR LUGAR LUGAR 24381 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules TABLE 9A.—HOSPITAL RECLASSIFICATIONS AND REDESIGNATIONS BY INDIVIDUAL HOSPITAL AND CBSA—FY2007— Continued Geographic CBSA wwhite on PROD1PC61 with PROPOSALS2 Provider No. 150006 150008 150011 150015 150030 150034 150048 150051 150065 150069 150076 150088 150090 150102 150112 150113 150122 150125 150126 150133 150146 150147 160001 160016 160057 160064 160080 160089 160147 170006 170010 170012 170013 170020 170023 170033 170058 170068 170120 170142 170175 170190 170193 180005 180011 180012 180013 180017 180018 180019 180024 180027 180028 180029 180044 180048 180066 180069 180075 180078 180080 180093 180102 180104 180116 180124 180127 180132 ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ VerDate Aug<31>2005 17:10 Apr 24, 2006 Jkt 208001 PO 00000 Frm 00387 Fmt 4701 33140 23844 15 33140 15 23844 15 14 15 15 15 11300 23844 15 18020 11300 15 23844 23844 15 15 23844 16 16 16 16 16 16 16 17 17 17 17 17 17 17 17 17 17 17 17 17 17 18 18 21060 14540 18 18 18 18 18 18 18 18 18 18 18 18 18 18 18 18 18 18 14540 18 18 Sfmt 4702 Reclassified CBSA 10/1/2006–3/31/ 2007 Reclassified CBSA 4/1/2007–9/30/ 2007 43780 16974 26900 16974 26900 16974 17140 020 26900 17140 43780 26900 16974 23844 26900 26900 26900 16974 16974 23060 23060 16974 19780 19780 26980 24 19340 19780 19780 27900 46140 48620 48620 48620 48620 48620 28140 11100 27900 45820 48620 45820 48620 26580 30460 31140 34980 21060 30460 17140 31140 17300 26580 28700 26580 31140 34980 26580 14540 26580 28940 21780 17300 17300 14 34980 31140 30460 E:\FR\FM\25APP2.SGM 25APP2 43780 16974 26900 16974 26900 16974 17140 26900 26900 17140 43780 26900 16974 23844 26900 26900 26900 16974 16974 23060 23060 16974 19780 19780 26980 24 19340 19780 19780 27900 46140 48620 48620 48620 48620 48620 28140 11100 27900 45820 48620 45820 48620 26580 30460 31140 34980 21060 30460 17140 31140 17300 26580 28700 26580 31140 34980 26580 14540 26580 28940 21780 17300 17300 14 34980 31140 30460 LUGAR LUGAR 26900 LUGAR LUGAR 24382 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules TABLE 9A.—HOSPITAL RECLASSIFICATIONS AND REDESIGNATIONS BY INDIVIDUAL HOSPITAL AND CBSA—FY2007— Continued Geographic CBSA Reclassified CBSA 10/1/2006–3/31/ 2007 18 19 19 19 19 19 19 12940 19 19 19 19 19 19 38860 30340 30340 20 20 20 49340 15764 21604 15764 49340 49340 49340 21604 21604 21604 15764 49340 14484 49340 15764 15764 44140 21604 15764 15764 49340 49340 15764 15764 15764 15764 49340 15764 21604 19804 26100 47644 47644 19804 23 19804 47644 23 23 23 23 47644 19804 23 ............................ 47644 47644 26100 30460 35380 29180 35380 33740 12940 10780 35380 12940 10780 12940 04 43340 12940 40484 38860 38860 38860 12620 38860 14484 14484 14484 14484 14484 14484 14484 14484 14484 14484 14484 14484 12700 14484 14484 14484 25540 14484 14484 14484 14484 14484 14484 14484 14484 14484 14484 14484 14484 ............................ ............................ ............................ ............................ ............................ 29620 ............................ ............................ 40980 24340 13020 11460 19804 ............................ 24580 19804 11460 ............................ ............................ wwhite on PROD1PC61 with PROPOSALS2 Provider No. 180139 190001 190003 190015 190086 190099 190106 190131 190155 190164 190191 190208 190218 190223 200020 200024 200034 200039 200050 200063 220001 220002 220010 220011 220019 220025 220028 220029 220033 220035 220049 220058 220060 220062 220063 220070 220077 220080 220082 220084 220090 220095 220098 220101 220105 220133 220163 220171 220174 230002 230003 230013 230019 230020 230022 230024 230029 230030 230035 230036 230037 230047 230053 230054 230065 230069 230071 230072 ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ VerDate Aug<31>2005 17:10 Apr 24, 2006 Jkt 208001 PO 00000 Frm 00388 Fmt 4701 Sfmt 4702 E:\FR\FM\25APP2.SGM Reclassified CBSA 4/1/2007–9/30/ 2007 25APP2 30460 35380 29180 35380 33740 12940 10780 35380 12940 10780 12940 04 43340 12940 40484 38860 38860 38860 12620 38860 14484 14484 14484 14484 14484 14484 14484 14484 14484 14484 14484 14484 12700 14484 14484 14484 25540 14484 14484 14484 14484 14484 14484 14484 14484 14484 14484 14484 14484 11460 34740 19804 19804 11460 29620 11460 19804 40980 24340 13020 11460 19804 11460 24580 11460 11460 19804 34740 LUGAR LUGAR LUGAR LUGAR Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules 24383 TABLE 9A.—HOSPITAL RECLASSIFICATIONS AND REDESIGNATIONS BY INDIVIDUAL HOSPITAL AND CBSA—FY2007— Continued Geographic CBSA Reclassified CBSA 10/1/2006–3/31/ 2007 40980 23 19804 27100 23 23 23 33780 19804 23 19804 23 47644 23 19804 19804 19804 47644 ............................ 26100 19804 47644 47644 47644 23 12980 47644 47644 19804 47644 47644 47644 47644 19804 19804 47644 47644 19804 23 24 24 41060 24 24 24 24 24 24 24 24 24 24 25 25 25 25 25 25 25 37700 25 25 25 25 25 25 25620 25 22420 40980 ............................ 29620 24340 28020 24340 11460 ............................ 13020 ............................ 29620 ............................ 26100 ............................ ............................ ............................ ............................ 19804 ............................ ............................ 19804 19804 ............................ 24340 29620 ............................ 19804 11460 ............................ 19804 19804 ............................ ............................ ............................ ............................ 11460 ............................ 26100 33460 41060 33460 20260 40340 40340 410060 410060 33460 40340 40340 33460 33460 22520 32820 32820 27180 250060 27140 32820 250060 32820 22520 46220 27140 46220 38220 250060 12940 wwhite on PROD1PC61 with PROPOSALS2 Provider No. 230077 230080 230089 230092 230093 230096 230097 230099 230104 230105 230119 230121 230130 230134 230135 230142 230146 230151 230165 230174 230176 230195 230204 230207 230208 230217 230223 230227 230244 230254 230257 230264 230269 230270 230273 230277 230279 230293 230295 240018 240030 240036 240064 240069 240071 240075 240088 240093 241050 240150 240187 240211 250002 250004 250006 250009 250023 250031 250034 250040 250042 250044 250069 250079 250081 250082 250094 250097 ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ VerDate Aug<31>2005 17:10 Apr 24, 2006 Jkt 208001 PO 00000 Frm 00389 Fmt 4701 Sfmt 4702 E:\FR\FM\25APP2.SGM Reclassified CBSA 4/1/2007–9/30/ 2007 25APP2 22420 40980 11460 29620 24340 28020 24340 11460 11460 13020 11460 29620 19804 26100 11460 11460 11460 19804 11460 34740 11460 19804 19804 19804 24340 29620 19804 19804 11460 19804 19804 19804 19804 11460 11460 19804 11460 11460 26100 33460 41060 33460 20260 40340 40340 410060 410060 33460 40340 40340 33460 33460 22520 32820 32820 27180 250060 27140 32820 250060 32820 22520 46220 27140 46220 38220 250060 12940 LUGAR LUGAR LUGAR LUGAR LUGAR LUGAR LUGAR LUGAR 24384 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules TABLE 9A.—HOSPITAL RECLASSIFICATIONS AND REDESIGNATIONS BY INDIVIDUAL HOSPITAL AND CBSA—FY2007— Continued Geographic CBSA wwhite on PROD1PC61 with PROPOSALS2 Provider No. 250099 250100 250104 250117 260009 260011 260015 260017 260022 260025 260049 260050 260064 260074 260094 260110 260113 260116 260119 260175 260183 260186 270003 270011 270017 270051 280009 280023 280032 280061 280065 280077 280125 290002 290006 290008 290019 300005 300011 300012 300014 300017 300018 300019 300020 300023 300029 300034 310002 310009 310013 310014 310015 310017 310018 310021 310031 310038 310039 310048 310050 310054 310070 310076 310078 310081 310083 310093 ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ VerDate Aug<31>2005 17:10 Apr 24, 2006 Jkt 208001 PO 00000 Frm 00390 Fmt 4701 25 25 25 25 26 27620 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 27 27 27 27 28 28 28 28 28 28 28 29 29 29 16180 30 31700 31700 40484 40484 40484 30 31700 40484 40484 31700 35084 35084 35084 15804 35084 35084 35084 45940 15804 20764 20764 20764 35084 35084 20764 35084 35084 15804 35084 35084 Sfmt 4702 Reclassified CBSA 10/1/2006–3/31/ 2007 Reclassified CBSA 4/1/2007–9/30/ 2007 27140 46220 27140 250060 28140 17860 27860 41180 16 41180 44180 41140 17860 17860 44180 41180 14 14 27860 28140 41180 17860 24500 24500 33540 33540 300700 300700 300700 53 24540 36540 43580 16180 39900 41620 39900 31700 15764 15764 31700 21604 31700 49340 15764 21604 21604 15764 35644 35644 35644 37964 35644 35644 35644 35084 20764 35644 35644 35084 35644 35644 35644 35644 35644 37964 35644 35644 E:\FR\FM\25APP2.SGM 25APP2 27140 46220 27140 250060 28140 17860 27860 41180 16 41180 44180 41140 17860 17860 44180 41180 14 14 27860 28140 41180 17860 24500 24500 33540 33540 300700 300700 300700 53 24540 36540 43580 16180 39900 41620 39900 31700 15764 15764 31700 21604 31700 49340 15764 21604 21604 15764 35644 35644 35644 37964 35644 35644 35644 35084 20764 35644 35644 35084 35644 35644 35644 35644 35644 37964 35644 35644 LUGAR LUGAR LUGAR LUGAR Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules 24385 TABLE 9A.—HOSPITAL RECLASSIFICATIONS AND REDESIGNATIONS BY INDIVIDUAL HOSPITAL AND CBSA—FY2007— Continued Geographic CBSA wwhite on PROD1PC61 with PROPOSALS2 Provider No. 310096 310108 310119 320005 320006 320013 320014 320033 320063 320065 330004 330008 330027 330038 330073 330079 330085 330094 330103 330106 330136 330157 330167 330181 330182 330191 330198 330224 330225 330229 330235 330239 330250 330259 330277 330331 330332 330359 330372 330386 340004 340008 340010 340013 340014 340021 340023 340027 340039 340047 340050 340051 340068 340069 340070 340071 340073 340091 340109 340114 340115 340124 340126 340127 340129 340131 340136 340138 ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ VerDate Aug<31>2005 17:10 Apr 24, 2006 Jkt 208001 PO 00000 Frm 00391 Fmt 4701 35084 20764 35084 22140 32 32 32 32 32 32 28740 33 35004 33 33 33 33 33 33 35004 33 33 35004 35004 35004 24020 35004 28740 35004 27460 33 27460 33 35004 33 35004 35004 33 35004 33 24660 34 24140 34 49180 34 11700 34 34 49180 34 34 34 39580 15500 34 39580 24660 34 39580 34 34 34 34 34 34 34 39580 Sfmt 4702 Reclassified CBSA 10/1/2006–3/31/ 2007 Reclassified CBSA 4/1/2007–9/30/ 2007 35644 35644 35644 10740 42140 42140 29740 42140 36220 36220 39100 15380 35644 40380 40380 47 450060 28740 39 ............................ 450060 450060 ............................ ............................ 35644 10580 ............................ 39100 ............................ 21500 450060 21500 15540 ............................ 270060 ............................ ............................ 39100 ............................ 39100 49180 16740 39580 24860 24660 16740 24860 24780 16740 24660 22180 25860 48900 200500 24660 39580 200500 49180 47260 200500 200500 39580 39580 200500 16740 24780 200500 200500 E:\FR\FM\25APP2.SGM 25APP2 35644 35644 35644 10740 42140 42140 29740 42140 36220 36220 39100 15380 35644 40380 40380 47 450060 28740 39 35644 450060 450060 35644 35644 35644 10580 35644 39100 35644 21500 450060 21500 15540 35644 270060 35644 35644 39100 35644 39100 49180 16740 39580 24860 24660 16740 24860 24780 16740 24660 22180 25860 48900 200500 24660 39580 200500 49180 47260 200500 200500 39580 39580 200500 16740 24780 200500 200500 LUGAR LUGAR LUGAR LUGAR LUGAR LUGAR LUGAR LUGAR LUGAR LUGAR 24386 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules TABLE 9A.—HOSPITAL RECLASSIFICATIONS AND REDESIGNATIONS BY INDIVIDUAL HOSPITAL AND CBSA—FY2007— Continued Geographic CBSA wwhite on PROD1PC61 with PROPOSALS2 Provider No. 340144 401345 340147 340148 340173 350003 350006 350009 360008 360010 360011 360013 360014 360019 360020 360025 360027 360036 360039 360054 360065 360078 360079 360084 360086 360095 360096 360107 360121 360125 360150 360159 360175 360185 360187 360197 360211 360238 360241 360245 360253 370004 370006 370014 370015 370016 370018 370022 370025 370026 370034 370047 370049 370099 370103 370113 380001 380022 380027 380050 380090 390006 390013 390030 390031 390046 390048 390065 ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ VerDate Aug<31>2005 17:10 Apr 24, 2006 Jkt 208001 PO 00000 Frm 00392 Fmt 4701 34 34 40580 49180 39580 35 35 35 36 36 36 36 36 10420 10420 41780 10420 36 36 36 36 10420 19380 15940 44220 36 36 36 36 36 10420 36 36 36 44220 36 48260 36 10420 36 19380 37 37 37 37 37 37 37 37 37 37 37 37 37 37 37 38 38 38 38 38 39 39 39 39 49620 39 39 Sfmt 4702 Reclassified CBSA 10/1/2006–3/31/ 2007 Reclassified CBSA 4/1/2007–9/30/ 2007 16740 16740 39580 24660 200500 13900 13900 22020 26580 10420 18140 30620 18140 17460 17460 17460 17460 17460 18140 26580 17460 17460 17140 10420 19380 45780 49660 45780 11460 17460 17460 18140 18140 49660 19380 18140 38300 49660 17460 17460 17140 27900 17 43300 46140 36420 46140 30020 46140 36420 22900 43300 36420 46140 45 22220 38900 18700 21660 32780 21660 25420 25420 10900 39740 29540 25420 47894 E:\FR\FM\25APP2.SGM 25APP2 16740 16740 39580 24660 200500 13900 13900 22020 26580 10420 18140 30620 18140 17460 17460 17460 17460 17460 18140 26580 17460 17460 17140 10420 19380 45780 49660 45780 11460 17460 17460 18140 18140 49660 19380 18140 38300 49660 17460 17460 17140 27900 17 43300 46140 36420 46140 30020 46140 36420 22900 43300 36420 46140 45 22220 38900 18700 21660 32780 21660 25420 25420 10900 39740 29540 25420 47894 LUGAR LUGAR LUGAR LUGAR LUGAR LUGAR LUGAR LUGAR LUGAR Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules 24387 TABLE 9A.—HOSPITAL RECLASSIFICATIONS AND REDESIGNATIONS BY INDIVIDUAL HOSPITAL AND CBSA—FY2007— Continued Geographic CBSA wwhite on PROD1PC61 with PROPOSALS2 Provider No. 390066 390071 390079 390081 390086 390091 390110 390113 390133 390151 390156 390180 390222 390246 400048 410010 410012 410013 420007 420009 420020 420027 420028 420030 420036 420039 420067 420068 420069 420070 420071 420080 420083 420085 430012 430014 430094 440002 440008 440020 440024 440025 440035 440050 440058 440059 440060 440067 440068 440072 440073 440148 440151 440175 440180 440185 440192 450007 450032 450039 450059 450064 450073 450080 450087 450099 450121 450135 ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ VerDate Aug<31>2005 17:10 Apr 24, 2006 Jkt 208001 PO 00000 Frm 00393 Fmt 4701 30140 39 39 37964 39 39 27780 39 10900 39 37964 37964 37964 39 25020 39300 39300 39300 43900 42 42 11340 42 42 42 42 42 42 42 44940 42 42 43900 34820 43 43 43 27180 44 44 17420 44 17300 44 44 44 44 34100 44 44 44 44 44 44 44 17420 44 45 45 23104 41700 23104 45 45 23104 45 23104 23104 Sfmt 4702 Reclassified CBSA 10/1/2006–3/31/ 2007 Reclassified CBSA 4/1/2007–9/30/ 2007 25420 48700 13780 48864 44300 38300 38300 36 37964 13644 48864 48864 48864 48700 41980 14484 14484 35980 24860 24860 16700 24860 44940 16700 16740 43900 42340 12260 44940 17900 24860 42340 24860 48900 43620 22020 53 32820 27180 26620 16860 34 34980 11700 16860 34980 27180 28940 16860 32820 34980 34980 34980 34980 28940 16860 34980 41700 43340 19124 12420 19124 10180 30980 19124 11100 19124 19124 E:\FR\FM\25APP2.SGM 25APP2 25420 48700 13780 48864 44300 38300 38300 36 37964 13644 48864 48864 48864 48700 41980 14484 14484 35980 24860 24860 16700 24860 44940 16700 16740 43900 42340 12260 44940 17900 24860 42340 24860 48900 43620 22020 53 32820 27180 26620 16860 34 34980 11700 16860 34980 27180 28940 16860 32820 34980 34980 34980 34980 28940 16860 34980 41700 43340 19124 12420 19124 10180 30980 19124 11100 19124 19124 LUGAR LUGAR LUGAR LUGAR LUGAR LUGAR 24388 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules TABLE 9A.—HOSPITAL RECLASSIFICATIONS AND REDESIGNATIONS BY INDIVIDUAL HOSPITAL AND CBSA—FY2007— Continued Geographic CBSA wwhite on PROD1PC61 with PROPOSALS2 Provider No. 450137 450144 450148 450187 450192 450194 450196 450211 450214 450224 450283 450286 450347 450351 450389 450395 450400 450419 450438 450447 450451 450484 450508 450547 450563 450639 450653 450656 450672 450675 450677 450694 450747 450755 450770 450779 450813 450830 450839 450858 450872 450880 460004 460005 460007 460011 460021 460039 460041 460042 470001 470011 470012 490004 490005 490013 490018 490042 490048 490079 490092 490105 490106 490109 500002 500003 500016 500021 ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ VerDate Aug<31>2005 17:10 Apr 24, 2006 Jkt 208001 PO 00000 Frm 00394 Fmt 4701 23104 45 23104 45 45 45 45 45 45 45 45 45 45 45 45 45 45 23104 45 45 45 45 45 45 23104 23104 45 45 23104 23104 23104 45 45 45 45 23104 45 45 45 23104 23104 23104 36260 36260 46 46 41100 46 36260 36260 47 47 47 25500 49020 49 49 13980 40220 49 49 49 49 47260 50 34580 48300 45104 Sfmt 4702 Reclassified CBSA 10/1/2006–3/31/ 2007 Reclassified CBSA 4/1/2007–9/30/ 2007 19124 36220 19124 26420 19124 19124 19124 26420 26420 46340 19124 17780 26420 23104 19124 26420 47380 19124 26420 19124 23104 30980 46340 19124 19124 19124 33260 46340 19124 19124 19124 26420 19124 31180 12420 19124 41700 36220 43340 19124 19124 19124 41620 41620 41100 39340 29820 36260 41620 41620 30 15764 38340 16820 47894 31340 16820 40220 31340 24660 400060 28700 16820 400060 28420 42644 42644 42644 E:\FR\FM\25APP2.SGM 25APP2 19124 36220 19124 26420 19124 19124 19124 26420 26420 46340 19124 17780 26420 23104 19124 26420 47380 19124 26420 19124 23104 30980 46340 19124 19124 19124 33260 46340 19124 19124 19124 26420 19124 31180 12420 19124 41700 36220 43340 19124 19124 19124 41620 41620 41100 39340 29820 36260 41620 41620 30 15764 38340 16820 47894 31340 16820 40220 31340 24660 400060 28700 16820 400060 28420 42644 42644 42644 LUGAR LUGAR LUGAR LUGAR LUGAR Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules 24389 TABLE 9A.—HOSPITAL RECLASSIFICATIONS AND REDESIGNATIONS BY INDIVIDUAL HOSPITAL AND CBSA—FY2007— Continued Geographic CBSA Provider No. 500024 500039 500041 500072 500079 500108 500129 500139 510001 510002 510006 510018 510024 510030 510046 510047 510062 510070 510071 510077 520002 520021 520028 520037 520059 520060 520066 520071 520076 520088 520094 520095 520096 520102 520107 520113 520116 520173 520189 530015 530025 ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ ................................................................................................ 36500 14740 31020 50 45104 45104 45104 36500 340060 51 51 51 340060 51 51 51 51 51 51 51 52 29404 52 52 39540 52 27500 52 52 22540 39540 52 39540 52 52 52 52 52 29404 53 53 Reclassified CBSA 10/1/2006–3/31/ 2007 Reclassified CBSA 4/1/2007–9/30/ 2007 45104 42644 38900 42644 42644 42644 42644 45104 38300 40220 38300 16620 38300 340060 16620 38300 16620 16620 16620 26580 48140 16974 31540 48140 29404 22540 31540 33340 31540 33340 33340 31540 33340 33340 24580 24580 33340 20260 16974 26820 22660 45104 42644 38900 42644 42644 42644 42644 45104 38300 40220 38300 16620 38300 340060 16620 38300 16620 16620 16620 26580 48140 16974 31540 48140 29404 22540 31540 33340 31540 33340 33340 31540 33340 33340 24580 24580 33340 20260 16974 26820 22660 LUGAR LUGAR LUGAR LUGAR LUGAR LUGAR TABLE 9B.—HOSPITAL RECLASSIFICATIONS AND REDESIGNATIONS BY INDIVIDUAL HOSPITAL UNDER SECTION 508 OF PUBLIC LAW 108–173—FY 2007 wwhite on PROD1PC61 with PROPOSALS2 Provider number 050494 050549 070001 070005 070006 070010 070016 070017 070018 070019 070022 070028 070031 070034 070039 160040 160067 Note ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. VerDate Aug<31>2005 17:10 Apr 24, 2006 Jkt 208001 PO 00000 ............ ............ ............ ............ * ............ ............ ............ * ............ ............ ............ ............ * ............ ............ ............ Frm 00395 Fmt 4701 05 37100 35300 35300 14860 14860 35300 35300 14860 35300 35300 14860 35300 14860 35300 47940 47940 Sfmt 4702 Wage index CBSA— 4/1/2007–9/30/ 2007* Wage index CBSA— 10/1/06–3/31/07 Geographic CBSA 42220 42220 35004 35004 35644 35644 35004 35004 35644 35004 35004 35644 35004 35644 35004 16300 16300 E:\FR\FM\25APP2.SGM Own Wage index— 10/1/06–3/31/07 ............................ ............................ ............................ ............................ ............................ ............................ ............................ ............................ ............................ ............................ ............................ ............................ ............................ ............................ ............................ ............................ ............................ ............................ ............................ ............................ ............................ ............................ ............................ ............................ ............................ ............................ ............................ ............................ ............................ ............................ ............................ ............................ ............................ ............................ 25APP2 24390 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules TABLE 9B.—HOSPITAL RECLASSIFICATIONS AND REDESIGNATIONS BY INDIVIDUAL HOSPITAL UNDER SECTION 508 OF PUBLIC LAW 108–173—FY 2007—Continued wwhite on PROD1PC61 with PROPOSALS2 Provider number 160110 220046 230003 230004 230013 230019 230020 230024 230029 230038 230053 230059 230066 230071 230072 230089 230104 230106 230119 230130 230135 230146 230151 230165 230174 230176 230207 230223 230236 230254 230269 230270 230273 230277 250078 250122 270002 270012 270023 270032 270057 310028 310051 310060 310115 310120 330023 330049 330067 330106 330126 330135 330205 330209 330264 340002 350002 350010 350014 350015 350017 350019 350030 390001 390003 390054 390072 390095 Note ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. VerDate Aug<31>2005 17:10 Apr 24, 2006 Jkt 208001 PO 00000 ............ ............ ............ ............ ............ ............ ............ ............ ............ ............ ............ ............ ............ ............ ............ ............ ............ ............ ............ ............ ............ ............ ............ ............ ............ ............ ............ ............ ............ ............ ............ ............ ............ ............ * ............ * * ............ ............ ............ ............ ............ ............ ............ ............ * ............ * ............ ............ ............ ............ ............ ............ ............ ............ ............ ............ ............ ............ * ............ ............ ............ ............ ............ ............ Frm 00396 Wage index CBSA— 10/1/06–3/31/07 Geographic CBSA Fmt 4701 47940 38340 26100 34740 47644 47644 19804 19804 47644 24340 19804 24340 34740 47644 26100 19804 19804 24340 19804 47644 19804 19804 47644 19804 26100 19804 47644 47644 24340 47644 47644 19804 19804 47644 25620 25 27 24500 33540 27 27 35084 35084 10900 10900 35084 39100 39100 39100 35004 39100 39100 39100 39100 39100 11700 13900 35 35 13900 35 24220 35 42540 39 42540 39 42540 Sfmt 4702 Wage index CBSA— 4/1/2007–9/30/ 2007* Own Wage index— 10/1/06–3/31/07 16300 14484 28020 28020 22420 22420 11460 11460 22420 28020 11460 28020 28020 22420 28020 11460 11460 28020 11460 22420 11460 11460 22420 11460 28020 11460 22420 22420 28020 22420 22420 11460 11460 22420 25060 25060 33540 33540 13740 13740 13740 35644 35644 35644 35644 35644 35644 35644 35644 ............................ 35644 35644 35644 35004 35004 16740 22020 22020 22020 22020 22020 22020 22020 10900 10900 29540 10900 10900 ............................ ............................ ............................ ............................ ............................ ............................ ............................ ............................ ............................ ............................ ............................ ............................ ............................ ............................ ............................ ............................ ............................ ............................ ............................ ............................ ............................ ............................ ............................ ............................ ............................ ............................ ............................ ............................ ............................ ............................ ............................ ............................ ............................ ............................ 25060 ............................ 33540 33540 ............................ ............................ ............................ ............................ ............................ ............................ ............................ ............................ 35644 ............................ 35644 ............................ ............................ ............................ ............................ ............................ ............................ ............................ ............................ ............................ ............................ ............................ ............................ 22020 ............................ ............................ ............................ ............................ ............................ ............................ ............................ ............................ ............................ ............................ ............................ ............................ ............................ ............................ ............................ ............................ ............................ ............................ ............................ ............................ ............................ ............................ ............................ ............................ ............................ ............................ ............................ ............................ ............................ ............................ ............................ ............................ ............................ ............................ ............................ ............................ ............................ ............................ ............................ ............................ ............................ ............................ ............................ ............................ ............................ ............................ ............................ ............................ ............................ ............................ ............................ ............................ ............................ ............................ ............................ 1.4485 ............................ ............................ ............................ ............................ ............................ ............................ ............................ ............................ ............................ ............................ ............................ ............................ ............................ ............................ ............................ ............................ ............................ ............................ E:\FR\FM\25APP2.SGM 25APP2 24391 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules TABLE 9B.—HOSPITAL RECLASSIFICATIONS AND REDESIGNATIONS BY INDIVIDUAL HOSPITAL UNDER SECTION 508 OF PUBLIC LAW 108–173—FY 2007—Continued Provider number 390119 390137 390169 390185 390192 390237 390270 430005 430008 430013 430015 430048 430060 430064 430077 430091 450010 450072 450591 470003 490001 490024 530008 530010 Note ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............ ............ ............ ............ ............ ............ ............ ............ * * ............ ............ ............ ............ ............ ............ ............ ............ ............ ............ ............ ............ * * Wage index CBSA— 4/1/2007–9/30/ 2007* Wage index CBSA— 10/1/06–3/31/07 Geographic CBSA 42540 42540 42540 42540 42540 42540 42540 43 43 43 43 43 43 43 39660 39660 48660 26420 26420 15540 49 40220 53 53 10900 10900 10900 29540 10900 10900 29540 39660 43620 43620 43620 43620 43620 43620 43620 43620 32580 26420 26420 14484 31340 19260 16220 16220 Own Wage index— 10/1/06–3/31/07 ............................ ............................ ............................ ............................ ............................ ............................ ............................ ............................ 43620 43620 ............................ ............................ ............................ ............................ ............................ ............................ ............................ ............................ ............................ ............................ ............................ ............................ 16220 16220 ............................ ............................ ............................ ............................ ............................ ............................ ............................ ............................ ............................ ............................ ............................ ............................ ............................ ............................ ............................ ............................ ............................ ............................ ............................ ............................ ............................ ............................ ............................ ............................ * These hospitals are assigned a wage index value under a special exceptions policy (see the FY 2005 IPPS final rule, 69 FR 49105). TABLE 9C.—HOSPITALS REDESIGNATED AS RURAL UNDER SECTION 1886(D)(8)(E) OF THE ACT—FY 2007 Geographic CBSA wwhite on PROD1PC61 with PROPOSALS2 Provider number 050192 050469 050528 050618 070004 100048 100134 170137 190048 230078 260006 260047 260195 330268 370054 380040 390052 390084 390093 390118 390125 390138 390146 390150 390181 390183 390189 390199 390201 440135 450052 450078 450243 450348 500060 500148 ..................................................................................................................................................................... ..................................................................................................................................................................... ..................................................................................................................................................................... ..................................................................................................................................................................... ..................................................................................................................................................................... ..................................................................................................................................................................... ..................................................................................................................................................................... ..................................................................................................................................................................... ..................................................................................................................................................................... ..................................................................................................................................................................... ..................................................................................................................................................................... ..................................................................................................................................................................... ..................................................................................................................................................................... ..................................................................................................................................................................... ..................................................................................................................................................................... ..................................................................................................................................................................... ..................................................................................................................................................................... ..................................................................................................................................................................... ..................................................................................................................................................................... ..................................................................................................................................................................... ..................................................................................................................................................................... ..................................................................................................................................................................... ..................................................................................................................................................................... ..................................................................................................................................................................... ..................................................................................................................................................................... ..................................................................................................................................................................... ..................................................................................................................................................................... ..................................................................................................................................................................... ..................................................................................................................................................................... ..................................................................................................................................................................... ..................................................................................................................................................................... ..................................................................................................................................................................... ..................................................................................................................................................................... ..................................................................................................................................................................... ..................................................................................................................................................................... ..................................................................................................................................................................... VerDate Aug<31>2005 17:10 Apr 24, 2006 Jkt 208001 PO 00000 Frm 00397 Fmt 4701 Sfmt 4702 E:\FR\FM\25APP2.SGM 25APP2 23420 40140 32900 40140 25540 37860 27260 29940 26380 35660 41140 27620 44180 10580 36420 13460 39 39 39 39 39 39 39 39 39 39 39 39 39 34980 45 10180 10180 45 42644 48300 Redesignated rural area 05 05 05 05 07 10 10 17 19 23 26 26 26 33 37 38 39 39 39 39 39 39 39 39 39 39 39 39 39 44 45 45 45 45 50 50 24392 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules TABLE 10.—GEOMETRIC MEAN PLUS THE LESSER OF .75 OF THE NATIONAL ADJUSTED OPERATING STANDARDIZED PAYMENT AMOUNT (INCREASED TO REFLECT THE DIFFERENCE BETWEEN COSTS AND CHARGES) OR .75 OF ONE STANDARD DEVIATION OF MEAN CHARGES BY DIAGNOSIS-RELATED GROUP (DRG) MARCH 2006 1 Number of cases wwhite on PROD1PC61 with PROPOSALS2 DRG 1 ........................ 2 ........................ 3 ........................ 6 ........................ 7 ........................ 8 ........................ 9 ........................ 10 ...................... 11 ...................... 12 ...................... 13 ...................... 14 ...................... 15 ...................... 16 ...................... 17 ...................... 18 ...................... 19 ...................... 20 ...................... 21 ...................... 22 ...................... 23 ...................... 24 ...................... 25 ...................... 26 ...................... 27 ...................... 28 ...................... 29 ...................... 31 ...................... 32 ...................... 34 ...................... 35 ...................... 36 ...................... 37 ...................... 38 ...................... 39 ...................... 40 ...................... 42 ...................... 43 ...................... 44 ...................... 45 ...................... 46 ...................... 47 ...................... 49 ...................... 50 ...................... 51 ...................... 52 ...................... 53 ...................... 55 ...................... 56 ...................... 57 ...................... 59 ...................... 60 ...................... 61 ...................... 62 ...................... 63 ...................... 64 ...................... 65 ...................... 66 ...................... 67 ...................... 68 ...................... VerDate Aug<31>2005 24,328 10,275 2 291 14,912 3,415 1,761 19,574 3,075 56,224 7,495 278,100 20,038 17,333 2,966 33,356 8,416 6,407 2,205 3,151 10,668 63,265 27,269 24 5,923 19,837 6,498 4,967 1,856 27,462 7,825 1,203 1,233 48 362 1,251 941 123 1,310 2,765 3,942 1,322 2,414 2,023 192 316 2,137 1,366 450 881 127 3 222 4 2,826 3,252 40,693 8,208 379 19,063 17:10 Apr 24, 2006 TABLE 10.—GEOMETRIC MEAN PLUS THE LESSER OF .75 OF THE NATIONAL ADJUSTED OPERATING STANDARDIZED PAYMENT AMOUNT (INCREASED TO REFLECT THE DIFFERENCE BETWEEN COSTS AND CHARGES) OR .75 OF ONE STANDARD DEVIATION OF MEAN CHARGES BY DIAGNOSIS-RELATED GROUP (DRG) MARCH 2006 1—Continued Threshold $53,938 $37,402 $70,158 $16,552 $41,716 $31,108 $25,283 $25,017 $18,962 $18,919 $17,715 $24,927 $20,826 $26,314 $15,701 $21,320 $15,732 $40,783 $26,935 $23,912 $16,962 $21,159 $13,798 $20,300 $25,046 $25,435 $15,810 $21,053 $14,058 $21,201 $14,408 $15,522 $24,385 $11,080 $14,021 $21,938 $17,594 $12,806 $14,842 $16,531 $16,755 $12,080 $31,141 $19,180 $19,172 $16,103 $26,620 $20,219 $19,353 $20,358 $15,100 $18,913 $28,884 $7,210 $26,658 $23,164 $13,497 $12,916 $17,295 $14,128 Jkt 208001 Number of cases DRG 69 ...................... 70 ...................... 71 ...................... 72 ...................... 73 ...................... 74 ...................... 75 ...................... 76 ...................... 77 ...................... 78 ...................... 79 ...................... 80 ...................... 81 ...................... 82 ...................... 83 ...................... 84 ...................... 85 ...................... 86 ...................... 87 ...................... 88 ...................... 89 ...................... 90 ...................... 91 ...................... 92 ...................... 93 ...................... 94 ...................... 95 ...................... 96 ...................... 97 ...................... 98 ...................... 99 ...................... 100 .................... 101 .................... 102 .................... 103 .................... 104 .................... 105 .................... 106 .................... 108 .................... 110 .................... 111 .................... 113 .................... 114 .................... 117 .................... 118 .................... 119 .................... 120 .................... 121 .................... 122 .................... 123 .................... 124 .................... 125 .................... 126 .................... 127 .................... 128 .................... 129 .................... 130 .................... 131 .................... 132 .................... 133 .................... PO 00000 Frm 00398 Fmt 4701 5,200 23 71 1,341 9,963 3 46,661 47,934 2,086 49,495 160,350 7,187 6 63,071 7,053 1,379 22,188 1,726 96,594 427,896 555,084 43,729 53 16,529 1,446 13,561 1,568 60,141 26,997 13 21,440 6,425 23,372 4,916 859 20,077 32,514 3,427 8,740 57,543 10,744 34,572 7,940 5,331 7,618 965 33,337 150,081 54,533 29,519 120,197 92,007 5,415 667,830 4,228 3,504 87,619 22,939 101,445 5,877 Sfmt 4702 TABLE 10.—GEOMETRIC MEAN PLUS THE LESSER OF .75 OF THE NATIONAL ADJUSTED OPERATING STANDARDIZED PAYMENT AMOUNT (INCREASED TO REFLECT THE DIFFERENCE BETWEEN COSTS AND CHARGES) OR .75 OF ONE STANDARD DEVIATION OF MEAN CHARGES BY DIAGNOSIS-RELATED GROUP (DRG) MARCH 2006 1—Continued Threshold $10,627 $7,427 $15,648 $16,527 $18,049 $8,105 $48,108 $43,517 $25,753 $26,329 $29,300 $18,853 $25,887 $26,543 $21,671 $12,820 $25,115 $15,503 $26,870 $19,083 $22,017 $13,109 $11,679 $24,748 $16,248 $23,676 $12,581 $15,900 $11,754 $12,587 $15,705 $12,166 $18,530 $12,328 $234,201 $124,179 $93,739 $111,298 $89,367 $59,240 $45,073 $45,534 $30,209 $25,603 $33,248 $25,877 $36,476 $29,689 $21,009 $25,707 $29,665 $23,825 $40,840 $21,961 $15,640 $21,695 $20,101 $12,055 $13,662 $12,148 DRG 134 135 136 138 139 140 141 142 143 144 145 146 147 148 149 150 151 152 153 154 155 156 157 158 159 160 161 162 163 164 165 166 167 168 169 170 171 172 173 174 175 176 177 178 179 180 181 182 183 184 185 186 187 188 189 190 191 192 193 194 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... E:\FR\FM\25APP2.SGM 25APP2 Number of cases 40,280 7,169 936 206,144 74,055 31,532 123,443 49,350 238,325 104,907 5,727 10,217 2,607 132,645 19,460 22,886 5,365 4,995 1,946 26,968 5,992 4 8,291 3,707 19,172 11,919 10,136 4,950 4 5,971 2,443 5,126 4,864 1,532 770 17,890 1,404 33,122 2,229 260,944 29,891 14,595 7,656 2,548 14,654 91,305 25,234 297,038 81,833 76 6,240 7 644 93,551 13,148 63 10,546 1,376 4,038 461 Threshold $13,518 $19,603 $14,048 $17,801 $11,519 $11,134 $16,543 $13,194 $12,583 $24,478 $12,846 $45,078 $31,265 $51,883 $30,248 $45,015 $27,699 $33,362 $23,355 $56,652 $27,799 $43,037 $25,914 $14,374 $28,300 $18,834 $25,538 $15,241 $14,007 $38,851 $25,609 $29,243 $19,695 $25,261 $16,756 $44,542 $26,663 $26,316 $16,793 $22,036 $12,609 $23,998 $20,625 $15,447 $23,043 $20,909 $12,552 $18,449 $13,162 $14,814 $18,863 $5,726 $18,582 $22,996 $13,298 $16,464 $54,836 $32,518 $51,797 $32,202 24393 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules TABLE 10.—GEOMETRIC MEAN PLUS THE LESSER OF .75 OF THE NATIONAL ADJUSTED OPERATING STANDARDIZED PAYMENT AMOUNT (INCREASED TO REFLECT THE DIFFERENCE BETWEEN COSTS AND CHARGES) OR .75 OF ONE STANDARD DEVIATION OF MEAN CHARGES BY DIAGNOSIS-RELATED GROUP (DRG) MARCH 2006 1—Continued Number of cases wwhite on PROD1PC61 with PROPOSALS2 DRG 195 196 197 198 199 200 201 202 203 204 205 206 207 208 210 211 212 213 216 217 218 219 220 223 224 225 226 227 228 229 230 232 233 234 235 236 237 238 239 240 241 242 243 244 245 246 247 248 249 250 251 253 254 256 257 258 259 260 261 262 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... VerDate Aug<31>2005 2,835 594 16,347 4,105 1,477 1,014 2,707 27,497 32,322 69,183 32,722 2,041 38,324 9,535 126,270 25,668 10 9,455 19,927 15,590 29,952 21,035 2 12,641 9,914 6,246 6,735 4,867 2,680 1,123 2,458 566 18,408 9,070 4,753 41,708 1,917 9,766 40,264 12,897 2,829 2,726 100,715 17,015 5,904 1,407 21,424 16,489 13,442 4,144 2,068 24,748 9,990 7,606 13,084 11,372 2,657 2,421 1,568 599 17:10 Apr 24, 2006 TABLE 10.—GEOMETRIC MEAN PLUS THE LESSER OF .75 OF THE NATIONAL ADJUSTED OPERATING STANDARDIZED PAYMENT AMOUNT (INCREASED TO REFLECT THE DIFFERENCE BETWEEN COSTS AND CHARGES) OR .75 OF ONE STANDARD DEVIATION OF MEAN CHARGES BY DIAGNOSIS-RELATED GROUP (DRG) MARCH 2006 1—Continued Threshold $50,330 $32,533 $42,001 $26,117 $37,170 $39,833 $52,939 $25,079 $26,139 $22,933 $23,282 $16,152 $24,655 $15,457 $36,343 $26,696 $18,770 $33,757 $35,368 $41,834 $32,692 $23,451 $24,004 $25,348 $18,586 $26,078 $29,288 $18,609 $24,599 $15,669 $26,420 $20,841 $34,741 $27,627 $16,296 $15,403 $13,860 $26,257 $23,062 $24,260 $14,155 $22,458 $17,004 $15,399 $10,392 $13,311 $12,727 $18,894 $15,428 $15,072 $10,611 $16,493 $10,194 $18,047 $19,605 $15,439 $21,683 $15,090 $20,742 $20,894 Jkt 208001 Number of cases DRG 263 264 265 266 267 268 269 270 271 272 273 274 275 276 277 278 279 280 281 283 284 285 286 287 288 289 290 291 292 293 294 295 296 297 298 299 300 301 302 303 304 305 306 307 308 309 310 311 312 313 314 315 316 317 318 319 320 321 322 323 PO 00000 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... Frm 00399 Fmt 4701 22,459 3,905 4,011 2,221 273 994 11,014 2,567 21,702 6,074 1,267 2,242 180 1,623 119,279 33,947 6 19,317 6,558 6,779 1,870 8,029 2,858 5,417 11,262 6,326 11,850 59 7,563 319 97,778 4,359 247,564 42,713 110 1,544 21,668 3,917 10,266 24,555 14,042 3,000 5,792 1,941 6,672 3,267 25,307 5,868 1,322 502 2 34,708 204,537 2,695 5,900 386 225,308 32,125 67 20,424 Sfmt 4702 TABLE 10.—GEOMETRIC MEAN PLUS THE LESSER OF .75 OF THE NATIONAL ADJUSTED OPERATING STANDARDIZED PAYMENT AMOUNT (INCREASED TO REFLECT THE DIFFERENCE BETWEEN COSTS AND CHARGES) OR .75 OF ONE STANDARD DEVIATION OF MEAN CHARGES BY DIAGNOSIS-RELATED GROUP (DRG) MARCH 2006 1—Continued Threshold $32,488 $22,421 $28,291 $19,694 $20,005 $25,612 $30,475 $17,712 $21,485 $20,835 $12,661 $22,532 $12,564 $15,496 $18,413 $11,744 $9,165 $16,070 $11,023 $15,588 $9,582 $35,326 $34,797 $31,354 $36,453 $19,747 $18,894 $13,196 $41,631 $27,017 $16,203 $16,127 $17,305 $10,753 $11,321 $21,193 $23,141 $13,502 $53,482 $38,849 $37,954 $25,713 $25,952 $13,794 $29,226 $20,392 $25,305 $14,225 $24,353 $16,746 $63,207 $34,675 $24,329 $17,236 $23,909 $13,776 $18,217 $12,238 $13,312 $18,227 DRG 324 325 326 327 328 329 331 332 333 334 335 336 337 338 339 341 342 344 345 346 347 348 349 350 352 353 354 355 356 357 358 359 360 361 362 363 364 365 366 367 368 369 370 371 372 373 374 375 376 377 378 379 380 381 382 383 384 389 392 394 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... E:\FR\FM\25APP2.SGM 25APP2 Number of cases 4,622 9,912 2,596 11 574 55 56,911 4,148 242 9,480 12,115 28,104 21,412 670 1,226 3,118 455 2,344 1,393 4,006 247 4,275 556 7,275 1,176 3,075 7,556 4,982 22,197 5,521 20,865 28,554 14,250 288 2 1,978 1,366 1,607 4,664 448 4,156 3,780 2,210 2,656 1,354 5,201 153 13 474 111 203 486 111 172 51 2,816 147 3 2,120 2,758 Threshold $11,415 $14,526 $9,757 $4,343 $15,429 $11,791 $22,376 $13,671 $18,937 $29,861 $24,029 $18,105 $12,512 $26,885 $24,456 $26,313 $16,807 $26,216 $24,179 $22,303 $11,878 $15,630 $10,034 $16,391 $16,670 $31,137 $29,687 $19,301 $16,341 $37,813 $24,333 $17,289 $19,091 $23,723 $6,842 $22,611 $20,070 $32,785 $23,778 $13,000 $23,392 $14,156 $17,586 $12,644 $10,859 $7,550 $12,838 $21,703 $12,994 $24,218 $16,225 $7,975 $9,309 $14,935 $3,954 $10,480 $7,366 $24,011 $45,705 $30,927 24394 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules TABLE 10.—GEOMETRIC MEAN PLUS THE LESSER OF .75 OF THE NATIONAL ADJUSTED OPERATING STANDARDIZED PAYMENT AMOUNT (INCREASED TO REFLECT THE DIFFERENCE BETWEEN COSTS AND CHARGES) OR .75 OF ONE STANDARD DEVIATION OF MEAN CHARGES BY DIAGNOSIS-RELATED GROUP (DRG) MARCH 2006 1—Continued Number of cases DRG 395 396 397 398 399 401 402 403 404 406 407 408 409 410 411 412 413 414 415 416 417 418 419 420 421 422 423 424 425 426 427 428 429 430 431 432 433 439 440 441 442 443 444 445 447 449 450 451 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... TABLE 10.—GEOMETRIC MEAN PLUS THE LESSER OF .75 OF THE NATIONAL ADJUSTED OPERATING STANDARDIZED PAYMENT AMOUNT (INCREASED TO REFLECT THE DIFFERENCE BETWEEN COSTS AND CHARGES) OR .75 OF ONE STANDARD DEVIATION OF MEAN CHARGES BY DIAGNOSIS-RELATED GROUP (DRG) MARCH 2006 1—Continued Threshold 115,676 20 16,409 18,602 1,639 6,443 1,341 31,499 3,625 2,300 608 1,941 1,733 29,018 5 8 5,727 481 55,695 287,720 33 29,891 17,735 3,052 13,248 77 9,071 1,034 13,105 4,244 1,575 831 24,102 75,185 338 401 5,145 1,750 5,181 687 18,524 3,570 6,004 2,259 6,341 40,812 7,395 2 $18,128 $13,145 $23,004 $24,048 $14,974 $43,881 $25,131 $29,820 $19,967 $42,504 $24,913 $33,805 $24,885 $23,855 $9,742 $9,732 $25,493 $16,066 $54,398 $29,284 $28,169 $22,126 $18,517 $12,846 $16,145 $11,732 $28,338 $36,130 $13,590 $10,349 $11,169 $13,862 $16,887 $13,563 $12,778 $14,072 $6,348 $29,718 $29,513 $20,575 $37,538 $22,683 $16,185 $11,272 $11,444 $18,232 $9,416 $19,140 Number of cases DRG 452 453 454 455 461 462 463 464 465 466 467 468 470 471 473 475 476 477 479 480 481 482 484 485 486 487 488 489 490 491 492 493 494 495 496 497 498 499 500 501 502 503 504 505 506 507 508 509 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... 28,659 5,379 4,754 885 2,271 7,854 32,979 7,677 171 1,250 1,035 51,806 130 15,526 8,554 119,935 2,840 28,074 27,582 884 1,183 5,076 456 3,658 2,607 4,877 823 13,661 5,338 22,679 3,897 60,901 24,434 336 3,709 31,216 21,383 35,204 46,619 3,171 756 5,858 191 180 964 323 662 157 TABLE 10.—GEOMETRIC MEAN PLUS THE LESSER OF .75 OF THE NATIONAL ADJUSTED OPERATING STANDARDIZED PAYMENT AMOUNT (INCREASED TO REFLECT THE DIFFERENCE BETWEEN COSTS AND CHARGES) OR .75 OF ONE STANDARD DEVIATION OF MEAN CHARGES BY DIAGNOSIS-RELATED GROUP (DRG) MARCH 2006 1—Continued Threshold $21,691 $11,466 $17,818 $10,307 $27,863 $16,912 $15,084 $11,282 $12,777 $13,996 $9,965 $57,172 $25,466 $55,551 $38,397 $50,639 $35,418 $34,213 $30,586 $128,973 $91,460 $49,252 $75,162 $51,585 $68,837 $31,891 $63,400 $28,266 $21,522 $35,764 $44,664 $34,560 $22,745 $120,908 $96,697 $62,841 $51,886 $28,301 $19,840 $42,481 $29,355 $26,581 $146,367 $27,936 $50,384 $31,731 $23,639 $16,201 DRG 510 511 512 513 515 518 519 520 521 522 523 524 525 528 529 530 531 532 533 534 535 536 537 538 539 540 541 542 543 544 545 546 547 548 549 550 551 552 553 554 555 556 557 558 559 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... Number of cases 1,797 636 530 213 58,105 23,620 12,544 16,505 32,468 5,801 15,604 109,106 203 1,841 5,109 3,372 4,873 2,832 46,519 42,490 8,761 8,187 8,952 5,453 4,953 1,491 25,000 23,215 5,478 444,509 44,574 2,345 32,602 32,109 13,098 34,456 53,802 81,841 39,188 77,170 37,270 18,914 123,764 191,880 2,887 Threshold $21,194 $13,509 $90,375 $101,858 $86,680 $34,456 $44,211 $35,796 $14,497 $10,106 $8,206 $16,158 $151,063 $107,892 $36,423 $25,893 $45,214 $27,950 $30,298 $22,177 $119,733 $109,139 $32,582 $22,363 $44,654 $25,570 $250,176 $150,533 $64,504 $39,461 $45,048 $83,613 $97,976 $79,666 $81,112 $63,667 $51,436 $40,493 $46,843 $36,841 $42,704 $37,680 $51,183 $42,313 $40,716 1 Cases taken from the FY 2005 MedPAR file; DRGs are from GROUPER Version 24.0. wwhite on PROD1PC61 with PROPOSALS2 TABLE 11.—PROPOSED FY 2007 LTC–DRGS, RELATIVE WEIGHTS, GEOMETRIC AVERAGE LENGTH OF STAY, AND 5⁄6THS OF THE GEOMETRIC AVERAGE LENGTH OF STAY LTC–DRG 1 ............... VerDate Aug<31>2005 Proposed relative weight Description 5 CRANIOTOMY 17:10 Apr 24, 2006 AGE >17 W CC ..................................................................................... Jkt 208001 PO 00000 Frm 00400 Fmt 4701 Sfmt 4702 E:\FR\FM\25APP2.SGM 1.6479 25APP2 Proposed geometric average length of stay 35.5 Proposed 5/6ths of the geometric average length of stay 29.6 24395 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules TABLE 11.—PROPOSED FY 2007 LTC–DRGS, RELATIVE WEIGHTS, GEOMETRIC AVERAGE LENGTH OF STAY, AND 5⁄6THS OF THE GEOMETRIC AVERAGE LENGTH OF STAY—Continued LTC–DRG wwhite on PROD1PC61 with PROPOSALS2 2 ............... 3 ............... 6 ............... 7 ............... 8 ............... 9 ............... 10 ............. 11 ............. 12 ............. 13 ............. 14 ............. 15 ............. 16 ............. 17 ............. 18 ............. 19 ............. 20 ............. 21 ............. 22 ............. 23 ............. 24 ............. 25 ............. 26 ............. 27 ............. 28 ............. 29 ............. 30 ............. 31 ............. 32 ............. 33 ............. 34 ............. 35 ............. 36 ............. 37 ............. 38 ............. 39 ............. 40 ............. 41 ............. 42 ............. 43 ............. 44 ............. 45 ............. 46 ............. 47 ............. 48 ............. 49 ............. 50 ............. 51 ............. 52 ............. 53 ............. 54 ............. 55 ............. 56 ............. 57 ............. 58 ............. 59 60 61 62 63 64 65 66 67 68 ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. VerDate Aug<31>2005 Proposed relative weight Description 7 CRANIOTOMY AGE > 17 W/O CC ................................................................................ AGE 0–17 .............................................................................................. 7 CARPAL TUNNEL RELEASE ......................................................................................... PERIPH & CRANIAL NERVE & OTHER NERV SYST PROC W CC .............................. 2 PERIPH & CRANIAL NERVE & OTHER NERV SYST PROC W/O CC ........................ SPINAL DISORDERS & INJURIES .................................................................................. NERVOUS SYSTEM NEOPLASMS W CC ...................................................................... 2 NERVOUS SYSTEM NEOPLASMS W/O CC ................................................................ DEGENERATIVE NERVOUS SYSTEM DISORDERS ..................................................... MULTIPLE SCLEROSIS & CEREBELLAR ATAXIA ......................................................... INTERCRANIAL HEMORRHAGE OR STROKE WITH INFARCT ................................... NONSPECIFIC CVA & PRECEREBRAL OCCULUSION WITHOUT INFARCT .............. NONSPECIFIC CEREBROVASCULAR DISORDERS W CC .......................................... 1 NONSPECIFIC CEREBROVASCULAR DISORDERS W/O CC .................................... CRANIAL & PERIPHERAL NERVE DISORDERS W CC ................................................ CRANIAL & PERIPHERAL NERVE DISORDERS W/O CC ............................................. NERVOUS SYSTEM INFECTION EXCEPT VIRAL MENINGITIS ................................... 3 VIRAL MENINGITIS ........................................................................................................ 3 HYPERTENSIVE ENCEPHALOPATHY ......................................................................... NONTRAUMATIC STUPOR & COMA .............................................................................. SEIZURE & HEADACHE AGE >17 W CC ....................................................................... 2 SEIZURE & HEADACHE AGE >17 W/O CC ................................................................. 7 SEIZURE & HEADACHE AGE 0–17 .............................................................................. TRAUMATIC STUPOR & COMA, COMA >1 HR ............................................................. TRAUMATIC STUPOR & COMA, COMA >1 HR AGE >17 W CC .................................. 1 TRAUMATIC STUPOR & COMA, COMA >1 HR AGE >17 W/O CC ............................ 7 TRAUMATIC STUPOR & COMA, COMA <1 HR AGE 0–17 ......................................... 1 CONCUSSION AGE >17 W CC ..................................................................................... 7 CONCUSSION AGE >17 W/O CC ................................................................................. 7 CONCUSSION AGE 0–17 .............................................................................................. OTHER DISORDERS OF NERVOUS SYSTEM W CC ................................................... OTHER DISORDERS OF NERVOUS SYSTEM W/O CC ................................................ 7 RETINAL PROCEDURES ............................................................................................... 7 ORBITAL PROCEDURES ............................................................................................... 7 PRIMARY IRIS PROCEDURES ..................................................................................... 7 LENS PROCEDURES WITH OR WITHOUT VITRECTOMY ......................................... 7 EXTRAOCULAR PROCEDURES EXCEPT ORBIT AGE >17 ....................................... 7 EXTRAOCULAR PROCEDURES EXCEPT ORBIT AGE 0–17 ..................................... 7 INTRAOCULAR PROCEDURES EXCEPT RETINA, IRIS & LENS ............................... 7 HYPHEMA ....................................................................................................................... 3 ACUTE MAJOR EYE INFECTIONS ............................................................................... 1 NEUROLOGICAL EYE DISORDERS ............................................................................. 2 OTHER DISORDERS OF THE EYE AGE >17 W CC ................................................... 7 OTHER DISORDERS OF THE EYE AGE >17 W/O CC ................................................ 7 OTHER DISORDERS OF THE EYE AGE 0–17 ............................................................ 7 MAJOR HEAD & NECK PROCEDURES ....................................................................... 7 SIALOADENECTOMY ..................................................................................................... 7 SALIVARY GLAND PROCEDURES EXCEPT SIALOADENECTOMY .......................... 7 CLEFT LIP & PALATE REPAIR ..................................................................................... 7 SINUS & MASTOID PROCEDURES AGE >17 .............................................................. 7 SINUS & MASTOID PROCEDURES AGE 0–17 ............................................................ 4 MISCELLANEOUS EAR, NOSE, MOUTH & THROAT PROCEDURES ........................ 7 RHINOPLASTY ............................................................................................................... 7 T&A PROC, EXCEPT TONSILLECTOMY &/OR ADENOIDECTOMY ONLY, AGE >17 7 T&A PROC, EXCEPT TONSILLECTOMY &/OR ADENOIDECTOMY ONLY, AGE 0– 17. 7 TONSILLECTOMY &/OR ADENOIDECTOMY ONLY, AGE >17 ................................... 7 TONSILLECTOMY &/OR ADENOIDECTOMY ONLY, AGE 0–17 ................................. 7 MYRINGOTOMY W TUBE INSERTION AGE >17 ......................................................... 7 MYRINGOTOMY W TUBE INSERTION AGE 0–17 ....................................................... 4 OTHER EAR, NOSE, MOUTH & THROAT O.R. PROCEDURES ................................. EAR, NOSE, MOUTH & THROAT MALIGNANCY ........................................................... 1 DYSEQUILIBRIUM .......................................................................................................... 7 EPISTAXIS ...................................................................................................................... 3 EPIGLOTTITIS ................................................................................................................ OTITIS MEDIA & URI AGE >17 W CC ............................................................................. 7 CRANIOTOMY 17:10 Apr 24, 2006 Jkt 208001 PO 00000 Frm 00401 Fmt 4701 Sfmt 4702 E:\FR\FM\25APP2.SGM Proposed geometric average length of stay Proposed 5/6ths of the geometric average length of stay 1.6479 1.6479 0.4109 1.2119 0.5655 1.0474 0.6992 0.5655 0.6811 0.6043 0.6798 0.7779 0.6960 0.4109 0.7397 0.4526 0.9141 0.7858 0.7858 1.0124 0.7194 0.5655 0.5655 1.0016 0.8052 0.4109 0.4109 0.4109 0.5655 0.5655 0.7057 0.5093 0.5655 0.5655 0.5655 0.5655 0.5655 0.5655 0.5655 0.4109 0.7858 0.4109 0.5655 0.4109 0.4109 1.1162 1.1162 1.1162 1.1162 1.1162 1.1162 1.1162 1.1162 0.4109 0.4109 35.5 35.5 17.1 36.2 21.2 34.0 22.1 21.2 25.2 23.1 24.8 26.1 23.1 17.1 25.2 19.5 24.9 25.2 25.2 29.4 23.8 21.2 21.1 30.6 25.8 17.1 17.1 17.1 21.1 21.1 23.4 21.1 21.1 21.1 21.1 21.1 21.1 21.1 21.1 17.1 25.2 17.1 21.2 17.1 17.1 29.5 29.5 29.5 29.5 29.5 29.5 29.5 29.5 17.1 17.1 29.6 29.6 14.3 30.2 17.7 28.3 18.4 17.7 21.0 19.3 20.7 21.8 19.3 14.3 21.0 16.3 20.8 21.0 21.0 24.5 19.8 17.7 17.6 25.5 21.5 14.3 14.3 14.3 17.6 17.6 19.5 17.6 17.6 17.6 17.6 17.6 17.6 17.6 17.6 14.3 21.0 14.3 17.7 14.3 14.3 24.6 24.6 24.6 24.6 24.6 24.6 24.6 24.6 14.3 14.3 0.4109 0.4109 0.4109 0.4109 1.1162 1.1890 0.4109 0.4109 0.7858 0.6238 17.1 17.1 17.1 17.1 29.5 26.2 17.1 17.1 25.2 20.3 14.3 14.3 14.3 14.3 24.6 21.8 14.3 14.3 21.0 16.9 25APP2 24396 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules TABLE 11.—PROPOSED FY 2007 LTC–DRGS, RELATIVE WEIGHTS, GEOMETRIC AVERAGE LENGTH OF STAY, AND 5⁄6THS OF THE GEOMETRIC AVERAGE LENGTH OF STAY—Continued LTC–DRG 69 ............. 70 ............. 71 ............. 72 ............. 73 ............. 74 ............. 75 ............. 76 ............. 77 ............. 78 ............. 79 ............. 80 ............. 81 ............. 82 ............. 83 ............. 84 ............. 85 ............. 86 ............. 87 ............. 88 ............. 89 ............. 90 ............. 91 ............. 92 ............. 93 ............. 94 ............. 95 ............. 96 ............. 97 ............. 98 ............. 99 ............. 100 ........... 101 ........... 102 ........... 103 ........... 104 ........... wwhite on PROD1PC61 with PROPOSALS2 105 ........... 106 108 110 111 113 114 117 118 119 120 121 122 123 124 125 126 127 128 129 130 131 132 133 134 135 136 137 ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... VerDate Aug<31>2005 Proposed relative weight Description 1 OTITIS MEDIA & URI AGE >17 W/O CC ....................................................................... MEDIA & URI AGE 0–17 ................................................................................... 7 LARYNGOTRACHEITIS .................................................................................................. 3 NASAL TRAUMA & DEFORMITY .................................................................................. 7 OTHER EAR, NOSE, MOUTH & THROAT DIAGNOSES AGE >17 ............................. 7 OTHER EAR, NOSE, MOUTH & THROAT DIAGNOSES AGE 0–17 ............................ MAJOR CHEST PROCEDURES ...................................................................................... OTHER RESP SYSTEM O.R. PROCEDURES W CC ..................................................... 2 OTHER RESP SYSTEM O.R. PROCEDURES W/O CC ............................................... PULMONARY EMBOLISM ................................................................................................ RESPIRATORY INFECTIONS & INFLAMMATIONS AGE >17 W CC ............................. RESPIRATORY INFECTIONS & INFLAMMATIONS AGE >17 W/O CC ......................... 7 RESPIRATORY INFECTIONS & INFLAMMATIONS AGE 0–17 .................................... RESPIRATORY NEOPLASMS ......................................................................................... 1 MAJOR CHEST TRAUMA W CC ................................................................................... 7 MAJOR CHEST TRAUMA W/O CC ............................................................................... PLEURAL EFFUSION W CC ............................................................................................ 7 PLEURAL EFFUSION W/O CC ...................................................................................... PULMONARY EDEMA & RESPIRATORY FAILURE ....................................................... CHRONIC OBSTRUCTIVE PULMONARY DISEASE ...................................................... SIMPLE PNEUMONIA & PLEURISY AGE >17 W CC ..................................................... SIMPLE PNEUMONIA & PLEURISY AGE >17 W/O CC ................................................. 7 SIMPLE PNEUMONIA & PLEURISY AGE 0–17 ............................................................ INTERSTITIAL LUNG DISEASE W CC ............................................................................ 1 INTERSTITIAL LUNG DISEASE W/O CC ...................................................................... 8 PNEUMOTHORAX W CC ............................................................................................... 8 PNEUMOTHORAX W/O CC ........................................................................................... 8 BRONCHITIS & ASTHMA AGE >17 W CC .................................................................... 8 BRONCHITIS & ASTHMA AGE >17 W/O CC ................................................................ 7 BRONCHITIS & ASTHMA AGE 0–17 ............................................................................. RESPIRATORY SIGNS & SYMPTOMS W CC ................................................................ 3 RESPIRATORY SIGNS & SYMPTOMS W/O CC .......................................................... OTHER RESPIRATORY SYSTEM DIAGNOSES W CC .................................................. 1 OTHER RESPIRATORY SYSTEM DIAGNOSES W/O CC ............................................ 6HEART TRANSPLANT OR IMPLANT OF HEART ASSIST SYSTEM ........................... 7 CARDIAC VALVE & OTHER MAJOR CARDIOTHORACIC PROC W CARDIAC CATH. 7 CARDIAC VALVE & OTHER MAJOR CARDIOTHORACIC PROC W/O CARDIAC CATH. 7 CORONARY BYPASS W PTCA ..................................................................................... 7 OTHER CARDIOTHORACIC PROCEDURES ................................................................ 4 MAJOR CARDIOVASCULAR PROCEDURES W CC .................................................... 7 MAJOR CARDIOVASCULAR PROCEDURES W/O CC ................................................ AMPUTATION FOR CIRC SYSTEM DISORDERS EXCEPT UPPER LIMB & TOE ....... UPPER LIMB & TOE AMPUTATION FOR CIRC SYSTEM DISORDERS ...................... 3 CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT .................... 3 CARDIAC PACEMAKER DEVICE REPLACEMENT ...................................................... 3 VEIN LIGATION & STRIPPING ...................................................................................... OTHER CIRCULATORY SYSTEM O.R. PROCEDURES ................................................ CIRCULATORY DISORDERS W AMI & MAJOR COMP, DISCHARGED ALIVE ........... 2CIRCULATORY DISORDERS W AMI W/O MAJOR COMP, DISCHARGED ALIVE ..... CIRCULATORY DISORDERS W AMI, EXPIRED ............................................................ 4 CIRCULATORY DISORDERS EXCEPT AMI, W CARD CATH & COMPLEX DIAG ..... 1 CIRCULATORY DISORDERS EXCEPT AMI, W CARD CATH W/O COMPLEX DIAG ACUTE & SUBACUTE ENDOCARDITIS .......................................................................... HEART FAILURE & SHOCK ............................................................................................. 2 DEEP VEIN THROMBOPHLEBITIS ............................................................................... 1 CARDIAC ARREST, UNEXPLAINED ............................................................................. PERIPHERAL VASCULAR DISORDERS W CC .............................................................. PERIPHERAL VASCULAR DISORDERS W/O CC .......................................................... ATHEROSCLEROSIS W CC ............................................................................................ 2 ATHEROSCLEROSIS W/O CC ...................................................................................... HYPERTENSION .............................................................................................................. CARDIAC CONGENITAL & VALVULAR DISORDERS AGE >17 W CC ......................... 1 CARDIAC CONGENITAL & VALVULAR DISORDERS AGE >17 W/O CC ................... 7 CARDIAC CONGENITAL & VALVULAR DISORDERS AGE 0–17 ................................ 7 OTITIS 17:10 Apr 24, 2006 Jkt 208001 PO 00000 Frm 00402 Fmt 4701 Sfmt 4702 E:\FR\FM\25APP2.SGM Proposed geometric average length of stay Proposed 5/6ths of the geometric average length of stay 0.4109 0.4109 0.5655 0.7858 0.7761 0.4109 2.1021 2.3766 0.5655 0.6774 0.8185 0.6565 0.4109 0.8276 0.4109 0.4109 0.6980 0.4109 1.0305 0.6417 0.6826 .4981 0.5655 0.6673 0.4109 0.6826 0.6826 0.6245 0.6245 0.5655 0.9396 0.7858 0.8165 0.4109 0.0000 1.1162 17.1 17.1 21.1 25.2 22.9 17.1 33.8 42.2 21.2 22.6 22.7 20.9 17.1 21.4 17.1 17.1 21.4 17.1 24.8 19.3 20.6 17.8 21.1 19.6 17.1 21.3 21.3 19.1 19.1 21.1 24.5 25.2 22.2 17.1 0.0 29.5 14.3 14.3 17.6 21.0 19.1 14.3 28.2 35.2 17.7 18.8 18.9 17.4 14.3 17.8 14.3 14.3 17.8 14.3 20.7 16.1 17.2 14.8 17.6 16.3 14.3 17.8 17.8 15.9 15.9 17.6 20.4 21.0 18.5 14.3 0.0 24.6 1.1162 29.5 24.6 1.1162 1.1162 1.1162 1.1162 1.3939 1.2598 0.7858 0.7858 0.7858 1.0891 0.7517 0.5655 0.7900 1.1162 0.4109 0.8925 0.6854 0.5655 0.4109 0.6488 0.5233 0.6584 0.5655 0.4895 0.8015 0.4109 0.4109 29.5 29.5 29.5 29.5 35.8 33.0 25.2 25.2 25.2 31.3 22.6 21.2 17.0 29.5 17.1 26.3 21.2 21.2 17.1 22.8 21.0 20.5 21.2 21.3 23.9 17.1 17.1 24.6 24.6 24.6 24.6 29.8 27.5 21.0 21.0 21.0 26.1 18.8 17.7 14.2 24.6 14.3 21.9 17.7 17.7 14.3 19.0 17.5 17.1 17.7 17.8 19.9 14.3 14.3 25APP2 24397 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules TABLE 11.—PROPOSED FY 2007 LTC–DRGS, RELATIVE WEIGHTS, GEOMETRIC AVERAGE LENGTH OF STAY, AND 5⁄6THS OF THE GEOMETRIC AVERAGE LENGTH OF STAY—Continued wwhite on PROD1PC61 with PROPOSALS2 LTC–DRG 138 139 140 141 142 143 144 145 146 147 148 149 150 151 152 153 154 155 156 157 158 159 160 161 162 163 164 165 166 167 168 169 170 171 172 173 174 175 176 177 178 179 180 181 182 183 184 185 186 187 188 189 190 191 192 193 194 195 196 197 198 199 200 201 202 203 ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... VerDate Aug<31>2005 Proposed relative weight Description CARDIAC ARRHYTHMIA & CONDUCTION DISORDERS W CC ................................... ARRHYTHMIA & CONDUCTION DISORDERS W/O CC ............................. 2 ANGINA PECTORIS ....................................................................................................... 8 SYNCOPE & COLLAPSE W CC .................................................................................... 8 SYNCOPE & COLLAPSE W/O CC ................................................................................ 1 CHEST PAIN ................................................................................................................... OTHER CIRCULATORY SYSTEM DIAGNOSES W CC .................................................. OTHER CIRCULATORY SYSTEM DIAGNOSES W/O CC .............................................. 5 RECTAL RESECTION W CC ......................................................................................... 7 RECTAL RESECTION W/O CC ..................................................................................... MAJOR SMALL & LARGE BOWEL PROCEDURES W CC ............................................ 7 MAJOR SMALL & LARGE BOWEL PROCEDURES W/O CC ....................................... 5 PERITONEAL ADHESIOLYSIS W CC ........................................................................... 7 PERITONEAL ADHESIOLYSIS W/O CC ....................................................................... 5 MINOR SMALL & LARGE BOWEL PROCEDURES W CC ........................................... 7 MINOR SMALL & LARGE BOWEL PROCEDURES W/O CC ....................................... 5 STOMACH, ESOPHAGEAL & DUODENAL PROCEDURES AGE >17 W CC ............. 7 STOMACH, ESOPHAGEAL & DUODENAL PROCEDURES AGE >17 W/O CC .......... 7 STOMACH, ESOPHAGEAL & DUODENAL PROCEDURES AGE 0–17 ....................... 4 ANAL & STOMAL PROCEDURES W CC ...................................................................... 7 ANAL & STOMAL PROCEDURES W/O CC .................................................................. 5 HERNIA PROCEDURES EXCEPT INGUINAL & FEMORAL AGE >17 W CC ............. 1 HERNIA PROCEDURES EXCEPT INGUINAL & FEMORAL AGE >17 W/O CC .......... 7 INGUINAL & FEMORAL HERNIA PROCEDURES AGE >17 W CC ............................. 7 INGUINAL & FEMORAL HERNIA PROCEDURES AGE >17 W/O CC ......................... 7 HERNIA PROCEDURES AGE 0–17 .............................................................................. 7 APPENDECTOMY W COMPLICATED PRINCIPAL DIAG W CC .................................. 7 APPENDECTOMY W COMPLICATED PRINCIPAL DIAG W/O CC .............................. 7 APPENDECTOMY W/O COMPLICATED PRINCIPAL DIAG W CC .............................. 7 APPENDECTOMY W/O COMPLICATED PRINCIPAL DIAG W/O CC .......................... 5 MOUTH PROCEDURES W CC ...................................................................................... 7 MOUTH PROCEDURES W/O CC .................................................................................. OTHER DIGESTIVE SYSTEM O.R. PROCEDURES W CC ............................................ 3 OTHER DIGESTIVE SYSTEM O.R. PROCEDURES W/O CC ...................................... DIGESTIVE MALIGNANCY W CC .................................................................................... 2 DIGESTIVE MALIGNANCY W/O CC .............................................................................. G.I. HEMORRHAGE W CC ............................................................................................... 2 G.I. HEMORRHAGE W/O CC ......................................................................................... COMPLICATED PEPTIC ULCER ..................................................................................... 2 UNCOMPLICATED PEPTIC ULCER W CC ................................................................... 7 UNCOMPLICATED PEPTIC ULCER W/O CC ............................................................... INFLAMMATORY BOWEL DISEASE ............................................................................... G.I. OBSTRUCTION W CC ............................................................................................... 1 G.I. OBSTRUCTION W/O CC ......................................................................................... ESOPHAGITIS, GASTROENT & MISC DIGEST DISORDERS AGE >17 W CC ............ ESOPHAGITIS, GASTROENT & MISC DIGEST DISORDERS AGE >17 W/O CC ........ 7 ESOPHAGITIS, GASTROENT & MISC DIGEST DISORDERS AGE 0–17 ................... DENTAL & ORAL DIS EXCEPT EXTRACTIONS & RESTORATIONS, AGE >17 .......... 7 DENTAL & ORAL DIS EXCEPT EXTRACTIONS & RESTORATIONS, AGE 0–17 ...... 7 DENTAL EXTRACTIONS & RESTORATIONS .............................................................. OTHER DIGESTIVE SYSTEM DIAGNOSES AGE >17 W CC ........................................ OTHER DIGESTIVE SYSTEM DIAGNOSES AGE >17 W/O CC .................................... 7 OTHER DIGESTIVE SYSTEM DIAGNOSES AGE 0–17 ............................................... 5 PANCREAS, LIVER & SHUNT PROCEDURES W CC .................................................. 7 PANCREAS, LIVER & SHUNT PROCEDURES W/O CC .............................................. 5 BILIARY TRACT PROC EXCEPT ONLY CHOLECYST W OR W/O C.D.E. W CC ...... 7 BILIARY TRACT PROC EXCEPT ONLY CHOLECYST W OR W/O C.D.E. W/O CC .. 5 CHOLECYSTECTOMY W C.D.E. W CC ........................................................................ 7 CHOLECYSTECTOMY W C.D.E. W/O CC .................................................................... 4 CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE W/O C.D.E. W CC .................. 7 CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE W/O C.D.E. W/O CC .............. 3 HEPATOBILIARY DIAGNOSTIC PROCEDURE FOR MALIGNANCY ........................... 5 HEPATOBILIARY DIAGNOSTIC PROCEDURE FOR NON–MALIGNANCY ................. OTHER HEPATOBILIARY OR PANCREAS O.R. PROCEDURES .................................. CIRRHOSIS & ALCOHOLIC HEPATITIS ......................................................................... MALIGNANCY OF HEPATOBILIARY SYSTEM OR PANCREAS ................................... 2 CARDIAC 17:10 Apr 24, 2006 Jkt 208001 PO 00000 Frm 00403 Fmt 4701 Sfmt 4702 E:\FR\FM\25APP2.SGM 0.6619 0.5655 0.5655 0.5918 0.5918 0.4109 0.7725 0.4305 1.6479 1.6479 1.8374 0.7858 1.6479 0.4109 1.6479 1.6479 1.6479 1.6479 1.6479 1.1162 1.1162 1.6479 0.4109 0.4109 0.4109 0.4109 1.6479 1.6479 1.6479 1.6479 1.6479 0.5655 1.6242 0.7858 0.8564 0.5655 0.6886 0.5655 0.9293 0.5655 0.4109 0.8190 0.9222 0.4109 0.8044 0.4656 0.4109 0.6611 0.5655 0.5655 0.9485 0.5316 0.5655 1.6479 1.6479 1.6479 1.6479 1.6479 1.1162 1.1162 1.1162 0.7858 1.6479 1.5988 0.6038 0.7053 25APP2 Proposed geometric average length of stay 21.9 21.2 21.2 22.1 22.1 17.1 22.1 17.0 35.5 35.5 34.2 25.2 35.5 17.1 35.5 35.5 35.5 35.5 35.5 29.5 29.5 35.5 17.1 17.1 17.1 17.1 35.5 35.5 35.5 35.5 35.5 21.1 35.7 25.2 21.8 21.2 22.7 21.2 25.4 21.2 17.1 23.3 22.9 17.1 22.5 17.6 17.1 23.2 21.1 21.1 24.1 18.1 21.1 35.5 35.5 35.5 35.5 35.5 29.5 29.5 29.5 25.2 35.5 28.8 20.2 19.4 Proposed 5/6ths of the geometric average length of stay 18.3 17.7 17.7 18.4 18.4 14.3 18.4 14.2 29.6 29.6 28.5 21.0 29.6 14.3 29.6 29.6 29.6 29.6 29.6 24.6 24.6 29.6 14.3 14.3 14.3 14.3 29.6 29.6 29.6 29.6 29.6 17.6 29.8 21.0 18.2 17.7 18.9 17.7 21.2 17.7 14.3 19.4 19.1 14.3 18.8 14.7 14.3 19.3 17.6 17.6 20.1 15.1 17.6 29.6 29.6 29.6 29.6 29.6 24.6 24.6 24.6 21.0 29.6 24.0 16.8 16.2 24398 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules TABLE 11.—PROPOSED FY 2007 LTC–DRGS, RELATIVE WEIGHTS, GEOMETRIC AVERAGE LENGTH OF STAY, AND 5⁄6THS OF THE GEOMETRIC AVERAGE LENGTH OF STAY—Continued LTC–DRG ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... 224 225 226 227 228 229 230 232 233 234 235 236 237 238 239 wwhite on PROD1PC61 with PROPOSALS2 204 205 206 207 208 210 211 212 213 216 217 218 219 220 223 ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... 240 241 242 243 244 245 246 247 248 249 250 251 252 253 254 255 256 257 258 259 260 261 262 263 264 265 266 267 268 269 270 271 272 273 ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... VerDate Aug<31>2005 Proposed relative weight Description DISORDERS OF PANCREAS EXCEPT MALIGNANCY .................................................. DISORDERS OF LIVER EXCEPT MALIG,CIRR,ALC HEPA W CC ................................ 2 DISORDERS OF LIVER EXCEPT MALIG,CIRR,ALC HEPA W/O CC .......................... DISORDERS OF THE BILIARY TRACT W CC ................................................................ 1 DISORDERS OF THE BILIARY TRACT W/O CC .......................................................... HIP & FEMUR PROCEDURES EXCEPT MAJOR JOINT AGE >17 W CC ..................... 7 HIP & FEMUR PROCEDURES EXCEPT MAJOR JOINT AGE >17 W/O CC ............... 7 HIP & FEMUR PROCEDURES EXCEPT MAJOR JOINT AGE 0–17 ............................ AMPUTATION FOR MUSCULOSKELETAL SYSTEM & CONN TISSUE DISORDERS BIOPSIES OF MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE .................... WND DEBRID & SKN GRFT EXCEPT HAND,FOR MUSCSKELET & CONN TISS DIS 5 LOWER EXTREM & HUMER PROC EXCEPT HIP,FOOT,FEMUR AGE >17 W CC ... 7 LOWER EXTREM & HUMER PROC EXCEPT HIP,FOOT,FEMUR AGE >17 W/O CC 7 LOWER EXTREM & HUMER PROC EXCEPT HIP,FOOT,FEMUR AGE 0–17 ............ 4 MAJOR SHOULDER/ELBOW PROC, OR OTHER UPPER EXTREMITY PROC W CC. 1 SHOULDER,ELBOW OR FOREARM PROC,EXC MAJOR JOINT PROC, W/O CC .... FOOT PROCEDURES ...................................................................................................... SOFT TISSUE PROCEDURES W CC ............................................................................. 3 SOFT TISSUE PROCEDURES W/O CC ....................................................................... 3 MAJOR THUMB OR JOINT PROC,OR OTH HAND OR WRIST PROC W CC ............ 7 HAND OR WRIST PROC, EXCEPT MAJOR JOINT PROC, W/O CC .......................... 5 LOCAL EXCISION & REMOVAL OF INT FIX DEVICES OF HIP & FEMUR ................ 5 ARTHROSCOPY ............................................................................................................. OTHER MUSCULOSKELET SYS & CONN TISS O.R. PROC W CC ............................. 7 OTHER MUSCULOSKELET SYS & CONN TISS O.R. PROC W/O CC ....................... 3 FRACTURES OF FEMUR .............................................................................................. FRACTURES OF HIP & PELVIS ...................................................................................... 1 SPRAINS, STRAINS, & DISLOCATIONS OF HIP, PELVIS & THIGH .......................... OSTEOMYELITIS .............................................................................................................. PATHOLOGICAL FRACTURES & MUSCULOSKELETAL & CONN TISS MALIGNANCY. CONNECTIVE TISSUE DISORDERS W CC ................................................................... 1 CONNECTIVE TISSUE DISORDERS W/O CC .............................................................. SEPTIC ARTHRITIS .......................................................................................................... MEDICAL BACK PROBLEMS ........................................................................................... BONE DISEASES & SPECIFIC ARTHROPATHIES W CC ............................................. BONE DISEASES & SPECIFIC ARTHROPATHIES W/O CC ......................................... 2 NON-SPECIFIC ARTHROPATHIES ............................................................................... SIGNS & SYMPTOMS OF MUSCULOSKELETAL SYSTEM & CONN TISSUE ............. TENDONITIS, MYOSITIS & BURSITIS ............................................................................ AFTERCARE, MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE .................... 1 FX, SPRN, STRN & DISL OF FOREARM, HAND, FOOT AGE >17 W CC .................. 7 FX, SPRN, STRN & DISL OF FOREARM, HAND, FOOT AGE >17 W/O CC .............. 7 FX, SPRN, STRN & DISL OF FOREARM, HAND, FOOT AGE 0–17 ........................... FX, SPRN, STRN & DISL OF UPARM,LOWLEG EX FOOT AGE >17 W CC ................ 1 FX, SPRN, STRN & DISL OF UPARM,LOWLEG EX FOOT AGE >17 W/O CC .......... 7 FX, SPRN, STRN & DISL OF UPARM,LOWLEG EX FOOT AGE 0–17 ....................... OTHER MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE DIAGNOSES ........ 4 TOTAL MASTECTOMY FOR MALIGNANCY W CC ...................................................... 7 TOTAL MASTECTOMY FOR MALIGNANCY W/O CC .................................................. 3 SUBTOTAL MASTECTOMY FOR MALIGNANCY W CC .............................................. 7 SUBTOTAL MASTECTOMY FOR MALIGNANCY W/O CC ........................................... 2 BREAST PROC FOR NON-MALIGNANCY EXCEPT BIOPSY & LOCAL EXCISION ... 4 BREAST BIOPSY & LOCAL EXCISION FOR NON- MALIGNANCY ............................. SKIN GRAFT &/OR DEBRID FOR SKN ULCER OR CELLULITIS W CC ...................... SKIN GRAFT &/OR DEBRID FOR SKN ULCER OR CELLULITIS W/O CC ................... SKIN GRAFT &/OR DEBRID EXCEPT FOR SKIN ULCER OR CELLULITIS W CC ...... 3 SKIN GRAFT &/OR DEBRID EXCEPT FOR SKIN ULCER OR CELLULITIS W/O CC 7 PERIANAL & PILONIDAL PROCEDURES ..................................................................... 4 SKIN, SUBCUTANEOUS TISSUE & BREAST PLASTIC PROCEDURES .................... OTHER SKIN, SUBCUT TISS & BREAST PROC W CC ................................................. 3 OTHER SKIN, SUBCUT TISS & BREAST PROC W/O CC ........................................... SKIN ULCERS ................................................................................................................... MAJOR SKIN DISORDERS W CC ................................................................................... 1 MAJOR SKIN DISORDERS W/O CC ............................................................................. 17:10 Apr 24, 2006 Jkt 208001 PO 00000 Frm 00404 Fmt 4701 Sfmt 4702 E:\FR\FM\25APP2.SGM Proposed geometric average length of stay Proposed 5/6ths of the geometric average length of stay 0.8882 0.6990 0.5655 0.7310 0.4109 1.4809 1.6479 1.6479 1.1780 1.2173 1.2470 1.6479 1.6479 1.6479 1.1162 22.1 23.1 21.2 21.5 17.1 41.9 35.5 35.5 33.4 37.5 36.5 35.5 35.5 35.5 29.5 18.4 19.3 17.7 17.9 14.3 34.9 29.6 29.6 27.8 31.3 30.4 29.6 29.6 29.6 24.6 0.4109 0.9579 1.0653 0.7858 0.7858 0.4109 1.6479 1.6479 1.1794 0.4109 0.7858 0.6874 0.4109 0.8602 0.6059 17.1 30.6 34.3 25.2 25.2 17.1 35.5 35.5 32.4 17.1 25.2 28.9 17.1 28.4 20.5 14.3 25.5 28.6 21.0 21.0 14.3 29.6 29.6 27.0 14.3 21.0 24.1 14.3 23.7 17.1 0.7178 0.4109 0.7699 0.6021 0.5541 0.4464 0.5655 0.4591 0.7341 0.6387 0.4109 0.4109 0.5655 0.5636 0.4109 0.5655 0.7208 1.1162 0.7858 0.7858 0.7858 0.5655 1.1162 1.2749 0.8524 1.1068 0.7858 0.7858 1.1162 1.2137 0.7858 0.8290 0.6576 0.4109 22.4 17.1 26.1 22.2 22.0 19.4 21.2 17.6 23.2 24.0 17.1 17.1 21.1 24.0 17.1 21.1 23.7 29.5 25.2 25.2 25.2 21.2 29.5 38.0 29.9 30.2 25.2 25.2 29.5 34.7 25.2 26.8 23.1 17.1 18.7 14.3 21.8 18.5 18.3 16.2 17.7 14.7 19.3 20.0 14.3 14.3 17.6 20.0 14.3 17.6 19.8 24.6 21.0 21.0 21.0 17.7 24.6 31.7 24.9 25.2 21.0 21.0 24.6 28.9 21.0 22.3 19.3 14.3 25APP2 24399 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules TABLE 11.—PROPOSED FY 2007 LTC–DRGS, RELATIVE WEIGHTS, GEOMETRIC AVERAGE LENGTH OF STAY, AND 5⁄6THS OF THE GEOMETRIC AVERAGE LENGTH OF STAY—Continued wwhite on PROD1PC61 with PROPOSALS2 LTC–DRG 274 275 276 277 278 279 280 281 282 283 284 285 286 287 288 289 290 291 292 293 294 295 296 297 298 299 300 301 302 303 304 305 306 307 308 309 310 311 312 313 314 315 316 317 318 319 320 321 322 323 324 325 326 327 328 329 330 331 332 333 334 335 336 337 338 339 ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... VerDate Aug<31>2005 Proposed relative weight Description MALIGNANT BREAST DISORDERS W CC ..................................................................... BREAST DISORDERS W/O CC ............................................................... 2 NON-MALIGANT BREAST DISORDERS ....................................................................... CELLULITIS AGE >17 W CC ............................................................................................ CELLULITIS AGE >17 W/O CC ........................................................................................ 7 CELLULITIS AGE 0–17 .................................................................................................. TRAUMA TO THE SKIN, SUBCUT TISS & BREAST AGE >17 W CC ........................... 2 TRAUMA TO THE SKIN, SUBCUT TISS & BREAST AGE >17 W/O CC ..................... 7 TRAUMA TO THE SKIN, SUBCUT TISS & BREAST AGE 0–17 .................................. MINOR SKIN DISORDERS W CC .................................................................................... 2 MINOR SKIN DISORDERS W/O CC .............................................................................. AMPUTAT OF LOWER LIMB FOR ENDOCRINE,NUTRIT,& METABOL DISORDERS 7 ADRENAL & PITUITARY PROCEDURES ..................................................................... SKIN GRAFTS & WOUND DEBRID FOR ENDOC, NUTRIT & METAB DISORDERS ... 4O.R. PROCEDURES FOR OBESITY ............................................................................. 7 PARATHYROID PROCEDURES .................................................................................... 7 THYROID PROCEDURES .............................................................................................. 7 THYROGLOSSAL PROCEDURES ................................................................................. 8 OTHER ENDOCRINE, NUTRIT & METAB O.R. PROC W CC ...................................... 8 OTHER ENDOCRINE, NUTRIT & METAB O.R. PROC W/O CC .................................. DIABETES AGE >35 ......................................................................................................... 2 DIABETES AGE 0–35 ..................................................................................................... NUTRITIONAL & MISC METABOLIC DISORDERS AGE >17 W CC ............................. NUTRITIONAL & MISC METABOLIC DISORDERS AGE >17 W/O CC .......................... 7 NUTRITIONAL & MISC METABOLIC DISORDERS AGE 0–17 .................................... 3 INBORN ERRORS OF METABOLISM ........................................................................... DENDOCRINE DISORDERS W CC ................................................................................. 2 ENDOCRINE DISORDERS W/O CC .............................................................................. 6 KIDNEY TRANSPLANT .................................................................................................. 7 KIDNEY,URETER & MAJOR BLADDER PROCEDURES FOR NEOPLASM ............... 5 KIDNEY,URETER & MAJOR BLADDER PROC FOR NON-NEOPL W CC .................. 7 KIDNEY,URETER & MAJOR BLADDER PROC FOR NON-NEOPL W/O CC .............. 4 PROSTATECTOMY W CC ............................................................................................. 7 PROSTATECTOMY W/O CC ......................................................................................... 4 MINOR BLADDER PROCEDURES W CC ..................................................................... 7 MINOR BLADDER PROCEDURES W/O CC ................................................................. 4 TRANSURETHRAL PROCEDURES W CC .................................................................... 7 TRANSURETHRAL PROCEDURES W/O CC ................................................................ 3 URETHRAL PROCEDURES, AGE >17 W CC ............................................................... 7 URETHRAL PROCEDURES, AGE >17 W/O CC ........................................................... 7 URETHRAL PROCEDURES, AGE 0–17 ........................................................................ OTHER KIDNEY & URINARY TRACT O.R. PROCEDURES .......................................... RENAL FAILURE .............................................................................................................. ADMIT FOR RENAL DIALYSIS ........................................................................................ KIDNEY & URINARY TRACT NEOPLASMS W CC ......................................................... 7 KIDNEY & URINARY TRACT NEOPLASMS W/O CC ................................................... KIDNEY & URINARY TRACT INFECTIONS AGE >17 W CC ......................................... KIDNEY & URINARY TRACT INFECTIONS AGE >17 W/O CC ..................................... 7 KIDNEY & URINARY TRACT INFECTIONS AGE 0– 17 ............................................... 1 URINARY STONES W CC, &/OR ESW LITHOTRIPSY ................................................ 1 URINARY STONES W/O CC .......................................................................................... 2 KIDNEY & URINARY TRACT SIGNS & SYMPTOMS AGE >17 W CC ........................ 7 KIDNEY & URINARY TRACT SIGNS & SYMPTOMS AGE >17 W/O CC .................... 7 KIDNEY & URINARY TRACT SIGNS & SYMPTOMS AGE 0–17 ................................. 7 URETHRAL STRICTURE AGE >17 W CC .................................................................... 7 URETHRAL STRICTURE AGE >17 W/O CC ................................................................. 7 URETHRAL STRICTURE AGE 0–17 ............................................................................. OTHER KIDNEY & URINARY TRACT DIAGNOSES AGE >17 W CC ............................ 1 OTHER KIDNEY & URINARY TRACT DIAGNOSES AGE >17 W/O CC ...................... 7 OTHER KIDNEY & URINARY TRACT DIAGNOSES AGE 0–17 ................................... 7 MAJOR MALE PELVIC PROCEDURES W CC .............................................................. 1 MAJOR MALE PELVIC PROCEDURES W/O CC .......................................................... 4 TRANSURETHRAL PROSTATECTOMY W CC ............................................................. 7 TRANSURETHRAL PROSTATECTOMY W/O CC ......................................................... 3 TESTES PROCEDURES, FOR MALIGNANCY ............................................................. 3 TESTES PROCEDURES, NON-MALIGNANCY AGE >17 ............................................. 7 MALIGNANT 17:10 Apr 24, 2006 Jkt 208001 PO 00000 Frm 00405 Fmt 4701 Sfmt 4702 E:\FR\FM\25APP2.SGM 0.7277 0.7858 0.5655 0.6087 0.4243 0.4109 0.6981 0.5655 0.5655 0.6946 0.5655 1.2354 1.1162 1.0502 1.1162 1.1162 1.1162 1.1162 1.1673 1.1673 0.6986 0.5655 0.7114 0.4609 0.4109 0.7858 0.7053 0.5655 0.0000 0.7858 1.6479 0.7858 1.1162 1.1162 1.1162 1.1162 1.1162 1.1162 0.7858 0.7858 0.7858 1.3823 0.8342 0.9186 0.7713 0.7858 0.6181 0.4478 0.4109 0.4109 0.4109 0.5655 0.4109 0.4109 0.5655 0.5655 0.5655 0.7776 0.4109 0.4109 0.4109 0.4109 1.1162 1.1162 0.7858 0.7858 25APP2 Proposed geometric average length of stay 21.8 25.2 21.2 20.8 18.0 17.1 23.9 21.2 21.1 23.1 21.2 31.3 29.5 33.0 29.5 29.5 29.5 29.5 31.9 31.9 23.8 21.2 22.3 19.3 17.1 25.2 23.7 21.2 0.0 25.2 35.5 25.2 29.5 29.5 29.5 29.5 29.5 29.5 25.2 25.2 25.2 33.4 22.9 24.3 21.3 25.2 21.6 18.5 17.1 17.1 17.1 21.2 17.1 17.1 21.1 21.1 21.1 22.5 17.1 17.1 17.1 17.1 29.5 29.5 25.2 25.2 Proposed 5/6ths of the geometric average length of stay 18.2 21.0 17.7 17.3 15.0 14.3 19.9 17.7 17.6 19.3 17.7 26.1 24.6 27.5 24.6 24.6 24.6 24.6 26.6 26.6 19.8 17.7 18.6 16.1 14.3 21.0 19.8 17.7 0.0 21.0 29.6 21.0 24.6 24.6 24.6 24.6 24.6 24.6 21.0 21.0 21.0 27.8 19.1 20.3 17.8 21.0 18.0 15.4 14.3 14.3 14.3 17.7 14.3 14.3 17.6 17.6 17.6 18.8 14.3 14.3 14.3 14.3 24.6 24.6 21.0 21.0 24400 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules TABLE 11.—PROPOSED FY 2007 LTC–DRGS, RELATIVE WEIGHTS, GEOMETRIC AVERAGE LENGTH OF STAY, AND 5⁄6THS OF THE GEOMETRIC AVERAGE LENGTH OF STAY—Continued LTC–DRG wwhite on PROD1PC61 with PROPOSALS2 340 341 342 343 344 345 ........... ........... ........... ........... ........... ........... 346 347 348 349 350 351 352 353 354 355 356 357 358 359 360 361 362 363 364 365 366 367 368 369 370 371 372 373 374 375 376 377 378 379 380 381 382 383 384 385 386 387 388 389 390 391 392 393 394 395 396 397 398 399 401 402 403 404 405 ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... VerDate Aug<31>2005 Proposed relative weight Description 7 TESTES PROCEDURES, NON-MALIGNANCY AGE 0–17 ........................................... PROCEDURES ................................................................................................... 7 CIRCUMCISION AGE >17 .............................................................................................. 7 CIRCUMCISION AGE 0–17 ............................................................................................ 3 OTHER MALE REPRODUCTIVE SYSTEM O.R. PROCEDURES FOR MALIGNANCY 4 OTHER MALE REPRODUCTIVE SYSTEM O.R. PROC EXCEPT FOR MALIGNANCY. 3 MALIGNANCY, MALE REPRODUCTIVE SYSTEM, W CC ........................................... 1 MALIGNANCY, MALE REPRODUCTIVE SYSTEM, W/O CC ....................................... 2 BENIGN PROSTATIC HYPERTROPHY W CC .............................................................. 7 BENIGN PROSTATIC HYPERTROPHY W/O CC .......................................................... INFLAMMATION OF THE MALE REPRODUCTIVE SYSTEM ........................................ 7 STERILIZATION, MALE .................................................................................................. OTHER MALE REPRODUCTIVE SYSTEM DIAGNOSES ............................................... 7 PELVIC EVISCERATION, RADICAL HYSTERECTOMY & RADICAL VULVECTOMY 7 UTERINE,ADNEXA PROC FOR NON-OVARIAN/ADNEXAL MALIG W CC ................. 7 UTERINE,ADNEXA PROC FOR NON-OVARIAN/ADNEXAL MALIG W/O CC ............. 7 FEMALE REPRODUCTIVE SYSTEM RECONSTRUCTIVE PROCEDURES ............... 7 UTERINE & ADNEXA PROC FOR OVARIAN OR ADNEXAL MALIGNANCY .............. 7 UTERINE & ADNEXA PROC FOR NON-MALIGNANCY W CC .................................... 7 UTERINE & ADNEXA PROC FOR NON-MALIGNANCY W/O CC ................................ 7 VAGINA, CERVIX & VULVA PROCEDURES ................................................................ 7 LAPAROSCOPY & INCISIONAL TUBAL INTERRUPTION ........................................... 7 ENDOSCOPIC TUBAL INTERRUPTION ....................................................................... 7 D&C, CONIZATION & RADIO-IMPLANT, FOR MALIGNANCY ..................................... 7 D&C, CONIZATION EXCEPT FOR MALIGNANCY ....................................................... 4 OTHER FEMALE REPRODUCTIVE SYSTEM O.R. PROCEDURES ............................ MALIGNANCY, FEMALE REPRODUCTIVE SYSTEM W CC .......................................... 1 MALIGNANCY, FEMALE REPRODUCTIVE SYSTEM W/O CC .................................... INFECTIONS, FEMALE REPRODUCTIVE SYSTEM ....................................................... 3 MENSTRUAL & OTHER FEMALE REPRODUCTIVE SYSTEM DISORDERS ............. 7 CESAREAN SECTION W CC ......................................................................................... 7 CESAREAN SECTION W/O CC ..................................................................................... 7 VAGINAL DELIVERY W COMPLICATING DIAGNOSES .............................................. 7 VAGINAL DELIVERY W/O COMPLICATING DIAGNOSES ........................................... 7 VAGINAL DELIVERY W STERILIZATION &/OR D&C ................................................... 7 VAGINAL DELIVERY W O.R. PROC EXCEPT STERIL &/OR D&C ............................. 4 POSTPARTUM & POST ABORTION DIAGNOSES W/O O.R. PROCEDURE ............. 7 POSTPARTUM & POST ABORTION DIAGNOSES W O.R. PROCEDURE ................. 7 ECTOPIC PREGNANCY ................................................................................................. 7 THREATENED ABORTION ............................................................................................ 7 ABORTION W/O D&C ..................................................................................................... 7 ABORTION W D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY ...................... 7 FALSE LABOR ................................................................................................................ 1 OTHER ANTEPARTUM DIAGNOSES W MEDICAL COMPLICATIONS ....................... 7 OTHER ANTEPARTUM DIAGNOSES W/O MEDICAL COMPLICATIONS ................... 7 NEONATES, DIED OR TRANSFERRED TO ANOTHER ACUTE CARE FACILITY ..... 7 EXTREME IMMATURITY ................................................................................................ 7 PREMATURITY W MAJOR PROBLEMS ....................................................................... 7 PREMATURITY W/O MAJOR PROBLEMS ................................................................... 7 FULL TERM NEONATE W MAJOR PROBLEMS .......................................................... 7 NEONATE W OTHER SIGNIFICANT PROBLEMS ........................................................ 7 NORMAL NEWBORN ..................................................................................................... 7 SPLENECTOMY AGE >17 ............................................................................................. 7 SPLENECTOMY AGE 0–17 ........................................................................................... 4 OTHER O.R. PROCEDURES OF THE BLOOD AND BLOOD FORMING ORGANS ... RED BLOOD CELL DISORDERS AGE >17 ..................................................................... 7RED BLOOD CELL DISORDERS AGE 0–17 ................................................................. COAGULATION DISORDERS .......................................................................................... RETICULOENDOTHELIAL & IMMUNITY DISORDERS W CC ....................................... 1 RETICULOENDOTHELIAL & IMMUNITY DISORDERS W/O CC .................................. 4 LYMPHOMA & NON-ACUTE LEUKEMIA W OTHER O.R. PROC W CC ..................... 7 LYMPHOMA & NON-ACUTE LEUKEMIA W OTHER O.R. PROC W/O CC ................. LYMPHOMA & NON-ACUTE LEUKEMIA W CC .............................................................. 3 LYMPHOMA & NON-ACUTE LEUKEMIA W/O CC ........................................................ 7 ACUTE LEUKEMIA W/O MAJOR O.R. PROCEDURE AGE 0–17 ................................ 5 PENIS 17:10 Apr 24, 2006 Jkt 208001 PO 00000 Frm 00406 Fmt 4701 Sfmt 4702 E:\FR\FM\25APP2.SGM Proposed geometric average length of stay Proposed 5/6ths of the geometric average length of stay 0.7858 1.6479 0.7858 0.7858 0.7858 1.1162 25.2 35.5 25.2 25.2 25.2 29.5 21.0 29.6 21.0 21.0 21.0 24.6 0.7858 0.4109 0.5655 0.7858 0.5630 0.7858 0.8138 1.1162 1.1162 1.1162 1.1162 1.1162 1.1162 1.1162 1.1162 0.4109 0.4109 0.4109 0.4109 1.1162 0.9119 0.4109 0.7859 0.7858 0.4109 0.4109 0.4109 0.4109 0.4109 0.4109 1.1162 0.4109 0.4109 0.4109 0.4109 0.4109 0.4109 0.4109 0.4109 0.4109 0.4109 0.4109 0.4109 0.4109 0.4109 0.4109 1.1162 1.1162 1.1162 0.6736 0.4109 0.8331 0.6890 0.4109 1.1162 0.5655 0.8776 0.7858 0.7858 25.2 17.1 21.2 25.2 21.0 25.2 27.1 29.5 29.5 29.5 29.5 29.5 29.5 29.5 29.5 17.1 17.1 17.1 17.1 29.5 21.6 17.1 21.3 25.2 17.1 17.1 17.1 17.1 17.1 17.1 29.5 17.1 17.1 17.1 17.1 17.1 17.1 17.1 17.1 17.1 17.1 17.1 17.1 17.1 17.1 17.1 29.5 29.5 29.5 21.4 17.1 20.4 21.0 17.1 29.5 21.1 23.7 25.2 25.2 21.0 14.3 17.7 21.0 17.5 21.0 22.6 24.6 24.6 24.6 24.6 24.6 24.6 24.6 24.6 14.3 14.3 14.3 14.3 24.6 18.0 14.3 17.8 21.0 14.3 14.3 14.3 14.3 14.3 14.3 24.6 14.3 14.3 14.3 14.3 14.3 14.3 14.3 14.3 14.3 14.3 14.3 14.3 14.3 14.3 14.3 24.6 24.6 24.6 17.8 14.3 17.0 17.5 14.3 24.6 17.6 19.8 21.0 21.0 25APP2 24401 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules TABLE 11.—PROPOSED FY 2007 LTC–DRGS, RELATIVE WEIGHTS, GEOMETRIC AVERAGE LENGTH OF STAY, AND 5⁄6THS OF THE GEOMETRIC AVERAGE LENGTH OF STAY—Continued wwhite on PROD1PC61 with PROPOSALS2 LTC–DRG 406 407 408 409 410 411 412 413 414 415 416 417 418 419 420 421 422 423 424 425 426 427 428 429 430 431 432 433 439 440 441 442 443 444 445 446 447 448 449 450 451 452 453 454 455 461 462 463 464 465 466 467 468 469 470 471 473 475 476 477 479 480 481 482 484 485 ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... VerDate Aug<31>2005 Proposed relative weight Description 5 MYELOPROLIF DISORD OR POORLY DIFF NEOPL W MAJ O.R.PROC W CC ........ DISORD OR POORLY DIFF NEOPL W MAJ O.R.PROC W/O CC .... 4 MYELOPROLIF DISORD OR POORLY DIFF NEOPL W OTHER O.R.PROC ............. RADIOTHERAPY .............................................................................................................. CHEMOTHERAPY W/O ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS ................ 7 HISTORY OF MALIGNANCY W/O ENDOSCOPY ......................................................... 7 HISTORY OF MALIGNANCY W ENDOSCOPY ............................................................. OTHER MYELOPROLIF DIS OR POORLY DIFF NEOPL DIAG W CC .......................... 3 OTHER MYELOPROLIF DIS OR POORLY DIFF NEOPL DIAG W/O CC .................... O.R. PROCEDURE FOR INFECTIOUS & PARASITIC DISEASES ................................ SEPTICEMIA AGE >17 ..................................................................................................... 7 SEPTICEMIA AGE 0–17 ................................................................................................. POSTOPERATIVE & POST–TRAUMATIC INFECTIONS ................................................ 2 FEVER OF UNKNOWN ORIGIN AGE >17 W CC ......................................................... 2 FEVER OF UNKNOWN ORIGIN AGE >17 W/O CC ..................................................... VIRAL ILLNESS AGE >17 ................................................................................................ 7 VIRAL ILLNESS & FEVER OF UNKNOWN ORIGIN AGE 0–17 ................................... OTHER INFECTIOUS & PARASITIC DISEASES DIAGNOSES ...................................... 3 O.R. PROCEDURE W PRINCIPAL DIAGNOSES OF MENTAL ILLNESS .................... 1 ACUTE ADJUSTMENT REACTION & PSYCHOLOGICAL DYSFUNCTION ................. DEPRESSIVE NEUROSES .............................................................................................. 2 NEUROSES EXCEPT DEPRESSIVE ............................................................................. DISORDERS OF PERSONALITY & IMPULSE CONTROL ............................................. ORGANIC DISTURBANCES & MENTAL RETARDATION .............................................. PSYCHOSES .................................................................................................................... 2 CHILDHOOD MENTAL DISORDERS ............................................................................. 1 OTHER MENTAL DISORDER DIAGNOSES .................................................................. 7 ALCOHOL/DRUG ABUSE OR DEPENDENCE, LEFT AMA .......................................... SKIN GRAFTS FOR INJURIES ........................................................................................ WOUND DEBRIDEMENTS FOR INJURIES ..................................................................... 2 HAND PROCEDURES FOR INJURIES ......................................................................... OTHER O.R. PROCEDURES FOR INJURIES W CC ...................................................... 7 OTHER O.R. PROCEDURES FOR INJURIES W/O CC ................................................ TRAUMATIC INJURY AGE >17 W CC ............................................................................. 2 TRAUMATIC INJURY AGE >17 W/O CC ....................................................................... 7 TRAUMATIC INJURY AGE 0–17 ................................................................................... 2 ALLERGIC REACTIONS AGE >17 ................................................................................. 7 ALLERGIC REACTIONS AGE 0–17 ............................................................................... 3 POISONING & TOXIC EFFECTS OF DRUGS AGE >17 W CC ................................... 7 POISONING & TOXIC EFFECTS OF DRUGS AGE >17 W/O CC ................................ 7 POISONING & TOXIC EFFECTS OF DRUGS AGE 0– 17 ........................................... COMPLICATIONS OF TREATMENT W CC ..................................................................... COMPLICATIONS OF TREATMENT W/O CC ................................................................. 3 OTHER INJURY, POISONING & TOXIC EFFECT DIAG W CC ................................... 7 OTHER INJURY, POISONING & TOXIC EFFECT DIAG W/O CC ................................ O.R. PROC W DIAGNOSES OF OTHER CONTACT W HEALTH SERVICES ............... REHABILITATION ............................................................................................................. SIGNS & SYMPTOMS W CC ........................................................................................... SIGNS & SYMPTOMS W/O CC ....................................................................................... AFTERCARE W HISTORY OF MALIGNANCY AS SECONDARY DIAGNOSIS ............. AFTERCARE W/O HISTORY OF MALIGNANCY AS SECONDARY DIAGNOSIS ......... 3 OTHER FACTORS INFLUENCING HEALTH STATUS ................................................. EXTENSIVE O.R. PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS ............... 6 PRINCIPAL DIAGNOSIS INVALID AS DISCHARGE DIAGNOSIS ................................ 6 UNGROUPABLE ............................................................................................................. 5 BILATERAL OR MULTIPLE MAJOR JOINT PROCS OF LOWER EXTREMITY .......... ACUTE LEUKEMIA W/O MAJOR O.R. PROCEDURE AGE >17 .................................... RESPIRATORY SYSTEM DIAGNOSIS WITH VENTILATOR SUPPORT ....................... 5 PROSTATIC O.R. PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS ............. NON-EXTENSIVE O.R. PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS ...... 2 OTHER VASCULAR PROCEDURES W/O CC .............................................................. 6 LIVER TRANSPLANT ..................................................................................................... 7 BONE MARROW TRANSPLANT ................................................................................... 5 TRACHEOSTOMY FOR FACE,MOUTH & NECK DIAGNOSES ................................... 7 CRANIOTOMY FOR MULTIPLE SIGNIFICANT TRAUMA ............................................ 7 LIMB REATTACHMENT, HIP AND FEMUR PROC FOR MULTIPLE SIGNIFICANT TR. 7 MYELOPROLIF 17:10 Apr 24, 2006 Jkt 208001 PO 00000 Frm 00407 Fmt 4701 Sfmt 4702 E:\FR\FM\25APP2.SGM 1.6479 1.1162 1.1162 0.8417 1.2412 0.5655 0.5655 0.8476 0.7858 1.3974 0.8081 0.7858 0.7961 0.5655 0.5655 0.7080 0.4109 1.0463 0.7858 0.4109 0.4007 0.5655 0.5164 0.5281 0.3970 0.5655 0.4109 0.4109 1.2390 1.2253 0.5655 1.3453 0.5655 0.6607 0.5655 0.5655 0.5655 0.5655 0.7858 0.7858 0.7858 0.9301 0.5809 0.7858 0.7858 1.1512 0.5847 0.6113 0.5850 0.6869 0.6666 0.7858 2.1241 0.0000 0.0000 1.6479 0.9992 1.9875 1.6479 1.5211 0.5655 0.0000 1.1162 1.6479 1.6479 1.1162 25APP2 Proposed geometric average length of stay 35.5 29.5 29.5 23.2 28.5 21.1 21.1 21.4 25.2 35.4 23.0 25.2 24.0 21.2 21.2 20.4 17.1 23.2 25.2 17.1 22.5 21.2 24.5 23.9 23.0 21.2 17.1 17.1 35.9 34.3 21.2 34.6 21.1 23.2 21.2 21.1 21.2 21.1 25.2 25.2 25.2 25.7 21.6 25.2 25.2 32.7 22.1 22.9 24.3 21.2 21.6 25.2 40.2 0.0 0.0 35.5 25.3 33.4 35.5 35.9 21.2 0.0 29.5 35.5 35.5 29.5 Proposed 5/6ths of the geometric average length of stay 29.6 24.6 24.6 19.3 23.8 17.6 17.6 17.8 21.0 29.5 19.2 21.0 20.0 17.7 17.7 17.0 14.3 19.3 21.0 14.3 18.8 17.7 20.4 19.9 19.2 17.7 14.3 14.3 29.9 28.6 17.7 28.8 17.6 19.3 17.7 17.6 17.7 17.6 21.0 21.0 21.0 21.4 18.0 21.0 21.0 27.3 18.4 19.1 20.3 17.7 18.0 21.0 33.5 0.0 0.0 29.6 21.1 27.8 29.6 29.9 17.7 0.0 24.6 29.6 29.6 24.6 24402 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules TABLE 11.—PROPOSED FY 2007 LTC–DRGS, RELATIVE WEIGHTS, GEOMETRIC AVERAGE LENGTH OF STAY, AND 5⁄6THS OF THE GEOMETRIC AVERAGE LENGTH OF STAY—Continued LTC–DRG 486 487 488 489 490 491 492 493 494 495 496 497 498 499 500 501 502 503 504 ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... 505 ........... 506 507 508 509 510 511 512 513 515 518 ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... 519 520 521 522 ........... ........... ........... ........... 523 ........... 524 525 528 529 530 531 532 533 534 535 536 537 ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... 538 ........... wwhite on PROD1PC61 with PROPOSALS2 539 ........... 540 ........... 541 ........... 542 ........... 543 544 545 546 ........... ........... ........... ........... VerDate Aug<31>2005 Proposed relative weight Description 3 OTHER O.R. PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA ..................... MULTIPLE SIGNIFICANT TRAUMA ................................................................. 4 HIV W EXTENSIVE O.R. PROCEDURE ........................................................................ HIV W MAJOR RELATED CONDITION ........................................................................... HIV W OR W/O OTHER RELATED CONDITION ............................................................ 5 MAJOR JOINT & LIMB REATTACHMENT PROCEDURES OF UPPER EXTREMITY 2 CHEMOTHERAPY W ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS .................. 4 LAPAROSCOPIC CHOLECYSTECTOMY W/O C.D.E. W CC ....................................... 7 LAPAROSCOPIC CHOLECYSTECTOMY W/O C.D.E. W/O CC ................................... 6 LUNG TRANSPLANT ...................................................................................................... 4 COMBINED ANTERIOR/POSTERIOR SPINAL FUSION ............................................... 5 SPINAL FUSION W CC .................................................................................................. 7 SPINAL FUSION W/O CC .............................................................................................. 5 BACK & NECK PROCEDURES EXCEPT SPINAL FUSION W CC .............................. 4 BACK & NECK PROCEDURES EXCEPT SPINAL FUSION W/O CC .......................... KNEE PROCEDURES W PDX OF INFECTION W CC ................................................... 2 KNEE PROCEDURES W PDX OF INFECTION W/O CC .............................................. 4 KNEE PROCEDURES W/O PDX OF INFECTION ......................................................... 5 EXTENSIVE BURN OR FULL THICKNESS BURNS WITH MECH VENT 96+ HOURS WITH SKIN GRAFT. 5 EXTENSIVE BURN OR FULL THICKNESS BURNS WITH MECH VENT 96+ HOURS WITHOUT SKIN GRAFT. 4 FULL THICKNESS BURN W SKIN GRAFT OR INHAL INJ W CC OR SIG TRAUMA 7 FULL THICKNESS BURN W SKIN GRFT OR INHAL INJ W/O CC OR SIG TRAUMA FULL THICKNESS BURN W/O SKIN GRFT OR INHAL INJ W CC OR SIG TRAUMA .. 1 FULL THICKNESS BURN W/O SKIN GRFT OR INH INJ W/O CC OR SIG TRAUMA NON-EXTENSIVE BURNS W CC OR SIGNIFICANT TRAUMA ...................................... 1 NON-EXTENSIVE BURNS W/O CC OR SIGNIFICANT TRAUMA ................................ 6 SIMULTANEOUS PANCREAS/KIDNEY TRANSPLANT ................................................ 6 PANCREAS TRANSPLANT ............................................................................................ 5 CARDIAC DEFIBRILATOR IMPLANT W/O CARDIAC CATH ........................................ 7 PERCUTANEOUS CARDIVASCULAR PROC W/O CORONARY ARTERY STENT OR AMI. 4 CERVICAL SPINAL FUSION W CC ............................................................................... 7 CERVICAL SPINAL FUSION W/O CC ........................................................................... 2 ALCOHOL/DRUG ABUSE OR DEPENDENCE W CC ................................................... 7 ALCOHOL/DRUG ABUSE OR DEPENDENCE W REHABILITATION THERAPY W/O CC. 1 ALCOHOL/DRUG ABUSE OR DEPENDENCE W/O REHABILITATION THERAPY W/ O CC. 2 TRANSIENT ISCHEMIA .................................................................................................. 7 OTHER HEART ASSIST SYSTEM IMPLANT ................................................................ 7 INTRACRANIAL VASCULAR PROC W PDX HEMORRHAGE ...................................... 5 VENTRICULAR SHUNT PROCEDURES W CC ............................................................ 7 VENTRICULAR SHUNT PROCEDURES W/O CC ........................................................ 5 SPINAL PROCEDURES WITH CC ................................................................................ 3 SPINAL PROCEDURES WITHOUT CC ......................................................................... 5 EXTRACRANIAL VASCULAR PROCEDURES WITH CC ............................................. 7 EXTRACRANIAL VASCULAR PROCEDURES WITHOUT CC ...................................... 5 CARDIAC DEFIB IMPLANT W CARDIAC CATH W AMI/HF/SHOCK ........................... 7 CARDIAC DEFIB IMPLANT W CARDIAC CATH W/O AMI/HF/SHOCK ....................... LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES EXCEPT HIP AND FEMUR WITH CC. 4 LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES EXCEPT HIP AND FEMUR WITHOUT CC. 4 LYMPHOMA AND LEUKEMIA WITH MAJOR O.R. PROCEDURE WITH CC .............. 7 LYMPHOMA AND LEUKEMIA WITH MAJOR O.R. PROCEDURE WITHOUT CC ....... ECMO OR TRACH W MECH VENT 96+ HRS OR PDX EXCEPT FACE,MOUTH & NECK DIAG WITH MAJOR OR. TRACH W MECH VENT 96+ HRS OR PDX EXCEPT FACE,MOUTH & NECK DIAG WITHOUT MAJOR OR. 5 CRANIOTOMY W IMPLANT OF CHEMO AGENT OR ACUTE COMPLEX CNS PDX 5 MAJOR JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY ..... 5 REVISION OF HIP OR KNEE REPLACEMENT ............................................................ 7 SPINAL FUSION EXCEPT CERVICAL WITH CURVATURE OF SPINE OR MALIGNANCY. 4 OTHER 17:10 Apr 24, 2006 Jkt 208001 PO 00000 Frm 00408 Fmt 4701 Sfmt 4702 E:\FR\FM\25APP2.SGM Proposed geometric average length of stay Proposed 5/6ths of the geometric average length of stay 0.7858 1.1162 1.1162 0.9391 0.6590 1.6479 0.5655 1.1162 1.1162 0.0000 1.1162 1.6479 1.6479 1.6479 1.1162 1.2227 0.5655 1.1162 1.6479 25.2 29.5 29.5 21.8 20.3 35.5 21.2 29.5 29.5 0.0 29.5 35.5 35.5 35.5 29.5 33.3 21.2 29.5 35.5 21.0 24.6 24.6 18.2 16.9 29.6 17.7 24.6 24.6 0.0 24.6 29.6 29.6 29.6 24.6 27.8 17.7 24.6 29.6 1.6479 35.5 29.6 1.1162 0.4109 0.7585 0.4109 0.6740 0.4109 0.0000 0.0000 1.6479 0.4109 29.5 17.1 25.6 17.1 22.6 17.1 0.0 0.0 35.5 17.1 24.6 14.3 21.3 14.3 18.8 14.3 0.0 0.0 29.6 14.3 1.1162 1.6479 0.5655 0.5655 29.5 35.5 21.2 21.1 24.6 29.6 17.7 17.6 0.4109 17.1 14.3 0.5655 1.6479 1.6479 1.6479 1.6479 1.6479 0.7858 1.6479 1.1162 1.6479 1.6479 1.4500 21.2 35.5 35.5 35.5 35.5 35.5 25.2 35.5 29.5 35.5 35.5 39.6 17.7 29.6 29.6 29.6 29.6 29.6 21.0 29.6 24.6 29.6 29.6 33.0 1.1162 29.5 24.6 1.1162 0.4109 3.8042 29.5 17.1 57.7 24.6 14.3 48.1 2.8365 44.7 37.3 1.6479 1.6479 1.6479 1.6479 35.5 35.5 35.5 35.5 29.6 29.6 29.6 29.6 25APP2 24403 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules TABLE 11.—PROPOSED FY 2007 LTC–DRGS, RELATIVE WEIGHTS, GEOMETRIC AVERAGE LENGTH OF STAY, AND 5⁄6THS OF THE GEOMETRIC AVERAGE LENGTH OF STAY—Continued LTC–DRG 547 548 549 550 ........... ........... ........... ........... 551 ........... 552 ........... 553 554 555 556 ........... ........... ........... ........... 557 ........... 558 ........... 559 ........... Proposed relative weight Description 7 CORONARY BYPASS WITH CARDIAC CATH WITH MAJOR CV DIAGNOSIS .......... BYPASS WITH CARDIAC CATH WITHOUT MAJOR CV DIAGNOSIS .. 7 CORONARY BYPASS WITHOUT CARDIAC CATH WITH MAJOR CV DIAGNOSIS .. 7 CORONARY BYPASS WITHOUT CARDIAC CATH WITHOUT MAJOR CV DIAGNOSIS. PERMANENT CARDIAC PACEMAKER IMPLANT WITH MAJOR CV DIAGNOSIS OR AICD LEAD OR GNRTR. 4 OTHER PERMANENT CARDIAC PACEMAKER IMPLANT WITHOUT MAJOR CV DIAGNOSIS. OTHER VASCULAR PROCEDURES WITH CC WITH MAJOR CV DIAGNOSIS ........... OTHER VASCULAR PROCEDURES WITH CC WITHOUT MAJOR CV DIAGNOSIS ... 3 PERCUTANEOUS CARDIOVASCULAR PROC WITH MAJOR CV DIAGNOSIS ......... 7 PERCUTANEOUS CARDIOVASCULAR PROC WITH NON-DRUG-ELUTING STENT WITHOUT MAJOR CV DIAGNOSIS. 4 PERCUTANEOUS CARDIOVASCULAR PROC WITH DRUG-ELUTING STENT WITH MAJOR CV DIAGNOSIS. 7 PERCUTANEOUS CARDIOVASCULAR PROC WITH DRUG-ELUTING STENT WITHOUT MAJOR CV DIAGNOSIS. 7 ACUTE ISCHEMIC STROKE WITH USE OF THROMBOLYTIC AGENT ..................... 7 CORONARY Proposed geometric average length of stay Proposed 5/6ths of the geometric average length of stay 1.6479 1.6479 1.6479 1.6479 35.5 35.5 35.5 35.5 29.6 29.6 29.6 29.6 1.6087 29.5 24.6 1.1162 29.5 24.6 1.5536 1.2892 0.7858 0.4109 31.8 31.6 25.2 17.1 26.5 26.3 21.0 14.3 1.1162 29.5 24.6 0.4109 17.1 14.3 0.7858 25.2 21.0 1 Proposed wwhite on PROD1PC61 with PROPOSALS2 relative weights for these proposed LTC–DRGs were determined by assigning these cases to proposed low-volume quintile 1. 2 Proposed relative weights for these proposed LTC–DRGs were determined by assigning these cases to proposed low-volume quintile 2. 3 Proposed relative weights for these proposed LTC–DRGs were determined by assigning these cases to proposed low-volume quintile 3. 4 Proposed relative weights for these proposed LTC–DRGs were determined by assigning these cases to proposed low-volume quintile 4. 5 Proposed relative weights for these proposed LTC–DRGs were determined by assigning these cases to proposed low-volume quintile 5. 6 Proposed relative weights for these proposed LTC–DRGs were assigned a value of 0.0000. 7 Proposed relative weights for these LTC–DRGs were determined by assigning these cases to the appropriate proposed low volume quintile because they had no LTCH cases in the FY 2005 MedPAR file. 8 Proposed relative weights for these proposed LTC–DRGs were determined after adjusting to account for nonmonotonicity (see step 5 above). VerDate Aug<31>2005 17:10 Apr 24, 2006 Jkt 208001 PO 00000 Frm 00409 Fmt 4701 Sfmt 4702 E:\FR\FM\25APP2.SGM 25APP2 24404 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules Appendix A—Regulatory Impact Analysis wwhite on PROD1PC61 with PROPOSALS2 (If you choose to comment on the issues in this section, please include the caption ‘‘Impact Analysis’’ at the beginning of your comment.) I. Overall Impact We have examined the impacts of this proposed rule as required by Executive Order 12866 (September 1993, Regulatory Planning and Review) and the Regulatory Flexibility Act (RFA) (September 19, 1980, Pub. L. 96– 354), section 1102(b) of the Social Security Act, the Unfunded Mandates Reform Act of 1995 (Pub. L. 104–4), and Executive Order 13132. Executive Order 12866 (as amended by Executive Order 13258, which merely reassigns responsibility of duties) directs agencies to assess all costs and benefits of available regulatory alternatives and, if regulation is necessary, to select regulatory approaches that maximize net benefits (including potential economic, environmental, public health and safety effects, distributive impacts, and equity). A regulatory impact analysis (RIA) must be prepared for major rules with economically significant effects ($100 million or more in any 1 year). We have determined that this proposed rule is a major rule as defined in 5 U.S.C. 804(2). We estimate that the proposed changes for FY 2007 operating and capital payments will redistribute in excess of $100 million among different types of inpatient cases. Further, the market basket update to IPPS rates required by the statute will result in an approximate $3.33 billion increase in FY 2007 operating and capital payments. This amount does not reflect changes in hospital admissions or case-mix intensity, which would also affect overall payment changes. The RFA requires agencies to analyze options for regulatory relief of small businesses. For purposes of the RFA, small entities include small businesses, nonprofit organizations, and government agencies. Most hospitals and most other providers and suppliers are considered to be small entities, either by nonprofit status or by having revenues of $6 million to $29 million in any 1 year. (For details, see the Small Business Administration’s final rule that sets forth size standards for health care industries at 65 FR 69432, November 17, 2000.) For purposes of the RFA, all hospitals and other providers and suppliers are considered to be small entities. Individuals and States are not included in the definition of a small entity. We believe that this proposed rule will have a significant impact on small entities as explained in this Appendix. Because we acknowledge that many of the affected entities are small entities, the analysis discussed throughout the preamble of this proposed rule constitutes our initial regulatory flexibility analysis. Therefore, we are soliciting comments on our estimates and analysis of the impact of this proposed rule on those small entities. In addition, section 1102(b) of the Act requires us to prepare a regulatory impact analysis for any proposed rule that may have VerDate Aug<31>2005 17:10 Apr 24, 2006 Jkt 208001 a significant impact on the operations of a substantial number of small rural hospitals. This analysis must conform to the provisions of section 603 of the RFA. With the exception of hospitals located in certain New England counties, for purposes of section 1102(b) of the Act, we previously defined a small rural hospital as a hospital with fewer than 100 beds that is located outside of a Metropolitan Statistical Area (MSA) or New England County Metropolitan Area (NECMA). However, under the new labor market definitions, we no longer employ NECMAs to define urban areas in New England. Therefore, we now define a small rural hospital as a hospital that is located outside of an MSA and has fewer than 100 beds. Section 601(g) of the Social Security Amendments of 1983 (Pub. L. 98–21) designated hospitals in certain New England counties as belonging to the adjacent NECMA. Thus, for purposes of the IPPS, we continue to classify these hospitals as urban hospitals. Section 202 of the Unfunded Mandates Reform Act of 1995 (Pub. L. 104–4) also requires that agencies assess anticipated costs and benefits before issuing any rule whose mandates require spending in any 1 year of $100 million in 1995 dollars, updated annually for inflation. That threshold level is currently approximately $120 million. This proposed rule will not mandate any requirements for State, local, or tribal governments, nor will it affect private sector costs. Executive Order 13132 establishes certain requirements that an agency must meet when it promulgates a proposed rule (and subsequent final rule) that imposes substantial direct requirement costs on State and local governments, preempts State law, or otherwise has Federalism implications. As stated above, this proposed rule will not have a substantial effect on State and local governments. The following analysis, in conjunction with the remainder of this document, demonstrates that this proposed rule is consistent with the regulatory philosophy and principles identified in Executive Order 12866, the RFA, and section 1102(b) of the Act. The proposed rule will affect payments to a substantial number of small rural hospitals, as well as other classes of hospitals, and the effects on some hospitals may be significant. II. Objectives The primary objective of the IPPS is to create incentives for hospitals to operate efficiently and minimize unnecessary costs while at the same time ensuring that payments are sufficient to adequately compensate hospitals for their legitimate costs. In addition, we share national goals of preserving the Medicare Hospital Insurance Trust Fund. We believe the changes in this proposed rule will further each of these goals while maintaining the financial viability of the hospital industry and ensuring access to high quality health care for Medicare beneficiaries. We expect that these proposed changes will ensure that the outcomes of this payment system are reasonable and equitable PO 00000 Frm 00410 Fmt 4701 Sfmt 4702 while avoiding or minimizing unintended adverse consequences. III. Limitations of Our Analysis The following quantitative analysis presents the projected effects of our proposed policy changes, as well as statutory changes effective for FY 2007, on various hospital groups. We estimate the effects of individual policy changes by estimating payments per case while holding all other payment policies constant. We use the best data available, but, generally, we do not attempt to predict behavioral responses to our policy changes (with the exception of the anticipated improvements in documentation and coding that may lead to increases in observed but not real case-mix in response to the adoption of consolidated severity DRGs in FY 2008 (if not earlier), and we do not make adjustments for future changes in such variables as admissions, lengths of stay, or case-mix. As we have done in the previous proposed rules, we are soliciting comments and information about the anticipated effects of these proposed changes on hospitals and our methodology for estimating them. Any timely comments that we receive in response to this proposed rule will be addressed in the final rule. IV. Hospitals Included In and Excluded From the IPPS The prospective payment systems for hospital inpatient operating and capitalrelated costs encompass nearly all general short-term, acute care hospitals that participate in the Medicare program. There were 35 Indian Health Service hospitals in our database, which we excluded from the analysis due to the special characteristics of the prospective payment method for these hospitals. Among other short-term, acute care hospitals, only the 46 such hospitals in Maryland remain excluded from the IPPS under the waiver at section 1814(b)(3) of the Act. As of March 2006, there are 3,539 IPPS hospitals to be included in our analysis. This represents about 59 percent of all Medicareparticipating hospitals. The majority of this impact analysis focuses on this set of hospitals. There are also approximately 1,274 critical access hospitals (CAHs). These small, limited service hospitals are paid on the basis of reasonable costs rather than under the IPPS. There are also 1,188 specialty hospitals and units that are excluded from the IPPS. These specialty hospitals include psychiatric hospitals and units (now referred to as IPFs), rehabilitation hospitals and units (now referred to as IRFs), long-term care hospitals (now referred to as LTCHs), Religious NonMedical Health Care Institutions (RNHCIs), children’s hospitals, and cancer hospitals. The impacts of our proposed policy changes on these hospitals are discussed below. V. Effects on Excluded Hospitals and Hospital Units As of March 2006, there were 1,188 hospitals excluded from the IPPS. Of these 1,188 hospitals, 476 IPFs, 81 children’s hospitals, 11 cancer hospitals, and 17 RNHCIs are being paid, in whole or in part, on a reasonable cost basis subject to the rateof-increase ceiling under § 413.40. The E:\FR\FM\25APP2.SGM 25APP2 wwhite on PROD1PC61 with PROPOSALS2 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules remaining providers, 217 IRFs and 386 LTCHs, are paid 100 percent of the Federal prospective rate under the IRF PPS and the LTCH PPS, respectively. (We note that, currently, there are 16 LTCHs that are being paid under the LTCH PPS transition blend methodology, which is based in part on a reasonable cost that is subject to a rate-ofincrease ceiling under § 413.40. For cost reporting periods that will begin during FY 2007, these LTCHs will no longer receive a portion of their payment that is based in part on a reasonable cost subject to a rate-ofincrease ceiling under § 413.40 because, in accordance with § 412.533, LTCHs are paid 100 percent of the adjusted Federal prospective payment amount for cost reporting periods beginning on or after October 1, 2006. In addition, there are 1,317 IPFs (paid on a blend of the IPF PPS per diem payment and the TEFRA reasonable costbased payment) and 1,011 IRFs (paid under the IRF PPS) in hospitals otherwise subject to the IPPS. Under § 413.40(a)(2)(i)(A), the rate-of-increase ceiling is not applicable to the 93 IPPS excluded hospitals and units in Maryland that are paid in accordance with the waiver at section 1814(b)(3) of the Act. In the past, hospitals and units excluded from the IPPS have been paid based on their reasonable costs subject to limits as established by the Tax Equity and Fiscal Responsibility Act of 1982 (TEFRA). Hospitals that continue to be paid fully on a reasonable cost basis are subject to TEFRA limits for FY 2007. For these hospitals (cancer and children’s hospitals), consistent with section 1886(b)(3)(B)(ii) of the Act, the proposed update will be the percentage increase in the FY 2007 IPPS operating market basket, currently estimated to be 3.4 percent. In addition, in accordance with § 403.752(a) of the regulations, RNHCIs are paid under § 413.40, which also uses section 1886(b)(3)(B)(ii) of the Act to update the percentage increase in the rate-of-increase limits. For RNHCIs, the proposed update will be the percentage increase in the FY 2007 IPPS operating market basket increase, currently estimated to be 3.4 percent. IRFs are paid under a prospective payment system (IRF PPS) for cost reporting periods beginning on or after January 1, 2002. For cost reporting periods beginning during FY 2007, the IRF PPS is based on 100 percent of the adjusted Federal IRF prospective payment amount, updated annually. Therefore, these hospitals are not affected by this proposed rule. Effective for cost reporting periods beginning on or after October 1, 2002, LTCHs are paid under a LTCH PPS, based on a Federal prospective payment amount that is updated annually. Existing LTCHs receive a blended payment that consists of the Federal prospective payment rate and a reasonable cost-based payment rate over a 5-year transition period, unless the LTCH elects to be paid at 100 percent of the Federal prospective rate at the beginning of any of its cost reporting periods during the 5-year transition period. Under § 412.533, the 5-year transition period for all existing hospitals subject to the LTCH PPS begins with the LTCH’s first cost reporting period beginning on or after October 1, 2002, and extends VerDate Aug<31>2005 17:10 Apr 24, 2006 Jkt 208001 through the LTCH’s cost reporting period beginning on or after October 1, 2006. In accordance with § 412.533, for cost reporting periods beginning on or after October 1, 2006, the LTCH PPS transition blend percentages are 100 percent of the Federal prospective payment amount and zero percent of the amount calculated under reasonable cost principles. Therefore, even though FY 2007 is the fifth year of the 5-year transition period established under § 412.533, because the reasonable cost principles amount is zero percent for cost reporting periods beginning during FY 2007, LTCHs will no longer receive a portion of their payment that is based in part on a reasonable cost subject to the rate-to-increase ceiling beginning with cost reporting periods beginning on or after October 1, 2006. Thus, there is no longer a need for an update factor for LTCH’s TEFRA target amount for FY 2007 and beyond. Section 124 of the Medicare, Medicaid, and SCHIP Balanced Budget Refinement Act of 1999 (BBRA) required the development of a per diem prospective payment system (PPS) for payment of inpatient hospital services furnished in IPFs. The final rule implementing the IPF PPS (69 FR 66922) established a 3-year transition to the IPF PPS during which some providers will receive a blend of the IPF PPS per diem payment and the TEFRA reasonable cost-based payment. For purposes of determining what the TEFRA payment to the IPF will be, we updated the IPF’s TEFRA target amount by the excluded hospital market basket percentage increase of 3.6 percent. The impact on excluded hospitals and hospital units of the update in the rate-ofincrease limit depends on the cumulative cost increases experienced by each excluded hospital or unit since its applicable base period. For excluded hospitals and units that have maintained their cost increases at a level below the rate-of-increase limits since their base period, the major effect is on the level of incentive payments these hospitals and hospital units receive. Conversely, for excluded hospitals and hospital units with per-case cost increases above the cumulative update in their rate-of-increase limits, the major effect is the amount of excess costs that will not be reimbursed. We note that, under § 413.40(d)(3), an excluded hospital or unit whose costs exceed 110 percent of its rate-of-increase limit receives its rate-of-increase limit plus 50 percent of the difference between its reasonable costs and 110 percent of the limit, not to exceed 110 percent of its limit. In addition, under the various provisions set forth in § 413.40, certain excluded hospitals and hospital units can obtain payment adjustments for justifiable increases in operating costs that exceed the limit. However, at the same time, by generally limiting payment increases, we continue to provide an incentive for excluded hospitals and hospital units to restrain the growth in their spending for patient services. PO 00000 Frm 00411 Fmt 4701 Sfmt 4702 24405 VI. Quantitative Effects of the Proposed Policy Changes Under the IPPS for Operating Costs A. Basis and Methodology of Estimates In this proposed rule, we are announcing policy changes and payment rate updates for the IPPS for operating costs. Changes to the capital payments are discussed in section VIII. of this Appendix. Based on the overall percentage change in payments per case estimated using our payment simulation model (a 3.4 percent increase), we estimate that total FY 2007 operating and capital payments will increase $3.33 billion compared to FY 2006 largely due to the statutorily mandated update to IPPS rates. This amount does not reflect changes in hospital admissions or case-mix intensity, which would also affect overall payment changes. We have prepared separate impact analyses of the proposed changes to each system. This section deals with proposed changes to the operating prospective payment system. Our payment simulation model relies on the most recent available data to enable us to estimate the impacts on payments per case of certain changes we are proposing in this rule. However, there are other changes we are proposing for which we do not have data available that would allow us to estimate the payment impacts using this model. For those proposed changes, we have attempted to predict the payment impacts based upon our experience and other more limited data. The data used in developing the quantitative analyses of changes in payments per case presented below are taken from the FY 2005 MedPAR file and the most current Provider-Specific File that is used for payment purposes. Although the analyses of the changes to the operating PPS do not incorporate cost data, data from the most recently available hospital cost report were used to categorize hospitals. Our analysis has several qualifications. First, we do not make adjustments for behavioral changes that hospitals may adopt in response to the proposed policy changes, and we do not adjust for future changes in such variables as admissions, lengths of stay, or case-mix. (However, as we indicated earlier, we are planning to adopt a severity DRG system in FY 2008 (if not earlier) and expect to make adjustments to the standardized amounts to account for anticipated improvements in documentation and coding that may lead to increases in observed but not real case mix). Second, due to the interdependent nature of the IPPS payment components, it is very difficult to precisely quantify the impact associated with each proposed change. Third, we use various sources for the data used to categorize hospitals in the tables. In some cases, particularly the number of beds, there is a fair degree of variation in the data from different sources. We have attempted to construct these variables with the best available source overall. However, for individual hospitals, some miscategorizations are possible. Using cases from the FY 2005 MedPAR file, we simulated payments under the operating IPPS given various combinations of payment parameters. Any short-term, acute E:\FR\FM\25APP2.SGM 25APP2 wwhite on PROD1PC61 with PROPOSALS2 24406 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules care hospitals not paid under the IPPS (Indian Health Service hospitals and hospitals in Maryland) were excluded from the simulations. The impact of payments under the capital IPPS, or the impact of payments for costs other than inpatient operating costs, are not analyzed in this section. Estimated payment impacts of proposed FY 2007 changes to the capital IPPS are discussed in section VIII. of this Appendix. The proposed changes discussed separately below are the following: • The effect of a reduced update to the standardized amount for hospitals that do not comply with section 1886(b)(3)(B)(viii) of the Act by submitting quality data in accordance with our requirements. • The effects of the MDH payment changes set forth in section 5003 of Pub. L. 109–171. • The effects of the annual reclassification of diagnoses and procedures and the recalibration of the DRG relative weights required by section 1886(d)(4)(C) of the Act. • The effects of the proposed changes in hospitals’ wage index values reflecting wage data from hospitals’ cost reporting periods beginning during FY 2003, compared to the FY 2002 wage data. • The effects of the proposed wage and recalibration budget neutrality factors. • The effects of the remaining labor market area transition for those hospitals that were urban under the old labor market area designations and are now considered rural hospitals. • The effects of geographic reclassifications by the MGCRB that will be effective in FY 2007. • The effects of section 505 of Pub. L. 108– 173, which provides for an increase in a hospital’s wage index if the hospital qualifies by meeting a threshold percentage of residents of the county where the hospital is located who commute to work at hospitals in counties with higher wage indexes. • The total change in payments based on proposed FY 2007 policies and MMAimposed changes relative to payments based on FY 2006 policies. To illustrate the impacts of the proposed FY 2007 changes, our analysis begins with a FY 2006 baseline simulation model using: The proposed update of 3.4 percent; the FY 2006 DRG GROUPER (version 23.0); the CBSA designations for hospitals based on OMB’s June 2003 MSA definitions; the FY 2006 wage index; and no MGCRB reclassifications. Outlier payments are set at 5.1 percent of total operating DRG and outlier payments. Section 1886(b)(3)(B)(vii) of the Act, as added by section 501(b) of Pub. L. 108–173, and amended by section 5001(a) of Pub. L. 109–171, provides that, for FYs 2005 through 2006, the update factors will be reduced by 0.4 percentage points for any hospital that does not submit quality data. Section 5001(a) of Pub. L. 109–171 provides that for FY 2007 and subsequent years, the update factor will be reduced by 2.0 percentage points for any hospital that does not submit quality data or that fails the quality data validation process. At the time this impact was prepared, 115 providers did not receive the full market basket rate-of-increate for FY 2006 because VerDate Aug<31>2005 17:10 Apr 24, 2006 Jkt 208001 they failed the quality data submission process. For purposes of the simulations shown below, we modeled the payment changes for FY 2007 using a reduced update for these 115 hospitals. However, we do not have enough information to determine which hospitals will not receive the full market basket rate-of-increase for FY 2007 at this time. Each proposed and statutory policy change is then added incrementally to this baseline, finally arriving at an FY 2007 model incorporating all of the proposed changes. This simulation allows us to isolate the effects of each proposed change. Our final comparison illustrates the percent change in payments per case from FY 2006 to FY 2007. Three factors not discussed separately have significant impacts here. The first is the update to the standardized amount. In accordance with section 1886(b)(3)(B)(i) of the Act, we have updated standardized amounts for FY 2007 using the most recently forecasted hospital market basket increase for FY 2007 of 3.4 percent. (Hospitals that fail to comply with the quality data submission requirement to receive the full update will receive an update reduced by 2.0 percentage points to 1.4 percent.) Under section 1886(b)(3)(B)(iv) of the Act, the updates to the hospital-specific amounts for sole community hospitals (SCHs) and for Medicare-dependent small rural hospitals (MDHs) are also equal to the market basket increase, or 3.4 percent. A second significant factor that affects changes in hospitals’ payments per case from FY 2006 to FY 2007 is the change in MGCRB status from one year to the next. That is, payments may be reduced for hospitals reclassified in FY 2006 that are no longer reclassified in FY 2007. Conversely, payments may increase for hospitals not reclassified in FY 2006 that are reclassified in FY 2007. In some cases, these impacts can be quite substantial, so if a relatively small number of hospitals in a particular category lose their reclassification status, the percentage change in payments for the category may be below the national mean. However, this effect is alleviated by section 1886(d)(10)(D)(v) of the Act, which provides that reclassifications for purposes of the wage index are for a 3-year period. A third significant factor is that we currently estimate that actual outlier payments during FY 2006 will be 4.7 percent of total DRG payments. When the FY 2006 final rule was published, we projected FY 2006 outlier payments would be 5.1 percent of total DRG plus outlier payments; the average standardized amounts were offset correspondingly. The effects of the lower than expected outlier payments during FY 2006 (as discussed in the Addendum to this proposed rule) are reflected in the analyses below comparing our current estimates of FY 2006 payments per case to estimated FY 2007 payments per case (with outlier payments projected to equal 5.1 percent of total DRG payments). B. Analysis of Table I Table I displays the results of our analysis of proposed changes for FY 2007. The table categorizes hospitals by various geographic PO 00000 Frm 00412 Fmt 4701 Sfmt 4702 and special payment consideration groups to illustrate the varying impacts on different types of hospitals. The top row of the table shows the overall impact on the 3,522 hospitals included in the analysis. There are 222 fewer hospitals than were included in the impact analysis in the FY 2006 final rule (70 FR 47690). The next four rows of Table I contain hospitals categorized according to their geographic location: All urban, which is further divided into large urban and other urban; and rural. There are 2,517 hospitals located in urban areas included in our analysis. Among these, there are 1,391 hospitals located in large urban areas (populations over 1 million), and 1,126 hospitals in other urban areas (populations of 1 million or fewer). In addition, there are 1,005 hospitals in rural areas. The next two groupings are by bed-size categories, shown separately for urban and rural hospitals. The final groupings by geographic location are by census divisions, also shown separately for urban and rural hospitals. The second part of Table I shows hospital groups based on hospitals’ proposed FY 2007 payment classifications, including any reclassifications under section 1886(d)(10) of the Act. For example, the rows labeled urban, large urban, other urban, and rural show that the number of hospitals paid based on these categorizations after consideration of geographic reclassifications (including reclassifications under 1886(d)(8)(B) and 1886(d)(8)(E) which have implications for capital payments) are 2,539, 1,400, 1,139, and 983, respectively. The next three groupings examine the impacts of the proposed changes on hospitals grouped by whether or not they have GME residency programs (teaching hospitals that receive an IME adjustment) or receive DSH payments, or some combination of these two adjustments. There are 2,449 non-teaching hospitals in our analysis, 836 teaching hospitals with fewer than 100 residents, and 237 teaching hospitals with 100 or more residents. In the DSH categories, hospitals are grouped according to their DSH payment status, and whether they are considered urban or rural for DSH purposes. The next category groups hospitals considered urban after geographic reclassification, in terms of whether they receive the IME adjustment, the DSH adjustment, both, or neither. The next five rows examine the impacts of the proposed changes on rural hospitals by special payment groups (sole community hospitals (SCHs), rural referral centers (RRCs), and Medicare dependent hospitals (MDHs)), as well as rural hospitals not receiving a special payment designation. There were 140 RRCs, 341 SCHs, 126 MDHs, 80 hospitals that are both SCHs and RRCs and 8 hospitals that are both MDHs and RRCs. The next two groupings are based on type of ownership and the hospital’s Medicare utilization expressed as a percent of total patient days. These data are taken primarily from the FY 2004 Medicare cost reports, if available (otherwise FY 2003 data are used). The next series of groupings concern the geographic reclassification status of E:\FR\FM\25APP2.SGM 25APP2 24407 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules hospitals. The first grouping displays all urban hospitals that were reclassified by the MGCRB for FY 2007. The next grouping shows the MGCRB rural reclassifications. The final three rows in Table I contain hospitals located in urban counties, but deemed to be rural under section 1886(d)(8)(E) of the Act, hospitals located in rural counties but deemed to be urban under section 1886(d)(8)(B) of the Act, and hospitals currently reclassified under section 508 of Public Law 108–173, which expires on March 31, 2007. TABLE I.—IMPACT ANALYSIS OF PROPOSED CHANGES FOR FY 2007 (2) wwhite on PROD1PC61 with PROPOSALS2 All Hospitals .............................................. By Geographic Location: Urban hospitals .................................. Large urban areas (populations over 1 million) ......................................... Other urban areas (populations of 1 million or fewer) .............................. Rural hospitals ................................... Bed Size (Urban): 0–99 beds ................................... 100–199 beds ............................. 200–299 beds ............................. 300–499 beds ............................. 500 or more beds ....................... Bed Size (Rural): 0–49 beds ................................... 50–99 beds ................................. 100–149 beds ............................. 150–199 beds ............................. 200 or more beds ....................... Urban by Region: New England .............................. Middle Atlantic ............................ South Atlantic .............................. East North Central ...................... East South Central ..................... West North Central ..................... West South Central .................... Mountain ..................................... Pacific ......................................... Puerto Rico ................................. Rural by Region: New England .............................. Middle Atlantic ............................ South Atlantic .............................. East North Central ...................... East South Central ..................... West North Central ..................... West South Central .................... Mountain ..................................... Pacific ......................................... By Payment Classification: Urban hospitals .................................. Large urban areas (populations over 1 million) ......................................... Other urban areas (populations of 1 million or fewer) .............................. Rural Areas ........................................ Teaching Status: Nonteaching ................................ Fewer than 100 residents ........... 100 or more residents ................ Urban DSH: Non-DSH ..................................... 100 or more beds ....................... Less than 100 beds .................... Rural DSH: SCH ............................................ RRC ............................................ Other Rural: 100 or more beds ....................... Less than 100 beds .................... Urban teaching and DSH: Both teaching and DSH .............. Teaching and no DSH ................ No teaching and DSH ................. No teaching and no DSH ........... Rural Hospital Types: Non special status hospitals ....... VerDate Aug<31>2005 17:10 Apr 24, 2006 (5) (3) (1) Jkt 208001 FY 2007 wage data 5 DRG rel. wts. and wage index changes 6 Wage index transition for hospitals moving from urban to rural 7 MGCRB reclassifications 8 Out-migration adjustment 9 (6) DRA MDH provisions 3 Hospital specific costs wts, DRG changes 4 (4) No. of hospitals 1 Quality data rate difference 2 (7) (8) (9) (10) All FY 2007 changes 10 3,522 0.0 0.1 0.1 0.0 0.0 0.0 0.0 0.1 3.4 2,517 0.0 0.0 ¥0.2 0.1 ¥0.4 0.0 ¥0.3 0.1 3.0 1,391 0.0 0.0 0.1 0.0 0.0 0.0 ¥0.5 0.0 3.4 1,126 1,005 0.0 0.0 0.0 0.5 ¥0.8 3.0 0.1 0.0 ¥0.8 2.8 0.0 0.3 ¥0.2 2.2 0.1 0.1 2.5 6.7 590 865 482 414 166 ¥0.1 0.0 0.0 0.0 0.0 0.1 0.0 0.0 0.0 0.0 0.9 1.9 0.1 ¥1.1 ¥1.5 0.1 0.2 0.1 0.1 ¥0.1 0.8 2.0 0.0 ¥1.2 ¥1.8 0.0 0.0 0.0 0.0 0.0 ¥0.5 ¥0.2 ¥0.3 ¥0.4 ¥0.4 0.0 0.0 0.1 0.1 0.0 4.1 5.2 3.4 2.2 1.6 349 366 179 64 47 ¥0.1 0.0 0.0 0.0 0.0 0.9 1.3 0.1 0.0 0.0 5.8 4.6 3.0 1.2 ¥0.1 ¥0.1 0.0 0.0 ¥0.1 ¥0.2 5.7 4.5 2.9 1.0 ¥0.4 0.1 0.3 0.5 0.5 0.0 0.9 1.1 2.6 3.7 3.3 0.2 0.2 0.1 0.1 0.0 10.1 9.3 6.2 4.2 2.9 127 353 381 388 163 156 350 143 404 52 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.5 0.1 ¥0.6 ¥0.2 ¥0.7 ¥1.2 ¥0.5 ¥1.1 0.7 3.2 0.7 0.2 ¥0.4 0.2 ¥0.4 ¥0.1 ¥0.4 0.6 0.6 ¥1.4 1.0 0.1 ¥1.1 ¥0.2 ¥1.3 ¥1.4 ¥1.1 ¥0.6 1.1 1.6 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.4 ¥0.1 ¥0.4 0.3 ¥0.5 ¥0.7 ¥0.6 ¥0.4 ¥0.3 ¥0.7 0.0 0.1 0.0 0.0 0.1 0.0 0.0 0.0 0.1 0.0 3.2 3.0 2.6 3.0 2.5 2.1 2.6 3.0 4.5 5.0 19 72 175 125 181 118 191 80 44 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 2.6 1.2 0.2 0.6 0.2 0.9 0.4 0.0 0.3 1.9 2.9 3.7 2.0 3.1 1.9 3.8 2.7 3.7 ¥0.4 0.3 0.0 ¥2.0 0.0 0.1 ¥0.1 ¥0.2 0.1 1.5 3.1 3.5 1.7 2.9 2.0 3.6 2.5 3.8 0.0 0.1 0.2 0.1 0.2 0.0 0.6 2.3 0.0 2.1 2.1 2.3 1.7 2.8 2.0 3.0 0.6 1.9 0.1 0.0 0.2 0.0 0.1 0.1 0.2 0.1 0.1 7.7 7.7 6.9 5.8 6.4 6.3 7.1 5.6 7.4 2,539 0.0 0.0 ¥0.2 0.1 ¥0.3 0.0 ¥0.3 0.1 3.0 1,400 0.0 0.0 0.1 0.0 0.0 0.0 ¥04 0.0 3.4 1,139 983 0.0 0.0 0.0 0.5 ¥0.7 2.9 0.1 0.0 ¥0.8 2.7 0.0 0.3 ¥0.2 2.1 0.1 0.1 2.5 6.6 2,449 836 237 0.0 0.0 0.0 0.1 0.0 0.0 1.3 ¥0.7 ¥0.9 0.0 0.0 0.2 1.2 ¥0.9 ¥0.9 0.0 0.0 0.0 0.2 ¥0.2 ¥0.3 0.1 0.0 0.0 4.8 2.6 2.6 854 1,513 333 0.0 0.0 0.0 0.1 0.0 0.1 ¥0.8 ¥0.1 3.7 0.0 0.1 0.3 ¥1.0 ¥0.2 3.9 0.0 0.0 0.0 ¥0.1 ¥0.3 ¥0.4 0.0 0.1 0.0 2.6 3.1 7.2 383 196 0.0 0.0 0.9 0.1 4.4 1.5 0.0 ¥0.1 4.4 1.3 0.3 0.2 0.7 3.7 0.1 0.0 8.7 4.6 55 188 0.0 ¥0.1 0.0 0.0 4.5 5.8 0.2 0.0 4.5 5.7 1.1 0.4 1.0 1.0 0.3 0.4 7.2 9.1 809 198 1,037 495 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 ¥0.6 ¥1.4 1.3 ¥0.6 0.0 0.1 0.1 ¥0.1 ¥0.8 ¥1.5 1.3 ¥0.9 0.0 0.0 0.0 0.0 ¥0.4 ¥0.1 ¥0.2 ¥0.3 0.0 0.1 0.1 0.0 2.5 1.6 4.7 2.8 288 ¥0.1 0.0 5.1 0.1 5.0 0.8 1.0 0.4 8.2 PO 00000 Frm 00413 Fmt 4701 Sfmt 4702 E:\FR\FM\25APP2.SGM 25APP2 24408 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules TABLE I.—IMPACT ANALYSIS OF PROPOSED CHANGES FOR FY 2007—Continued (2) (5) (3) (1) RRC ............................................ SCH ............................................ MDH ............................................ SCH and RRC ............................ MDH and RRC ............................ Type of Ownership: Voluntary ..................................... Proprietary .................................. Government ................................ Medicare Utilization as a Percent of Inpatient Days: 0–25 ................................................... 25–50 ................................................. 50–65 ................................................. Over 65 .............................................. Unknown ............................................ Urban Hospitals Reclassified by the Medicare Geographic Classification Review Board: First Half FY 2007 Reclassifications ....................................................... Urban Nonreclassified, First Half FY 2007 All Urban Hospitals Reclassified Second Half FY 2007 ......................................... Urban Nonreclassified Hospitals Second Half FY 2007 ......................................... All Rural Hospitals Reclassified Full Year FY 2007 ................................................. Rural Nonreclassified Hospitals Full Year 2007 ....................................................... All Section 401 Reclassified Hospitals ..... Other Reclassified Hospitals (Section 1886(d)(8)(B)) ........................................ Section 508 Hospitals ............................... FY 2007 wage data 5 DRG rel. wts. and wage index changes 6 Wage index transition for hospitals moving from urban to rural 7 MGCRB reclassifications 8 Out-migration adjustment 9 (6) DRA MDH provisions 3 Hospital specific costs wts, DRG changes 4 (4) No. of hospitals 1 Quality data rate difference 2 (7) (8) (9) (10) All FY 2007 changes 10 140 341 126 80 8 0.0 0.0 0.0 0.0 0.0 0.0 0.0 5.9 0.0 12.8 1.1 4.1 5.3 1.1 2.6 ¥0.1 0.0 0.0 ¥0.2 0.0 0.9 4.0 5.2 0.9 2.7 0.3 0.3 0.0 0.0 0.0 4.3 0.5 0.8 2.2 0.8 0.0 0.1 0.1 0.0 0.0 4.3 7.5 14.6 4.1 17.5 2,087 831 604 0.0 0.0 0.0 0.1 0.0 0.1 ¥0.1 0.3 1.2 0.1 ¥0.1 0.1 ¥0.2 0.0 1.2 0.0 0.1 0.0 ¥0.1 0.0 0.1 0.1 0.0 0.1 3.1 3.7 4.7 252 1,302 1,490 459 19 0.0 0.0 0.0 0.0 ¥0.2 0.0 0.0 0.1 0.4 0.0 2.3 ¥0.4 0.5 0.5 3.8 0.5 0.0 0.1 ¥0.1 0.5 2.6 ¥0.6 0.4 0.2 4.1 0.0 0.0 0.0 0.0 0.0 ¥0.3 ¥0.4 0.4 0.5 ¥0.3 0.0 0.0 0.1 0.1 0.0 5.8 2.8 3.9 4.1 8.2 319 2,119 0.0 0.0 0.0 0.0 ¥0.3 ¥0.2 0.2 0.0 ¥0.3 ¥0.4 0.0 0.0 2.1 ¥0.7 0.0 0.1 3.1 3.1 339 0.0 0.0 ¥0.2 0.1 ¥0.2 0.0 1.9 0.0 3.2 2,099 0.0 0.0 ¥0.2 0.0 ¥0.4 0.0 ¥0.7 0.1 3.1 385 0.0 0.5 1.8 0.0 1.6 0.1 3.8 0.0 5.3 604 38 ¥0.1 0.0 0.6 3.0 4.8 3.1 0.0 0.1 4.6 3.2 0.6 0.0 0.0 ¥0.3 0.3 0.0 8.8 9.2 54 95 ¥0.1 0.0 0.5 0.0 4.8 ¥0.4 0 0.3 4.7 ¥0.2 0.0 0.0 4.0 ¥0.2 0.0 0.1 8.7 0.6 1 Because data necessary to classify some hospitals by category were missing, the total number of hospitals in each category may not equal the national total. Discharge data are from FY 2003, and hospital cost report data are from reporting periods beginning in FY 2002 and FY 2001. 2 This column displays the payment impact of the hospitals that did not submit quality update information. 3 This column displays the impact of the Deficit Reduction Act section 5003 that apply to Medicare Dependent Hospitals. 4 This column displays the payment impact of the changes to the V24 GROUPER and the recalibration of the DRG HSRVcc weights based on FY 2005 MedPAR data in accordance with section 1886(d)(4)(C)(iii) of the Act. 5 This column displays the payment impact of updating the wage index data to the FY 2003 cost report data. 6 This column displays the payment impact of the budget neutrality factor for DRG and wage index changes data in accordance with section 1886(d)(4)(C)(iii) of the Act and section 1886(d)(3)(E) of the Act. 7 Shown here are the effects of providing rural hospitals formerly located in urban areas with urban wage index values in FY 2007. The effects reflected here are budget neutral: this column therefore includes the effect of the 0.999591 adjustment that we have applied to the rates to ensure budget neutrality. 8 Shown here are the effects of geographic reclassifications by the Medicare Geographic Classification Review Board (MGCRB). The effects demonstrate the FY 2007 payment impact of going from no reclassifications to the reclassifications scheduled to be in effect for FY 2007. Reclassification for prior years has no bearing on the payment impacts shown here. This column reflects the geographic budget neutrality factor of 0.991727. 9 This column displays the impact of the FY 2007 implementation of section 505 of Pub. L. 108–173, which provides for an increase in a hospital’s wage index if the hospital qualifies by meeting a threshold percentage of residents of the county where the hospital is located who commute to work at hospitals in counties with higher wage indexes. 10 This column shows changes in payments from FY 2006 to FY 2007. It incorporates all of the changes displayed in Columns 3, 4, 7, 8, and 9 (the changes displayed in Columns 5 and 6 are included in Column 7). It also reflects the impact of the FY 2007 update, changes in hospitals’ reclassification status in FY 2007 compared to FY 2006, and the changes in payments as a result of continuing the reclassifications under section 508 of Pub. L. 108–173. The sum of these impacts may be different from the percentage changes shown here due to rounding and interactive effect. wwhite on PROD1PC61 with PROPOSALS2 C. Effects on the Hospitals That Failed the Quality Data Submission Process (Column 2) Column 2 of Table I shows the effect of assigning a reduced update to the standardized amount to hospitals that either fail to submit quality data or fail the data validation requirements. This column shows the effect of paying these providers based on an update of market basket, less 2.0 percentage points (1.4 percent) relative to a full market basket update (3.4 percent), for FY 2007. There are 115 hospitals in this analysis that we expect will not receive the full market basket update for FY 2007. Most of these hospitals are either small rural or small urban hospitals. We project that these hospitals will receive an overall decrease in payments of 0.1 percent from last year’s payment. VerDate Aug<31>2005 17:10 Apr 24, 2006 Jkt 208001 D. Effects of the DRA Provision Related to MDHs (Column 3) In Column 3 of Table I, we show the effects of implementing section 5003 of Pub. L. 109– 171 for MDHs. Section 5003 requires MDHs to rebase their hospital-specific rate to the FY 2002 cost reporting period, if doing so increases their target amount. It also increases the hospital-specific payment amount from the Federal rate plus 50 percent of the difference between the Federal rate and the hospital-specific amount (presuming the hospital-specific amount exceeds the Federal amount) to the Federal rate plus 75 percent of the difference. In addition, MDHs are no longer subject to the 12-percent cap on their DSH payments, effective FY 2007. This column compares the FY 2007 payment rates under the section 5003 provisions to payments under the FY 2006 MDH provisions. (The MDH provisions were PO 00000 Frm 00414 Fmt 4701 Sfmt 4702 set to expire at the end of FY 2006 but were extended by section 5003(a)(1)). Overall, hospitals experience a 0.1 percent increase. This is primarily due to the substantial increase in payments to MDH providers; MDH providers experience a 5.9 percent increase while MDH/RRC combination providers experience a 12.8 percent increase. E. Effects of the Changes to the DRG Reclassifications and Relative Cost-Based Weights (Column 4) In Column 4 of Table I, we present the combined effects of the DRG reclassifications and recalibration, as discussed in section II. of the preamble to this proposed rule. Section 1886(d)(4)(C)(i) of the Act requires us annually to make appropriate classification changes in order to reflect changes in treatment patterns, technology, and any other E:\FR\FM\25APP2.SGM 25APP2 24409 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules factors that may change the relative use of hospital resources. As discussed in the preamble of this proposed rule, we are proposing to change the relative weight calculation methodology from a charge-based method to a hospital specific, cost center adjusted method. In this column, we compare aggregate payments using the proposed FY 2007 hospital-specific cost weights (GROUPER Version 24) to the FY 2006 DRG relative charge weights (GROUPER Version 23.0). This method is described in more detail in section II of the preamble to this proposed rule. We note that, consistent with section 1886(d)(4)(C)(iii) of the Act, we have applied a budget neutrality factor to ensure that the overall payment impact of the DRG changes (combined with the wage index changes) is budget neutral. This budget neutrality factor of 0.998363 is applied to payments in Column 6. Because this is a combined DRG reclassification and recalibration and wage index budget neutrality factor, it is not applied to payments in Column 4. We have not proposed substantial changes to the FY 2007 GROUPER in this rule so most of the differences observed in this column illustrate the effect of setting the relative weights under the HSRVcc methodology, which is discussed in detail in section II.C. of the preamble to this proposed rule. In general, surgical DRGs tend to have charges concentrated in ancillary cost center groups while medical DRGs tend to have charges concentrated in routine or intensive care unit (ICU) cost center groups. As discussed in the preamble of this proposed rule, the cost to charge ratios for ancillary cost center groups are lower than the cost to charge ratios for routine and ICU cost center groups, indicating that the charge mark ups for ancillary services are higher. Because the HSRVcc weighting methodology adjusts the weights to remove differential mark-ups in charges, the FY 2007 weights are redistributed among medical and surgical DRGs, which will result in a redistribution of payments among hospitals according to the types of cases they provide. For instance, hospitals that perform more surgical procedures are likely to experience decreases in payments while hospitals with heavy concentrations of medical DRGs are expected to experience increases in payments. Hospitals with a case-mix that is equal to average will see little or no change in payment. Rural DSH hospitals with less than 100 beds and small rural hospitals (0–49 beds) show the greatest increase in payments of 5.8 percent. Urban hospitals with more than 500 beds and teaching hospitals with no DSH payments have the largest decrease in payments with declines of 1.5 and 1.4 percent respectively. Urban hospitals in West North Central, Mountain, East South Central, South Atlantic, West South Central, and East North Central experience decreases in payment of .2 to 1.2 percent. F. Effects of Proposed Wage Index Changes (Column 5) Section 1886(d)(3)(E) of the Act requires that, beginning October 1, 1993, we annually update the wage data used to calculate the wage index. In accordance with this requirement, the proposed wage index for FY 2007 is based on data submitted for hospital cost reporting periods beginning on or after October 1, 2002 and before October 1, 2003. The impact of the new data on hospital payments is isolated in Column 5 by holding the other payment parameters constant in this simulation. That is, Column 5 shows the percentage changes in payments when going from a model using the FY 2006 wage index, based on FY 2002 wage data, to a model using the proposed FY 2007 prereclassification wage index, based on FY 2003 wage data. The wage data collected on the FY 2003 cost report are the same as the FY 2002 wage data those were used to calculate the FY 2006 wage index. Column 5 shows the impacts of updating the wage data using FY 2003 cost reports. Overall, the new wage data will lead to a 0.0 percent change for all hospitals and a 0.1 percent increase for hospitals in urban areas. This increase is due to fluctuations in the wage data. Among regions, the largest increase is in the urban New England region, which experiences a 0.7 percent increase. The largest decline from updating the wage data is seen in the Puerto Rico region (a 1.4 percent decrease). In looking at the wage data itself, the national average hourly wage increased 5.7 percent compared to FY 2006. Therefore, the only manner in which to maintain or exceed the previous year’s wage index was to match or exceed the national 5.7 percent increase in average hourly wage. Of the 3,500 hospitals with wage data for both FYs 2006 and 2007, 1,606, or 45.9 percent, also experienced an average hourly wage increase of 5.7 percent or more. The following chart compares the shifts in wage index values for hospitals for FY 2007 relative to FY 2006. Among urban hospitals, 45 will experience an increase of between 5 percent and 10 percent and 3 will experience an increase of more than 10 percent. No rural hospitals will experience increases greater than 5 percent. However, 996 rural hospitals will experience increases or decreases of less than 5 percent, while 2,380 urban hospitals will experience increases or decreases of less than 5 percent. Sixty urban hospitals will experience decreases in their wage index values of at least 5 percent, but less than 10 percent. Twelve urban hospitals will experience decreases in their wage index values of greater than 10 percent. Four rural hospitals will experience decreases of more than 10 percent. The following chart shows the projected impact for urban and rural hospitals. Number of hospitals Percentage change in area wage index values Urban Increase more than 10 percent ....................................................................................................................................... Increase more than 5 percent and less than 10 percent ................................................................................................ Increase or decrease less than 5 percent ....................................................................................................................... Decrease more than 5 percent and less than 10 percent .............................................................................................. Decrease more than 10 percent ...................................................................................................................................... wwhite on PROD1PC61 with PROPOSALS2 G. Combined Effects of Proposed DRG and Wage Index Changes, Including Budget Neutrality Adjustment (Column 6) The impact of the DRG reclassifications on aggregate payments is required by section 1886(d)(4)(C)(iii) of the Act to be budget neutral. In addition, section 1886(d)(3)(E) of the Act specifies that any updates or adjustments to the wage index are to be budget neutral. As noted in the Addendum to this proposed rule, in determining the budget neutrality factor, we compared simulated aggregate payments using the FY 2006 DRG relative weights, the blended wage index, and labor share percentage to simulated aggregate payments using the VerDate Aug<31>2005 17:10 Apr 24, 2006 Jkt 208001 proposed FY 2007 DRG relative weights and wage index. We computed a wage and DRG recalibration budget neutrality factor of 0.998363. The 0.0 percent impact for all hospitals demonstrates that these changes, in combination with the budget neutrality factor, are budget neutral. In Table I, the combined overall impacts of the effects of both the DRG reclassifications and the updated wage index are shown in Column 6. The changes in this column are the sum of the proposed changes in Columns 4 and 5, combined with the budget neutrality factor and the wage index floor for urban areas required by section 4410 of Pub. L. 105–33 to be budget neutral. There also may be some PO 00000 Frm 00415 Fmt 4701 Sfmt 4702 3 45 2,380 60 12 Rural 0 0 996 0 4 variation of plus or minus 0.1 percentage point due to rounding. Small rural hospitals show a 5.7 percent increase in payments that is primarily due to the change to the relative weight methodology used in the DRG recalibration process. Among urban regions, the largest impacts are in the Pacific region and Puerto Rico, with 1.1 and 1.6 percent increases, respectively. The West North Central region experiences the largest decrease of 1.4 percent. Among rural regions, the Pacific region benefits the most with a 3.8 percent increase, while the New England region experiences the smallest increase (1.5 percent). E:\FR\FM\25APP2.SGM 25APP2 24410 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules wwhite on PROD1PC61 with PROPOSALS2 H. Effects of the 3-Year Provision Allowing Urban Hospitals That Were Converted to Rural as a Result of the FY 2005 Labor Market Area Changes To Maintain the Wage Index of the Urban Labor Market Area in Which They Were Formerly Located (Column 7) To help alleviate the decreased payments for urban hospitals that became rural under the new labor market area definitions, for purposes of the wage index, we adopted a policy in FY 2005 to allow them to maintain the wage index assignment of the MSA where they were located for the 3-year period FY 2005, FY 2006, and FY 2007. Column 7 shows the impact of the remaining labor market area transition, for those hospitals that were urban under the old labor market area designations and are now considered rural hospitals. Section 1886(d)(3)(E) of the Act specifies that any updates or adjustments to the wage index are to be budget neutral. Therefore, we applied an adjustment of 0.999591 to ensure that the effects of reclassification are budget neutral as indicated by the zero effect on payments to hospitals overall. The rural hospital row shows a 0.3 percent benefit from this provision as these hold harmless hospitals are now considered geographically rural. I. Effects of MGCRB Reclassifications (Column 8) Our impact analysis to this point has assumed hospitals are paid on the basis of their actual geographic location (with the exception of ongoing policies that provide that certain hospitals receive payments on other bases than where they are geographically located, such as hospitals in rural counties that are deemed urban under section 1886(d)(8)(B) of the Act). The changes in Column 8 reflect the per case payment impact of moving from this baseline to a simulation incorporating the MGCRB decisions for FY 2007 which affect hospitals’ wage index area assignments. By February 28 of each year, the MGCRB makes reclassification determinations that will be effective for the next fiscal year, which begins on October 1. The MGCRB may approve a hospital’s reclassification request for the purpose of using another area’s wage index value. The proposed FY 2007 wage index values incorporate all of the MGCRB’s reclassification decisions for FY 2007. The wage index values also reflect any decisions made by the CMS Administrator through the appeals and review process through February 28, 2006. For FY 2007, as stated in the FY 2006 IPPS final rule (70 FR 47382, August 12, 2005), we established procedural rules under section 1886(d)(10)(D)(v) of the Act to address specific circumstances where individual and group reclassifications involve a section 508 hospital. The rules were designed to recognize the special circumstances of section 508 hospital reclassifications ending mid-year during FY 2007 and were intended to allow previously approved reclassifications to continue through March 31, 2007, and new section 1886(d)(10) reclassifications to begin April 1, 2007, upon the conclusion of the section 508 reclassifications. Under these procedural VerDate Aug<31>2005 17:10 Apr 24, 2006 Jkt 208001 rules, some section 1886(d)(10) hospital reclassifications are only in effect for the second half of the fiscal year. The first and second half fiscal year section 1886(d)(10) reclassifications permitted under these procedural rules have implications for the calculation of the reclassified wage indices and the reclassification budget neutrality factor. Section 1886(d)(8)(c) of the Act provides requirements for determining the wage index values for hospitals that were reclassified as a result of the MGCRB decisions under 1886(d)(10) of the Act. As provided in the statute, we are required to calculate a separate wage index for hospitals reclassified to an area if including the wage data for the reclassified hospitals would reduce the area wage index by more than 1 percent. Because of the half-year reclassifications permitted under the procedural rules, in this proposed rule we are proposing to issue two separate wage indexes for affected areas (one effective from October 1, 2006 through March 31, 2007 and a second reclassified wage index effective April 1, 2007 through September 30, 2007). The proposed FY 2007 wage index values are calculated based on the wage data for hospitals reclassified to the area in the respective half of the fiscal year. The impact of this policy is modeled in Column 8 of Table I above. The overall effect of geographic reclassification is required by section 1886(d)(8)(D) of the Act to be budget neutral. In this proposed rule, we are proposing to calculate one budget neutrality adjustment that reflects the average of the adjustments required for first and second half fiscal year reclassifications, respectively. Therefore, we applied an adjustment of 0.991727 to ensure that the effects of the section 1886(d)(10) reclassifications are budget neutral. (See section II.A. of the Addendum to this proposed rule.) As a group, rural hospitals benefit from geographic reclassification. We estimate that their payments will rise 2.2 percent as shown in Column 8. Payments to urban hospitals will decline by 0.3 percent. Hospitals in other urban areas will experience an overall decrease in payments of 0.2 percent, while large urban hospitals will lose 0.5 percent. Among urban hospital groups (that is, bed size, census division, and special payment status), payments generally would decline. A positive impact is evident among all of the rural hospital groups. The smallest increase among the rural census divisions is 0.6 percent for the Mountain region. The largest increases are in the rural East South Central region, with an increase of 2.8 percent, and in the West South Central region, which would experience an increase of 3.0 percent. Urban hospitals reclassified for the first half of FY 2007 are expected to receive an increase of 2.1 percent and urban hospitals reclassified for the second half of FY 2007 are expected to receive a 1.9 percent increase in payments. The same set of rural hospital providers are reclassified for the entire FY 2007 year and are expected to receive a 3.8 percent increase in payments from the MGCRB changes. Payments to urban hospitals that did not reclassify for either the PO 00000 Frm 00416 Fmt 4701 Sfmt 4702 first or second half of FY 2007 are expected to decrease slightly (by 0.7 percent) due to the MGCRB changes. FY 2007 payments to non-reclassifying rural hospitals are not affected by the MGCRB changes. J. Effects of the Proposed Wage Index Adjustment for Out-Migration (Column 9) Section 1886(d)(13) of the Act, as added by section 505 of Pub. L. 108–173, provides for an increase in the wage index for hospitals located in certain counties that have a relatively high percentage of hospital employees who reside in the county, but work in a different area with a higher wage index. Hospitals located in counties that qualify for the payment adjustment are to receive an increase in the wage index that is equal to a weighted average of the difference between the wage index of the resident county and the higher wage index work area(s), weighted by the overall percentage of workers who are employed in an area with a higher wage index. Using our established criteria, 321 counties and 586 hospitals qualify to receive a commuting adjustment in FY 2007. Due to the statutory formula to calculate the adjustment and the small number of counties that qualify, the impact on hospitals is minimal, with an overall impact on all hospitals of 0.1 percent. K. Effects of All Changes (Column 10) Column 10 compares our estimate of payments per case, incorporating all changes reflected in this proposed rule for FY 2007 (including statutory changes), to our estimate of payments per case in FY 2006. This column includes all of the proposed policy changes. Column 10 reflects all FY 2007 changes relative to FY 2006, shown in Columns 2 through 9 and those not applied until the final rates are calculated. The average increase for all hospitals is approximately 3.4 percent. This increase includes the effects of the 3.4 percent market basket update. It also reflects the 0.4 percentage point difference between the projected outlier payments in FY 2006 (5.1 percent of total DRG payments) and the current estimate of the percentage of actual outlier payments in FY 2006 (4.7 percent), as described in the introduction to this Appendix and the Addendum to this proposed rule. As a result, payments are projected to be 0.4 percentage points lower in FY 2006 than originally estimated, resulting in a 0.4 percentage point greater increase for FY 2007 than would otherwise occur. In addition, the impact of section 505 adjustments accounted for a 0.1 percent increase. Indirect medical education formula changes for teaching hospitals under section 502 of Pub. L. 108–173, changes in payments due to the difference between the FY 2006 and FY 2007 wage index values assigned to providers reclassified under section 508 of Pub. L. 108–173, and changes in the incremental increase in payments from section 505 of Pub. L. 108–173 out-migration adjustments account for the remaining ¥0.5 percent. There might also be interactive effects among the various factors comprising the payment system that we are not able to E:\FR\FM\25APP2.SGM 25APP2 24411 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules isolate. For these reasons, the values in Column 10 may not equal the product of the percentage changes described above. The overall change in payments per case for hospitals in FY 2007 would increase by 3.4 percent. Hospitals in urban areas would experience a 3.0 percent increase in payments per case compared to FY 2006. Hospitals in large urban areas would experience a 3.4 percent increase in payments and hospitals in other urban areas would experience a 2.5 percent increase in payments. Hospitals in rural areas, meanwhile, would experience a 6.7 percent payment increase. Among urban census divisions, the largest payment increases would be 4.6 percent in the Pacific region and 5.0 percent in Puerto Rico. The smallest urban increase would occur in the West North Central region, with an increase of 2.1 percent. Among rural regions in Column 10, no hospital category would experience overall payment decreases. The New England and Middle Atlantic regions would benefit the most, with 7.7 percent increases. The smallest increase would occur in the Mountain region, with a 5.6 percent increase in payments. Among special categories of rural hospitals in Column 10, MDH/RRC providers receive an increase in payments of 17.5 percent and MDH providers receive an increase of 14.6 percent, primarily due to the changes to MDH payments set forth in section 5003 of Pub. L. 109–171. SCHs also see a positive increase of 7.5 percent. Urban hospitals reclassified for the first half of FY 2007 are anticipated to receive an increase of 3.1 percent, while urban hospitals that reclassified for the second half of FY 2007 are expected to receive an increase of 3.2 percent. The same set of rural hospitals is reclassified for the first and second half of FY 2007. Rural hospitals reclassifying for the entire year of FY 2007 are anticipated to receive a 5.3 percent payment increase. Those hospitals located in rural counties, but deemed to be urban under section 1886(d)(8)(B) of the Act are expected to receive an increase in payments of 8.7 percent. Hospitals that were reclassified under section 508 of Pub. L. 108–173, which is only effective through March 31, 2007, are expected to receive an increase of 0.6 percent. This is due in large part to the fact that the 508 wage index is only in effect for 6 months of FY 2007. Of the 95 section 508 providers listed in this row, 28 have a reduction in their FY 2007 blended final wage index (relative to their FY 2006 final wage index) of between 5 and 10 percent while 55 others have a reduction of 0 to 5 percent in their wage index values. L. Effects of Policy on Payment Adjustments for Low-Volume Hospitals For FY 2007, we are proposing to continue to apply the volume adjustment criteria we specified in the FY 2005 IPPS final rule (69 FR 49099). We expect that two providers would receive the low-volume adjustment for FY 2007. We estimate the impact of these providers receiving the additional 25-percent payment increase to be approximately $90,000. M. Impact Analysis of Table II Table II presents the projected impact of the proposed changes for FY 2007 for urban and rural hospitals and for the different categories of hospitals shown in Table I. It compares the estimated payments per case for FY 2006 with the average estimated per case payments for FY 2007, as calculated under our models. Thus, this table presents, in terms of the average dollar amounts paid per discharge, the combined effects of the changes presented in Table I. The percentage changes shown in the last column of Table II equal the percentage changes in average payments from Column 10 of Table I. TABLE II.—IMPACT ANALYSIS OF CHANGES FOR FY 2007 OPERATING PROSPECTIVE PAYMENT SYSTEM [Payments Per Case] All hospitals ...................................................................................................................................... By Geographic Location: Urban hospitals ......................................................................................................................... Large urban areas (populations over 1 million) ....................................................................... Other urban areas (populations of 1 million or fewer) ............................................................. Rural hospitals .......................................................................................................................... Bed Size (Urban): 0–99 beds .......................................................................................................................... 100–199 beds .................................................................................................................... 200–299 beds .................................................................................................................... 300–499 beds .................................................................................................................... 500 or more beds .............................................................................................................. Bed Size (Rural): 0–49 beds .......................................................................................................................... 50–99 beds ........................................................................................................................ 100–149 beds .................................................................................................................... 150–199 beds .................................................................................................................... 200 or more beds .............................................................................................................. Urban by Region: New England ..................................................................................................................... Middle Atlantic ................................................................................................................... South Atlantic .................................................................................................................... East North Central ............................................................................................................. East South Central ............................................................................................................ West North Central ............................................................................................................ West South Central ........................................................................................................... Mountain ............................................................................................................................ Pacific ................................................................................................................................ Puerto Rico ........................................................................................................................ Rural by Region: New England ..................................................................................................................... Middle Atlantic ................................................................................................................... South Atlantic .................................................................................................................... East North Central ............................................................................................................. East South Central ............................................................................................................ VerDate Aug<31>2005 17:10 Apr 24, 2006 Jkt 208001 PO 00000 Frm 00417 Fmt 4701 Sfmt 4702 Average FY 2006 payment per case 1 Average FY 2007 payment per case 1 All FY 2007 changes; (1) wwhite on PROD1PC61 with PROPOSALS2 Number of hospitals (2) (3) (4) 3,522 8,529 8,820 3.4 2,517 1,391 1,126 1,005 8,933 9,335 8,449 6,268 9,201 9,652 8,657 6,685 3.0 3.4 2.5 6.7 590 865 482 414 166 6,736 7,465 8,377 9,437 11,294 7,015 7,856 8,666 9,647 11,470 4.1 5.2 3.4 2.2 1.6 349 366 179 64 47 5,285 5,669 6,218 7,053 7,871 5,817 6,199 6,604 7,351 8,102 10.1 9.3 6.2 4.2 2.9 127 353 381 388 163 156 350 143 404 52 9,406 9,735 8,483 8,555 8,252 8,681 8,447 8,872 10,705 4,187 9,706 10,026 8,702 8,815 8,460 8,860 8,663 9,140 11,193 4,395 3.2 3.0 2.6 3.0 2.5 2.1 2.6 3.0 4.6 5.0 19 72 175 125 181 8,209 6,283 6,057 6,482 6,013 8,838 6,766 6,477 6,860 6,396 7.7 7.7 6.9 5.8 6.4 E:\FR\FM\25APP2.SGM 25APP2 24412 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules TABLE II.—IMPACT ANALYSIS OF CHANGES FOR FY 2007 OPERATING PROSPECTIVE PAYMENT SYSTEM—Continued [Payments Per Case] Number of hospitals wwhite on PROD1PC61 with PROPOSALS2 1 These Average FY 2007 payment per case 1 All FY 2007 changes; (1) West North Central ............................................................................................................ West South Central ........................................................................................................... Mountain ............................................................................................................................ Pacific ................................................................................................................................ By Payment Classification: Urban hospitals ......................................................................................................................... Large urban areas (populations over 1 million) ....................................................................... Other urban areas (populations of 1 million or fewer) ............................................................. Rural areas ............................................................................................................................... Teaching Status: Non-teaching ..................................................................................................................... Fewer than 100 Residents ................................................................................................ 100 or more Residents ...................................................................................................... Urban DSH: Non-DSH ........................................................................................................................... 100 or more beds .............................................................................................................. Less than 100 beds ........................................................................................................... Rural DSH: SCH ................................................................................................................................... RRC ................................................................................................................................... Other Rural:. 100 or more beds .............................................................................................................. Less than 100 beds ........................................................................................................... Urban teaching and DSH: Both teaching and DSH .................................................................................................... Teaching and no DSH ....................................................................................................... No teaching and DSH ....................................................................................................... No teaching and no DSH .................................................................................................. Rural Hospital Types: Non special status hospitals ............................................................................................. RRC ................................................................................................................................... SCH ................................................................................................................................... MDH .................................................................................................................................. SCH and RRC ................................................................................................................... MDH and RRC .................................................................................................................. Type of Ownership: Voluntary ........................................................................................................................... Proprietary ......................................................................................................................... Government ....................................................................................................................... Medicare Utilization as a Percent of Inpatient Days: 0–25 ................................................................................................................................... 25–50 ................................................................................................................................. 50–65 ................................................................................................................................. Over 65 .............................................................................................................................. Unknown ............................................................................................................................ Hospitals Reclassified by the Medicare Geographic Classification Review Board: FY 2005 Reclassifications. Urban Hospitals Reclassified by the Medicare Geographic Classification Review Board: First Half FY 2007 Reclassifications .................................................................................................... Urban Nonreclassified, First Half FY 2007 ...................................................................................... All Urban Hospitals Reclassified Second Half FY 2007 .................................................................. Urban Nonreclassified Hospitals Second Half FY 2007 .................................................................. All Rural Hospitals Reclassified Second Half FY 2007 ................................................................... Rural Nonreclassified Hospitals Second Half FY 2007 ................................................................... All Section 401 Reclassified Hospitals ............................................................................................ Other Reclassified Hospitals (Section 1886(d)(8)(B)) ..................................................................... Section 508 Hospitals ...................................................................................................................... Average FY 2006 payment per case 1 (2) (3) (4) 118 191 80 44 6,460 5,730 6,723 7,707 6,864 6,137 7,099 8,278 6.3 7.1 5.6 7.4 2,539 1,400 1,139 983 8,916 9,321 8,426 6,317 9,185 9,639 8,636 6,732 3.0 3.4 2.5 6.6 2,449 836 237 7,131 8,634 12,590 7,475 8,857 12,857 4.8 2.6 2.1 854 1,513 333 7,716 9,398 6,217 7,915 9,691 6,664 2.6 3.1 7.2 383 196 5,860 7,013 6,371 7,338 8.7 4.6 55 188 5,729 5,140 6,144 5,606 7.2 9.1 809 198 1,037 495 10,329 8,614 7,624 7,246 10,590 8,752 7,982 7,446 2.5 1.6 4.7 2.8 288 140 341 126 80 8 5,367 6,982 6,079 5,245 7,261 6,483 5,807 7,282 6,535 6,012 7,562 7,619 8.2 4.3 7.5 14.6 4.1 17.5 2,087 831 604 8,658 7,734 8,783 8,930 8,023 9,192 3.1 3.7 4.7 252 1,302 1,490 459 19 12,185 9,712 7,458 6,668 6,427 12,897 9,982 7,745 6,940 6,956 5.8 2.8 3.9 4.1 8.2 319 2,119 339 2,099 385 604 38 54 95 8,750 8,933 8,746 8,935 6,782 5,616 6,945 5,871 9,341 9,024 9,212 9,027 9,213 7,143 6,108 7,580 6,380 9,401 3.1 3.1 3.2 3.1 5.3 8.8 9.2 8.7 0.6 payment amounts per case do not reflect any estimates of annual case-mix increase. VII. Effects of Other Proposed Policy Changes In addition to those proposed changes discussed above that we are able to model VerDate Aug<31>2005 17:10 Apr 24, 2006 Jkt 208001 using our IPPS payment simulation model, we are making various other changes in this proposed rule. Generally, we have limited or no specific data available with which to PO 00000 Frm 00418 Fmt 4701 Sfmt 4702 estimate the impacts of these changes. Our estimates of the likely impacts associated with these other changes are discussed below. E:\FR\FM\25APP2.SGM 25APP2 wwhite on PROD1PC61 with PROPOSALS2 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules A. Effects of LTC–DRG Reclassifications and Relative Weights for LTCHs In section II.F. of the preamble to this proposed rule, we discuss the proposed changes in the LTC–DRG relative weights for FY 2007, which are based on the proposed version 24.0 of the CMS GROUPER (including the proposed changes in the classifications, relative weights and geometric mean length of stay for each LTC– DRG). As also discussed in that same section of this proposed rule, currently, there is no statutory or regulatory requirement that the annual update to the LTC–DRG classifications and relative weights be done in a budget neutral manner. As discussed in the FY 2006 IPPS final rule (70 FR 47701), the LTCH PPS is still in the midst of a transition from a reasonable cost-based payment system to fully Federal PPS payments, during which time LTCH coding and data are still in flux. The LTCH PPS was implemented for cost reporting periods beginning on or after October 1, 2002 (FY 2003). Therefore, the FY 2005 MedPAR data used to compute the proposed FY 2007 LTC–DRG relative weights are based on LTCH claims data taken from only the second full year of the LTCH PPS. Based on LTCH cases in the December 2005 update of the FY 2005 MedPAR files, we estimate that the proposed changes to the LTC–DRG classifications and relative weights for FY 2007 would result in an aggregate decrease in LTCH PPS payments of approximately 1.4 percent based on the data from the 363 LTCHs in our database. (We note that this estimated aggregate decrease in LTCH PPS payments of approximately 1.4 percent was determined based on the current payment rates and policies established in the RY 2006 LTCH PPS final rule (70 FR 24168 through 24261, May 6, 2005) and do not include any proposed policy or changes presented in the RY 2007 LTCH PPS proposed rule (71 FR 4648-4779, January 27, 2006).) When we compared the GROUPER Version 23.0 (FY 2006) LTC–DRG relative weights to the proposed GROUPER Version 24.0 (FY 2007) proposed LTC–DRG relative weights, we found that approximately 62 percent of the LTC–DRGs would have a higher relative weight under Version 23.0, while the remaining approximately 38 percent of the LTC–DRGs would have a higher relative weight under Version 24.0. We also found that, based on FY 2005 LTCH cases, the GROUPER Version 23.0 LTC–DRG relative weights were, on average, approximately 3.1 percent higher than the proposed GROUPER Version 24.0 LTC–DRG relative weights. In addition, based on an analysis of the most recent available LTCH claims data from the FY 2005 MedPAR file, we continue to observe that the average proposed LTC–DRG relative weight decreases due to an increase of relatively lower charge cases being assigned to LTC–DRGs with higher relative weights in the prior year. Contributing to this increase in these relatively lower charge cases being assigned to proposed LTC–DRGs with higher relative weights in the prior year are improvements in coding practices, which are typical when moving from a reasonable cost-based VerDate Aug<31>2005 17:10 Apr 24, 2006 Jkt 208001 payment system to a PPS. The impact of including additional cases with relatively lower charges into LTC–DRGs that had a relatively higher relative weight in the GROUPER Version 23.0 (FY 2006) is a decrease in the average relative weight for those LTC–DRGs in the proposed GROUPER Version 24.0. As noted above in section II.F. of the preamble to this proposed rule, LTCHs are a specialized provider type that typically do not treat a broad spectrum of patients in their facilities with many different diagnoses. While there are 526 valid proposed GROUPER Version 24.0 LTC–DRGs, 191 LTC–DRGs have no LTCH cases. In addition, another 173 LTC–DRGs are categorized as ‘‘low volume’’ (that is, have less than 25 cases annually). Consequently, only about 162 LTC–DRGs are used by most LTCHs on a ‘‘regular basis’’ (that is, nationally LTCHs discharge, in total, an average of 25 or more of these cases annually). Of these 162 LTC–DRGs that are used on a ‘‘regular basis,’’ we found that approximately 60 percent of the LTC–DRGs would have higher relative weights under GROUPER Version 23.0 in comparison to proposed GROUPER Version 24.0, and the remaining 40 percent of the 162 LTC–DRGs that are used on a ‘‘regular basis’’ would have higher relative weights under proposed GROUPER Version 24 in comparison to GROUPER Version 23.0. In addition, about 25 percent of the 162 LTC–DRGs that are used on a ‘‘regular basis’’ would experience a decrease in the average charge per case as compared to the average charge per case in that DRG based on FY 2004 data, which generally results in a lower relative weight. Moreover, of the162 LTC–DRGs that are used on a ‘‘regular basis,’’ approximately 63 percent of those LTC–DRGs would experience a change in the average charge per case from FY 2004 LTCH data as compared to FY 2005 LTCH data that is less than the increase in overall average LTCH charges across all LTC–DRGs from FY 2004 to FY 2005 of about 8.3 percent. Accordingly, those LTC–DRGs would also have a proposed reduction in their relative weight as compared to the relative weight in FY 2006. For those LTC–DRGs in which the average charge within the LTC–DRG increase is less than 8.3 percent, the proposed relative weights for those LTC–DRGs would decrease because the average charge for each of those LTC–DRGs is being divided by a larger number (that is, the average charge across all LTC–DRGs). For the reasons discussed above, we believe that the proposed changes in the LTC–DRG relative weights, which include a significant number of LTC–DRGs with lower proposed relative weights, would result in approximately a 1.4 percent decrease in estimated aggregate LTCH PPS payments. B. Effects of Proposed New Technology AddOn Payments In section II.G. of the preamble to this proposed rule, we discuss proposed add-on payments for new medical services and technologies. As explained in that section, we are no longer required to ensure that any add-on payments for new technology under section 1886(d)(5)(K) of the Act are budget neutral. However, we are still providing an PO 00000 Frm 00419 Fmt 4701 Sfmt 4702 24413 estimate of the payment increases here, as they will have an impact on total payments made in FY 2007. New technology add-on payments are limited to the lesser of 50 percent of the costs of the technology, or 50 percent of the costs in excess of the DRG payment for the case. Because it is difficult to predict the actual new technology add-on payment for each case, we are estimating the increase in payment for FY 2007 as if every claim with these add-on payments will receive the maximum add-on payment. As discussed in section II.G. of the preamble to this proposed rule, we are not proposing to approve any of the new technology applications that were filed for FY 2007 for new technology add-on payment at this time. However, we are proposing to continue to make add-on payments in FY 2007 for two technologies that were approved for FY 2006 new technology add-on payments: Restore Rechargeable Implantable Neurostimulator and GORE TAG. We estimate these payments for these technologies will increase overall FY 2007 payments by $6.01 million and $16.61 million, respectively. The total increase in payments for these two new technologies, approximately $22.6 million, is not reflected in the tables. C. Effects of Requirements for Hospital Reporting of Quality Data for Annual Hospital Payment Update In section IV.A. of the preamble to this proposed rule, we discuss new requirements for hospital reporting of quality data based on our continuing experience with this program and recent legislation. Section 5001(a) of Pub. L. 109–171 (DRA) sets out extensive new requirements for the Reporting Hospital Quality Data for Annual Payment Update (RHQDAPU) program. The RHQDAPU program was established to implement section 501(b) of Pub. L. 108–173 (MMA). Section 5001(a) of Pub. L. 109–171 revised the mechanism used to update the standardized amount for payment for hospital inpatient operating costs. New sections 1886(b)(3)(B)(viii)(I) and (II) of the Act provide that the payment update for FY 2007 and each subsequent fiscal year will be reduced by 2.0 percentage points for any ‘‘subsection (d) hospital’’ that does not submit certain quality data in a form and manner, and at a time, specified by the Secretary. We have modeled the payment impact of this change in Table 1 of this Appendix, and discussed it in section VI. of this Appendix. We discuss other policy changes we propose to make to the RHQDAPU program in section IV.A. of the preamble to this proposed rule. We also note that, for the FY 2007 payment update, hospitals must pass our validation requirement of a minimum of 80 percent reliability, based upon our chart-audit validation process, for the first three quarters of data from CY 2005. These data were due to the QIO Clinical Warehouse by July 15, 2005 (first quarter CY 2005 discharges), November 15, 2005 (second quarter CY 2005 discharges), and February 15, 2005 (third quarter CY 2005 discharges). We have continued our efforts to ensure that QIOs provide assistance to all hospitals that wish to submit data. In the preamble of this E:\FR\FM\25APP2.SGM 25APP2 24414 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules proposed rule, we are providing additional validation criteria to ensure that the quality data being sent to CMS are accurate. The requirement of 5 charts per hospital will result in approximately 19,000 charts per quarter total submitted to the agency. We reimburse hospitals for the cost of sending charts to the Clinical Data Abstraction Center (CDAC) at the rate of 12 cents per page for copying and approximately $4.00 per chart for postage. Our experience shows that the average chart received at the CDAC is approximately 140 pages. Thus, the agency will have expenditures of approximately $380,000 per quarter to collect the charts. Given that we reimburse for the data collection effort, we believe that a requirement for five charts per hospital per quarter represents a minimal burden to the participating hospital. wwhite on PROD1PC61 with PROPOSALS2 D. Effects of Other Proposed Policy Changes Affecting Sole Community Hospitals (SCHs) and Medicare-Dependent, Small Rural Hospitals (MDHs) In section IV.C. of the preamble to this proposed rule, we discuss the payment changes for MDHs made by section 5003 of Pub. L. 109–171. We modeled the payment impact of these changes in Table 1 of this Appendix and discussed them in section VI. of this Appendix. In addition, in section IV.C.2. of the preamble to this proposed rule, we discussed a proposed change to the data source and methodology that we would use to compute the volume decrease adjustment for MDHs and SCHs. If certain requirements are met, this adjustment may be made if the hospital’s total discharges decrease by more than 5 percent from one cost reporting period to the next. We do not believe that these proposed changes, which would not take effect until FY 2008, will have any significant impact on Medicare payment to these hospitals. for determining the hospital-specific PRA for new teaching hospitals and propose to make a change to the existing regulations at § 413.77(e) in order to specify a base period for certain situations, that is, for new teaching hospitals that did not have residents on duty during the first month of the cost reporting period in which the hospital became a new teaching hospital. The proposed base period for these hospitals would be the next cost reporting period following the cost reporting period where any residents were on duty at the new teaching hospital. Because this proposed change is administrative in nature, we do not foresee that it would result in a financial impact for FY 2007. 3. Requirements for Counting and Appropriate Documentation of FTE Residents In section IV.H.4. of the preamble to this proposed rule, we are proposing to clarify the policies that apply in determining hospitals’ FTE resident counts for Medicare GME payment purposes. Because this is a clarification of existing policy, there is no financial impact for FY 2007. 4. Resident Time Spent in Nonpatient Care Activities as Part of an Approved Residency Program In section IV.H.5. of the preamble to this proposed rule, we are proposing to clarify our policy that, with respect to residency training in nonhospital settings, only the time residents spend in patient care activities may be counted for purposes of direct GME and IME payments; and with respect to training in the hospital, residents training in all areas of the hospital complex may be counted for direct GME purposes, but may only be counted for IME purposes if the residents are furnishing patient care. Because we are proposing to clarify existing policy, there is no financial impact of this proposed clarification for FY 2007. E. Effects of Proposed Policy on Payment for Direct Costs of Graduate Medical Education 1. Determination of Weighted Average GME PRAs for Merged Teaching Hospitals In section IV.H.2. of the preamble to this proposed rule, we discuss our proposed changes related to determining the weighted average GME PRA for a merged teaching hospital. Our current policy is that when two or more teaching hospitals merge, we determine a weighted PRA for the surviving merged hospital using GME costs and resident data from the base year cost report for each teaching hospital in the merger. We are proposing to revise our policy to determine a merged teaching hospital’s PRA by using PRA data and FTE resident data from the most recent settled cost reports of the merging hospitals, rather than using the direct GME cost data from the hospitals’ base year cost report. This proposed policy revision is administrative in nature, and we do not foresee that the proposed revision would result in payment increases to merged teaching hospitals. 2. Determination of PRAs for New Teaching Hospitals In section IV.H.3. of the preamble to this proposed rule, we discuss the methodology F. Effects of Proposed Policy Changes Relating to Emergency Services Under EMTALA In section IV.J. of the preamble to this proposed rule, we discuss several proposed policy changes under the EMTALA requirements. We are proposing to clarify that any participating hospital with specialized capabilities or facilities, even if it does not have a dedicated emergency department, may not refuse to accept an appropriate transfer if the hospital has the capacity to treat the individual. We note that this proposed revision does not reflect any change in current CMS policy. We further note that the revision would not require hospitals without dedicated emergency departments to open dedicated emergency departments nor would it impose any EMTALA obligation on these hospitals with respect to individuals who come to the hospital as their initial point of entry into the medical system seeking a medical screening examination or treatment for a medical condition. Thus, there would be no impact on Medicare payment policies or practices. In addition, we are proposing to modify the definition of ‘‘labor’’ to state that a woman experiencing contractions is in true labor unless a physician, certified nurse-midwife, VerDate Aug<31>2005 17:10 Apr 24, 2006 Jkt 208001 PO 00000 Frm 00420 Fmt 4701 Sfmt 4702 or other qualified medical person acting within his or her scope of practice as defined in hospital medical staff bylaws and State law, certifies that, after a reasonable time of observation, the woman is in false labor. The effect of this change would be to have a single, uniform policy on the personnel who are authorized to make a determination as to whether an individual has an emergency medical condition. This proposal would have a Medicare payment effect, if any, only on payments to physicians and nonphysician practitioners under the physician fee schedule. The amount of any impact would be negligible because only a very small number of Medicare beneficiaries are women of childbearing age. G. Effects of Policy on Rural Community Hospital Demonstration Program In section IV.L. of the preamble to this proposed rule, we discuss our implementation of section 410A of Pub.L. 108–173 that required the Secretary to establish a demonstration that will modify reimbursement for inpatient services for up to 15 small rural hospitals. Section 410A(c)(2) requires that ‘‘in conducting the demonstration program under this section, the Secretary shall ensure that the aggregate payments made by the Secretary do not exceed the amount which the Secretary would have paid if the demonstration program under this section was not implemented.’’ As discussed in section IV.L. of the preamble to this proposed rule, we are satisfying this requirement by adjusting national IPPS rates by a factor that is sufficient to account for the added costs of this demonstration. We estimate that the average additional annual payment for FY 2007 that will be made to each participating hospital under the demonstration will be approximately $1,021,985. We based this estimate on the recent historical experience of the difference between inpatient cost and payment for hospitals that are participating in the demonstration. For the 9 participating hospitals, the total annual impact of the demonstration program is estimated to be $9,197,870. The proposed adjustment factor to the Federal rate used in calculating Medicare inpatient prospective payments as a result of the demonstration is 0.999905. H. Effects of Proposed Policy on HospitalsWithin-Hospitals and Satellite Facilities In section VI.A.5. of the preamble to this proposed rule, we discuss our proposal to revise the regulations for grandfathered HwHs, grandfathered hospital satellites and grandfathered satellite units at §§ 412.22(f), 412.22(h)(3), and 412.25(e)(3), respectively, to allow these facilities to reduce their square footage or number of beds without jeopardizing their grandfathered status. We also discuss our proposal to revise the HwH provision at § 412.22(f)(3) that would allow for increases or decreases in square footage, or decreases in the number of beds of the HwH that are made necessary by the relocation of a hospital in order to permit construction or renovation necessary to comply with Federal, State, or local law affecting the physical facility or because of catastrophic events such as fires, floods, earthquakes, or tornadoes. E:\FR\FM\25APP2.SGM 25APP2 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules wwhite on PROD1PC61 with PROPOSALS2 Because we are proposing to allow these currently grandfathered HwHs, hospital satellites and satellite units to retain their grandfathered status if they reduce their square footage or number of beds, there would be no effect on the treatment of such hospitals as a result of this proposal. Because payments to HwHs and satellites are made on a per discharge basis (either under a PPS or under reasonable cost principles), if grandfathered HwHs and satellites were to reduce their size in the event this proposal is implemented, the effect of this change would likely be a reduction in Medicare payments to such hospitals and satellites because they would probably have fewer discharges. However, we cannot predict which HwHs or satellite facilities will opt to decrease their size or bed numbers nor can we predict the conditions under which HwHs would have to seek CMS approval for changes in the terms and conditions of their present construction or renovation of square footage or bed numbers made necessary by relocation of a hospital to permit compliance with Federal, State or local law affecting the physical facility or because of catastrophic events, and therefore, we are unable to quantify the impact of these proposed changes. I. Effects of Proposed Policy Changes to the Methodology for Determining LTCH CCRs and the Reconciliation of LTCH PPS Outlier Payments In section VI.A.6. of the preamble to this proposed rule, we discuss our proposal to revise and clarify the existing policies governing the determination of LTCHs’ CCRs and the reconciliation of high-cost and shortstay outlier payments under the LTCH PPS. Under the LTCH PPS high-cost outlier and short-stay outlier policies, CCRs are used to determine the estimated cost of the case by multiplying the LTCH’s overall CCR by the Medicare allowable charges for the case. In that section, specifically, we present our proposal to revise our methodology for determining the annual LTCH CCR ceiling. Based on the most recent complete IPPS total CCR data, we are proposing a total CCR ceiling of 1.313 under the LTCH PPS effective October 1, 2006. This proposed ceiling was determined based on the same data used to determine the separate proposed IPPS operating CCR ceiling (1.25) and proposed IPPS capital CCR ceiling (0.158). The LTCH CCR ceiling determined under our current ‘‘combined’’ methodology would result in a slightly higher LTCH CCR ceiling (that is, 1.25 + 0.158 = 1.408) for FY 2007 compared to the proposed ‘‘total’’ CCR ceiling of 1.313 for FY 2007. However, we note that, based on the most recent complete IPPS and LTCH CCR data, there are no LTCHs that currently have a CCR that is greater than the proposed ceiling of 1.313 (the highest LTCH CCR in the database of 363 LTCHs is 1.132). Therefore, based on these data, because no LTCHs currently have a CCR that is in excess of the proposed LTCH CCR ceiling, we believe that there would be no significant impact on LTCH PPS payments based on this proposed policy. Also in section VI.A.6. of the preamble to this proposed rule, we discuss our proposal VerDate Aug<31>2005 17:10 Apr 24, 2006 Jkt 208001 to revise our methodology for determining the applicable statewide average LTCH CCRs. Based on the most recent complete IPPS total CCR data, the proposed LTCH PPS statewide average CCRs that would be effective October 1, 2006, are presented in Table 8C of the Addendum to this proposed rule. A comparison of the proposed statewide average total CCRs in Table 8C of the Addendum to this proposed rule to the ‘‘combined’’ statewide average CCRs that would be calculated under our existing methodology from the proposed operating PPS statewide average CCRs in Table 8A of the Addendum to this proposed rule and the proposed capital PPS statewide average CCRs in Table 8B of the Addendum to this proposed rule shows that the proposed changes to our methodology for determining LTCH statewide average CCRs would result in minor changes in the average CCR for each state. In particular, the largest decrease in a statewide average CCR (with the exception of Maryland, which would be assigned the national average total CCR as discussed in section VI.A.6 of the preamble of this proposed rule) would be in urban Indiana (¥1.9 percent), and there are currently no LTCHs located in Indiana. The largest increase in a statewide average CCR would be in urban District of Columbia (2.8 percent), and there are currently only two LTCHs located in the District of Columbia. Thus, we believe that the proposed change in the methodology for determining the applicable statewide average LTCH CCRs would result in no significant impact on LTCH PPS payments. In addition, in section VI.A.6 of the preamble of this proposed rule we discussed our proposal to codify in Subpart O of 42 CFR Part 412 the provisions governing the determination of LTCHs’ CCRs and the reconciliation of high cost and short-stay outlier payments under the LTCH PPS, including proposed modifications and editorial clarifications to our existing methodology. These proposals are similar or almost identical (except for the minor clarifications and modifications) to our current policy governing the determination of LTCHs’ CCRs and the reconciliation of high cost and short-stay outlier payments under the LTCH PPS, and therefore, there would be no expected impact if such policies were codified. J. Effects of Proposed Policy on Payment for Services Furnished Outside the United States In section VII. of the preamble to this proposed rule, we discuss our proposed clarification of our regulations regarding payment for Medicare services furnished outside the United States. The clarification proposes to revise references in our regulations that could be read to limit Medicare payment for certain services furnished outside the United States to services furnished in Canada or Mexico, contrary to the provisions of the Act. Only a small fraction of Medicare claims are paid as a result of services furnished outside of the United States. Moreover, we are unaware of any claims for payment that would otherwise satisfy the requirements under the Act that have not been paid due to the language in our PO 00000 Frm 00421 Fmt 4701 Sfmt 4702 24415 current regulations. Therefore, because we are proposing to clarify existing policy, this proposed clarification has little or no financial impact for FY 2007. K. Effects of Proposed Policy on Limitation on Payments to SNFs In section IX. of the preamble to this proposed rule, we discuss our proposed implementation of section 5004 of Pub. L. 109–171, which mandated that, for cost reporting periods beginning on or after October 1, 2005, Medicare payments to SNFs for certain otherwise allowable debt amounts attributable to the coinsurance amounts for patients who are not full-benefit dual eligible individuals be reduced by 30 percent. We anticipate that the provisions of section 5004 of Pub. L. 109–171 will result in a decrease in payments to SNFs of $490 million over the 5-year period from FY 2006 to FY 2010. VIII. Impact of Proposed Changes in the Capital PPS A. General Considerations Fiscal year (FY) 2001 was the last year of the 10-year transition period established to phase in the PPS for hospital capital-related costs. During the transition period, hospitals were paid under one of two payment methodologies: fully prospective or hold harmless. Under the fully prospective methodology, hospitals were paid a blend of the capital Federal rate and their hospitalspecific rate (see § 412.340). Under the holdharmless methodology, unless a hospital elected payment based on 100 percent of the capital Federal rate, hospitals were paid 85 percent of reasonable costs for old capital costs (100 percent for SCHs) plus an amount for new capital costs based on a proportion of the capital Federal rate (see § 412.344). As we state in section V. of the preamble of this proposed rule, with the 10-year transition period ending with hospital cost reporting periods beginning on or after October 1, 2001 (FY 2002), beginning in FY 2002 capital prospective payment system payments for most hospitals are based solely on the capital Federal rate. Therefore, we no longer include information on obligated capital costs or projections of old capital costs and new capital costs, which were factors needed to calculate payments during the transition period, for our impact analysis. In accordance with § 412.312, the basic methodology for determining a capital PPS payment is: (Standard Federal Rate) x (DRG weight) x (Geographic Adjustment Factor (GAF)) x (Large Urban Add-on, if applicable) x (COLA for hospitals located in Alaska and Hawaii) x (1 + Disproportionate Share (DSH) Adjustment Factor + Indirect Medical Education (IME) Adjustment Factor, if applicable). In addition, hospitals may also receive outlier payments for those cases that qualify under the threshold established for each fiscal year. The data used in developing the impact analysis presented below are taken from the December 2005 update of the FY 2005 MedPAR file and the December 2005 update of the Provider-Specific File that is used for payment purposes. Although the analyses of E:\FR\FM\25APP2.SGM 25APP2 wwhite on PROD1PC61 with PROPOSALS2 24416 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules the changes to the capital prospective payment system do not incorporate cost data, we used the December 2005 update of the most recently available hospital cost report data (FYs 2003–2004) to categorize hospitals. Our analysis has several qualifications. First, we do not make adjustments for behavioral changes that hospitals may adopt in response to policy changes. Second, due to the interdependent nature of the IPPS, it is very difficult to precisely quantify the impact associated with each change. Third, we draw upon various sources for the data used to categorize hospitals in the tables. In some cases (for instance, the number of beds), there is a fair degree of variation in the data from different sources. We have attempted to construct these variables with the best available sources overall. However, for individual hospitals, some miscategorizations are possible. Using cases from the December 2005 update of the FY 2005 MedPAR file, we simulated payments under the capital PPS for FY 2006 and FY 2007 for a comparison of total payments per case. Any short-term, acute care hospitals not paid under the general IPPS (Indian Health Service hospitals and hospitals in Maryland) are excluded from the simulations. As we explain in section III.A. of the Addendum to this proposed rule, payments are no longer made under the regular exceptions provision under §§ 412.348(b) through (e). Therefore, we no longer use the actuarial capital cost model (described in Appendix B of the August 1, 2001 proposed rule (66 FR 40099)). We modeled payments for each hospital by multiplying the capital Federal rate by the GAF and the hospital’s case-mix. We then added estimated payments for indirect medical education, disproportionate share, large urban add-on, and outliers, if applicable. For purposes of this impact analysis, the model includes the following assumptions: • We estimate that the Medicare case-mix index will increase by 1.0 percent in both FYs 2006 and 2007. • We estimate that the Medicare discharges will be 13.5 million in FY 2006 and 13.1 million in FY 2007 for a 3.0 percent decrease from FY 2006 to FY 2007. • The capital Federal rate was updated beginning in FY 1996 by an analytical framework that considers changes in the prices associated with capital-related costs and adjustments to account for forecast error, changes in the case-mix index, allowable changes in intensity, and other factors. The proposed FY 2007 update is 0.8 percent (see section III.A.1. of the Addendum to this proposed rule). • In addition to the proposed FY 2007 update factor, the proposed FY 2007 capital Federal rate was calculated based on a proposed GAF/DRG budget neutrality factor of 1.0012, a proposed outlier adjustment factor of 0.9513, and a proposed exceptions adjustment factor of 0.9997. B. Results We used the actuarial model described above to estimate the potential impact of our proposed changes for FY 2007 on total capital payments per case, using a universe VerDate Aug<31>2005 17:10 Apr 24, 2006 Jkt 208001 of 3,522 hospitals. As described above, the individual hospital payment parameters are taken from the best available data, including the December 2005 update of the FY 2005 MedPAR file, the December 2005 update to the Provider-Specific File, and the most recent cost report data from the December 2005 update of HCRIS. In Table III, we present a comparison of total payments per case for FY 2006 compared to FY 2007 based on the proposed FY 2007 payment policies. Column 2 shows estimates of payments per case under our model for FY 2006. Column 3 shows estimates of payments per case under our model for FY 2007. Column 4 shows the total percentage change in payments from FY 2006 to FY 2007. The change represented in Column 4 includes the proposed 0.8 percent update to the capital Federal rate, a proposed 0.0 percent increase in case-mix, proposed changes in the adjustments to the capital Federal rate (for example, the effect of the proposed hospital wage index on the GAF), and reclassifications by the MGCRB. The comparisons are provided by: (1) Geographic location; (2) region; and (3) payment classification. The simulation results show that, on average, capital payments per case can be expected to increase 2.0 percent in FY 2007. In addition to the 0.8 percent increase due to the capital market basket update, this projected increase in capital payments per case is largely attributable to the proposed change in the DRG recalibration process methodology for FY 2007 as discussed in section II.C. of the preamble, and to a lesser extent, an estimated increase in capital PPS outlier payments. The results of our comparisons by geographic location and by region are indicative of the results we expected after applying the proposed changes to the DRG recalibration methodology. The geographic comparison shows that urban hospitals are expected to experience a 1.7 percent increase in IPPS capital payments per case, while rural hospitals are expected to experience a 4.6 percent increase in capital payments per case. This difference is mostly due to the proposed changes to the methodology used to recalibrate DRGs discussed in section II.C. of the preamble of this proposed rule. As discussed in greater detail in that section of this proposed rule, analysis of our current methodology for setting DRG weights (using gross charges) indicates that bias is introduced into the weighting process. Specifically, we have also observed that ancillary service cost centers, in general, have higher charge markups than routine and ICU service cost centers, and therefore, higher weights for DRGs that use more ancillary services as opposed to DRGs that use more routine services. Surgical DRGs tend to have charges concentrated in ancillary cost center groups while medical DRGs tend to have charges concentrated in routine or ICU cost center groups. The bias in our current methodology results in artificially higher DRG relative weights for hospitals that are generally more expensive, such as teaching hospitals and specialty hospitals. Hospitals with these characteristics are generally found in urban locations. Since the proposed HSRVcc weighting methodology (discussed in section II.C. of the PO 00000 Frm 00422 Fmt 4701 Sfmt 4702 preamble of this proposed rule) would adjust the weights to remove differential markups in charges, the proposed FY 2007 DRG relative weights are redistributed among medical and surgical DRGs, which translates into a redistribution of payments among hospitals. For instance, hospitals that perform more surgical procedures (such as many urban hospitals) are likely to experience decreases in payments, while hospitals with heavy concentrations of medical DRGs (such as many rural hospitals) are expected to experience increases in payments as a result of this proposed change in our DRG recalibration methodology. All regions are estimated to receive an increase in total capital payments per case from FY 2006 to FY 2007. Changes by region vary from a minimum increase of 0.7 percent (West North Central urban) to a maximum increase of 6.1 percent (Pacific rural). As previously discussed, the relatively small increase in projected capital payments per discharge for hospitals located in the urban regions and the larger increase for hospitals in rural regions is largely attributable to the proposed changes in the DRG recalibration methodology. Hospitals located in Puerto Rico are expected to experience an increase in total capital payments per case of 2.4 percent. This slightly higher than average increase in payment per case for hospitals located in Puerto Rico is, again, largely due to the proposed changes in the DRG recalibration methodology. By type of ownership, government hospitals are projected to have the largest rate of increase of total payment changes (3.2 percent). Similarly, payments to voluntary and proprietary hospitals are expected to increase 1.8 percent and 2.1 percent, respectively. As noted above, this slightly larger projected increase in capital payments per case for government hospitals is mostly due to the changes in the DRG calibration methodology. Section 1886(d)(10) of the Act established the MGCRB. Before FY 2005, hospitals could apply to the MGCRB for reclassification for purposes of the standardized amount, wage index, or both. Section 401(c) of Pub. L. 108– 173 equalized the standardized amounts under the operating IPPS. Therefore, beginning in FY 2005, there is no longer reclassification for the purposes of the standardized amounts; however, hospitals still may apply for reclassification for purposes of the wage index for FY 2007. Reclassification for wage index purposes also affects the GAF because that factor is constructed from the hospital wage index. As discussed in section III.H.5. of the preamble of this proposed rule, procedural rules were established in the FY 2006 final rule (70 FR 47382) to recognize the special circumstances of section 508 hospital reclassifications ending mid-year during FY 2007. Under these procedural rules, some § 1886(d)(10) hospital reclassifications are only in effect for the second half of the fiscal year. These half fiscal year reclassifications have implications for the calculation of reclassified wage indices and therefore, affect capital payments since GAF values are calculated from the hospital wage index. To present the effects of the hospitals being reclassified for FY 2007, we show the average E:\FR\FM\25APP2.SGM 25APP2 24417 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules payments per case for reclassified hospitals for each half of FY 2007 compared to the average payments per case for the same time period in FY 2006. The reclassified groups are compared to all other nonreclassified hospitals for the same time period. These categories are further identified by urban and rural designation. In general, the average payments per case in the first half of FY 2007 is the same as the average payments per case in the second half of FY 2007 with the exception of urban reclassifications, which increases by 0.1 percent (1.9 percent to 2.0 percent) for the second half of FY 2007. Rural hospitals, both reclassified and nonreclassified, are expected to have the largest increases in payments, although rural nonreclassified hospitals are projected to have the greater increase of 6.3 percent (for both halves of FY 2007) as compared to the 3.5 percent increase for rural reclassified hospitals (for both halves of FY 2007). As explained above in this section, this larger than average increase in payments per case from FY 2006 to FY 2007 for both rural reclassified and non-reclassified hospitals is mostly due to the redistributive effects of the proposed changes in the DRG recalibration methodology. Conversely, for urban hospitals, reclassified (urban) hospitals are projected to have increases of 1.9 percent and 2.0 percent in the first and second halves of FY 2007, respectively, while non-reclassified (urban) hospitals are projected to have a slightly lesser increase of 1.7 percent. As discussed in section VI.B. of the preamble of this proposed rule, we are proposing a technical revision to § 412.316(b) and § 412.320 to clarify that hospitals reclassified as rural under § 412.103 are not eligible for the large urban add-on or for capital DSH to reflect our historic policy that hospitals reclassified as rural under § 412.103 also are considered rural under capital PPS regulations. Currently, there are 38 hospitals that reclassified under this regulation and only 12 of these hospitals (about 0.3 percent of all IPPS hospitals) would be affected by the proposed technical revisions to sections § 412.316(b) and § 412.320 concerning the treatment of hospitals reclassified as rural under section § 412.103. Based on the most recent available data, we estimate that the impact of these proposed changes would be less than a 0.00001 percent decrease in aggregate IPPS payments. TABLE III.—COMPARISON OF TOTAL PAYMENTS PER CASE [FY 2006 Payments Compared To Proposed FY 2007 Payments] wwhite on PROD1PC61 with PROPOSALS2 Number of hospitals By Geographic Location: All hospitals .............................................................................................. Large urban areas (populations over 1 million) ....................................... Other urban areas (populations of 1 million of fewer) ............................. Rural areas ............................................................................................... Urban hospitals ......................................................................................... 0–99 beds .......................................................................................... 100–199 beds .................................................................................... 200–299 beds .................................................................................... 300–499 beds .................................................................................... 500 or more beds .............................................................................. Rural hospitals .......................................................................................... 0–49 beds .......................................................................................... 50–99 beds ........................................................................................ 100–149 beds .................................................................................... 150–199 beds .................................................................................... 200 or more beds .............................................................................. By Region: Urban by Region ...................................................................................... New England ..................................................................................... Middle Atlantic ................................................................................... South Atlantic .................................................................................... East North Central ............................................................................. East South Central ............................................................................ West North Central ............................................................................ West South Central ........................................................................... Mountain ............................................................................................ Pacific ................................................................................................ Puerto Rico ........................................................................................ Rural by Region ........................................................................................ New England ..................................................................................... Middle Atlantic ................................................................................... South Atlantic .................................................................................... East North Central ............................................................................. East South Central ............................................................................ West North Central ............................................................................ West South Central ........................................................................... Mountain ............................................................................................ Pacific ................................................................................................ By Payment Classification: All hospitals .............................................................................................. Large urban areas (populations over 1 million) ....................................... Other urban areas (populations of 1 million of fewer) ............................. Rural areas ............................................................................................... Teaching Status. Non-teaching ..................................................................................... Fewer than 100 Residents ................................................................ 100 or more Residents ...................................................................... Urban DSH: 100 or more beds ....................................................................... VerDate Aug<31>2005 17:10 Apr 24, 2006 Jkt 208001 PO 00000 Frm 00423 Fmt 4701 Sfmt 4702 Average FY 2006 payments/case Average FY 2007 payments/case Change 3,522 1,391 1,126 1,005 2,517 590 865 482 414 166 1,005 349 366 179 64 47 740 823 729 512 780 607 660 735 816 978 512 422 472 514 567 630 755 840 738 535 794 624 684 750 823 984 535 454 501 537 582 642 2.0 2.1 1.2 4.6 1.7 2.7 3.8 2.0 0.9 0.7 4.6 7.6 6.3 4.3 2.7 1.8 2,517 127 353 381 388 163 156 350 143 404 52 1,005 19 72 175 125 181 118 191 80 44 780 831 844 746 766 713 769 729 787 899 342 512 685 516 497 544 475 533 470 535 615 794 853 862 754 781 720 775 737 799 926 351 535 709 539 522 566 496 555 494 554 652 1.7 2.7 2.1 1.1 1.9 0.9 0.7 1.1 1.6 3.0 2.4 4.6 3.5 4.5 5.0 4.2 4.4 4.1 5.1 3.5 6.1 3,522 1,400 1,139 983 740 821 728 513 755 839 737 536 2.0 2.1 1.3 4.5 2,449 836 237 621 753 1,075 640 762 1,090 3.0 1.2 1.4 1,513 806 821 1.8 E:\FR\FM\25APP2.SGM 25APP2 24418 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules TABLE III.—COMPARISON OF TOTAL PAYMENTS PER CASE—Continued [FY 2006 Payments Compared To Proposed FY 2007 Payments] Number of hospitals Less than 100 beds ................................................................... Rural DSH: Sole Community (SCH/EACH) ................................................... Referral Center (RRC/EACH) .................................................... Other Rural: 100 or more beds ................................................................ Less than 100 beds ............................................................ Urban teaching and DSH: Both teaching and DSH .................................................................... Teaching and no DSH ....................................................................... No teaching and DSH ....................................................................... No teaching and no DSH .................................................................. Rural Hospital Types: Non special status hospitals .............................................................. RRC/EACH ........................................................................................ SCH/EACH ........................................................................................ Medicare-dependent hospitals (MDH) ............................................... SCH, RRC and EACH ....................................................................... Hospitals Reclassified by the Medicare Geographic Classification Review Board: FY2007 Reclassifications: All Urban Reclassified 1st Half .......................................................... All Urban Non-Reclassified 1st Half .................................................. All Rural Reclassified 1st Half ........................................................... All Rural Non-Reclassified 1st Half ................................................... All Urban Reclassified 2nd Half ........................................................ All Urban Non-Reclassified 2nd Half ................................................. All Rural Reclassified 2nd Half .......................................................... All Rural Non-Reclassified 2nd Half .................................................. All Section 401 Reclassified Hospitals .............................................. Other Reclassified Hospitals (Section 1886(d)(8)(B)) ....................... Type of Ownership: Voluntary ........................................................................................... Proprietary ......................................................................................... Government ....................................................................................... Medicare Utilization as a Percent of Inpatient Days: 0–25 ................................................................................................... 25–50 ................................................................................................. 50–65 ................................................................................................. Over 65 .............................................................................................. IX. Alternatives Considered This proposed rule contains a range of policies, including some proposals related to specific DRA and MMA provisions. The preamble of this proposed rule provides descriptions of the statutory provisions that are addressed, identifies those policies when discretion has been exercised, presents rationale for our decisions and, where relevant, alternatives that were considered. wwhite on PROD1PC61 with PROPOSALS2 X. Overall Conclusion The changes in this proposed rule would affect all classes of hospitals. Some hospitals are expected to experience significant gains and others less significant gains, but overall hospitals are projected to experience positive updates in IPPS payments in FY 2007. Table Average FY 2006 payments/case Average FY 2007 payments/case Change 333 542 572 5.6 383 196 465 567 493 585 6.1 3.0 55 188 469 425 496 457 5.8 7.4 809 198 1,037 495 884 792 658 682 896 798 678 691 1.4 0.7 3.1 1.3 288 40 341 126 80 448 575 479 433 577 477 590 507 463 596 6.6 2.6 5.8 6.9 3.3 316 2,178 373 563 374 2,120 373 563 38 54 767 783 556 451 785 780 556 451 516 513 782 796 576 480 801 793 576 480 537 544 1.9 1.7 3.5 6.3 2.0 1.7 3.5 6.3 4.1 6.1 2,087 831 604 757 670 727 770 685 751 1.8 2.1 3.2 252 1,302 1,490 459 970 838 655 589 1,016 851 670 601 4.7 1.5 2.4 2.1 I of section VI of this Appendix demonstrates the estimated distributional impact of the IPPS budget neutrality requirements for DRG and wage index changes, for the hold harmless transition for rural hospitals formerly classified as urban, and for the wage index reclassifications under the MGCRB. Table I also shows an overall increase of 3.4 percent in operating payments, which, in conjunction with the estimated 2.0 percent increase in capital payments to IPPS providers shown in Table III of section VIII of this Appendix, should result in a net increase of $3.33 billion to IPPS providers. The discussions presented in the previous pages, in combination with the rest of this proposed rule, constitute a regulatory impact analysis. XI. Accounting Statement As required by OMB Circular A–4 (available at https://www.whitehousegov/omb/ circulars/a004/a-4.pdf), in Table IV below, we have prepared an accounting statement showing the classification of the expenditures associated with the provisions of this proposed rule. This table provides our best estimate of the increase in Medicare payments on providers as a result of the proposed changes to the IPPS, the LTCH case-mix, and the limitation on payments to SNFs for bad debt presented in this rule. All expenditures are classified as transfers to Medicare providers. TABLE IV.—ACCOUNTING STATEMENT: CLASSIFICATION OF ESTIMATED EXPENDITURES FROM FY 2006 TO FY 2007 Category Transfers Annualized Monetized Transfers .............................................................. VerDate Aug<31>2005 18:22 Apr 24, 2006 Jkt 208001 PO 00000 Frm 00424 Fmt 4701 $3.809 Billion. Sfmt 4702 E:\FR\FM\25APP2.SGM 25APP2 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules 24419 TABLE IV.—ACCOUNTING STATEMENT: CLASSIFICATION OF ESTIMATED EXPENDITURES FROM FY 2006 TO FY 2007— Continued Category Transfers From Whom to Whom .............................................................................. Total ................................................................................................... XII. Executive Order 12866 In accordance with the provisions of Executive Order 12866, the Office of Management and Budget reviewed this proposed rule. Appendix B: Recommendation of Update Factors for Operating Cost Rates of Payment for Inpatient Hospital Services (If you choose to comment on issues in this section, please include the caption ‘‘Update Factors’’ at the beginning of your comment.) wwhite on PROD1PC61 with PROPOSALS2 I. Background Section 1886(e)(4)(A) of the Act requires that the Secretary, taking into consideration the recommendations of the Medicare Payment Advisory Commission (MedPAC), recommend update factors for inpatient hospital services for each fiscal year that take into account the amounts necessary for the efficient and effective delivery of medically appropriate and necessary care of high quality. Under section 1886(e)(5)(B) of the Act, we are required to publish the proposed and final update factors recommended by the Secretary in the proposed and final IPPS rules respectively. Accordingly, this Appendix provides the recommendations of appropriate update factors for the IPPS standardized amount, the hospital-specific rates for SCHs and MDHs, and the rate-ofincrease limits for hospitals and hospital units excluded from the IPPS. We also discuss our response to MedPAC’s recommended update factors for inpatient hospital services. II. Inpatient Hospital Update for FY 2007 Section 1886(b)(3)(B)(i)(XX) of the Act, as amended by section 5001(a) of Pub. L. 109– 171, sets the FY 2007 percentage increase in the operating cost standardized amount equal to the rate-of-increase in the hospital market basket for IPPS hospitals in all areas, subject to the hospital submitting quality information under rules established by the Secretary under section 1886(b)(3)(B)(viii) of the Act. For hospitals that do not provide these data, the update is equal to the market basket percentage increase less 2.0 percentage points. Consistent with current law, based on the Office of the Actuary’s first quarter 2006 forecast of the FY 2007 market basket increase, we are estimating that the FY 2007 update to the standardized amount will be 3.4 percent (that is, the current estimate of the market basket rate-of-increase) for hospitals in all areas, provided the hospital submits quality data in accordance with our rules. For hospitals that do not submit quality data, we are estimating that the update to the standardized amount will be 1.4 percent (that is, the current estimate of VerDate Aug<31>2005 17:10 Apr 24, 2006 Jkt 208001 Federal Government to IPPS Medicare Providers, LTCHs, and SNFs. $3.809 Billion. the market basket rate-of-increase minus 2.0 percentage points). Section 1886(b)(3)(B)(iv) of the Act sets the FY 2007 percentage increase in the hospitalspecific rates applicable to SCHs and MDHs equal to the rate set forth in section 1886(b)(3)(B)(i) of the Act (that is, the same update factor as for all other hospitals subject to the IPPS, or the rate-of-increase in the market basket). Therefore, the update to the hospital-specific rates applicable to SCHs and MDHs is also estimated to be 3.4 percent. Section 1886(b)(3)(B)(ii) of the Act is used for purposes of determining the percentage increase in the rate-of-increase limits for children’s and cancer hospitals. Section 1886(b)(3)(B)(ii) of the Act sets the percentage increase in the rate-of-increase limits equal to the market basket percentage increase for years after FY 2002. In accordance with § 403.752(a) of the regulations, RNHCIs are paid under § 413.40, which also uses section 1886(b)(3)(B)(ii) of the Act to update the percentage increase in the rate-of-increase limits. Section 1886(j)(3)(C) of the Act addresses the increase factor for the Federal prospective payment rate of IRFs. Section 123 of Pub. L. 106–113, as amended by section 307(b) of Pub. L. 106– 554, provides the statutory authority for updating payment rates under the LTCH PPS. In addition, section 124 of the BBRA provides the statutory authority for updating the payment rates of IPFs. Under this broad authority, IPFs that are not defined as new under § 412.426(c) will be paid under a blend methodology for cost reporting periods beginning on or after January 1, 2005, through June 30, 2008. The blend methodology consists of a blend of the estimated Federal per diem payment amount and a facility-specific payment amount. Under the authority of section 124 of the BBRA, the estimated Federal per diem payment amount is updated and the facilityspecific payment is updated in accordance with 42 CFR Part 413, which uses section 1886(b)(3)(B)(ii) of the Act to determine the percentage increase in the rate-of-increase limits. New IPFs are paid based on 100 percent of the Federal per diem payment amount, which is updated under the authority of section 124 of the BBRA. In addition, some LTCHs and IPFs are transitioning to 100 percent of the Federal rate and currently receive a blend of reasonable cost-based payments computed under the TEFRA methodology and their respective Federal payment rates. As discussed below, the transition ends for LTCHs (not defined as new and that have not elected to be paid under 100 percent of the Federal rate) for cost reporting periods beginning on or after October 1, 2006. Therefore, because no portion of LTCHs’ PO 00000 Frm 00425 Fmt 4701 Sfmt 4702 prospective payments will be based on reasonable costs for cost reporting periods beginning on or after October 1, 2006, we are not proposing an FY 2007 rate-of-increase adjustment under section 1886(b)(3)(B)(ii) of the Act for LTCHs. Any IPFs that receive reasonable cost-based payments will have that portion of its payments determined subject to the TEFRA rate-of-increase limits for FY 2007. Currently, children’s hospitals, cancer hospitals and RNHCIs are the remaining three types of hospitals still reimbursed fully under reasonable costs. As we discuss in section IV. of the Addendum to this proposed rule, we are proposing to provide an estimate of the FY 2007 IPPS operating market basket percentage increase (3.4 percent) that will be used to update the target limits for children’s hospitals, cancer hospitals, and RNHCIs. Effective since cost reporting periods beginning FY 2003, LTCHs have been paid under the LTCH PPS, which was implemented with a 5-year transition period for LTCHs not defined as new under § 412.23(e)(4) (hereafter referred to as ‘‘existing’’). (Refer to 67 FR 55954, August 30, 2002.) An existing LTCH could have elected to be paid on 100 percent of the Federal prospective rate at the start of any of its cost reporting periods during the 5-year transition period. During this transition period, if an existing LTCH did not elect to be paid 100 percent of the Federal prospective payment rate, it received a payment which consisted of a blend of its reasonable cost-based payment (subject to the TEFRA rate-ofincrease limits) and the Federal prospective payment rate. Because the transition period ends with LTCH cost reporting periods beginning on or after October 1, 2006, those LTCHs who now receive blended payments will be paid based on 100 percent of the Federal prospective rate. Effective for cost reporting periods beginning on or after January 1, 2005, IPFs are paid under the IPF PPS. IPF PPS payments are based on a Federal per diem rate that is based on the sum of the average routine operating, ancillary, and capital costs for each patient day of psychiatric care in an IPF, adjusted for budget neutrality. During a transition period between January 1, 2005 and January 1, 2008, existing IPFs are paid based on a blend of the reasonable cost-based payments, subject to the TEFRA limit, and the Federal per diem base rate. For cost reporting periods beginning on or after January 1, 2008, IPFs will be paid based on 100 percent of the Federal per diem rate. For purposes of the update factor for FY 2007, the portion of the IPF PPS transitional blend payment based on reasonable costs would be determined by updating the IPF’s TEFRA limit by the current estimate of the excluded E:\FR\FM\25APP2.SGM 25APP2 24420 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules hospital market basket, which is estimated to be 3.6 percent. The estimated update to the Federal per diem rate for July 1, 2006, through June 30, 2007, was provided in the RY 2007 IPF proposed rule (71 FR 3620). IRFs are paid under the IRF PPS for cost reporting periods beginning on or after January 1, 2002. For cost reporting periods beginning on or after October 1, 2002 (FY 2003), and thereafter, the Federal prospective payments to IRFs are based on 100 percent of the adjusted Federal IRF prospective payment amount, updated annually. (Refer to the IRF final rule (69 FR 45721).) III. Secretary’s Recommendation wwhite on PROD1PC61 with PROPOSALS2 In previous years, in making a recommendation, we included an update framework that analyzed hospital productivity, scientific and technological advances, practice pattern changes, changes in case-mix, the effects of reclassification on recalibration and forecast error correction. Although we have used this framework in past years, as we stated in the FY 2006 proposed rule, we are no longer including this analysis in our recommendation for the update (70 FR 23672, May 4, 2005). MedPAC is recommending an inpatient hospital update equal to the market basket rate of increase for FY 2007 minus an adjustment factor of 0.45 percentage points. The 0.45 percentage point reduction represents half of estimated productivity growth in the general economy for 2007 that the Commission expects the hospital industry to achieve. MedPAC’s rationale for this update recommendation is described in more detail below. Using the 2006 first quarter forecast from the Office of the Actuary of the FY 2007 market basket increase and an adjustment factor based on the FY 2007 President’s budget, we are recommending an update to the standardized amount of 2.95 percent (that is, the market basket rate-of-increase of 3.4 minus an adjustment factor of 0.45 percentage points). Our update recommendation is the same as MedPAC’s. In addition to making a recommendation for IPPS hospitals, in accordance with section 1886(e)(4)(A) of the Act, we are also recommending update factors for all other types of hospitals. Using the 2006 first quarter forecast from the Office of the Actuary of the FY 2007 market basket increase and an adjustment factor based on the FY 2007 President’s budget, for FY 2007, VerDate Aug<31>2005 17:10 Apr 24, 2006 Jkt 208001 for SCHs and MDHs, we are recommending an update of 2.95 percent. For FY 2007, for children’s hospitals, cancer hospitals, and RNHCIs, based on the first quarter forecast from the Office of the Actuary of the FY 2007 market basket increase and an adjustment factor from the FY 2007 President’s budget, we are also recommending an update of 2.95 percent to the target limits. For IPFs that are currently paid a blend of reasonable cost-based (subject to the TEFRA limits) and Federal prospective payment amounts, based on the latest estimate from the Office of the Actuary and an adjustment factor from the FY 2007 President’s budget, we are recommending an update factor of 3.15 percent for the portion of the payment that is based on reasonable costs, subject to the TEFRA limits. We note that section 1886(e)(3) of the Act directs the Secretary to report to Congress an initial estimate of the recommendation of an appropriate payment inflation update for inpatient hospital services for the upcoming fiscal year. In the Secretary’s Report to Congress this year, the Secretary recommended the President’s FY 2007 update of 2.95 percent (3.4 percent minus an adjustment factor of 0.45 percentage points) for the market basket update for the TEFRA portion of IPF blended payment rates. The difference between the update recommendation in the Secretary’s Report to Congress and the update we are recommending in this proposed rule (3.15 percent) is due to the availability and use of more recent data for the market basket than were available at the time the Secretary’s recommendation was developed. Consistent with our proposal in the RY 2007 LTCH PPS proposed rule (71 FR 4667, January 27, 2006), we are recommending the Federal rate remain unchanged for RY 2007. In the RY 2007 IPF PPS proposed rule (71 FR 3620, January 23, 2006), we proposed an update factor of 4.5 percent to the IPF PPS for RY 2007. The proposed update reflects an increase from the 18-month period beginning January 1, 2005, when the IPF PPS was first adopted. Consistent with the RY 2007 IPF proposed rule, we are recommending an update factor of 4.5 percent for inpatient psychiatric facilities. Finally, consistent with the President’s FY 2007 budget, we are recommending the Federal rate to the IRF PPS remain unchanged for FY 2007. PO 00000 Frm 00426 Fmt 4701 Sfmt 4702 IV. MedPAC Recommendation for Assessing Payment Adequacy and Updating Payments in Traditional Medicare In the past, MedPAC has suggested specific adjustments to its update recommendation for each of the factors discussed under section III. of this Appendix. In its March 2006 Report to Congress, MedPAC assessed the adequacy of current payments and costs and the relationship between payments and an appropriate cost base, utilizing an established methodology used by the Commission in the past several years. Despite a projected negative overall Medicare margin of ¥2.2 percent in 2006, the Commission recommended an update to the hospital inpatient rates equal to the increase in the hospital market basket minus an adjustment factor of 0.45 percentage points. The 0.45 percentage point reduction represents half of an estimate of productivity growth in the general economy for 2007 that the Commission expects the hospital industry to achieve. MedPAC noted that, notwithstanding negative overall Medicare margins, most of the indicators of Medicare payment adequacy to hospitals are positive, including beneficiaries’ access to care, increased access to capital, and service volume increases. MedPAC also noted that Medicare payment rates should cover the costs of efficient hospitals and that, ‘‘more efficient hospitals may not be performing as poorly as the [hospital] industry’s aggregate margin would suggest.’’ Response: We agree with MedPAC and are also recommending an inpatient hospital update equal to the market basket minus an adjustment factor of 0.45 percentage points. However, we note that the law would need to be changed in order for the MedPAC recommendation and our update recommendation to be applied. Without a change in law, we will update the IPPS rates by the full market basket, which we currently estimate to be 3.4 percent for FY 2007, for hospitals that submit quality data that meet our validation requirements. For all other hospitals, the IPPS update will equal the market basket minus 2.0 percentage points. In addition, because the operating and capital prospective payment systems remain separate, we are proposing to continue to use separate updates for operating and capital payments. The proposed update to the capital payment rate is discussed in section III. of the Addendum to this proposed rule. E:\FR\FM\25APP2.SGM 25APP2 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules 24421 APPENDIX C.—COMBINATIONS OF PROPOSED CONSOLIDATED SEVERITY-ADJUSTED DRGS Type Consolidated severity-adjusted DRG MDC wwhite on PROD1PC61 with PROPOSALS2 S S S S S S S S S S S S S S ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 S S S S S S S S S S S S S S S S S S S S S S S S M M M M M M M M M M M M M M M M M M M M M M M M M M M M M M M ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... 0 0 0 0 0 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 VerDate Aug<31>2005 17:10 Apr 24, 2006 Consolidated severity-adjusted DRG description LIVER TRANSPLANT AND/OR INTESTINAL TRANSPLANT SOI 1 & 2. LIVER TRANSPLANT AND/OR INTESTINAL TRANSPLANT SOI 3. LIVER TRANSPLANT AND/OR INTESTINAL TRANSPLANT SOI 4. HEART &/OR LUNG TRANSPLANT SOI 1 & 2. HEART &/OR LUNG TRANSPLANT SOI 3. HEART &/OR LUNG TRANSPLANT SOI 4. BONE MARROW TRANSPLANT SOI 1. BONE MARROW TRANSPLANT SOI 2. BONE MARROW TRANSPLANT SOI 3. BONE MARROW TRANSPLANT SOI 4. TRACHEOSTOMY W LONG TERM MECHANICAL VENTILATION W EXTENSIVE PROCEDURE SOI 1 & 2. TRACHEOSTOMY W LONG TERM MECHANICAL VENTILATION W EXTENSIVE PROCEDURE SOI 3. TRACHEOSTOMY W LONG TERM MECHANICAL VENTILATION W EXTENSIVE PROCEDURE SOI 4. TRACHEOSTOMY W LONG TERM MECHANICAL VENTILATION W/O EXTENSIVE PROCEDURE SOI 1 & 2. TRACHEOSTOMY W LONG TERM MECHANICAL VENTILATION W/O EXTENSIVE PROCEDURE SOI 3. TRACHEOSTOMY W LONG TERM MECHANICAL VENTILATION W/O EXTENSIVE PROCEDURE SOI 4. PANCREAS TRANSPLANT SOI 1 & 2. PANCREAS TRANSPLANT SOI 3. PANCREAS TRANSPLANT SOI 4. NERVOUS SYSTEM PROCDURES SOI 4. CRANIOTOMY FOR TRAUMA SOI 1. CRANIOTOMY FOR TRAUMA SOI 2. CRANIOTOMY FOR TRAUMA SOI 3. CRANIOTOMY EXCEPT FOR TRAUMA SOI 1. CRANIOTOMY EXCEPT FOR TRAUMA SOI 2. CRANIOTOMY EXCEPT FOR TRAUMA SOI 3. VENTRICULAR SHUNT PROCEDURES SOI 1. VENTRICULAR SHUNT PROCEDURES SOI 2. VENTRICULAR SHUNT PROCEDURES SOI 3. SPINAL PROCEDURES SOI 1. SPINAL PROCEDURES SOI 2. SPINAL PROCEDURES SOI 3. EXTRACRANIAL VASCULAR PROCEDURES SOI 1. EXTRACRANIAL VASCULAR PROCEDURES SOI 2. EXTRACRANIAL VASCULAR PROCEDURES SOI 3. OTHER NERVOUS SYSTEM & RELATED PROCEDURES SOI 1. OTHER NERVOUS SYSTEM & RELATED PROCEDURES SOI 2. OTHER NERVOUS SYSTEM & RELATED PROCEDURES SOI 3. NERVOUS SYSTEM MEDICAL DIAGNOSES EXCEPT INFECTIONS SOI 4. INFECTIONS OF NERVOUS SYSTEM SOI 4. SPINAL DISORDERS & INJURIES SOI 1. SPINAL DISORDERS & INJURIES SOI 2. SPINAL DISORDERS & INJURIES SOI 3. NERVOUS SYSTEM MALIGNANCY SOI 1. NERVOUS SYSTEM MALIGNANCY SOI 2. NERVOUS SYSTEM MALIGNANCY SOI 3. DEGENERATIVE NERVOUS SYSTEM DISORDERS EXC MULT SCLEROSIS SOI 1. DEGENERATIVE NERVOUS SYSTEM DISORDERS EXC MULT SCLEROSIS SOI 2. DEGENERATIVE NERVOUS SYSTEM DISORDERS EXC MULT SCLEROSIS SOI 3. MULTIPLE SCLEROSIS & OTHER DEMYELINATING DISEASES SOI 1. MULTIPLE SCLEROSIS & OTHER DEMYELINATING DISEASES SOI 2. MULTIPLE SCLEROSIS & OTHER DEMYELINATING DISEASES SOI 3. INTRACRANIAL HEMORRHAGE SOI 1. INTRACRANIAL HEMORRHAGE SOI 2. INTRACRANIAL HEMORRHAGE SOI 3. CVA & PRECEREBRAL OCCLUSION W INFARCT SOI 1. CVA & PRECEREBRAL OCCLUSION W INFARCT SOI 2. CVA & PRECEREBRAL OCCLUSION W INFARCT SOI 3. NONSPECIFIC CVA & PRECEREBRAL OCCLUSION W/O INFARCT SOI 1. NONSPECIFIC CVA & PRECEREBRAL OCCLUSION W/O INFARCT SOI 2. NONSPECIFIC CVA & PRECEREBRAL OCCLUSION W/O INFARCT SOI 3. TRANSIENT ISCHEMIA SOI 1. TRANSIENT ISCHEMIA SOI 2. TRANSIENT ISCHEMIA SOI 3. PERIPHERAL, CRANIAL & AUTONOMIC NERVE DISORDERS SOI 1. PERIPHERAL, CRANIAL & AUTONOMIC NERVE DISORDERS SOI 2. PERIPHERAL, CRANIAL & AUTONOMIC NERVE DISORDERS SOI 3. BACTERIAL & TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM SOI 1. BACTERIAL & TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM SOI 2. Jkt 208001 PO 00000 Frm 00427 Fmt 4701 Sfmt 4702 E:\FR\FM\25APP2.SGM 25APP2 24422 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules APPENDIX C.—COMBINATIONS OF PROPOSED CONSOLIDATED SEVERITY-ADJUSTED DRGS—Continued Type ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85 86 87 88 89 90 91 92 M ....... 1 93 M ....... wwhite on PROD1PC61 with PROPOSALS2 M M M M M M M M M M M M M M M M M M M M M M M Consolidated severity-adjusted DRG MDC 1 94 M M M S S S S S S S M M M M M M M S S S S S S S S S S S S S S S S S S S S S S S S S 1 1 1 2 2 2 2 2 2 2 2 2 2 2 2 2 2 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 95 96 97 98 99 100 101 102 103 104 105 106 107 108 109 110 111 112 113 114 115 116 117 118 119 120 121 122 123 124 125 126 127 128 129 130 131 132 133 134 135 136 ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... VerDate Aug<31>2005 17:10 Apr 24, 2006 Consolidated severity-adjusted DRG description BACTERIAL & TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM SOI 3. NON-BACTERIAL INFECTIONS OF NERVOUS SYSTEM EXC VIRAL MENINGITIS SOI 1. NON-BACTERIAL INFECTIONS OF NERVOUS SYSTEM EXC VIRAL MENINGITIS SOI 2. NON-BACTERIAL INFECTIONS OF NERVOUS SYSTEM EXC VIRAL MENINGITIS SOI 3. VIRAL MENINGITIS SOI 1. VIRAL MENINGITIS SOI 2. VIRAL MENINGITIS SOI 3. NONTRAUMATIC STUPOR & COMA SOI 1. NONTRAUMATIC STUPOR & COMA SOI 2. NONTRAUMATIC STUPOR & COMA SOI 3. SEIZURE SOI 1. SEIZURE SOI 2. SEIZURE SOI 3. MIGRAINE & OTHER HEADACHES SOI 1. MIGRAINE & OTHER HEADACHES SOI 2. MIGRAINE & OTHER HEADACHES SOI 3. HEAD TRAUMA W COMA >1 HR OR HEMORRHAGE SOI 1. HEAD TRAUMA W COMA >1 HR OR HEMORRHAGE SOI 2. HEAD TRAUMA W COMA >1 HR OR HEMORRHAGE SOI 3. BRAIN CONTUSION/LACERATION & COMPLICATED SKULL FX, COMA < 1 HR OR NO COMA SOI 1. BRAIN CONTUSION/LACERATION & COMPLICATED SKULL FX, COMA < 1 HR OR NO COMA SOI 2. BRAIN CONTUSION/LACERATION & COMPLICATED SKULL FX, COMA < 1 HR OR NO COMA SOI 3. CONCUSSION, CLOSED SKULL FX NOS,UNCOMPLICATED INTRACRANIAL INJURY, COMA < 1 HR OR NO COMA SOI 1. CONCUSSION, CLOSED SKULL FX NOS,UNCOMPLICATED INTRACRANIAL INJURY, COMA < 1 HR OR NO COMA SOI 2. CONCUSSION, CLOSED SKULL FX NOS,UNCOMPLICATED INTRACRANIAL INJURY, COMA < 1 HR OR NO COMA SOI 3. OTHER DISORDERS OF NERVOUS SYSTEM SOI 1. OTHER DISORDERS OF NERVOUS SYSTEM SOI 2. OTHER DISORDERS OF NERVOUS SYSTEM SOI 3. EYE PROCEDURES SOI 4. ORBITAL PROCEDURES SOI 1. ORBITAL PROCEDURES SOI 2. ORBITAL PROCEDURES SOI 3. EYE PROCEDURES EXCEPT ORBIT SOI 1. EYE PROCEDURES EXCEPT ORBIT SOI 2. EYE PROCEDURES EXCEPT ORBIT SOI 3. EYE DIAGNOSES SOI 4. ACUTE MAJOR EYE INFECTIONS SOI 1. ACUTE MAJOR EYE INFECTIONS SOI 2. ACUTE MAJOR EYE INFECTIONS SOI 3. EYE DISORDERS EXCEPT MAJOR INFECTIONS SOI 1. EYE DISORDERS EXCEPT MAJOR INFECTIONS SOI 2. EYE DISORDERS EXCEPT MAJOR INFECTIONS SOI 3. EAR, NOSE, MOUTH & THROAT PROCEDURES SOI 4. MAJOR CRANIAL/FACIAL BONE PROCEDURES SOI 1. MAJOR CRANIAL/FACIAL BONE PROCEDURES SOI 2. MAJOR CRANIAL/FACIAL BONE PROCEDURES SOI 3. MAJOR LARYNX & TRACHEA PROCEDURES SOI 1. MAJOR LARYNX & TRACHEA PROCEDURES SOI 2. MAJOR LARYNX & TRACHEA PROCEDURES SOI 3. OTHER MAJOR HEAD & NECK PROCEDURES SOI 1. OTHER MAJOR HEAD & NECK PROCEDURES SOI 2. OTHER MAJOR HEAD & NECK PROCEDURES SOI 3. FACIAL BONE PROCEDURES EXCEPT MAJOR CRANIAL/FACIAL BONE PROCEDURES SOI 1. FACIAL BONE PROCEDURES EXCEPT MAJOR CRANIAL/FACIAL BONE PROCEDURES SOI 2. FACIAL BONE PROCEDURES EXCEPT MAJOR CRANIAL/FACIAL BONE PROCEDURES SOI 3. SINUS & MASTOID PROCEDURES SOI 1. SINUS & MASTOID PROCEDURES SOI 2. SINUS & MASTOID PROCEDURES SOI 3. CLEFT LIP & PALATE REPAIR SOI 1. CLEFT LIP & PALATE REPAIR SOI 2. CLEFT LIP & PALATE REPAIR SOI 3. TONSIL & ADENOID PROCEDURES SOI 1. TONSIL & ADENOID PROCEDURES SOI 2. TONSIL & ADENOID PROCEDURES SOI 3. OTHER EAR, NOSE, MOUTH & THROAT PROCEDURES SOI 1. OTHER EAR, NOSE, MOUTH & THROAT PROCEDURES SOI 2. OTHER EAR, NOSE, MOUTH & THROAT PROCEDURES SOI 3 Jkt 208001 PO 00000 Frm 00428 Fmt 4701 Sfmt 4702 E:\FR\FM\25APP2.SGM 25APP2 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules 24423 APPENDIX C.—COMBINATIONS OF PROPOSED CONSOLIDATED SEVERITY-ADJUSTED DRGS—Continued wwhite on PROD1PC61 with PROPOSALS2 Type M M M M M M M M M M M M M M M M S S S S S S S M M M M M M M M M M M M M M M M M M M M M M M M M M M M M M M M M M M M M M M M M M M M S S S Consolidated severity-adjusted DRG MDC ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... VerDate Aug<31>2005 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 5 5 5 137 138 139 140 141 142 143 144 145 146 147 148 149 150 151 152 153 154 155 156 157 158 159 160 161 162 163 164 165 166 167 168 169 170 171 172 173 174 175 176 177 178 179 180 181 182 183 184 185 186 187 188 189 190 191 192 193 194 195 196 197 198 199 200 201 202 203 204 205 206 17:10 Apr 24, 2006 Consolidated severity-adjusted DRG description EAR, NOSE, MOUTH & THROAT DIAGNOSES SOI 4. EAR, NOSE, MOUTH, THROAT, CRANIAL/FACIAL MALIGNANCIES . SOI 1. EAR, NOSE, MOUTH, THROAT, CRANIAL/FACIAL MALIGNANCIES . SOI 2. EAR, NOSE, MOUTH, THROAT, CRANIAL/FACIAL MALIGNANCIES . SOI 3. VERTIGO & OTHER LABYRINTH DISORDERS SOI 1. VERTIGO & OTHER LABYRINTH DISORDERS SOI 2. VERTIGO & OTHER LABYRINTH DISORDERS SOI 3. INFECTIONS OF UPPER RESPIRATORY TRACT SOI 1. INFECTIONS OF UPPER RESPIRATORY TRACT SOI 2. INFECTIONS OF UPPER RESPIRATORY TRACT SOI 3. DENTAL & ORAL DISEASES & INJURIES SOI 1. DENTAL & ORAL DISEASES & INJURIES SOI 2. DENTAL & ORAL DISEASES & INJURIES SOI 3. OTHER EAR, NOSE, MOUTH,THROAT & CRANIAL/FACIAL DIAGNOSES SOI 1. OTHER EAR, NOSE, MOUTH,THROAT & CRANIAL/FACIAL DIAGNOSES SOI 2. OTHER EAR, NOSE, MOUTH,THROAT & CRANIAL/FACIAL DIAGNOSES SOI 3. RESPIRATORY & CHEST PROCEDURES SOI 4. MAJOR RESPIRATORY & CHEST PROCEDURES SOI 1. MAJOR RESPIRATORY & CHEST PROCEDURES SOI 2. MAJOR RESPIRATORY & CHEST PROCEDURES SOI 3. OTHER RESPIRATORY & CHEST PROCEDURES SOI 1. OTHER RESPIRATORY & CHEST PROCEDURES SOI 2. OTHER RESPIRATORY & CHEST PROCEDURES SOI 3. RESPIRATORY SYSTEM DIAGNOSES EXCEPT W VENTILATOR . SUPPORT 96+ HOURS SOI 4. RESPIRATORY SYSTEM DIAGNOSIS W VENTILATOR SUPPORT 96+ HOURS SOI 1. RESPIRATORY SYSTEM DIAGNOSIS W VENTILATOR SUPPORT 96+ HOURS SOI 2. RESPIRATORY SYSTEM DIAGNOSIS W VENTILATOR SUPPORT 96+ HOURS SOI 3. RESPIRATORY SYSTEM DIAGNOSIS W VENTILATOR SUPPORT 96+ HOURS SOI 4. CYSTIC FIBROSIS - PULMONARY DISEASE SOI 1. CYSTIC FIBROSIS - PULMONARY DISEASE SOI 2. CYSTIC FIBROSIS - PULMONARY DISEASE SOI 3. PULMONARY EDEMA & RESPIRATORY FAILURE SOI 1. PULMONARY EDEMA & RESPIRATORY FAILURE SOI 2. PULMONARY EDEMA & RESPIRATORY FAILURE SOI 3. PULMONARY EMBOLISM SOI 1. PULMONARY EMBOLISM SOI 2. PULMONARY EMBOLISM SOI 3. MAJOR CHEST & RESPIRATORY TRAUMA SOI 1. MAJOR CHEST & RESPIRATORY TRAUMA SOI 2. MAJOR CHEST & RESPIRATORY TRAUMA SOI 3. RESPIRATORY MALIGNANCY SOI 1. RESPIRATORY MALIGNANCY SOI 2. RESPIRATORY MALIGNANCY SOI 3. MAJOR RESPIRATORY INFECTIONS & INFLAMMATIONS SOI 1. MAJOR RESPIRATORY INFECTIONS & INFLAMMATIONS SOI 2. MAJOR RESPIRATORY INFECTIONS & INFLAMMATIONS SOI 3. BRONCHIOLITIS & RSV PNEUMONIA SOI 1. BRONCHIOLITIS & RSV PNEUMONIA SOI 2. BRONCHIOLITIS & RSV PNEUMONIA SOI 3. OTHER PNEUMONIA SOI 1. OTHER PNEUMONIA SOI 2. OTHER PNEUMONIA SOI 3. CHRONIC OBSTRUCTIVE PULMONARY DISEASE SOI 1. CHRONIC OBSTRUCTIVE PULMONARY DISEASE SOI 2. CHRONIC OBSTRUCTIVE PULMONARY DISEASE SOI 3. ASTHMA SOI 1. ASTHMA SOI 2. ASTHMA SOI 3. INTERSTITIAL LUNG DISEASE SOI 1. INTERSTITIAL LUNG DISEASE SOI 2. INTERSTITIAL LUNG DISEASE SOI 3. OTHER RESPIRATORY DIAGNOSES EXCEPT SIGNS, SYMPTOMS & . MINOR DIAGNOSES SOI 1. OTHER RESPIRATORY DIAGNOSES EXCEPT SIGNS, SYMPTOMS & . MINOR DIAGNOSES SOI 2. OTHER RESPIRATORY DIAGNOSES EXCEPT SIGNS, SYMPTOMS & . MINOR DIAGNOSES SOI 3. RESPIRATORY SIGNS, SYMPTOMS & MINOR DIAGNOSES SOI 1. RESPIRATORY SIGNS, SYMPTOMS & MINOR DIAGNOSES SOI 2. RESPIRATORY SIGNS, SYMPTOMS & MINOR DIAGNOSES SOI 3. CARDIOTHORACIC PROCEDURES SOI 4. VASCULAR PROCEDURES SOI 4. OTHER CIRCULATORY SYSTEM PROCEDURES SOI 4. Jkt 208001 PO 00000 Frm 00429 Fmt 4701 Sfmt 4702 E:\FR\FM\25APP2.SGM 25APP2 24424 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules APPENDIX C.—COMBINATIONS OF PROPOSED CONSOLIDATED SEVERITY-ADJUSTED DRGS—Continued wwhite on PROD1PC61 with PROPOSALS2 Type S S S S S S S S S S S S S S S S S S S S S S S S S S S S S S S S S S S S S S S S S S S S S M M M M M M M M M M M M M M M M M M M M M M M M M Consolidated severity-adjusted DRG MDC ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... VerDate Aug<31>2005 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 207 208 209 210 211 212 213 214 215 216 217 218 219 220 221 222 223 224 225 226 227 228 229 230 231 232 233 234 235 236 237 238 239 240 241 242 243 244 245 246 247 248 249 250 251 252 253 254 255 256 257 258 259 260 261 262 263 264 265 266 267 268 269 270 271 272 273 274 275 276 17:10 Apr 24, 2006 Consolidated severity-adjusted DRG description CARDIAC DEFIBRILLATOR & HEART ASSIST IMPLANT SOI 1. CARDIAC DEFIBRILLATOR & HEART ASSIST IMPLANT SOI 2. CARDIAC DEFIBRILLATOR & HEART ASSIST IMPLANT SOI 3. CARDIAC VALVE PROCEDURES W CARDIAC CATHETERIZATION . SOI 1. CARDIAC VALVE PROCEDURES W CARDIAC CATHETERIZATION . SOI 2. CARDIAC VALVE PROCEDURES W CARDIAC CATHETERIZATION . SOI 3. CARDIAC VALVE PROCEDURES W/O CARDIAC CATHETERIZATION SOI 1. CARDIAC VALVE PROCEDURES W/O CARDIAC CATHETERIZATION SOI 2. CARDIAC VALVE PROCEDURES W/O CARDIAC CATHETERIZATION SOI 3. CORONARY BYPASS W CARDIAC CATH OR PERCUTANEOUS CARDIAC PROCEDURE SOI 1. CORONARY BYPASS W CARDIAC CATH OR PERCUTANEOUS CARDIAC PROCEDURE SOI 2. CORONARY BYPASS W CARDIAC CATH OR PERCUTANEOUS CARDIAC PROCEDURE SOI 3. CORONARY BYPASS W/O CARDIAC CATH OR PERCUTANEOUS CARDIAC PROCEDURE SOI 1. CORONARY BYPASS W/O CARDIAC CATH OR PERCUTANEOUS CARDIAC PROCEDURE SOI 2. CORONARY BYPASS W/O CARDIAC CATH OR PERCUTANEOUS CARDIAC PROCEDURE SOI 3. OTHER CARDIOTHORACIC PROCEDURES SOI 1. OTHER CARDIOTHORACIC PROCEDURES SOI 2. OTHER CARDIOTHORACIC PROCEDURES SOI 3. MAJOR THORACIC & ABDOMINAL VASCULAR PROCEDURES SOI 1. MAJOR THORACIC & ABDOMINAL VASCULAR PROCEDURES SOI 2. MAJOR THORACIC & ABDOMINAL VASCULAR PROCEDURES SOI 3. PERMANENT CARDIAC PACEMAKER IMPLANT W AMI, HEART FAILURE OR SHOCK SOI 1. PERMANENT CARDIAC PACEMAKER IMPLANT W AMI, HEART FAILURE OR SHOCK SOI 2. PERMANENT CARDIAC PACEMAKER IMPLANT W AMI, HEART FAILURE OR SHOCK SOI 3. PERM CARDIAC PACEMAKER IMPLANT W/O AMI, HEART FAILURE OR SHOCK SOI 1. PERM CARDIAC PACEMAKER IMPLANT W/O AMI, HEART FAILURE OR SHOCK SOI 2. PERM CARDIAC PACEMAKER IMPLANT W/O AMI, HEART FAILURE OR SHOCK SOI 3. OTHER VASCULAR PROCEDURES SOI 1. OTHER VASCULAR PROCEDURES SOI 2. OTHER VASCULAR PROCEDURES SOI 3. PERCUTANEOUS CARDIOVASCULAR PROCEDURES W AMI SOI 1. PERCUTANEOUS CARDIOVASCULAR PROCEDURES W AMI SOI 2. PERCUTANEOUS CARDIOVASCULAR PROCEDURES W AMI SOI 3. PERCUTANEOUS CARDIOVASCULAR PROCEDURES W/O AMI SOI 1. PERCUTANEOUS CARDIOVASCULAR PROCEDURES W/O AMI SOI 2. PERCUTANEOUS CARDIOVASCULAR PROCEDURES W/O AMI SOI 3. CARDIAC PACEMAKER & DEFIBRILLATOR DEVICE REPLACEMENT SOI 1. CARDIAC PACEMAKER & DEFIBRILLATOR DEVICE REPLACEMENT SOI 2. CARDIAC PACEMAKER & DEFIBRILLATOR DEVICE REPLACEMENT SOI 3. CARDIAC PACEMAKER & DEFIBRILLATOR REVISION EXCEPT DEVICE REPLACEMENT SOI 1. CARDIAC PACEMAKER & DEFIBRILLATOR REVISION EXCEPT DEVICE REPLACEMENT SOI 2. CARDIAC PACEMAKER & DEFIBRILLATOR REVISION EXCEPT DEVICE REPLACEMENT SOI 3. OTHER CIRCULATORY SYSTEM PROCEDURES SOI 1. OTHER CIRCULATORY SYSTEM PROCEDURES SOI 2. OTHER CIRCULATORY SYSTEM PROCEDURES SOI 3. CIRCULATORY SYSTEM DIAGNOSES SOI 4. ACUTE MYOCARDIAL INFARCTION SOI 1. ACUTE MYOCARDIAL INFARCTION SOI 2. ACUTE MYOCARDIAL INFARCTION SOI 3. CARDIAC CATHETERIZATION W CIRC DISORD EXC ISCHEMIC HEART DISEASE SOI 1. CARDIAC CATHETERIZATION W CIRC DISORD EXC ISCHEMIC HEART DISEASE SOI 2. CARDIAC CATHETERIZATION W CIRC DISORD EXC ISCHEMIC HEART DISEASE SOI 3. CARDIAC CATHETERIZATION FOR ISCHEMIC HEART DISEASE SOI 1. CARDIAC CATHETERIZATION FOR ISCHEMIC HEART DISEASE SOI 2. CARDIAC CATHETERIZATION FOR ISCHEMIC HEART DISEASE SOI 3. ACUTE & SUBACUTE ENDOCARDITIS SOI 1. ACUTE & SUBACUTE ENDOCARDITIS SOI 2. ACUTE & SUBACUTE ENDOCARDITIS SOI 3. HEART FAILURE SOI 1. HEART FAILURE SOI 2. HEART FAILURE SOI 3. CARDIAC ARREST SOI 1. CARDIAC ARREST SOI 2. CARDIAC ARREST SOI 3. PERIPHERAL & OTHER VASCULAR DISORDERS SOI 1. PERIPHERAL & OTHER VASCULAR DISORDERS SOI 2. PERIPHERAL & OTHER VASCULAR DISORDERS SOI 3. ANGINA PECTORIS & CORONARY ATHEROSCLEROSIS SOI 1. ANGINA PECTORIS & CORONARY ATHEROSCLEROSIS SOI 2. ANGINA PECTORIS & CORONARY ATHEROSCLEROSIS SOI 3. Jkt 208001 PO 00000 Frm 00430 Fmt 4701 Sfmt 4702 E:\FR\FM\25APP2.SGM 25APP2 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules 24425 APPENDIX C.—COMBINATIONS OF PROPOSED CONSOLIDATED SEVERITY-ADJUSTED DRGS—Continued wwhite on PROD1PC61 with PROPOSALS2 Type M M M M M M M M M M M M M M M M M M M M M M M M S S S S S S S S S S S S S S S S S S S S S S S S S S S S S S S S M M M M M M M M M M M M M M Consolidated severity-adjusted DRG MDC ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... VerDate Aug<31>2005 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 277 278 279 280 281 282 283 284 285 286 287 288 289 290 291 292 293 294 295 296 297 298 299 300 301 302 303 304 305 306 307 308 309 310 311 312 313 314 315 316 317 318 319 320 321 322 323 324 325 326 327 328 329 330 331 332 333 334 335 336 337 338 339 340 341 342 343 344 345 346 17:10 Apr 24, 2006 Consolidated severity-adjusted DRG description HYPERTENSION SOI 1. HYPERTENSION SOI 2. HYPERTENSION SOI 3. CARDIAC STRUCTURAL & VALVULAR DISORDERS SOI 1. CARDIAC STRUCTURAL & VALVULAR DISORDERS SOI 2. CARDIAC STRUCTURAL & VALVULAR DISORDERS SOI 3. CARDIAC ARRHYTHMIA & CONDUCTION DISORDERS SOI 1. CARDIAC ARRHYTHMIA & CONDUCTION DISORDERS SOI 2. CARDIAC ARRHYTHMIA & CONDUCTION DISORDERS SOI 3. CHEST PAIN SOI 1. CHEST PAIN SOI 2. CHEST PAIN SOI 3. SYNCOPE & COLLAPSE SOI 1. SYNCOPE & COLLAPSE SOI 2. SYNCOPE & COLLAPSE SOI 3. CARDIOMYOPATHY SOI 1. CARDIOMYOPATHY SOI 2. CARDIOMYOPATHY SOI 3. MALFUNCTION, REACTION, COMPLICATION OF CARDIAC/VASC DEVICE OR PROCEDURE SOI 1. MALFUNCTION, REACTION, COMPLICATION OF CARDIAC/VASC DEVICE OR PROCEDURE SOI 2. MALFUNCTION, REACTION, COMPLICATION OF CARDIAC/VASC DEVICE OR PROCEDURE SOI 3. OTHER CIRCULATORY SYSTEM DIAGNOSES SOI 1. OTHER CIRCULATORY SYSTEM DIAGNOSES SOI 2. OTHER CIRCULATORY SYSTEM DIAGNOSES SOI 3. MAJOR GASTROINTESTINAL PROCEDURES SOI 4. OTHER GASTROINTESTINAL & ABDOMINAL PROCEDURES SOI 4. MAJOR STOMACH, ESOPHAGEAL & DUODENAL PROCEDURES SOI 1. MAJOR STOMACH, ESOPHAGEAL & DUODENAL PROCEDURES SOI 2. MAJOR STOMACH, ESOPHAGEAL & DUODENAL PROCEDURES SOI 3. MAJOR SMALL & LARGE BOWEL PROCEDURES SOI 1. MAJOR SMALL & LARGE BOWEL PROCEDURES SOI 2. MAJOR SMALL & LARGE BOWEL PROCEDURES SOI 3. OTHER STOMACH, ESOPHAGEAL & DUODENAL PROCEDURES SOI 1. OTHER STOMACH, ESOPHAGEAL & DUODENAL PROCEDURES SOI 2. OTHER STOMACH, ESOPHAGEAL & DUODENAL PROCEDURES SOI 3. OTHER SMALL & LARGE BOWEL PROCEDURES SOI 1. OTHER SMALL & LARGE BOWEL PROCEDURES SOI 2. OTHER SMALL & LARGE BOWEL PROCEDURES SOI 3. PERITONEAL ADHESIOLYSIS SOI 1. PERITONEAL ADHESIOLYSIS SOI 2. PERITONEAL ADHESIOLYSIS SOI 3. APPENDECTOMY SOI 1. APPENDECTOMY SOI 2. APPENDECTOMY SOI 3. ANAL PROCEDURES SOI 1. ANAL PROCEDURES SOI 2. ANAL PROCEDURES SOI 3. HERNIA PROCEDURES EXCEPT INGUINAL, FEMORAL & UMBILICAL SOI 1. HERNIA PROCEDURES EXCEPT INGUINAL, FEMORAL & UMBILICAL SOI 2. HERNIA PROCEDURES EXCEPT INGUINAL, FEMORAL & UMBILICAL SOI 3. INGUINAL, FEMORAL & UMBILICAL HERNIA PROCEDURES SOI 1. INGUINAL, FEMORAL & UMBILICAL HERNIA PROCEDURES SOI 2. INGUINAL, FEMORAL & UMBILICAL HERNIA PROCEDURES SOI 3. OTHER DIGESTIVE SYSTEM & ABDOMINAL PROCEDURES SOI 1. OTHER DIGESTIVE SYSTEM & ABDOMINAL PROCEDURES SOI 2. OTHER DIGESTIVE SYSTEM & ABDOMINAL PROCEDURES SOI 3. DIGESTIVE SYSTEM DIAGNOSES SOI 4. DIGESTIVE MALIGNANCY SOI 1. DIGESTIVE MALIGNANCY SOI 2. DIGESTIVE MALIGNANCY SOI 3. PEPTIC ULCER & GASTRITIS SOI 1. PEPTIC ULCER & GASTRITIS SOI 2. PEPTIC ULCER & GASTRITIS SOI 3. MAJOR ESOPHAGEAL DISORDERS SOI 1. MAJOR ESOPHAGEAL DISORDERS SOI 2. MAJOR ESOPHAGEAL DISORDERS SOI 3. OTHER ESOPHAGEAL DISORDERS SOI 1. OTHER ESOPHAGEAL DISORDERS SOI 2. OTHER ESOPHAGEAL DISORDERS SOI 3. DIVERTICULITIS & DIVERTICULOSIS SOI 1. Jkt 208001 PO 00000 Frm 00431 Fmt 4701 Sfmt 4702 E:\FR\FM\25APP2.SGM 25APP2 24426 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules APPENDIX C.—COMBINATIONS OF PROPOSED CONSOLIDATED SEVERITY-ADJUSTED DRGS—Continued wwhite on PROD1PC61 with PROPOSALS2 Type M M M M M M M M M M M M M M M M M M M M M M M M M M M M M S S S S S S S S S S S S S S S S S M M M M M M M M M M M M M M M M M M M S S S S S Consolidated severity-adjusted DRG MDC ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... VerDate Aug<31>2005 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 8 8 8 8 8 347 348 349 350 351 352 353 354 355 356 357 358 359 360 361 362 363 364 365 366 367 368 369 370 371 372 373 374 375 376 377 378 379 380 381 382 383 384 385 386 387 388 389 390 391 392 393 394 395 396 397 398 399 400 401 402 403 404 405 406 407 408 409 410 411 412 413 414 415 416 17:10 Apr 24, 2006 Consolidated severity-adjusted DRG description DIVERTICULITIS & DIVERTICULOSIS SOI 2. DIVERTICULITIS & DIVERTICULOSIS SOI 3. INFLAMMATORY BOWEL DISEASE SOI 1. INFLAMMATORY BOWEL DISEASE SOI 2. INFLAMMATORY BOWEL DISEASE SOI 3. GASTROINTESTINAL VASCULAR INSUFFICIENCY SOI 1. GASTROINTESTINAL VASCULAR INSUFFICIENCY SOI 2. GASTROINTESTINAL VASCULAR INSUFFICIENCY SOI 3. INTESTINAL OBSTRUCTION SOI 1. INTESTINAL OBSTRUCTION SOI 2. INTESTINAL OBSTRUCTION SOI 3. MAJOR GASTROINTESTINAL & PERITONEAL INFECTIONS SOI 1. MAJOR GASTROINTESTINAL & PERITONEAL INFECTIONS SOI 2. MAJOR GASTROINTESTINAL & PERITONEAL INFECTIONS SOI 3. NON-BACTERIAL GASTROENTERITIS, NAUSEA & VOMITING SOI 1. NON-BACTERIAL GASTROENTERITIS, NAUSEA & VOMITING SOI 2. NON-BACTERIAL GASTROENTERITIS, NAUSEA & VOMITING SOI 3. ABDOMINAL PAIN SOI 1. ABDOMINAL PAIN SOI 2. ABDOMINAL PAIN SOI 3. MALFUNCTION, REACTION & COMPLICATION OF GI DEVICE OR PROCEDURE SOI 1. MALFUNCTION, REACTION & COMPLICATION OF GI DEVICE OR PROCEDURE SOI 2. MALFUNCTION, REACTION & COMPLICATION OF GI DEVICE OR PROCEDURE SOI 3. OTHER & UNSPECIFIED GASTROINTESTINAL HEMORRHAGE SOI 1. OTHER & UNSPECIFIED GASTROINTESTINAL HEMORRHAGE SOI 2. OTHER & UNSPECIFIED GASTROINTESTINAL HEMORRHAGE SOI 3. OTHER DIGESTIVE SYSTEM DIAGNOSES SOI 1. OTHER DIGESTIVE SYSTEM DIAGNOSES SOI 2. OTHER DIGESTIVE SYSTEM DIAGNOSES SOI 3. MAJOR HEPATOBILIARY, PANCREAS & LIVER PROCEDURES SOI 4. CHOLECYSTECTOMY AND OTHER HEPATOBILIARY, PANCREAS & ABDOMINAL PROCEDURES SOI 4. MAJOR PANCREAS, LIVER & SHUNT PROCEDURES SOI 1. MAJOR PANCREAS, LIVER & SHUNT PROCEDURES SOI 2. MAJOR PANCREAS, LIVER & SHUNT PROCEDURES SOI 3. MAJOR BILIARY TRACT PROCEDURES SOI 1. MAJOR BILIARY TRACT PROCEDURES SOI 2. MAJOR BILIARY TRACT PROCEDURES SOI 3. CHOLECYSTECTOMY EXCEPT LAPAROSCOPIC SOI 1. CHOLECYSTECTOMY EXCEPT LAPAROSCOPIC SOI 2. CHOLECYSTECTOMY EXCEPT LAPAROSCOPIC SOI 3. LAPAROSCOPIC CHOLECYSTECTOMY SOI 1. LAPAROSCOPIC CHOLECYSTECTOMY SOI 2. LAPAROSCOPIC CHOLECYSTECTOMY SOI 3. OTHER HEPATOBILIARY, PANCREAS & ABDOMINAL PROCEDURES SOI 1. OTHER HEPATOBILIARY, PANCREAS & ABDOMINAL PROCEDURES SOI 2. OTHER HEPATOBILIARY, PANCREAS & ABDOMINAL PROCEDURES SOI 3. HEPATOBILIARY, PANCREAS & ABDOMINAL DIAGNOSES SOI 4. HEPATIC COMA & OTHER MAJOR ACUTE LIVER DISORDERS SOI 1. HEPATIC COMA & OTHER MAJOR ACUTE LIVER DISORDERS SOI 2. HEPATIC COMA & OTHER MAJOR ACUTE LIVER DISORDERS SOI 3. ALCOHOLIC LIVER DISEASE SOI 1. ALCOHOLIC LIVER DISEASE SOI 2. ALCOHOLIC LIVER DISEASE SOI 3. MALIGNANCY OF HEPATOBILIARY SYSTEM & PANCREAS SOI 1. MALIGNANCY OF HEPATOBILIARY SYSTEM & PANCREAS SOI 2. MALIGNANCY OF HEPATOBILIARY SYSTEM & PANCREAS SOI 3. DISORDERS OF PANCREAS EXCEPT MALIGNANCY SOI 1. DISORDERS OF PANCREAS EXCEPT MALIGNANCY SOI 2. DISORDERS OF PANCREAS EXCEPT MALIGNANCY SOI 3. OTHER DISORDERS OF THE LIVER SOI 1. OTHER DISORDERS OF THE LIVER SOI 2. OTHER DISORDERS OF THE LIVER SOI 3. DISORDERS OF GALLBLADDER & BILIARY TRACT SOI 1. DISORDERS OF GALLBLADDER & BILIARY TRACT SOI 2. DISORDERS OF GALLBLADDER & BILIARY TRACT SOI 3. MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE PROCEDURES EXCEPT SPINAL FUSION SOI 4. SPINAL FUSION PROCEDURES SOI 4. HIP JOINT REPLACEMENT SOI 1. HIP JOINT REPLACEMENT SOI 2. HIP JOINT REPLACEMENT SOI 3. Jkt 208001 PO 00000 Frm 00432 Fmt 4701 Sfmt 4702 E:\FR\FM\25APP2.SGM 25APP2 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules 24427 APPENDIX C.—COMBINATIONS OF PROPOSED CONSOLIDATED SEVERITY-ADJUSTED DRGS—Continued wwhite on PROD1PC61 with PROPOSALS2 Type S S S S S S S S S S S S S S S S S S S S S S S S S S S S S S S S S S S S S S S S S S S S S S S M M M M M M M M M M M M M M M M M M M M M M M Consolidated severity-adjusted DRG MDC ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... VerDate Aug<31>2005 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 417 418 419 420 421 422 423 424 425 426 427 428 429 430 431 432 433 434 435 436 437 438 439 440 441 442 443 444 445 446 447 448 449 450 451 452 453 454 455 456 457 458 459 460 461 462 463 464 465 466 467 468 469 470 471 472 473 474 475 476 477 478 479 480 481 482 483 484 485 486 17:10 Apr 24, 2006 Consolidated severity-adjusted DRG description KNEE JOINT REPLACEMENT SOI 1. KNEE JOINT REPLACEMENT SOI 2. KNEE JOINT REPLACEMENT SOI 3. DORSAL & LUMBAR FUSION PROC FOR CURVATURE OF BACK SOI 1. DORSAL & LUMBAR FUSION PROC FOR CURVATURE OF BACK SOI 2. DORSAL & LUMBAR FUSION PROC FOR CURVATURE OF BACK SOI 3. DORSAL & LUMBAR FUSION PROC EXCEPT FOR CURVATURE OF BACK SOI 1. DORSAL & LUMBAR FUSION PROC EXCEPT FOR CURVATURE OF BACK SOI 2. DORSAL & LUMBAR FUSION PROC EXCEPT FOR CURVATURE OF BACK SOI 3. AMPUTATION OF LOWER LIMB EXCEPT TOES SOI 1. AMPUTATION OF LOWER LIMB EXCEPT TOES SOI 2. AMPUTATION OF LOWER LIMB EXCEPT TOES SOI 3. HIP & FEMUR PROCEDURES FOR TRAUMA EXCEPT JOINT REPLACEMENT SOI 1. HIP & FEMUR PROCEDURES FOR TRAUMA EXCEPT JOINT REPLACEMENT SOI 2. HIP & FEMUR PROCEDURES FOR TRAUMA EXCEPT JOINT REPLACEMENT SOI 3. HIP & FEMUR PROCEDURES FOR NON-TRAUMA EXCEPT JOINT REPLACEMENT SOI 1. HIP & FEMUR PROCEDURES FOR NON-TRAUMA EXCEPT JOINT REPLACEMENT SOI 2. HIP & FEMUR PROCEDURES FOR NON-TRAUMA EXCEPT JOINT REPLACEMENT SOI 3. INTERVERTEBRAL DISC EXCISION & DECOMPRESSION SOI 1. INTERVERTEBRAL DISC EXCISION & DECOMPRESSION SOI 2. INTERVERTEBRAL DISC EXCISION & DECOMPRESSION SOI 3. SKIN GRAFT, EXCEPT HAND, FOR MUSCULOSKELETAL & CONNECTIVE TISSUE DIAGNOSES SKIN GRAFT, EXCEPT HAND, FOR MUSCULOSKELETAL & CONNECTIVE TISSUE DIAGNOSES SKIN GRAFT, EXCEPT HAND, FOR MUSCULOSKELETAL & CONNECTIVE TISSUE DIAGNOSES SKIN GRAFT, EXCEPT HAND, FOR MUSCULOSKELETAL & CONNECTIVE TISSUE DIAGNOSES KNEE & LOWER LEG PROCEDURES EXCEPT FOOT SOI 1. KNEE & LOWER LEG PROCEDURES EXCEPT FOOT SOI 2. KNEE & LOWER LEG PROCEDURES EXCEPT FOOT SOI 3. FOOT & TOE PROCEDURES SOI 1. FOOT & TOE PROCEDURES SOI 2. FOOT & TOE PROCEDURES SOI 3. SHOULDER, UPPER ARM & FOREARM PROCEDURES SOI 1. SHOULDER, UPPER ARM & FOREARM PROCEDURES SOI 2. SHOULDER, UPPER ARM & FOREARM PROCEDURES SOI 3. HAND & WRIST PROCEDURES SOI 1. HAND & WRIST PROCEDURES SOI 2. HAND & WRIST PROCEDURES SOI 3. TENDON, MUSCLE & OTHER SOFT TISSUE PROCEDURES SOI 1. TENDON, MUSCLE & OTHER SOFT TISSUE PROCEDURES SOI 2. TENDON, MUSCLE & OTHER SOFT TISSUE PROCEDURES SOI 3. OTHER MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE PROCEDURES SOI 1. OTHER MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE PROCEDURES SOI 2. OTHER MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE PROCEDURES SOI 3. OTHER MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE PROCEDURES SOI 4. CERVICAL SPINAL FUSION & OTHER BACK/NECK PROC EXC DISC EXCIS/DECOMP SOI 1. CERVICAL SPINAL FUSION & OTHER BACK/NECK PROC EXC DISC EXCIS/DECOMP SOI 2. CERVICAL SPINAL FUSION & OTHER BACK/NECK PROC EXC DISC EXCIS/DECOMP SOI 3. MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE DIAGNOSES SOI 4. FRACTURE OF FEMUR SOI 1. FRACTURE OF FEMUR SOI 2. FRACTURE OF FEMUR SOI 3. FRACTURE OF PELVIS OR DISLOCATION OF HIP SOI 1. FRACTURE OF PELVIS OR DISLOCATION OF HIP SOI 2. FRACTURE OF PELVIS OR DISLOCATION OF HIP SOI 3. FRACTURES & DISLOCATIONS EXCEPT FEMUR, PELVIS & BACK SOI 1. FRACTURES & DISLOCATIONS EXCEPT FEMUR, PELVIS & BACK SOI 2. FRACTURES & DISLOCATIONS EXCEPT FEMUR, PELVIS & BACK SOI 3. MUSCULOSKELETAL MALIGNANCY & PATHOL FRACTURE D/T MUSCSKEL MALIG SOI 1. MUSCULOSKELETAL MALIGNANCY & PATHOL FRACTURE D/T MUSCSKEL MALIG SOI 2. MUSCULOSKELETAL MALIGNANCY & PATHOL FRACTURE D/T MUSCSKEL MALIG SOI 3. OSTEOMYELITIS, SEPTIC ARTHRITIS & OTHER MUSCULOSKELETAL INFECTIONS SOI 1. OSTEOMYELITIS, SEPTIC ARTHRITIS & OTHER MUSCULOSKELETAL INFECTIONS SOI 2. OSTEOMYELITIS, SEPTIC ARTHRITIS & OTHER MUSCULOSKELETAL INFECTIONS SOI 3. CONNECTIVE TISSUE DISORDERS SOI 1. CONNECTIVE TISSUE DISORDERS SOI 2. CONNECTIVE TISSUE DISORDERS SOI 3. OTHER BACK & NECK DISORDERS, FRACTURES & INJURIES SOI 1. OTHER BACK & NECK DISORDERS, FRACTURES & INJURIES SOI 2. OTHER BACK & NECK DISORDERS, FRACTURES & INJURIES SOI 3. MALFUNCTION, REACTION, COMPLIC OF ORTHOPEDIC DEVICE OR PROCEDURE SOI 1. Jkt 208001 PO 00000 Frm 00433 Fmt 4701 Sfmt 4702 E:\FR\FM\25APP2.SGM 25APP2 SOI SOI SOI SOI 1. 2. 3. 4. 24428 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules APPENDIX C.—COMBINATIONS OF PROPOSED CONSOLIDATED SEVERITY-ADJUSTED DRGS—Continued wwhite on PROD1PC61 with PROPOSALS2 Type M M M M M S S S S S S S S S S S S S M M M M M M M M M M M M M M M M M M M S S S S S S S S S S S S S M M M M M M M M M M M M M M M M M M M S MDC ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... VerDate Aug<31>2005 8 8 8 8 8 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 10 10 10 10 10 10 10 10 10 10 10 10 10 10 10 10 10 10 10 10 10 10 10 10 10 10 10 10 10 10 10 10 11 Consolidated severity-adjusted DRG 487 488 489 490 491 492 493 494 495 496 497 498 499 500 501 502 503 504 505 506 507 508 509 510 511 512 513 514 515 516 517 518 519 520 521 522 523 524 525 526 527 528 529 530 531 532 533 534 535 536 537 538 539 540 541 542 543 544 545 546 547 548 549 550 551 552 553 554 555 556 17:10 Apr 24, 2006 Consolidated severity-adjusted DRG description MALFUNCTION, REACTION, COMPLIC OF ORTHOPEDIC DEVICE OR PROCEDURE SOI 2. MALFUNCTION, REACTION, COMPLIC OF ORTHOPEDIC DEVICE OR PROCEDURE SOI 3. OTHER MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE DIAGNOSES SOI 1. OTHER MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE DIAGNOSES SOI 2. OTHER MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE DIAGNOSES SOI 3. SKIN, SUBCUTANEOUS TISSUE, BREAST & RELATED PROCEDURES SOI 4. SKIN GRAFT FOR SKIN & SUBCUTANEOUS TISSUE DIAGNOSES SOI 1. SKIN GRAFT FOR SKIN & SUBCUTANEOUS TISSUE DIAGNOSES SOI 2. SKIN GRAFT FOR SKIN & SUBCUTANEOUS TISSUE DIAGNOSES SOI 3. MASTECTOMY PROCEDURES SOI 1. MASTECTOMY PROCEDURES SOI 2. MASTECTOMY PROCEDURES SOI 3. BREAST PROCEDURES EXCEPT MASTECTOMY SOI 1. BREAST PROCEDURES EXCEPT MASTECTOMY SOI 2. BREAST PROCEDURES EXCEPT MASTECTOMY SOI 3. OTHER SKIN, SUBCUTANEOUS TISSUE & RELATED PROCEDURES SOI 1. OTHER SKIN, SUBCUTANEOUS TISSUE & RELATED PROCEDURES SOI 2. OTHER SKIN, SUBCUTANEOUS TISSUE & RELATED PROCEDURES SOI 3. SKIN, SUBCUTANEOUS TISSUE & BREAST DIAGNOSES SOI 4. SKIN ULCERS SOI 1. SKIN ULCERS SOI 2. SKIN ULCERS SOI 3. MAJOR SKIN DISORDERS SOI 1. MAJOR SKIN DISORDERS SOI 2. MAJOR SKIN DISORDERS SOI 3. MALIGNANT BREAST DISORDERS SOI 1. MALIGNANT BREAST DISORDERS SOI 2. MALIGNANT BREAST DISORDERS SOI 3. CELLULITIS & OTHER BACTERIAL SKIN INFECTIONS SOI 1. CELLULITIS & OTHER BACTERIAL SKIN INFECTIONS SOI 2. CELLULITIS & OTHER BACTERIAL SKIN INFECTIONS SOI 3. CONTUSION, OPEN WOUND & OTHER TRAUMA TO SKIN & SUBCUTANEOUS TISSUE SOI 1. CONTUSION, OPEN WOUND & OTHER TRAUMA TO SKIN & SUBCUTANEOUS TISSUE SOI 2. CONTUSION, OPEN WOUND & OTHER TRAUMA TO SKIN & SUBCUTANEOUS TISSUE SOI 3. OTHER SKIN, SUBCUTANEOUS TISSUE & BREAST DISORDERS SOI 1. OTHER SKIN, SUBCUTANEOUS TISSUE & BREAST DISORDERS SOI 2. OTHER SKIN, SUBCUTANEOUS TISSUE & BREAST DISORDERS SOI 3. PROCEDURES FOR ENDOCRINE, NUTRITIONAL & METABOLIC DISORDERS SOI 4. PITUITARY & ADRENAL PROCEDURES SOI 1. PITUITARY & ADRENAL PROCEDURES SOI 2. PITUITARY & ADRENAL PROCEDURES SOI 3. PROCEDURES FOR OBESITY SOI 1. PROCEDURES FOR OBESITY SOI 2. PROCEDURES FOR OBESITY SOI 3. THYROID, PARATHYROID & THYROGLOSSAL PROCEDURES SOI 1. THYROID, PARATHYROID & THYROGLOSSAL PROCEDURES SOI 2. THYROID, PARATHYROID & THYROGLOSSAL PROCEDURES SOI 3. OTHER PROCEDURES FOR ENDOCRINE, NUTRITIONAL & METABOLIC DISORDERS SOI 1. OTHER PROCEDURES FOR ENDOCRINE, NUTRITIONAL & METABOLIC DISORDERS SOI 2. OTHER PROCEDURES FOR ENDOCRINE, NUTRITIONAL & METABOLIC DISORDERS SOI 3. ENDOCRINE DIAGNOSES SOI 4. DIABETES SOI 1. DIABETES SOI 2. DIABETES SOI 3. MALNUTRITION, FAILURE TO THRIVE & OTHER NUTRITIONAL DISORDERS SOI 1. MALNUTRITION, FAILURE TO THRIVE & OTHER NUTRITIONAL DISORDERS SOI 2. MALNUTRITION, FAILURE TO THRIVE & OTHER NUTRITIONAL DISORDERS SOI 3. HYPOVOLEMIA & RELATED ELECTROLYTE DISORDERS SOI 1. HYPOVOLEMIA & RELATED ELECTROLYTE DISORDERS SOI 2. HYPOVOLEMIA & RELATED ELECTROLYTE DISORDERS SOI 3. INBORN ERRORS OF METABOLISM SOI 1. INBORN ERRORS OF METABOLISM SOI 2. INBORN ERRORS OF METABOLISM SOI 3. OTHER ENDOCRINE DISORDERS SOI 1. OTHER ENDOCRINE DISORDERS SOI 2. OTHER ENDOCRINE DISORDERS SOI 3. ELECTROLYTE DISORDERS EXCEPT HYPOVOLEMIA RELATED SOI 1. ELECTROLYTE DISORDERS EXCEPT HYPOVOLEMIA RELATED SOI 2. ELECTROLYTE DISORDERS EXCEPT HYPOVOLEMIA RELATED SOI 3. URINARY TRACT & RELATED PROCEDURES EXCEPT KIDNEY TRANSPLANT SOI 4. Jkt 208001 PO 00000 Frm 00434 Fmt 4701 Sfmt 4702 E:\FR\FM\25APP2.SGM 25APP2 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules APPENDIX C.—COMBINATIONS OF PROPOSED CONSOLIDATED SEVERITY-ADJUSTED DRGS—Continued wwhite on PROD1PC61 with PROPOSALS2 Type S S S S S S S S S S S S S S S S S S S S S S S S S M M M M M M M M M M M M M M M M M M M M M M S S S S S S S S S S S S S S S S M M M M M M M MDC ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... VerDate Aug<31>2005 11 11 11 11 11 11 11 11 11 11 11 11 11 11 11 11 11 11 11 11 11 11 11 11 11 11 11 11 11 11 11 11 11 11 11 11 11 11 11 11 11 11 11 11 11 11 11 12 12 12 12 12 12 12 12 12 12 12 12 12 12 12 12 12 12 12 12 12 12 12 Consolidated severity-adjusted DRG 557 558 559 560 561 562 563 564 565 566 567 568 569 570 571 572 573 574 575 576 577 578 579 580 581 582 583 584 585 586 587 588 589 590 591 592 593 594 595 596 597 598 599 600 601 602 603 604 605 606 607 608 609 610 611 612 613 614 615 616 617 618 619 620 621 622 623 624 625 626 17:10 Apr 24, 2006 Consolidated severity-adjusted DRG description KIDNEY TRANSPLANT SOI 1. KIDNEY TRANSPLANT SOI 2. KIDNEY TRANSPLANT SOI 3. KIDNEY TRANSPLANT SOI 4. MAJOR BLADDER PROCEDURES SOI 1. MAJOR BLADDER PROCEDURES SOI 2. MAJOR BLADDER PROCEDURES SOI 3. KIDNEY & URINARY TRACT PROCEDURES FOR MALIGNANCY SOI 1. KIDNEY & URINARY TRACT PROCEDURES FOR MALIGNANCY SOI 2. KIDNEY & URINARY TRACT PROCEDURES FOR MALIGNANCY SOI 3. KIDNEY & URINARY TRACT PROCEDURES FOR NONMALIGNANCY SOI 1. KIDNEY & URINARY TRACT PROCEDURES FOR NONMALIGNANCY SOI 2. KIDNEY & URINARY TRACT PROCEDURES FOR NONMALIGNANCY SOI 3. RENAL DIALYSIS ACCESS DEVICE PROCEDURE ONLY SOI 1. RENAL DIALYSIS ACCESS DEVICE PROCEDURE ONLY SOI 2. RENAL DIALYSIS ACCESS DEVICE PROCEDURE ONLY SOI 3. OTHER BLADDER PROCEDURES SOI 1. OTHER BLADDER PROCEDURES SOI 2. OTHER BLADDER PROCEDURES SOI 3. URETHRAL & TRANSURETHRAL PROCEDURES SOI 1. URETHRAL & TRANSURETHRAL PROCEDURES SOI 2. URETHRAL & TRANSURETHRAL PROCEDURES SOI 3. OTHER KIDNEY, URINARY TRACT & RELATED PROCEDURES SOI 1. OTHER KIDNEY, URINARY TRACT & RELATED PROCEDURES SOI 2. OTHER KIDNEY, URINARY TRACT & RELATED PROCEDURES SOI 3. KIDNEY & URINARY TRACT DIAGNOSES SOI 4. RENAL FAILURE SOI 1. RENAL FAILURE SOI 2. RENAL FAILURE SOI 3. KIDNEY & URINARY TRACT MALIGNANCY SOI 1. KIDNEY & URINARY TRACT MALIGNANCY SOI 2. KIDNEY & URINARY TRACT MALIGNANCY SOI 3. NEPHRITIS & NEPHROSIS SOI 1. NEPHRITIS & NEPHROSIS SOI 2. NEPHRITIS & NEPHROSIS SOI 3. KIDNEY & URINARY TRACT INFECTIONS SOI 1. KIDNEY & URINARY TRACT INFECTIONS SOI 2. KIDNEY & URINARY TRACT INFECTIONS SOI 3. URINARY STONES & ACQUIRED UPPER URINARY TRACT OBSTRUCTION SOI 1. URINARY STONES & ACQUIRED UPPER URINARY TRACT OBSTRUCTION SOI 2. URINARY STONES & ACQUIRED UPPER URINARY TRACT OBSTRUCTION SOI 3. MALFUNCTION, REACTION, COMPLIC OF GENITOURINARY DEVICE OR PROC SOI 1. MALFUNCTION, REACTION, COMPLIC OF GENITOURINARY DEVICE OR PROC SOI 2. MALFUNCTION, REACTION, COMPLIC OF GENITOURINARY DEVICE OR PROC SOI 3. OTHER KIDNEY & URINARY TRACT DIAGNOSES, SIGNS & SYMPTOMS SOI 1. OTHER KIDNEY & URINARY TRACT DIAGNOSES, SIGNS & SYMPTOMS SOI 2. OTHER KIDNEY & URINARY TRACT DIAGNOSES, SIGNS & SYMPTOMS SOI 3. MALE REPRODUCTIVE SYSTEM & RELATED PROCEDURES SOI 4. MAJOR MALE PELVIC PROCEDURES SOI 1. MAJOR MALE PELVIC PROCEDURES SOI 2. MAJOR MALE PELVIC PROCEDURES SOI 3. PENIS PROCEDURES SOI 1. PENIS PROCEDURES SOI 2. PENIS PROCEDURES SOI 3. TRANSURETHRAL PROSTATECTOMY SOI 1. TRANSURETHRAL PROSTATECTOMY SOI 2. TRANSURETHRAL PROSTATECTOMY SOI 3. TESTES & SCROTAL PROCEDURES SOI 1. TESTES & SCROTAL PROCEDURES SOI 2. TESTES & SCROTAL PROCEDURES SOI 3. OTHER MALE REPRODUCTIVE SYSTEM & RELATED PROCEDURES SOI 1. OTHER MALE REPRODUCTIVE SYSTEM & RELATED PROCEDURES SOI 2. OTHER MALE REPRODUCTIVE SYSTEM & RELATED PROCEDURES SOI 3. MALE REPRODUCTIVE SYSTEM DIAGNOSES SOI 4. MALIGNANCY, MALE REPRODUCTIVE SYSTEM SOI 1. MALIGNANCY, MALE REPRODUCTIVE SYSTEM SOI 2. MALIGNANCY, MALE REPRODUCTIVE SYSTEM SOI 3. MALE REPRODUCTIVE SYSTEM DIAGNOSES EXCEPT MALIGNANCY SOI 1. MALE REPRODUCTIVE SYSTEM DIAGNOSES EXCEPT MALIGNANCY SOI 2. MALE REPRODUCTIVE SYSTEM DIAGNOSES EXCEPT MALIGNANCY SOI 3. Jkt 208001 PO 00000 Frm 00435 Fmt 4701 Sfmt 4702 E:\FR\FM\25APP2.SGM 25APP2 24429 24430 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules APPENDIX C.—COMBINATIONS OF PROPOSED CONSOLIDATED SEVERITY-ADJUSTED DRGS—Continued wwhite on PROD1PC61 with PROPOSALS2 Type S S S S S S S S S S S S S S S S S S S S S S S S S M M M M M M M M M M S S S S S S S S S S S M M M M M M M M M M M M M M M M M M M M M M M M MDC ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... VerDate Aug<31>2005 13 13 13 13 13 13 13 13 13 13 13 13 13 13 13 13 13 13 13 13 13 13 13 13 13 13 13 13 13 13 13 13 13 13 13 14 14 14 14 14 14 14 14 14 14 14 14 14 14 14 14 14 14 14 14 14 14 15 15 15 15 15 15 15 15 15 15 15 15 15 Consolidated severity-adjusted DRG 627 628 629 630 631 632 633 634 635 636 637 638 639 640 641 642 643 644 645 646 647 648 649 650 651 652 653 654 655 656 657 658 659 660 661 662 663 664 665 666 667 668 669 670 671 672 673 674 675 676 677 678 679 680 681 682 683 684 685 686 687 688 689 690 691 692 693 694 695 696 17:10 Apr 24, 2006 Consolidated severity-adjusted DRG description FEMALE REPRODUCTIVE SYSTEM & RELATED PROCEDURES SOI 4. PELVIC EVISCERATION, RADICAL HYSTERECTOMY & OTHER RADICAL GYN PROCS SOI 1. PELVIC EVISCERATION, RADICAL HYSTERECTOMY & OTHER RADICAL GYN PROCS SOI 2. PELVIC EVISCERATION, RADICAL HYSTERECTOMY & OTHER RADICAL GYN PROCS SOI 3. UTERINE & ADNEXA PROCEDURES FOR OVARIAN & ADNEXAL MALIGNANCY SOI 1. UTERINE & ADNEXA PROCEDURES FOR OVARIAN & ADNEXAL MALIGNANCY SOI 2. UTERINE & ADNEXA PROCEDURES FOR OVARIAN & ADNEXAL MALIGNANCY SOI 3. UTERINE & ADNEXA PROCEDURES FOR NON-OVARIAN & NON-ADNEXAL MALIG SOI 1. UTERINE & ADNEXA PROCEDURES FOR NON-OVARIAN & NON-ADNEXAL MALIG SOI 2. UTERINE & ADNEXA PROCEDURES FOR NON-OVARIAN & NON-ADNEXAL MALIG SOI 3. UTERINE & ADNEXA PROCEDURES FOR NON-MALIGNANCY EXCEPT LEIOMYOMA SOI 1. UTERINE & ADNEXA PROCEDURES FOR NON-MALIGNANCY EXCEPT LEIOMYOMA SOI 2. UTERINE & ADNEXA PROCEDURES FOR NON-MALIGNANCY EXCEPT LEIOMYOMA SOI 3. FEMALE REPRODUCTIVE SYSTEM RECONSTRUCTIVE PROCEDURES SOI 1. FEMALE REPRODUCTIVE SYSTEM RECONSTRUCTIVE PROCEDURES SOI 2. FEMALE REPRODUCTIVE SYSTEM RECONSTRUCTIVE PROCEDURES SOI 3. DILATION & CURETTAGE FOR NON-OBSTETRIC DIAGNOSES SOI 1. DILATION & CURETTAGE FOR NON-OBSTETRIC DIAGNOSES SOI 2. DILATION & CURETTAGE FOR NON-OBSTETRIC DIAGNOSES SOI 3. OTHER FEMALE REPRODUCTIVE SYSTEM & RELATED PROCEDURES SOI 1. OTHER FEMALE REPRODUCTIVE SYSTEM & RELATED PROCEDURES SOI 2. OTHER FEMALE REPRODUCTIVE SYSTEM & RELATED PROCEDURES SOI 3. UTERINE & ADNEXA PROCEDURES FOR LEIOMYOMA SOI 1. UTERINE & ADNEXA PROCEDURES FOR LEIOMYOMA SOI 2. UTERINE & ADNEXA PROCEDURES FOR LEIOMYOMA SOI 3. FEMALE REPRODUCTIVE SYSTEM DIAGNOSES SOI 4. FEMALE REPRODUCTIVE SYSTEM MALIGNANCY SOI 1. FEMALE REPRODUCTIVE SYSTEM MALIGNANCY SOI 2. FEMALE REPRODUCTIVE SYSTEM MALIGNANCY SOI 3. FEMALE REPRODUCTIVE SYSTEM INFECTIONS SOI 1. FEMALE REPRODUCTIVE SYSTEM INFECTIONS SOI 2. FEMALE REPRODUCTIVE SYSTEM INFECTIONS SOI 3. MENSTRUAL & OTHER FEMALE REPRODUCTIVE SYSTEM DISORDERS SOI 1. MENSTRUAL & OTHER FEMALE REPRODUCTIVE SYSTEM DISORDERS SOI 2. MENSTRUAL & OTHER FEMALE REPRODUCTIVE SYSTEM DISORDERS SOI 3. O.R. PROC FOR OBSTETRIC DIAGNOSES EXCEPT CESAREAN DELIVERY SOI 4. CESAREAN DELIVERY SOI 1. CESAREAN DELIVERY SOI 2. CESAREAN DELIVERY SOI 3. CESAREAN DELIVERY SOI 4. VAGINAL DELIVERY PROCEDURES SOI 1. VAGINAL DELIVERY PROCEDURES SOI 2. VAGINAL DELIVERY PROCEDURES SOI 3. OTHER PROCEDURES FOR OBSTETRIC DIAGNOSES EXCEPT DELIVERY DIAGNOSES SOI 1. OTHER PROCEDURES FOR OBSTETRIC DIAGNOSES EXCEPT DELIVERY DIAGNOSES SOI 2. OTHER PROCEDURES FOR OBSTETRIC DIAGNOSES EXCEPT DELIVERY DIAGNOSES SOI 3. ANTEPARTUM DIAGNOSES EXCEPT VAGINAL DELIVERY DIAGNOSIS SOI 4. VAGINAL DELIVERY SOI 1. VAGINAL DELIVERY SOI 2. VAGINAL DELIVERY SOI 3. VAGINAL DELIVERY SOI 4. POSTPARTUM & ABORTION DIAGNOSES W/O PROCEDURE SOI 1. POSTPARTUM & ABORTION DIAGNOSES W/O PROCEDURE SOI 2. POSTPARTUM & ABORTION DIAGNOSES W/O PROCEDURE SOI 3. ANTEPARTUM DIAGNOSES SOI 1. ANTEPARTUM DIAGNOSES SOI 2. ANTEPARTUM DIAGNOSES SOI 3. NEONATE, TRANSFERRED <5 DAYS OLD SOI 1 & 2. NEONATE, TRANSFERRED <5 DAYS OLD SOI 3 & 4. EXTREME IMMATURITY OR RESPIRATORY DISTRESS SYNDROME, NEONATE SOI 1 & 2. EXTREME IMMATURITY OR RESPIRATORY DISTRESS SYNDROME, NEONATE SOI 3 & 4. PREMAUTRITY WITH MAJOR PROBLEMS SOI 1 & 2. PREMAUTRITY WITH MAJOR PROBLEMS SOI 3 & 4. PREMAUTRITY WITHOUT MAJOR PROBLEMS SOI 1 & 2. PREMAUTRITY WITHOUT MAJOR PROBLEMS SOI 3 & 4. FULL TERM NEONATE WITH MAJOR PROBLEMS SOI 1 & 2. FULL TERM NEONATE WITH MAJOR PROBLEMS SOI 3 & 4. NEONATE WITH OTHER SIGNIFICANT PROBLEMS SOI 1 & 2. NEONATE WITH OTHER SIGNIFICANT PROBLEMS SOI 3 & 4. NEONATE > 2,000 GRAMS WITHOUT SIGNIFICANT PROBLEMS SOI 1 & 2. Jkt 208001 PO 00000 Frm 00436 Fmt 4701 Sfmt 4702 E:\FR\FM\25APP2.SGM 25APP2 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules APPENDIX C.—COMBINATIONS OF PROPOSED CONSOLIDATED SEVERITY-ADJUSTED DRGS—Continued wwhite on PROD1PC61 with PROPOSALS2 Type M S S S S S S S M M M M M M M M M M M M M S S S S S S S M M M M M M M M M M M M M M M M M S S S S S S S M M M M M M M M M M M M M M M M S S MDC ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... VerDate Aug<31>2005 15 16 16 16 16 16 16 16 16 16 16 16 16 16 16 16 16 16 16 16 16 17 17 17 17 17 17 17 17 17 17 17 17 17 17 17 17 17 17 17 17 17 17 17 17 18 18 18 18 18 18 18 18 18 18 18 18 18 18 18 18 18 18 18 18 18 18 18 19 19 Consolidated severity-adjusted DRG 697 698 699 700 701 702 703 704 705 706 707 708 709 710 711 712 713 714 715 716 717 718 719 720 721 722 723 724 725 726 727 728 729 730 731 732 733 734 735 736 737 738 739 740 741 742 743 744 745 746 747 748 749 750 751 752 753 754 755 756 757 758 759 760 761 762 763 764 765 766 17:10 Apr 24, 2006 Consolidated severity-adjusted DRG description NEONATE > 2,000 GRAMS WITHOUT SIGNIFICANT PROBLEMS SOI 3 & 4. PROCEDURES OF BLOOD & BLOOD-FORMING ORGANS SOI 4. SPLENECTOMY SOI 1. SPLENECTOMY SOI 2. SPLENECTOMY SOI 3. OTHER PROCEDURES OF BLOOD & BLOOD-FORMING ORGANS SOI 1. OTHER PROCEDURES OF BLOOD & BLOOD-FORMING ORGANS SOI 2. OTHER PROCEDURES OF BLOOD & BLOOD-FORMING ORGANS SOI 3. ANEMIA & DIAGNOSES OF BLOOD & BLOOD-FORMING ORGANS SOI 4. MAJOR HEMATOLOGIC/IMMUNOLOGIC DIAG EXC SICKLE CELL CRISIS & COAGUL SOI 1. MAJOR HEMATOLOGIC/IMMUNOLOGIC DIAG EXC SICKLE CELL CRISIS & COAGUL SOI 2. MAJOR HEMATOLOGIC/IMMUNOLOGIC DIAG EXC SICKLE CELL CRISIS & COAGUL SOI 3. COAGULATION & PLATELET DISORDERS SOI 1. COAGULATION & PLATELET DISORDERS SOI 2. COAGULATION & PLATELET DISORDERS SOI 3. SICKLE CELL ANEMIA CRISIS SOI 1. SICKLE CELL ANEMIA CRISIS SOI 2. SICKLE CELL ANEMIA CRISIS SOI 3. OTHER ANEMIA & DISORDERS OF BLOOD & BLOOD-FORMING ORGANS SOI 1. OTHER ANEMIA & DISORDERS OF BLOOD & BLOOD-FORMING ORGANS SOI 2. OTHER ANEMIA & DISORDERS OF BLOOD & BLOOD-FORMING ORGANS SOI 3. PROCEDURES FOR LYMPHATIC/HEMATOPOIETIC/OTHER NEOPLASMS SOI 4. MAJOR O.R. PROCEDURES FOR LYMPHATIC/HEMATOPOIETIC/OTHER NEOPLASMS SOI 1. MAJOR O.R. PROCEDURES FOR LYMPHATIC/HEMATOPOIETIC/OTHER NEOPLASMS SOI 2. MAJOR O.R. PROCEDURES FOR LYMPHATIC/HEMATOPOIETIC/OTHER NEOPLASMS SOI 3. OTHER O.R. PROCEDURES FOR LYMPHATIC/HEMATOPOIETIC/OTHER NEOPLASMS SOI 1. OTHER O.R. PROCEDURES FOR LYMPHATIC/HEMATOPOIETIC/OTHER NEOPLASMS SOI 2. OTHER O.R. PROCEDURES FOR LYMPHATIC/HEMATOPOIETIC/OTHER NEOPLASMS SOI 3. LEUKEMIA, LYMPHOMA, MYELOMA, CHEMOTHERAPY, AND RADIOTHERAPY SOI 4. ACUTE LEUKEMIA SOI 1. ACUTE LEUKEMIA SOI 2. ACUTE LEUKEMIA SOI 3. LYMPHOMA, MYELOMA & NON-ACUTE LEUKEMIA SOI 1. LYMPHOMA, MYELOMA & NON-ACUTE LEUKEMIA SOI 2. LYMPHOMA, MYELOMA & NON-ACUTE LEUKEMIA SOI 3. RADIOTHERAPY SOI 1. RADIOTHERAPY SOI 2. RADIOTHERAPY SOI 3. CHEMOTHERAPY SOI 1. CHEMOTHERAPY SOI 2. CHEMOTHERAPY SOI 3. LYMPHATIC & OTHER MALIGNANCIES & NEOPLASMS OF UNCERTAIN BEHAVIOR SOI 1. LYMPHATIC & OTHER MALIGNANCIES & NEOPLASMS OF UNCERTAIN BEHAVIOR SOI 2. LYMPHATIC & OTHER MALIGNANCIES & NEOPLASMS OF UNCERTAIN BEHAVIOR SOI 3. LYMPHATIC & OTHER MALIGNANCIES & NEOPLASMS OF UNCERTAIN BEHAVIOR SOI 4. INFECTIOUS & PARASITIC DISEASES W O.R. PROCEDURE SOI 4. INFECTIOUS & PARASITIC DISEASES INCLUDING HIV W O.R. PROCEDURE SOI 1. INFECTIOUS & PARASITIC DISEASES INCLUDING HIV W O.R. PROCEDURE SOI 2. INFECTIOUS & PARASITIC DISEASES INCLUDING HIV W O.R. PROCEDURE SOI 3. POST-OP, POST-TRAUMA, OTHER DEVICE INFECTIONS W O.R. PROCEDURE SOI 1. POST-OP, POST-TRAUMA, OTHER DEVICE INFECTIONS W O.R. PROCEDURE SOI 2. POST-OP, POST-TRAUMA, OTHER DEVICE INFECTIONS W O.R. PROCEDURE SOI 3. INFECTIOUS & PARASITIC DISEASES SOI 4. SEPTICEMIA & DISSEMINATED INFECTIONS SOI 1. SEPTICEMIA & DISSEMINATED INFECTIONS SOI 2. SEPTICEMIA & DISSEMINATED INFECTIONS SOI 3. POST-OPERATIVE, POST-TRAUMATIC, OTHER DEVICE INFECTIONS SOI 1. POST-OPERATIVE, POST-TRAUMATIC, OTHER DEVICE INFECTIONS SOI 2. POST-OPERATIVE, POST-TRAUMATIC, OTHER DEVICE INFECTIONS SOI 3. FEVER SOI 1. FEVER SOI 2. FEVER SOI 3. VIRAL ILLNESS SOI 1. VIRAL ILLNESS SOI 2. VIRAL ILLNESS SOI 3. OTHER INFECTIOUS & PARASITIC DISEASES SOI 1. OTHER INFECTIOUS & PARASITIC DISEASES SOI 2. OTHER INFECTIOUS & PARASITIC DISEASES SOI 3. MENTAL ILLNESS DIAGNOSIS W O.R. PROCEDURE SOI 1. MENTAL ILLNESS DIAGNOSIS W O.R. PROCEDURE SOI 2. Jkt 208001 PO 00000 Frm 00437 Fmt 4701 Sfmt 4702 E:\FR\FM\25APP2.SGM 25APP2 24431 24432 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules APPENDIX C.—COMBINATIONS OF PROPOSED CONSOLIDATED SEVERITY-ADJUSTED DRGS—Continued wwhite on PROD1PC61 with PROPOSALS2 Type S S M M M M M M M M M M M M M M M M M M S S S S M M M M M M M M M M M M M S S S S M M M M M M M S S S S M M M M M M M M M M M M M M M M M M MDC ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... VerDate Aug<31>2005 19 19 19 19 19 19 19 19 19 19 19 19 19 19 20 20 20 20 20 20 21 21 21 21 21 21 21 21 21 21 21 21 21 21 21 21 21 22 22 22 22 22 22 22 22 22 22 22 23 23 23 23 23 23 23 23 23 23 23 23 23 23 24 24 24 24 24 24 24 24 Consolidated severity-adjusted DRG 767 768 769 770 771 772 773 774 775 776 777 778 779 780 781 782 783 784 785 786 787 788 789 790 791 792 793 794 795 796 797 798 799 800 801 802 803 804 805 806 807 808 809 810 811 812 813 814 815 816 817 818 819 820 821 822 823 824 825 826 827 828 829 830 831 832 833 834 835 836 17:10 Apr 24, 2006 Consolidated severity-adjusted DRG description MENTAL ILLNESS DIAGNOSIS W O.R. PROCEDURE SOI 3. MENTAL ILLNESS DIAGNOSIS W O.R. PROCEDURE SOI 4. MAJOR DEPRESSIVE, SCHIZOPHRENIA & BIPOLAR DISORDERS SOI 1. MAJOR DEPRESSIVE, SCHIZOPHRENIA & BIPOLAR DISORDERS SOI 2. MAJOR DEPRESSIVE, SCHIZOPHRENIA & BIPOLAR DISORDERS SOI 3. MAJOR DEPRESSIVE, SCHIZOPHRENIA & BIPOLAR DISORDERS SOI 4. ORGANIC MENTAL HEALTH DISTURBANCES SOI 1. ORGANIC MENTAL HEALTH DISTURBANCES SOI 2. ORGANIC MENTAL HEALTH DISTURBANCES SOI 3. ORGANIC MENTAL HEALTH DISTURBANCES SOI 4. OTHER MENTAL HEALTH DISORDERS SOI 1. OTHER MENTAL HEALTH DISORDERS SOI 2. OTHER MENTAL HEALTH DISORDERS SOI 3. OTHER MENTAL HEALTH DISORDERS SOI 4. DRUG & ALCOHOL ABUSE OR DEPENDENCE, LEFT AGAINST MEDICAL ADVICE SOI 1 & 2. DRUG & ALCOHOL ABUSE OR DEPENDENCE, LEFT AGAINST MEDICAL ADVICE SOI 3 & 4. DRUG ABUSE & DEPENDENCE DIAGNOSES SOI 1. DRUG ABUSE & DEPENDENCE DIAGNOSES SOI 2. DRUG ABUSE & DEPENDENCE DIAGNOSES SOI 3. DRUG ABUSE & DEPENDENCE DIAGNOSES SOI 4. O.R. PROCEDURE FOR OTHER COMPLICATIONS OF TREATMENT SOI 1. O.R. PROCEDURE FOR OTHER COMPLICATIONS OF TREATMENT SOI 2. O.R. PROCEDURE FOR OTHER COMPLICATIONS OF TREATMENT SOI 3. O.R. PROCEDURE FOR OTHER COMPLICATIONS OF TREATMENT SOI 4. INJURIES, POISONINGS & TOXIC EFFECTS OF DRUGS DIAGNOSES SOI 4. ALLERGIC REACTIONS SOI 1. ALLERGIC REACTIONS SOI 2. ALLERGIC REACTIONS SOI 3. POISONING OF MEDICINAL AGENTS SOI 1. POISONING OF MEDICINAL AGENTS SOI 2. POISONING OF MEDICINAL AGENTS SOI 3. OTHER COMPLICATIONS OF TREATMENT SOI 1. OTHER COMPLICATIONS OF TREATMENT SOI 2. OTHER COMPLICATIONS OF TREATMENT SOI 3. OTHER INJURY, POISONING & TOXIC EFFECT DIAGNOSES SOI 1. OTHER INJURY, POISONING & TOXIC EFFECT DIAGNOSES SOI 2. OTHER INJURY, POISONING & TOXIC EFFECT DIAGNOSES SOI 3. BURN PROCEDURES SOI 4. EXTENSIVE 3RD DEGREE OR FULL THICKNESS BURNS W SKIN GRAFT SOI 1. EXTENSIVE 3RD DEGREE OR FULL THICKNESS BURNS W SKIN GRAFT SOI 2. EXTENSIVE 3RD DEGREE OR FULL THICKNESS BURNS W SKIN GRAFT SOI 3. BURN DIAGNOSES SOI 4. EXTENSIVE 3RD DEGREE OR FULL THICKNESS BURNS W/O SKIN GRAFT SOI 1. EXTENSIVE 3RD DEGREE OR FULL THICKNESS BURNS W/O SKIN GRAFT SOI 2. EXTENSIVE 3RD DEGREE OR FULL THICKNESS BURNS W/O SKIN GRAFT SOI 3. PARTIAL THICKNESS BURNS W OR W/O SKIN GRAFT SOI 1. PARTIAL THICKNESS BURNS W OR W/O SKIN GRAFT SOI 2. PARTIAL THICKNESS BURNS W OR W/O SKIN GRAFT SOI 3. PROCEDURE W DIAG OF REHAB, AFTERCARE OR OTH CONTACT W HEALTH SERVICE SOI 1. PROCEDURE W DIAG OF REHAB, AFTERCARE OR OTH CONTACT W HEALTH SERVICE SOI 2. PROCEDURE W DIAG OF REHAB, AFTERCARE OR OTH CONTACT W HEALTH SERVICE SOI 3. PROCEDURE W DIAG OF REHAB, AFTERCARE OR OTH CONTACT W HEALTH SERVICE SOI 4. REHABILITATION / AFTERCARE / CONVALESCENCE EXCEPT NEONATAL AFTERCARE SOI 4. REHABILITATION SOI 1. REHABILITATION SOI 2. REHABILITATION SOI 3. SIGNS, SYMPTOMS & OTHER FACTORS INFLUENCING HEALTH STATUS SOI 1. SIGNS, SYMPTOMS & OTHER FACTORS INFLUENCING HEALTH STATUS SOI 2. SIGNS, SYMPTOMS & OTHER FACTORS INFLUENCING HEALTH STATUS SOI 3. OTHER AFTERCARE & CONVALESCENCE SOI 1. OTHER AFTERCARE & CONVALESCENCE SOI 2. OTHER AFTERCARE & CONVALESCENCE SOI 3. HIV DIAGNOSES SOI 4. HIV W MULTIPLE MAJOR HIV RELATED CONDITIONS SOI 1 & 2. HIV W MULTIPLE MAJOR HIV RELATED CONDITIONS SOI 3. HIV W MAJOR HIV RELATED CONDITION SOI 1 & 2. HIV W MAJOR HIV RELATED CONDITION SOI 3. HIV W MULTIPLE SIGNIFICANT HIV RELATED CONDITIONS SOI 1 & 2. HIV W MULTIPLE SIGNIFICANT HIV RELATED CONDITIONS SOI 3. HIV W ONE SIGNIF HIV COND OR W/O SIGNIF RELATED COND SOI 1. Jkt 208001 PO 00000 Frm 00438 Fmt 4701 Sfmt 4702 E:\FR\FM\25APP2.SGM 25APP2 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules 24433 APPENDIX C.—COMBINATIONS OF PROPOSED CONSOLIDATED SEVERITY-ADJUSTED DRGS—Continued Type M M S S S S S S S M M M S S S S S S S S S S S Consolidated severity-adjusted DRG MDC ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... 24 24 25 25 25 25 25 25 25 25 25 25 25 25 25 25 25 25 25 25 25 25 25 26 26 837 838 839 840 841 842 843 844 845 846 847 848 987 988 989 990 991 992 993 994 995 996 997 998 999 Consolidated severity-adjusted DRG description HIV W ONE SIGNIF HIV COND OR W/O SIGNIF RELATED COND SOI 2. HIV W ONE SIGNIF HIV COND OR W/O SIGNIF RELATED COND SOI 3. MULTIPLE SIGNIFICANT TRAUMA PROCEDURES SOI 4. CRANIOTOMY FOR MULTIPLE SIGNIFICANT TRAUMA SOI 1 & 2. CRANIOTOMY FOR MULTIPLE SIGNIFICANT TRAUMA SOI 3. EXTENSIVE ABDOMINAL/THORACIC PROCEDURES FOR MULT SIGNIFICANT TRAUMA SOI 1 & 2. EXTENSIVE ABDOMINAL/THORACIC PROCEDURES FOR MULT SIGNIFICANT TRAUMA SOI 3. MUSCULOSKELETAL & OTHER PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA SOI 1 & 2. MUSCULOSKELETAL & OTHER PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA SOI 3. MULTIPLE SIGNIFICANT TRAUMA W/O O.R. PROCEDURE SOI 1 & 2. MULTIPLE SIGNIFICANT TRAUMA W/O O.R. PROCEDURE SOI 3. MULTIPLE SIGNIFICANT TRAUMA W/O O.R. PROCEDURE SOI 4. EXTENSIVE PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS SOI 1. EXTENSIVE PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS SOI 2. EXTENSIVE PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS SOI 3. EXTENSIVE PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS SOI 4. NON MAJOR PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS SOI 4. MODERATELY EXTENSIVE PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS SOI 1. MODERATELY EXTENSIVE PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS SOI 2. MODERATELY EXTENSIVE PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS SOI 3. NONEXTENSIVE PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS SOI 1. NONEXTENSIVE PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS SOI 2. NONEXTENSIVE PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS SOI 3. PRINCIPAL DIAGNOSIS INVALID AS DISCHARGE DIAGNOSIS. UNGROUPABLE. M = Medical. S = Surgical. SOI = Severity of Illness Subclass APPENDIX D.—CROSSWALK OF PROPOSED CONSOLIDATED SEVERITY-ADJUSTED DRGS TO RESPECTIVE APR DRGS TYPE Consolidated severity-adjusted DRG MDC 0 1 S ........ 0 1 S ........ 0 2 S ........ 0 3 S ........ 0 4 S ........ 0 4 S S S S S S S ........ ........ ........ ........ ........ ........ ........ 0 0 0 0 0 0 0 5 6 7 8 9 10 11 S ........ 0 11 S ........ wwhite on PROD1PC61 with PROPOSALS2 S ........ 0 12 S ........ 0 13 S ........ 0 14 VerDate Aug<31>2005 17:10 Apr 24, 2006 Consolidated severity-adjusted DRG description APR DRG LIVER TRANSPLANT AND/OR INTESTINAL TRANSPLANT SOI 1 & 2. LIVER TRANSPLANT AND/OR INTESTINAL TRANSPLANT SOI 1 & 2. LIVER TRANSPLANT AND/OR INTESTINAL TRANSPLANT SOI 3. LIVER TRANSPLANT AND/OR INTESTINAL TRANSPLANT SOI 4. HEART &/OR LUNG TRANSPLANT SOI 1 & 2. HEART &/OR LUNG TRANSPLANT SOI 1 & 2. HEART &/OR LUNG TRANSPLANT SOI 3 HEART &/OR LUNG TRANSPLANT SOI 4 BONE MARROW TRANSPLANT SOI 1 ..... BONE MARROW TRANSPLANT SOI 2 ..... BONE MARROW TRANSPLANT SOI 3 ..... BONE MARROW TRANSPLANT SOI 4 ..... TRACHEOSTOMY W LONG TERM MECHANICAL VENTILATION W EXTENSIVE PROCEDURE SOI 1 & 2. TRACHEOSTOMY W LONG TERM MECHANICAL VENTILATION W EXTENSIVE PROCEDURE SOI 1 & 2. TRACHEOSTOMY W LONG TERM MECHANICAL VENTILATION W EXTENSIVE PROCEDURE SOI 3. TRACHEOSTOMY W LONG TERM MECHANICAL VENTILATION W EXTENSIVE PROCEDURE SOI 4. TRACHEOSTOMY W LONG TERM MECHANICAL VENTILATION W/O EXTENSIVE PROCEDURE SOI 1 & 2. Jkt 208001 PO 00000 Frm 00439 Fmt 4701 Sfmt 4702 SOI APR DRG description 001 1 001 2 001 3 001 4 002 1 LIVER TRANSPLANT AND/OR INTESTINAL TRANSPLANT SOI 1. LIVER TRANSPLANT AND/OR INTESTINAL TRANSPLANT SOI 2. LIVER TRANSPLANT AND/OR INTESTINAL TRANSPLANT SOI 3. LIVER TRANSPLANT AND/OR INTESTINAL TRANSPLANT SOI 4. HEART &/OR LUNG TRANSPLANT SOI 1. 002 2 HEART &/OR LUNG TRANSPLANT SOI 2. 002 002 003 003 003 003 004 3 4 1 2 3 4 1 004 2 004 3 004 4 005 1 HEART &/OR LUNG TRANSPLANT SOI 3. HEART &/OR LUNG TRANSPLANT SOI 4. BONE MARROW TRANSPLANT SOI 1. BONE MARROW TRANSPLANT SOI 2. BONE MARROW TRANSPLANT SOI 3. BONE MARROW TRANSPLANT SOI 4. TRACHEOSTOMY W LONG TERM MECHANICAL VENTILATION W EXTENSIVE PROCEDURE SOI 1. TRACHEOSTOMY W LONG TERM MECHANICAL VENTILATION W EXTENSIVE PROCEDURE SOI 2. TRACHEOSTOMY W LONG TERM MECHANICAL VENTILATION W EXTENSIVE PROCEDURE SOI 3. TRACHEOSTOMY W LONG TERM MECHANICAL VENTILATION W EXTENSIVE PROCEDURE SOI 4. TRACHEOSTOMY W LONG TERM MECHANICAL VENTILATION W/O EXTENSIVE PROCEDURE SOI 1. E:\FR\FM\25APP2.SGM 25APP2 24434 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules APPENDIX D.—CROSSWALK OF PROPOSED CONSOLIDATED SEVERITY-ADJUSTED DRGS TO RESPECTIVE APR DRGS— Continued TYPE Consolidated severity-adjusted DRG MDC 0 14 S ........ 0 15 S ........ 0 16 S S S S S S ........ ........ ........ ........ ........ ........ 0 0 0 0 1 1 S ........ APR DRG 17 17 18 19 20 20 TRACHEOSTOMY W LONG TERM MECHANICAL VENTILATION W/O EXTENSIVE PROCEDURE SOI 1 & 2. TRACHEOSTOMY W LONG TERM MECHANICAL VENTILATION W/O EXTENSIVE PROCEDURE SOI 3. TRACHEOSTOMY W LONG TERM MECHANICAL VENTILATION W/O EXTENSIVE PROCEDURE SOI 4. PANCREAS TRANSPLANT SOI 1 & 2 ....... PANCREAS TRANSPLANT SOI 1 & 2 ....... PANCREAS TRANSPLANT SOI 3 .............. PANCREAS TRANSPLANT SOI 4 .............. NERVOUS SYSTEM PROCDURES SOI 4 NERVOUS SYSTEM PROCDURES SOI 4 1 20 S ........ S ........ 1 1 S ........ S S S S SOI APR DRG description 005 2 005 3 005 4 006 006 006 006 020 021 1 2 3 4 4 4 NERVOUS SYSTEM PROCDURES SOI 4 022 4 20 20 NERVOUS SYSTEM PROCDURES SOI 4 NERVOUS SYSTEM PROCDURES SOI 4 023 024 4 4 1 20 NERVOUS SYSTEM PROCDURES SOI 4 026 4 ........ ........ ........ ........ 1 1 1 1 21 22 23 24 1 2 3 1 1 25 021 2 S ........ 1 26 021 3 S ........ 1 27 022 1 S ........ 1 28 022 2 S ........ 1 29 022 3 S S S S ........ ........ ........ ........ 1 1 1 1 30 31 32 33 023 023 023 024 1 2 3 1 S ........ 1 34 024 2 S ........ 1 35 024 3 S ........ 1 36 026 1 S ........ 1 37 026 2 S ........ 1 38 026 3 M ....... 1 39 040 4 TRACHEOSTOMY W LONG TERM MECHANICAL VENTILATION W/O EXTENSIVE PROCEDURE SOI 2. TRACHEOSTOMY W LONG TERM MECHANICAL VENTILATION W/O EXTENSIVE PROCEDURE SOI 3. TRACHEOSTOMY W LONG TERM MECHANICAL VENTILATION W/O EXTENSIVE PROCEDURE SOI 4. PANCREAS TRANSPLANT SOI 1. PANCREAS TRANSPLANT SOI 2. PANCREAS TRANSPLANT SOI 3. PANCREAS TRANSPLANT SOI 4. CRANIOTOMY FOR TRAUMA SOI 4. CRANIOTOMY EXCEPT FOR TRAUMA SOI 4. VENTRICULAR SHUNT PROCEDURES SOI 4. SPINAL PROCEDURES SOI 4. EXTRACRANIAL VASCULAR PROCEDURES SOI 4. OTHER NERVOUS SYSTEM & RELATED PROCEDURES SOI 4. CRANIOTOMY FOR TRAUMA SOI 1. CRANIOTOMY FOR TRAUMA SOI 2. CRANIOTOMY FOR TRAUMA SOI 3. CRANIOTOMY EXCEPT FOR TRAUMA SOI 1. CRANIOTOMY EXCEPT FOR TRAUMA SOI 2. CRANIOTOMY EXCEPT FOR TRAUMA SOI 3. VENTRICULAR SHUNT PROCEDURES SOI 1. VENTRICULAR SHUNT PROCEDURES SOI 2. VENTRICULAR SHUNT PROCEDURES SOI 3. SPINAL PROCEDURES SOI 1. SPINAL PROCEDURES SOI 2. SPINAL PROCEDURES SOI 3. EXTRACRANIAL VASCULAR PROCEDURES SOI 1. EXTRACRANIAL VASCULAR PROCEDURES SOI 2. EXTRACRANIAL VASCULAR PROCEDURES SOI 3. OTHER NERVOUS SYSTEM & RELATED PROCEDURES SOI 1. OTHER NERVOUS SYSTEM & RELATED PROCEDURES SOI 2. OTHER NERVOUS SYSTEM & RELATED PROCEDURES SOI 3. SPINAL DISORDERS & INJURIES SOI 4. M ....... 1 39 041 4 NERVOUS SYSTEM MALIGNANCY SOI 4. M ....... 1 39 CRANIOTOMY FOR TRAUMA SOI 1 ......... CRANIOTOMY FOR TRAUMA SOI 2 ......... CRANIOTOMY FOR TRAUMA SOI 3 ......... CRANIOTOMY EXCEPT FOR TRAUMA SOI 1. CRANIOTOMY EXCEPT FOR TRAUMA SOI 2. CRANIOTOMY EXCEPT FOR TRAUMA SOI 3. VENTRICULAR SHUNT PROCEDURES SOI 1. VENTRICULAR SHUNT PROCEDURES SOI 2. VENTRICULAR SHUNT PROCEDURES SOI 3. SPINAL PROCEDURES SOI 1 ................... SPINAL PROCEDURES SOI 2 ................... SPINAL PROCEDURES SOI 3 ................... EXTRACRANIAL VASCULAR PROCEDURES SOI 1. EXTRACRANIAL VASCULAR PROCEDURES SOI 2. EXTRACRANIAL VASCULAR PROCEDURES SOI 3. OTHER NERVOUS SYSTEM & RELATED PROCEDURES SOI 1. OTHER NERVOUS SYSTEM & RELATED PROCEDURES SOI 2. OTHER NERVOUS SYSTEM & RELATED PROCEDURES SOI 3. NERVOUS SYSTEM MEDICAL DIAGNOSES EXCEPT INFECTIONS SOI 4. NERVOUS SYSTEM MEDICAL DIAGNOSES EXCEPT INFECTIONS SOI 4. NERVOUS SYSTEM MEDICAL DIAGNOSES EXCEPT INFECTIONS SOI 4. 020 020 020 021 S ........ wwhite on PROD1PC61 with PROPOSALS2 S ........ Consolidated severity-adjusted DRG description 042 4 M ....... 1 39 043 4 M ....... 1 39 044 4 DEGENERATIVE NERVOUS SYSTEM DISORDERS EXC MULT SCLEROSIS SOI 4. MULTIPLE SCLEROSIS & OTHER DEMYELINATING DISEASES SOI 4. INTRACRANIAL HEMORRHAGE SOI 4. M ....... 1 39 045 4 M ....... 1 39 046 4 VerDate Aug<31>2005 17:10 Apr 24, 2006 NERVOUS SYSTEM MEDICAL DIAGNOSES EXCEPT INFECTIONS SOI 4. NERVOUS SYSTEM MEDICAL DIAGNOSES EXCEPT INFECTIONS SOI 4. NERVOUS SYSTEM MEDICAL DIAGNOSES EXCEPT INFECTIONS SOI 4. NERVOUS SYSTEM MEDICAL DIAGNOSES EXCEPT INFECTIONS SOI 4. Jkt 208001 PO 00000 Frm 00440 Fmt 4701 Sfmt 4702 CVA & PRECEREBRAL OCCLUSION W INFARCT SOI 4. NONSPECIFIC CVA & PRECEREBRAL OCCLUSION W/O INFARCT SOI 4. E:\FR\FM\25APP2.SGM 25APP2 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules 24435 APPENDIX D.—CROSSWALK OF PROPOSED CONSOLIDATED SEVERITY-ADJUSTED DRGS TO RESPECTIVE APR DRGS— Continued TYPE Consolidated severity-adjusted DRG MDC 1 39 M ....... 1 39 M ....... 1 39 M ....... 1 39 M ....... 1 39 M ....... 1 39 M ....... 1 39 M ....... 1 39 M ....... 1 M ....... APR DRG SOI APR DRG description NERVOUS SYSTEM MEDICAL DIAGNOSES EXCEPT INFECTIONS SOI 4. NERVOUS SYSTEM MEDICAL DIAGNOSES EXCEPT INFECTIONS SOI 4. NERVOUS SYSTEM MEDICAL DIAGNOSES EXCEPT INFECTIONS SOI 4. NERVOUS SYSTEM MEDICAL DIAGNOSES EXCEPT INFECTIONS SOI 4. NERVOUS SYSTEM MEDICAL DIAGNOSES EXCEPT INFECTIONS SOI 4. NERVOUS SYSTEM MEDICAL DIAGNOSES EXCEPT INFECTIONS SOI 4. NERVOUS SYSTEM MEDICAL DIAGNOSES EXCEPT INFECTIONS SOI 4. NERVOUS SYSTEM MEDICAL DIAGNOSES EXCEPT INFECTIONS SOI 4. 047 4 TRANSIENT ISCHEMIA SOI 4. 048 4 051 4 PERIPHERAL, CRANIAL & AUTONOMIC NERVE DISORDERS SOI 4. VIRAL MENINGITIS SOI 4. 052 4 053 4 NONTRAUMATIC STUPOR & COMA SOI 4. SEIZURE SOI 4. 054 4 MIGRAINE & OTHER HEADACHES SOI 4. 055 4 056 4 39 NERVOUS SYSTEM MEDICAL DIAGNOSES EXCEPT INFECTIONS SOI 4. 057 4 1 39 4 1 40 049 4 M ....... 1 40 NERVOUS SYSTEM MEDICAL DIAGNOSES EXCEPT INFECTIONS SOI 4. INFECTIONS OF NERVOUS SYSTEM SOI 4. INFECTIONS OF NERVOUS SYSTEM SOI 4. 058 M ....... 050 4 M M M M M M M ....... ....... ....... ....... ....... ....... ....... 1 1 1 1 1 1 1 41 42 43 44 45 46 47 1 2 3 1 2 3 1 1 48 042 2 M ....... 1 49 042 3 M ....... 1 50 043 1 M ....... 1 51 043 2 M ....... 1 52 043 3 M M M M ....... ....... ....... ....... 1 1 1 1 53 54 55 56 044 044 044 045 1 2 3 1 M ....... 1 57 045 2 M ....... 1 58 045 3 M ....... 1 59 046 1 M ....... 1 60 046 2 M ....... 1 61 046 3 M M M M 1 1 1 1 62 63 64 65 SPINAL DISORDERS & INJURIES SOI 1 .. SPINAL DISORDERS & INJURIES SOI 2 .. SPINAL DISORDERS & INJURIES SOI 3 .. NERVOUS SYSTEM MALIGNANCY SOI 1 NERVOUS SYSTEM MALIGNANCY SOI 2 NERVOUS SYSTEM MALIGNANCY SOI 3 DEGENERATIVE NERVOUS SYSTEM DISORDERS EXC MULT SCLEROSIS SOI 1. DEGENERATIVE NERVOUS SYSTEM DISORDERS EXC MULT SCLEROSIS SOI 2. DEGENERATIVE NERVOUS SYSTEM DISORDERS EXC MULT SCLEROSIS SOI 3. MULTIPLE SCLEROSIS & OTHER DEMYELINATING DISEASES SOI 1. MULTIPLE SCLEROSIS & OTHER DEMYELINATING DISEASES SOI 2. MULTIPLE SCLEROSIS & OTHER DEMYELINATING DISEASES SOI 3. INTRACRANIAL HEMORRHAGE SOI 1 ..... INTRACRANIAL HEMORRHAGE SOI 2 ..... INTRACRANIAL HEMORRHAGE SOI 3 ..... CVA & PRECEREBRAL OCCLUSION W INFARCT SOI 1. CVA & PRECEREBRAL OCCLUSION W INFARCT SOI 2. CVA & PRECEREBRAL OCCLUSION W INFARCT SOI 3. NONSPECIFIC CVA & PRECEREBRAL OCCLUSION W/O INFARCT SOI 1. NONSPECIFIC CVA & PRECEREBRAL OCCLUSION W/O INFARCT SOI 2. NONSPECIFIC CVA & PRECEREBRAL OCCLUSION W/O INFARCT SOI 3. TRANSIENT ISCHEMIA SOI 1 .................... TRANSIENT ISCHEMIA SOI 2 .................... TRANSIENT ISCHEMIA SOI 3 .................... PERIPHERAL, CRANIAL & AUTONOMIC NERVE DISORDERS SOI 1. 040 040 040 041 041 041 042 M ....... wwhite on PROD1PC61 with PROPOSALS2 M ....... Consolidated severity-adjusted DRG description 047 047 047 048 1 2 3 1 HEAD TRAUMA W COMA >1 HR OR HEMORRHAGE SOI 4. BRAIN CONTUSION/LACERATION & COMPLICATED SKULL FX, COMA <1 HR OR NO COMA SOI 4. CONCUSSION, CLOSED SKULL FX NOS, UNCOMPLICATED INTRACRANIAL INJURY, COMA <1 HR OR NO COMA SOI 4. OTHER DISORDERS OF NERVOUS SYSTEM SOI 4. BACTERIAL & TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM SOI 4. NON-BACTERIAL INFECTIONS OF NERVOUS SYSTEM EXC VIRAL MENINGITIS SOI 4. SPINAL DISORDERS & INJURIES SOI 1. SPINAL DISORDERS & INJURIES SOI 2. SPINAL DISORDERS & INJURIES SOI 3. NERVOUS SYSTEM MALIGNANCY SOI 1. NERVOUS SYSTEM MALIGNANCY SOI 2. NERVOUS SYSTEM MALIGNANCY SOI 3. DEGENERATIVE NERVOUS SYSTEM DISORDERS EXC MULT SCLEROSIS SOI 1. DEGENERATIVE NERVOUS SYSTEM DISORDERS EXC MULT SCLEROSIS SOI 2. DEGENERATIVE NERVOUS SYSTEM DISORDERS EXC MULT SCLEROSIS SOI 3. MULTIPLE SCLEROSIS & OTHER DEMYELINATING DISEASES SOI 1. MULTIPLE SCLEROSIS & OTHER DEMYELINATING DISEASES SOI 2. MULTIPLE SCLEROSIS & OTHER DEMYELINATING DISEASES SOI 3. INTRACRANIAL HEMORRHAGE SOI 1. INTRACRANIAL HEMORRHAGE SOI 2. INTRACRANIAL HEMORRHAGE SOI 3. CVA & PRECEREBRAL OCCLUSION W INFARCT SOI 1. CVA & PRECEREBRAL OCCLUSION W INFARCT SOI 2. CVA & PRECEREBRAL OCCLUSION W INFARCT SOI 3. NONSPECIFIC CVA & PRECEREBRAL OCCLUSION W/O INFARCT SOI 1. NONSPECIFIC CVA & PRECEREBRAL OCCLUSION W/O INFARCT SOI 2. NONSPECIFIC CVA & PRECEREBRAL OCCLUSION W/O INFARCT SOI 3. TRANSIENT ISCHEMIA SOI 1. TRANSIENT ISCHEMIA SOI 2. TRANSIENT ISCHEMIA SOI 3. PERIPHERAL, CRANIAL & AUTONOMIC NERVE DISORDERS SOI 1. ....... ....... ....... ....... VerDate Aug<31>2005 17:10 Apr 24, 2006 Jkt 208001 PO 00000 Frm 00441 Fmt 4701 Sfmt 4702 E:\FR\FM\25APP2.SGM 25APP2 24436 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules APPENDIX D.—CROSSWALK OF PROPOSED CONSOLIDATED SEVERITY-ADJUSTED DRGS TO RESPECTIVE APR DRGS— Continued TYPE Consolidated severity-adjusted DRG MDC 1 66 M ....... 1 67 M ....... 1 68 M ....... 1 69 M ....... 1 70 M ....... 1 71 M ....... 1 72 M ....... 1 73 M M M M ....... ....... ....... ....... 1 1 1 1 74 75 76 77 M ....... 1 78 M ....... 1 79 M M M M M M M ....... ....... ....... ....... ....... ....... ....... 1 1 1 1 1 1 1 80 81 82 83 84 85 86 M ....... 1 87 M ....... 1 88 M ....... 1 89 M ....... 1 90 M ....... 1 91 M ....... 1 92 M ....... 1 93 M ....... wwhite on PROD1PC61 with PROPOSALS2 M ....... 1 94 M ....... 1 95 M ....... 1 96 M ....... 1 97 S ........ 2 98 VerDate Aug<31>2005 17:10 Apr 24, 2006 Consolidated severity-adjusted DRG description APR DRG PERIPHERAL, CRANIAL & AUTONOMIC NERVE DISORDERS SOI 2. PERIPHERAL, CRANIAL & AUTONOMIC NERVE DISORDERS SOI 3. BACTERIAL & TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM SOI 1. BACTERIAL & TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM SOI 2. BACTERIAL & TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM SOI 3. NON-BACTERIAL INFECTIONS OF NERVOUS SYSTEM EXC VIRAL MENINGITIS SOI 1. NON-BACTERIAL INFECTIONS OF NERVOUS SYSTEM EXC VIRAL MENINGITIS SOI 2. NON-BACTERIAL INFECTIONS OF NERVOUS SYSTEM EXC VIRAL MENINGITIS SOI 3. VIRAL MENINGITIS SOI 1 .......................... VIRAL MENINGITIS SOI 2 .......................... VIRAL MENINGITIS SOI 3 .......................... NONTRAUMATIC STUPOR & COMA SOI 1. NONTRAUMATIC STUPOR & COMA SOI 2. NONTRAUMATIC STUPOR & COMA SOI 3. SEIZURE SOI 1 ........................................... SEIZURE SOI 2 ........................................... SEIZURE SOI 3 ........................................... MIGRAINE & OTHER HEADACHES SOI 1 MIGRAINE & OTHER HEADACHES SOI 2 MIGRAINE & OTHER HEADACHES SOI 3 HEAD TRAUMA W COMA >1 HR OR HEMORRHAGE SOI 1. HEAD TRAUMA W COMA >1 HR OR HEMORRHAGE SOI 2. HEAD TRAUMA W COMA >1 HR OR HEMORRHAGE SOI 3. BRAIN CONTUSION/LACERATION & COMPLICATED SKULL FX, COMA <1 HR OR NO COMA SOI 1. BRAIN CONTUSION/LACERATION & COMPLICATED SKULL FX, COMA <1 HR OR NO COMA SOI 2. BRAIN CONTUSION/LACERATION & COMPLICATED SKULL FX, COMA <1 HR OR NO COMA SOI 3. CONCUSSION, CLOSED SKULL FX NOS, UNCOMPLICATED INTRACRANIAL INJURY, COMA <1 HR OR NO COMA SOI 1. CONCUSSION, CLOSED SKULL FX NOS, UNCOMPLICATED INTRACRANIAL INJURY, COMA <1 HR OR NO COMA SOI 2. CONCUSSION, CLOSED SKULL FX NOS, UNCOMPLICATED INTRACRANIAL INJURY, COMA <1 HR OR NO COMA SOI 3. OTHER DISORDERS OF NERVOUS SYSTEM SOI 1. OTHER DISORDERS OF NERVOUS SYSTEM SOI 2. OTHER DISORDERS OF NERVOUS SYSTEM SOI 3. EYE PROCEDURES SOI 4 ......................... Jkt 208001 PO 00000 Frm 00442 Fmt 4701 Sfmt 4702 SOI APR DRG description 048 2 048 3 049 1 049 2 049 3 050 1 050 2 050 3 051 051 051 052 1 2 3 1 052 2 052 3 053 053 053 054 054 054 055 1 2 3 1 2 3 1 055 2 055 3 056 1 056 2 056 3 057 1 057 2 057 3 058 1 058 2 058 3 070 4 PERIPHERAL, CRANIAL & AUTONOMIC NERVE DISORDERS SOI 2. PERIPHERAL, CRANIAL & AUTONOMIC NERVE DISORDERS SOI 3. BACTERIAL & TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM SOI 1. BACTERIAL & TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM SOI 2. BACTERIAL & TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM SOI 3. NON-BACTERIAL INFECTIONS OF NERVOUS SYSTEM EXC VIRAL MENINGITIS SOI 1. NON-BACTERIAL INFECTIONS OF NERVOUS SYSTEM EXC VIRAL MENINGITIS SOI 2. NON-BACTERIAL INFECTIONS OF NERVOUS SYSTEM EXC VIRAL MENINGITIS SOI 3. VIRAL MENINGITIS SOI 1. VIRAL MENINGITIS SOI 2. VIRAL MENINGITIS SOI 3. NONTRAUMATIC STUPOR & COMA SOI 1. NONTRAUMATIC STUPOR & COMA SOI 2. NONTRAUMATIC STUPOR & COMA SOI 3. SEIZURE SOI 1. SEIZURE SOI 2. SEIZURE SOI 3. MIGRAINE & OTHER HEADACHES SOI 1. MIGRAINE & OTHER HEADACHES SOI 2. MIGRAINE & OTHER HEADACHES SOI 3. HEAD TRAUMA W COMA >1 HR OR HEMORRHAGE SOI 1. HEAD TRAUMA W COMA >1 HR OR HEMORRHAGE SOI 2. HEAD TRAUMA W COMA >1 HR OR HEMORRHAGE SOI 3. BRAIN CONTUSION/LACERATION & COMPLICATED SKULL FX, COMA <1 HR OR NO COMA SOI 1. BRAIN CONTUSION/LACERATION & COMPLICATED SKULL FX, COMA <1 HR OR NO COMA SOI 2. BRAIN CONTUSION/LACERATION & COMPLICATED SKULL FX, COMA <1 HR OR NO COMA SOI 3. CONCUSSION, CLOSED SKULL FX NOS, UNCOMPLICATED INTRACRANIAL INJURY, COMA <1 HR OR NO COMA SOI 1. CONCUSSION, CLOSED SKULL FX NOS, UNCOMPLICATED INTRACRANIAL INJURY, COMA <1 HR OR NO COMA SOI 2. CONCUSSION, CLOSED SKULL FX NOS, UNCOMPLICATED INTRACRANIAL INJURY, COMA <1 HR OR NO COMA SOI 3. OTHER DISORDERS OF NERVOUS SYSTEM SOI 1. OTHER DISORDERS OF NERVOUS SYSTEM SOI 2. OTHER DISORDERS OF NERVOUS SYSTEM SOI 3. ORBITAL PROCEDURES SOI 4. E:\FR\FM\25APP2.SGM 25APP2 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules 24437 APPENDIX D.—CROSSWALK OF PROPOSED CONSOLIDATED SEVERITY-ADJUSTED DRGS TO RESPECTIVE APR DRGS— Continued TYPE Consolidated severity-adjusted DRG MDC Consolidated severity-adjusted DRG description APR DRG SOI APR DRG description 2 98 EYE PROCEDURES SOI 4 ......................... 073 4 S S S S ........ ........ ........ ........ 2 2 2 2 99 100 101 102 1 2 3 1 2 103 073 2 S ........ 2 104 073 3 M ....... M ....... 2 2 105 105 ORBITAL PROCEDURES SOI 1 ................. ORBITAL PROCEDURES SOI 2 ................. ORBITAL PROCEDURES SOI 3 ................. EYE PROCEDURES EXCEPT ORBIT SOI 1. EYE PROCEDURES EXCEPT ORBIT SOI 2. EYE PROCEDURES EXCEPT ORBIT SOI 3. EYE DIAGNOSES SOI 4 ............................. EYE DIAGNOSES SOI 4 ............................. 070 070 070 073 S ........ 080 082 4 4 M M M M ....... ....... ....... ....... 2 2 2 2 106 107 108 109 1 2 3 1 2 110 082 2 M ....... 2 111 082 3 S ........ 3 112 089 4 S ........ 3 112 090 4 S ........ 3 112 091 4 S ........ 3 112 ACUTE MAJOR EYE INFECTIONS SOI 1 ACUTE MAJOR EYE INFECTIONS SOI 2 ACUTE MAJOR EYE INFECTIONS SOI 3 EYE DISORDERS EXCEPT MAJOR INFECTIONS SOI 1. EYE DISORDERS EXCEPT MAJOR INFECTIONS SOI 2. EYE DISORDERS EXCEPT MAJOR INFECTIONS SOI 3. EAR, NOSE, MOUTH & THROAT PROCEDURES SOI 4. EAR, NOSE, MOUTH & THROAT PROCEDURES SOI 4. EAR, NOSE, MOUTH & THROAT PROCEDURES SOI 4. EAR, NOSE, MOUTH & THROAT PROCEDURES SOI 4. 080 080 080 082 M ....... 092 4 S ........ 3 112 093 4 3 112 095 4 CLEFT LIP & PALATE REPAIR SOI 4. S ........ 3 112 097 4 S ........ 3 112 098 4 S ........ 3 113 089 1 S ........ 3 114 089 2 S ........ 3 115 089 3 S ........ 3 116 090 1 S ........ 3 117 090 2 S ........ 3 118 090 3 S ........ 3 119 091 1 S ........ 3 120 091 2 S ........ 3 121 091 3 S ........ 3 122 092 1 S ........ 3 123 092 2 S ........ 3 124 092 3 S ........ S ........ 3 3 125 126 EAR, NOSE, MOUTH & THROAT PROCEDURES SOI 4. EAR, NOSE, MOUTH & THROAT PROCEDURES SOI 4. EAR, NOSE, MOUTH & THROAT PROCEDURES SOI 4. EAR, NOSE, MOUTH & THROAT PROCEDURES SOI 4. MAJOR CRANIAL/FACIAL BONE PROCEDURES SOI 1. MAJOR CRANIAL/FACIAL BONE PROCEDURES SOI 2. MAJOR CRANIAL/FACIAL BONE PROCEDURES SOI 3. MAJOR LARYNX & TRACHEA PROCEDURES SOI 1. MAJOR LARYNX & TRACHEA PROCEDURES SOI 2. MAJOR LARYNX & TRACHEA PROCEDURES SOI 3. OTHER MAJOR HEAD & NECK PROCEDURES SOI 1. OTHER MAJOR HEAD & NECK PROCEDURES SOI 2. OTHER MAJOR HEAD & NECK PROCEDURES SOI 3. FACIAL BONE PROCEDURES EXCEPT MAJOR CRANIAL/FACIAL BONE PROCEDURES SOI 1. FACIAL BONE PROCEDURES EXCEPT MAJOR CRANIAL/FACIAL BONE PROCEDURES SOI 2. FACIAL BONE PROCEDURES EXCEPT MAJOR CRANIAL/FACIAL BONE PROCEDURES SOI 3. SINUS & MASTOID PROCEDURES SOI 1 SINUS & MASTOID PROCEDURES SOI 2 EYE PROCEDURES EXCEPT ORBIT SOI 4. ORBITAL PROCEDURES SOI 1. ORBITAL PROCEDURES SOI 2. ORBITAL PROCEDURES SOI 3. EYE PROCEDURES EXCEPT ORBIT SOI 1. EYE PROCEDURES EXCEPT ORBIT SOI 2. EYE PROCEDURES EXCEPT ORBIT SOI 3. ACUTE MAJOR EYE INFECTIONS SOI 4. EYE DISORDERS EXCEPT MAJOR INFECTIONS SOI 4. ACUTE MAJOR EYE INFECTIONS SOI 1. ACUTE MAJOR EYE INFECTIONS SOI 2. ACUTE MAJOR EYE INFECTIONS SOI 3. EYE DISORDERS EXCEPT MAJOR INFECTIONS SOI 1. EYE DISORDERS EXCEPT MAJOR INFECTIONS SOI 2. EYE DISORDERS EXCEPT MAJOR INFECTIONS SOI 3. MAJOR CRANIAL/FACIAL BONE PROCEDURES SOI 4. MAJOR LARYNX & TRACHEA PROCEDURES SOI 4. OTHER MAJOR HEAD & NECK PROCEDURES SOI 4. FACIAL BONE PROCEDURES EXCEPT MAJOR CRANIAL/FACIAL BONE PROCEDURES SOI 4. SINUS & MASTOID PROCEDURES SOI 4. S ........ wwhite on PROD1PC61 with PROPOSALS2 S ........ 093 093 1 2 TONSIL & ADENOID PROCEDURES SOI 4. OTHER EAR, NOSE, MOUTH & THROAT PROCEDURES SOI 4. MAJOR CRANIAL/FACIAL BONE PROCEDURES SOI 1. MAJOR CRANIAL/FACIAL BONE PROCEDURES SOI 2. MAJOR CRANIAL/FACIAL BONE PROCEDURES SOI 3. MAJOR LARYNX & TRACHEA PROCEDURES SOI 1. MAJOR LARYNX & TRACHEA PROCEDURES SOI 2. MAJOR LARYNX & TRACHEA PROCEDURES SOI 3. OTHER MAJOR HEAD & NECK PROCEDURES SOI 1. OTHER MAJOR HEAD & NECK PROCEDURES SOI 2. OTHER MAJOR HEAD & NECK PROCEDURES SOI 3. FACIAL BONE PROCEDURES EXCEPT MAJOR CRANIAL/FACIAL BONE PROCEDURES SOI 1. FACIAL BONE PROCEDURES EXCEPT MAJOR CRANIAL/FACIAL BONE PROCEDURES SOI 2. FACIAL BONE PROCEDURES EXCEPT MAJOR CRANIAL/FACIAL BONE PROCEDURES SOI 3. SINUS & MASTOID PROCEDURES SOI 1. SINUS & MASTOID PROCEDURES SOI 2. VerDate Aug<31>2005 17:10 Apr 24, 2006 Jkt 208001 PO 00000 Frm 00443 Fmt 4701 Sfmt 4702 E:\FR\FM\25APP2.SGM 25APP2 24438 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules APPENDIX D.—CROSSWALK OF PROPOSED CONSOLIDATED SEVERITY-ADJUSTED DRGS TO RESPECTIVE APR DRGS— Continued TYPE ........ ........ ........ ........ ........ 3 3 3 3 3 127 128 129 130 131 S ........ 3 132 S ........ 3 133 S ........ 3 134 S ........ 3 135 S ........ 3 136 M ....... 3 137 M ....... 3 137 M ....... 3 137 M ....... 3 137 M ....... 3 137 M ....... 3 138 M ....... 3 139 M ....... 3 140 M ....... 3 141 M ....... 3 142 M ....... 3 143 M ....... 3 144 M ....... 3 145 M ....... 3 146 M ....... 3 147 M ....... 3 148 M ....... 3 149 M ....... 3 150 M ....... 3 151 M ....... 3 152 S ........ 4 153 S ........ wwhite on PROD1PC61 with PROPOSALS2 S S S S S Consolidated severity-adjusted DRG MDC 4 153 S ........ 4 154 S ........ 4 155 S ........ 4 156 S ........ 4 157 VerDate Aug<31>2005 17:10 Apr 24, 2006 Consolidated severity-adjusted DRG description APR DRG SINUS & MASTOID PROCEDURES SOI 3 CLEFT LIP & PALATE REPAIR SOI 1 ....... CLEFT LIP & PALATE REPAIR SOI 2 ....... CLEFT LIP & PALATE REPAIR SOI 3 ....... TONSIL & ADENOID PROCEDURES SOI 1. TONSIL & ADENOID PROCEDURES SOI 2. TONSIL & ADENOID PROCEDURES SOI 3. OTHER EAR, NOSE, MOUTH & THROAT PROCEDURES SOI 1. OTHER EAR, NOSE, MOUTH & THROAT PROCEDURES SOI 2. OTHER EAR, NOSE, MOUTH & THROAT PROCEDURES SOI 3. EAR, NOSE, MOUTH & THROAT DIAGNOSES SOI 4. EAR, NOSE, MOUTH & THROAT DIAGNOSES SOI 4. EAR, NOSE, MOUTH & THROAT DIAGNOSES SOI 4. EAR, NOSE, MOUTH & THROAT DIAGNOSES SOI 4. EAR, NOSE, MOUTH & THROAT DIAGNOSES SOI 4. EAR, NOSE, MOUTH, THROAT, CRANIAL/FACIAL MALIGNANCIES SOI 1. EAR, NOSE, MOUTH, THROAT, CRANIAL/FACIAL MALIGNANCIES SOI 2. EAR, NOSE, MOUTH, THROAT, CRANIAL/FACIAL MALIGNANCIES SOI 3. VERTIGO & OTHER LABYRINTH DISORDERS SOI 1. VERTIGO & OTHER LABYRINTH DISORDERS SOI 2. VERTIGO & OTHER LABYRINTH DISORDERS SOI 3. INFECTIONS OF UPPER RESPIRATORY TRACT SOI 1. INFECTIONS OF UPPER RESPIRATORY TRACT SOI 2. INFECTIONS OF UPPER RESPIRATORY TRACT SOI 3. DENTAL & ORAL DISEASES & INJURIES SOI 1. DENTAL & ORAL DISEASES & INJURIES SOI 2. DENTAL & ORAL DISEASES & INJURIES SOI 3. OTHER EAR, NOSE, MOUTH, THROAT & CRANIAL/FACIAL DIAGNOSES SOI 1. OTHER EAR, NOSE, MOUTH, THROAT & CRANIAL/FACIAL DIAGNOSES SOI 2. OTHER EAR, NOSE, MOUTH, THROAT & CRANIAL/FACIAL DIAGNOSES SOI 3. RESPIRATORY & CHEST PROCEDURES SOI 4. RESPIRATORY & CHEST PROCEDURES SOI 4. MAJOR RESPIRATORY & CHEST PROCEDURES SOI 1. MAJOR RESPIRATORY & CHEST PROCEDURES SOI 2. MAJOR RESPIRATORY & CHEST PROCEDURES SOI 3. OTHER RESPIRATORY & CHEST PROCEDURES SOI 1. Jkt 208001 PO 00000 Frm 00444 Fmt 4701 Sfmt 4702 SOI APR DRG description 093 095 095 095 097 3 1 2 3 1 097 2 097 3 098 1 098 2 098 3 110 4 111 4 113 4 114 4 115 4 110 1 110 2 110 3 111 1 111 2 111 3 113 1 113 2 113 3 114 1 114 2 114 3 115 1 115 2 115 3 120 4 121 4 120 1 120 2 120 3 121 1 SINUS & MASTOID PROCEDURES SOI 3. CLEFT LIP & PALATE REPAIR SOI 1. CLEFT LIP & PALATE REPAIR SOI 2. CLEFT LIP & PALATE REPAIR SOI 3. TONSIL & ADENOID PROCEDURES SOI 1. TONSIL & ADENOID PROCEDURES SOI 2. TONSIL & ADENOID PROCEDURES SOI 3. OTHER EAR, NOSE, MOUTH & THROAT PROCEDURES SOI 1. OTHER EAR, NOSE, MOUTH & THROAT PROCEDURES SOI 2. OTHER EAR, NOSE, MOUTH & THROAT PROCEDURES SOI 3. EAR, NOSE, MOUTH, THROAT, CRANIAL/FACIAL MALIGNANCIES SOI 4. VERTIGO & OTHER LABYRINTH DISORDERS SOI 4. INFECTIONS OF UPPER RESPIRATORY TRACT SOI 4. DENTAL & ORAL DISEASES & INJURIES SOI 4. OTHER EAR, NOSE, MOUTH,THROAT & CRANIAL/FACIAL DIAGNOSES SOI 4. EAR, NOSE, MOUTH, THROAT, CRANIAL/FACIAL MALIGNANCIES SOI 1. EAR, NOSE, MOUTH, THROAT, CRANIAL/FACIAL MALIGNANCIES SOI 2. EAR, NOSE, MOUTH, THROAT, CRANIAL/FACIAL MALIGNANCIES SOI 3. VERTIGO & OTHER LABYRINTH DISORDERS SOI 1. VERTIGO & OTHER LABYRINTH DISORDERS SOI 2. VERTIGO & OTHER LABYRINTH DISORDERS SOI 3. INFECTIONS OF UPPER RESPIRATORY TRACT SOI 1. INFECTIONS OF UPPER RESPIRATORY TRACT SOI 2. INFECTIONS OF UPPER RESPIRATORY TRACT SOI 3. DENTAL & ORAL DISEASES & INJURIES SOI 1. DENTAL & ORAL DISEASES & INJURIES SOI 2. DENTAL & ORAL DISEASES & INJURIES SOI 3. OTHER EAR, NOSE, MOUTH, THROAT & CRANIAL/FACIAL DIAGNOSES SOI 1. OTHER EAR, NOSE, MOUTH, THROAT & CRANIAL/FACIAL DIAGNOSES SOI 2. OTHER EAR, NOSE, MOUTH, THROAT & CRANIAL/FACIAL DIAGNOSES SOI 3. MAJOR RESPIRATORY & CHEST PROCEDURES SOI 4. OTHER RESPIRATORY & CHEST PROCEDURES SOI 4. MAJOR RESPIRATORY & CHEST PROCEDURES SOI 1. MAJOR RESPIRATORY & CHEST PROCEDURES SOI 2. MAJOR RESPIRATORY & CHEST PROCEDURES SOI 3. OTHER RESPIRATORY & CHEST PROCEDURES SOI 1. E:\FR\FM\25APP2.SGM 25APP2 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules 24439 APPENDIX D.—CROSSWALK OF PROPOSED CONSOLIDATED SEVERITY-ADJUSTED DRGS TO RESPECTIVE APR DRGS— Continued TYPE Consolidated severity-adjusted DRG MDC 4 158 S ........ 4 159 M ....... 4 160 M ....... 4 160 M ....... 4 160 M ....... 4 160 M ....... 4 160 M ....... 4 160 M ....... 4 160 M ....... 4 160 M ....... 4 160 M ....... 4 160 M ....... 4 160 M ....... 4 160 M ....... 4 160 M ....... 4 160 M ....... 4 161 M ....... 4 162 M ....... 4 163 M ....... 4 164 M ....... wwhite on PROD1PC61 with PROPOSALS2 S ........ 4 165 M ....... 4 166 M ....... 4 167 M ....... 4 168 M ....... 4 169 VerDate Aug<31>2005 17:10 Apr 24, 2006 Consolidated severity-adjusted DRG description APR DRG OTHER RESPIRATORY & CHEST PROCEDURES SOI 2. OTHER RESPIRATORY & CHEST PROCEDURES SOI 3. RESPIRATORY SYSTEM DIAGNOSES EXCEPT W VENTILATOR SUPPORT 96+ HOURS SOI 4. RESPIRATORY SYSTEM DIAGNOSES EXCEPT W VENTILATOR SUPPORT 96+ HOURS SOI 4. RESPIRATORY SYSTEM DIAGNOSES EXCEPT W VENTILATOR SUPPORT 96+ HOURS SOI 4. RESPIRATORY SYSTEM DIAGNOSES EXCEPT W VENTILATOR SUPPORT 96+ HOURS SOI 4. RESPIRATORY SYSTEM DIAGNOSES EXCEPT W VENTILATOR SUPPORT 96+ HOURS SOI 4. RESPIRATORY SYSTEM DIAGNOSES EXCEPT W VENTILATOR SUPPORT 96+ HOURS SOI 4. RESPIRATORY SYSTEM DIAGNOSES EXCEPT W VENTILATOR SUPPORT 96+ HOURS SOI 4. RESPIRATORY SYSTEM DIAGNOSES EXCEPT W VENTILATOR SUPPORT 96+ HOURS SOI 4. RESPIRATORY SYSTEM DIAGNOSES EXCEPT W VENTILATOR SUPPORT 96+ HOURS SOI 4. RESPIRATORY SYSTEM DIAGNOSES EXCEPT W VENTILATOR SUPPORT 96+ HOURS SOI 4. RESPIRATORY SYSTEM DIAGNOSES EXCEPT W VENTILATOR SUPPORT 96+ HOURS SOI 4. RESPIRATORY SYSTEM DIAGNOSES EXCEPT W VENTILATOR SUPPORT 96+ HOURS SOI 4. RESPIRATORY SYSTEM DIAGNOSES EXCEPT W VENTILATOR SUPPORT 96+ HOURS SOI 4. RESPIRATORY SYSTEM DIAGNOSES EXCEPT W VENTILATOR SUPPORT 96+ HOURS SOI 4. RESPIRATORY SYSTEM DIAGNOSIS W VENTILATOR SUPPORT 96+ HOURS SOI 1. RESPIRATORY SYSTEM DIAGNOSIS W VENTILATOR SUPPORT 96+ HOURS SOI 2. RESPIRATORY SYSTEM DIAGNOSIS W VENTILATOR SUPPORT 96+ HOURS SOI 3. RESPIRATORY SYSTEM DIAGNOSIS W VENTILATOR SUPPORT 96+ HOURS SOI 4. CYSTIC FIBROSIS—PULMONARY DISEASE SOI 1. CYSTIC FIBROSIS—PULMONARY DISEASE SOI 2. CYSTIC FIBROSIS—PULMONARY DISEASE SOI 3. PULMONARY EDEMA & RESPIRATORY FAILURE SOI 1. PULMONARY EDEMA & RESPIRATORY FAILURE SOI 2. Jkt 208001 PO 00000 Frm 00445 Fmt 4701 Sfmt 4702 SOI APR DRG description 121 2 OTHER RESPIRATORY & CHEST PROCEDURES SOI 2. OTHER RESPIRATORY & CHEST PROCEDURES SOI 3. CYSTIC FIBROSIS—PULMONARY DISEASE SOI 4. 121 3 131 4 132 4 133 4 134 4 PULMONARY EMBOLISM SOI 4. 135 4 MAJOR CHEST & RESPIRATORY TRAUMA SOI 4. 136 4 RESPIRATORY MALIGNANCY SOI 4. 137 4 MAJOR RESPIRATORY INFECTIONS & INFLAMMATIONS SOI 4. 138 4 BRONCHIOLITIS & RSV PNEUMONIA SOI 4. 139 4 OTHER PNEUMONIA SOI 4. 140 4 CHRONIC OBSTRUCTIVE PULMONARY DISEASE SOI 4. 141 4 ASTHMA SOI 4. 142 4 INTERSTITIAL LUNG DISEASE SOI 4. 143 4 144 4 OTHER RESPIRATORY DIAGNOSES EXCEPT SIGNS, SYMPTOMS & MINOR DIAGNOSES SOI 4. RESPIRATORY SIGNS, SYMPTOMS & MINOR DIAGNOSES SOI 4. 130 1 130 2 130 3 130 4 131 1 131 2 131 3 133 1 133 2 BPD & OTH CHRONIC RESPIRATORY DISEASES ARISING IN PERINATAL PERIOD SOI 4. PULMONARY EDEMA & RESPIRATORY FAILURE SOI 4. RESPIRATORY SYSTEM DIAGNOSIS W VENTILATOR SUPPORT 96+ HOURS SOI 1. RESPIRATORY SYSTEM DIAGNOSIS W VENTILATOR SUPPORT 96+ HOURS SOI 2. RESPIRATORY SYSTEM DIAGNOSIS W VENTILATOR SUPPORT 96+ HOURS SOI 3. RESPIRATORY SYSTEM DIAGNOSIS W VENTILATOR SUPPORT 96+ HOURS SOI 4. CYSTIC FIBROSIS—PULMONARY DISEASE SOI 1. CYSTIC FIBROSIS—PULMONARY DISEASE SOI 2. CYSTIC FIBROSIS—PULMONARY DISEASE SOI 3. PULMONARY EDEMA & RESPIRATORY FAILURE SOI 1. PULMONARY EDEMA & RESPIRATORY FAILURE SOI 2. E:\FR\FM\25APP2.SGM 25APP2 24440 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules APPENDIX D.—CROSSWALK OF PROPOSED CONSOLIDATED SEVERITY-ADJUSTED DRGS TO RESPECTIVE APR DRGS— Continued TYPE Consolidated severity-adjusted DRG MDC 4 170 M M M M ....... ....... ....... ....... 4 4 4 4 171 172 173 174 M ....... 4 175 M ....... 4 176 M M M M ....... ....... ....... ....... 4 4 4 4 177 178 179 180 M ....... 4 181 M ....... 4 182 M ....... 4 183 M ....... 4 184 M ....... 4 185 M M M M ....... ....... ....... ....... 4 4 4 4 186 187 188 189 M ....... 4 190 M ....... 4 191 M M M M ....... ....... ....... ....... 4 4 4 4 M ....... M ....... APR DRG SOI APR DRG description 133 3 134 134 134 135 1 2 3 1 135 2 135 3 136 136 136 137 1 2 3 1 137 2 137 3 138 1 138 2 138 3 139 139 139 140 1 2 3 1 140 2 140 3 192 193 194 195 PULMONARY EDEMA & RESPIRATORY FAILURE SOI 3. PULMONARY EMBOLISM SOI 1 ................ PULMONARY EMBOLISM SOI 2 ................ PULMONARY EMBOLISM SOI 3 ................ MAJOR CHEST & RESPIRATORY TRAUMA SOI 1. MAJOR CHEST & RESPIRATORY TRAUMA SOI 2. MAJOR CHEST & RESPIRATORY TRAUMA SOI 3. RESPIRATORY MALIGNANCY SOI 1 ........ RESPIRATORY MALIGNANCY SOI 2 ........ RESPIRATORY MALIGNANCY SOI 3 ........ MAJOR RESPIRATORY INFECTIONS & INFLAMMATIONS SOI 1. MAJOR RESPIRATORY INFECTIONS & INFLAMMATIONS SOI 2. MAJOR RESPIRATORY INFECTIONS & INFLAMMATIONS SOI 3. BRONCHIOLITIS & RSV PNEUMONIA SOI 1. BRONCHIOLITIS & RSV PNEUMONIA SOI 2. BRONCHIOLITIS & RSV PNEUMONIA SOI 3. OTHER PNEUMONIA SOI 1 ....................... OTHER PNEUMONIA SOI 2 ....................... OTHER PNEUMONIA SOI 3 ....................... CHRONIC OBSTRUCTIVE PULMONARY DISEASE SOI 1. CHRONIC OBSTRUCTIVE PULMONARY DISEASE SOI 2. CHRONIC OBSTRUCTIVE PULMONARY DISEASE SOI 3. ASTHMA SOI 1 ............................................ ASTHMA SOI 2 ............................................ ASTHMA SOI 3 ............................................ INTERSTITIAL LUNG DISEASE SOI 1 ....... 141 141 141 132 1 2 3 1 4 4 195 196 INTERSTITIAL LUNG DISEASE SOI 1 ....... INTERSTITIAL LUNG DISEASE SOI 2 ....... 142 132 1 2 M ....... M ....... 4 4 196 197 INTERSTITIAL LUNG DISEASE SOI 2 ....... INTERSTITIAL LUNG DISEASE SOI 3 ....... 142 132 2 3 M ....... M ....... 4 4 197 198 3 1 4 199 143 2 M ....... 4 200 143 3 M ....... 4 201 144 1 M ....... 4 202 144 2 M ....... 4 203 144 3 S ........ 5 204 INTERSTITIAL LUNG DISEASE SOI 3 ....... OTHER RESPIRATORY DIAGNOSES EXCEPT SIGNS, SYMPTOMS & MINOR DIAGNOSES SOI 1. OTHER RESPIRATORY DIAGNOSES EXCEPT SIGNS, SYMPTOMS & MINOR DIAGNOSES SOI 2. OTHER RESPIRATORY DIAGNOSES EXCEPT SIGNS, SYMPTOMS & MINOR DIAGNOSES SOI 3. RESPIRATORY SIGNS, SYMPTOMS & MINOR DIAGNOSES SOI 1. RESPIRATORY SIGNS, SYMPTOMS & MINOR DIAGNOSES SOI 2. RESPIRATORY SIGNS, SYMPTOMS & MINOR DIAGNOSES SOI 3. CARDIOTHORACIC PROCEDURES SOI 4 142 143 M ....... wwhite on PROD1PC61 with PROPOSALS2 M ....... Consolidated severity-adjusted DRG description 160 4 S ........ 5 204 CARDIOTHORACIC PROCEDURES SOI 4 161 4 VerDate Aug<31>2005 17:10 Apr 24, 2006 Jkt 208001 PO 00000 Frm 00446 Fmt 4701 Sfmt 4702 PULMONARY EDEMA & RESPIRATORY FAILURE SOI 3. PULMONARY EMBOLISM SOI 1. PULMONARY EMBOLISM SOI 2. PULMONARY EMBOLISM SOI 3. MAJOR CHEST & RESPIRATORY TRAUMA SOI 1. MAJOR CHEST & RESPIRATORY TRAUMA SOI 2. MAJOR CHEST & RESPIRATORY TRAUMA SOI 3. RESPIRATORY MALIGNANCY SOI 1. RESPIRATORY MALIGNANCY SOI 2. RESPIRATORY MALIGNANCY SOI 3. MAJOR RESPIRATORY INFECTIONS & INFLAMMATIONS SOI 1. MAJOR RESPIRATORY INFECTIONS & INFLAMMATIONS SOI 2. MAJOR RESPIRATORY INFECTIONS & INFLAMMATIONS SOI 3. BRONCHIOLITIS & RSV PNEUMONIA SOI 1. BRONCHIOLITIS & RSV PNEUMONIA SOI 2. BRONCHIOLITIS & RSV PNEUMONIA SOI 3. OTHER PNEUMONIA SOI 1. OTHER PNEUMONIA SOI 2. OTHER PNEUMONIA SOI 3. CHRONIC OBSTRUCTIVE PULMONARY DISEASE SOI 1. CHRONIC OBSTRUCTIVE PULMONARY DISEASE SOI 2. CHRONIC OBSTRUCTIVE PULMONARY DISEASE SOI 3. ASTHMA SOI 1. ASTHMA SOI 2. ASTHMA SOI 3. BPD & OTH CHRONIC RESPIRATORY DISEASES ARISING IN PERINATAL PERIOD SOI 1. INTERSTITIAL LUNG DISEASE SOI 1. BPD & OTH CHRONIC RESPIRATORY DISEASES ARISING IN PERINATAL PERIOD SOI 2. INTERSTITIAL LUNG DISEASE SOI 2. BPD & OTH CHRONIC RESPIRATORY DISEASES ARISING IN PERINATAL PERIOD SOI 3. INTERSTITIAL LUNG DISEASE SOI 3. OTHER RESPIRATORY DIAGNOSES EXCEPT SIGNS, SYMPTOMS & MINOR DIAGNOSES SOI 1. OTHER RESPIRATORY DIAGNOSES EXCEPT SIGNS, SYMPTOMS & MINOR DIAGNOSES SOI 2. OTHER RESPIRATORY DIAGNOSES EXCEPT SIGNS, SYMPTOMS & MINOR DIAGNOSES SOI 3. RESPIRATORY SIGNS, SYMPTOMS & MINOR DIAGNOSES SOI 1. RESPIRATORY SIGNS, SYMPTOMS & MINOR DIAGNOSES SOI 2. RESPIRATORY SIGNS, SYMPTOMS & MINOR DIAGNOSES SOI 3. MAJOR CARDIOTHORACIC REPAIR OF HEART ANOMALY SOI 4. CARDIAC DEFIBRILLATOR & HEART ASSIST IMPLANT SOI 4. E:\FR\FM\25APP2.SGM 25APP2 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules 24441 APPENDIX D.—CROSSWALK OF PROPOSED CONSOLIDATED SEVERITY-ADJUSTED DRGS TO RESPECTIVE APR DRGS— Continued TYPE Consolidated severity-adjusted DRG MDC Consolidated severity-adjusted DRG description APR DRG SOI APR DRG description 5 204 CARDIOTHORACIC PROCEDURES SOI 4 162 4 S ........ 5 204 CARDIOTHORACIC PROCEDURES SOI 4 163 4 S ........ 5 204 CARDIOTHORACIC PROCEDURES SOI 4 165 4 S ........ 5 204 CARDIOTHORACIC PROCEDURES SOI 4 166 4 S ........ 5 204 CARDIOTHORACIC PROCEDURES SOI 4 167 4 S ........ 5 205 VASCULAR PROCEDURES SOI 4 ............. 169 4 S ........ 5 205 VASCULAR PROCEDURES SOI 4 ............. 173 4 S ........ 5 206 OTHER CIRCULATORY SYSTEM PROCEDURES SOI 4. 170 4 S ........ 5 206 OTHER CIRCULATORY SYSTEM PROCEDURES SOI 4. 171 4 S ........ 5 206 4 5 206 175 4 S ........ 5 206 OTHER CIRCULATORY SYSTEM PROCEDURES SOI 4. OTHER CIRCULATORY SYSTEM PROCEDURES SOI 4. OTHER CIRCULATORY SYSTEM PROCEDURES SOI 4. 174 S ........ 176 4 S ........ 5 206 OTHER CIRCULATORY SYSTEM PROCEDURES SOI 4. 177 4 S ........ 5 206 4 5 207 161 1 S ........ 5 208 161 2 S ........ 5 209 161 3 S ........ 5 210 162 1 S ........ 5 211 162 2 S ........ 5 212 162 3 S ........ 5 213 163 1 S ........ 5 214 163 2 S ........ 5 215 163 3 S ........ 5 216 165 1 S ........ 5 217 165 2 S ........ 5 218 165 3 S ........ 5 219 166 1 S ........ 5 220 OTHER CIRCULATORY SYSTEM PROCEDURES SOI 4. CARDIAC DEFIBRILLATOR & HEART ASSIST IMPLANT SOI 1. CARDIAC DEFIBRILLATOR & HEART ASSIST IMPLANT SOI 2. CARDIAC DEFIBRILLATOR & HEART ASSIST IMPLANT SOI 3. CARDIAC VALVE PROCEDURES W CARDIAC CATHETERIZATION SOI 1. CARDIAC VALVE PROCEDURES W CARDIAC CATHETERIZATION SOI 2. CARDIAC VALVE PROCEDURES W CARDIAC CATHETERIZATION SOI 3. CARDIAC VALVE PROCEDURES W/O CARDIAC CATHETERIZATION SOI 1. CARDIAC VALVE PROCEDURES W/O CARDIAC CATHETERIZATION SOI 2. CARDIAC VALVE PROCEDURES W/O CARDIAC CATHETERIZATION SOI 3. CORONARY BYPASS W CARDIAC CATH OR PERCUTANEOUS CARDIAC PROCEDURE SOI 1. CORONARY BYPASS W CARDIAC CATH OR PERCUTANEOUS CARDIAC PROCEDURE SOI 2. CORONARY BYPASS W CARDIAC CATH OR PERCUTANEOUS CARDIAC PROCEDURE SOI 3. CORONARY BYPASS W/O CARDIAC CATH OR PERCUTANEOUS CARDIAC PROCEDURE SOI 1. CORONARY BYPASS W/O CARDIAC CATH OR PERCUTANEOUS CARDIAC PROCEDURE SOI 2. 180 S ........ wwhite on PROD1PC61 with PROPOSALS2 S ........ 166 2 VerDate Aug<31>2005 17:10 Apr 24, 2006 Jkt 208001 PO 00000 Frm 00447 Fmt 4701 Sfmt 4702 CARDIAC VALVE PROCEDURES W CARDIAC CATHETERIZATION SOI 4. CARDIAC VALVE PROCEDURES W/O CARDIAC CATHETERIZATION SOI 4. CORONARY BYPASS W CARDIAC CATH OR PERCUTANEOUS CARDIAC PROCEDURE SOI 4. CORONARY BYPASS W/O CARDIAC CATH OR PERCUTANEOUS CARDIAC PROCEDURE SOI 4. OTHER CARDIOTHORACIC PROCEDURES SOI 4. MAJOR THORACIC & ABDOMINAL VASCULAR PROCEDURES SOI 4. OTHER VASCULAR PROCEDURES SOI 4. PERMANENT CARDIAC PACEMAKER IMPLANT W AMI, HEART FAILURE OR SHOCK SOI 4. PERM CARDIAC PACEMAKER IMPLANT W/O AMI, HEART FAILURE OR SHOCK SOI 4. PERCUTANEOUS CARDIOVASCULAR PROCEDURES W AMI SOI 4. PERCUTANEOUS CARDIOVASCULAR PROCEDURES W/O AMI SOI 4. CARDIAC PACEMAKER & DEFIBRILLATOR DEVICE REPLACEMENT SOI 4. CARDIAC PACEMAKER & DEFIBRILLATOR REVISION EXCEPT DEVICE REPLACEMENT SOI 4. OTHER CIRCULATORY SYSTEM PROCEDURES SOI 4. CARDIAC DEFIBRILLATOR & HEART ASSIST IMPLANT SOI 1. CARDIAC DEFIBRILLATOR & HEART ASSIST IMPLANT SOI 2. CARDIAC DEFIBRILLATOR & HEART ASSIST IMPLANT SOI 3. CARDIAC VALVE PROCEDURES W CARDIAC CATHETERIZATION SOI 1. CARDIAC VALVE PROCEDURES W CARDIAC CATHETERIZATION SOI 2. CARDIAC VALVE PROCEDURES W CARDIAC CATHETERIZATION SOI 3. CARDIAC VALVE PROCEDURES W/O CARDIAC CATHETERIZATION SOI 1. CARDIAC VALVE PROCEDURES W/O CARDIAC CATHETERIZATION SOI 2. CARDIAC VALVE PROCEDURES W/O CARDIAC CATHETERIZATION SOI 3. CORONARY BYPASS W CARDIAC CATH OR PERCUTANEOUS CARDIAC PROCEDURE SOI 1. CORONARY BYPASS W CARDIAC CATH OR PERCUTANEOUS CARDIAC PROCEDURE SOI 2. CORONARY BYPASS W CARDIAC CATH OR PERCUTANEOUS CARDIAC PROCEDURE SOI 3. CORONARY BYPASS W/O CARDIAC CATH OR PERCUTANEOUS CARDIAC PROCEDURE SOI 1. CORONARY BYPASS W/O CARDIAC CATH OR PERCUTANEOUS CARDIAC PROCEDURE SOI 2. E:\FR\FM\25APP2.SGM 25APP2 24442 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules APPENDIX D.—CROSSWALK OF PROPOSED CONSOLIDATED SEVERITY-ADJUSTED DRGS TO RESPECTIVE APR DRGS— Continued TYPE Consolidated severity-adjusted DRG MDC 5 221 S ........ 5 222 S ........ 5 222 S ........ 5 223 S ........ 5 223 S ........ 5 224 S ........ 5 224 S ........ 5 225. S ........ 5 226. S ........ 5 227 S ........ 5 228 S ........ 5 229 S ........ 5 230 S ........ 5 231 S ........ 5 232 S ........ 5 233 S ........ 5 S ........ APR DRG SOI APR DRG description 166 3 160 1 167 1 160 2 167 2 160 3 167 3 169 1 169 2 169 3 170 1 170 2 170 3 171 1 171 2 171 3 234 CORONARY BYPASS W/O CARDIAC CATH OR PERCUTANEOUS CARDIAC PROCEDURE SOI 3. OTHER CARDIOTHORACIC PROCEDURES SOI 1. OTHER CARDIOTHORACIC PROCEDURES SOI 1. OTHER CARDIOTHORACIC PROCEDURES SOI 2. OTHER CARDIOTHORACIC PROCEDURES SOI 2. OTHER CARDIOTHORACIC PROCEDURES SOI 3. OTHER CARDIOTHORACIC PROCEDURES SOI 3. MAJOR THORACIC & ABDOMINAL VASCULAR PROCEDURES SOI 1. MAJOR THORACIC & ABDOMINAL VASCULAR PROCEDURES SOI 2. MAJOR THORACIC & ABDOMINAL VASCULAR PROCEDURES SOI 3. PERMANENT CARDIAC PACEMAKER IMPLANT W AMI, HEART FAILURE OR SHOCK SOI 1. PERMANENT CARDIAC PACEMAKER IMPLANT W AMI, HEART FAILURE OR SHOCK SOI 2. PERMANENT CARDIAC PACEMAKER IMPLANT W AMI, HEART FAILURE OR SHOCK SOI 3. PERM CARDIAC PACEMAKER IMPLANT W/O AMI, HEART FAILURE OR SHOCK SOI 1. PERM CARDIAC PACEMAKER IMPLANT W/O AMI, HEART FAILURE OR SHOCK SOI 2. PERM CARDIAC PACEMAKER IMPLANT W/O AMI, HEART FAILURE OR SHOCK SOI 3. OTHER VASCULAR PROCEDURES SOI 1 173 1 5 235 OTHER VASCULAR PROCEDURES SOI 2 173 2 S ........ 5 236 OTHER VASCULAR PROCEDURES SOI 3 173 3 S ........ 5 237 1 5 238 174 2 S ........ 5 239 174 3 S ........ 5 240 175 1 S ........ 5 241 175 2 S ........ 5 242 175 3 S ........ 5 243 176 1 S ........ 5 244 176 2 S ........ 5 245 176 3 S ........ 5 246 PERCUTANEOUS CARDIOVASCULAR PROCEDURES W AMI SOI 1. PERCUTANEOUS CARDIOVASCULAR PROCEDURES W AMI SOI 2. PERCUTANEOUS CARDIOVASCULAR PROCEDURES W AMI SOI 3. PERCUTANEOUS CARDIOVASCULAR PROCEDURES W/O AMI SOI 1. PERCUTANEOUS CARDIOVASCULAR PROCEDURES W/O AMI SOI 2. PERCUTANEOUS CARDIOVASCULAR PROCEDURES W/O AMI SOI 3. CARDIAC PACEMAKER & DEFIBRILLATOR DEVICE REPLACEMENT SOI 1. CARDIAC PACEMAKER & DEFIBRILLATOR DEVICE REPLACEMENT SOI 2. CARDIAC PACEMAKER & DEFIBRILLATOR DEVICE REPLACEMENT SOI 3. CARDIAC PACEMAKER & DEFIBRILLATOR REVISION EXCEPT DEVICE REPLACEMENT SOI 1. 174 S ........ wwhite on PROD1PC61 with PROPOSALS2 S ........ Consolidated severity-adjusted DRG description 177 1 VerDate Aug<31>2005 17:10 Apr 24, 2006 Jkt 208001 PO 00000 Frm 00448 Fmt 4701 Sfmt 4702 CORONARY BYPASS W/O CARDIAC CATH OR PERCUTANEOUS CARDIAC PROCEDURE SOI 3. MAJOR CARDIOTHORACIC REPAIR OF HEART ANOMALY SOI 1. OTHER CARDIOTHORACIC PROCEDURES SOI 1. MAJOR CARDIOTHORACIC REPAIR OF HEART ANOMALY SOI 2. OTHER CARDIOTHORACIC PROCEDURES SOI 2. MAJOR CARDIOTHORACIC REPAIR OF HEART ANOMALY SOI 3. OTHER CARDIOTHORACIC PROCEDURES SOI 3. MAJOR THORACIC & ABDOMINAL VASCULAR PROCEDURES SOI 1. MAJOR THORACIC & ABDOMINAL VASCULAR PROCEDURES SOI 2. MAJOR THORACIC & ABDOMINAL VASCULAR PROCEDURES SOI 3. PERMANENT CARDIAC PACEMAKER IMPLANT W AMI, HEART FAILURE OR SHOCK SOI 1. PERMANENT CARDIAC PACEMAKER IMPLANT W AMI, HEART FAILURE OR SHOCK SOI 2. PERMANENT CARDIAC PACEMAKER IMPLANT W AMI, HEART FAILURE OR SHOCK SOI 3. PERM CARDIAC PACEMAKER IMPLANT W/O AMI, HEART FAILURE OR SHOCK SOI 1. PERM CARDIAC PACEMAKER IMPLANT W/O AMI, HEART FAILURE OR SHOCK SOI 2. PERM CARDIAC PACEMAKER IMPLANT W/O AMI, HEART FAILURE OR SHOCK SOI 3. OTHER VASCULAR PROCEDURES SOI 1. OTHER VASCULAR PROCEDURES SOI 2. OTHER VASCULAR PROCEDURES SOI 3. PERCUTANEOUS CARDIOVASCULAR PROCEDURES W AMI SOI 1. PERCUTANEOUS CARDIOVASCULAR PROCEDURES W AMI SOI 2. PERCUTANEOUS CARDIOVASCULAR PROCEDURES W AMI SOI 3. PERCUTANEOUS CARDIOVASCULAR PROCEDURES W/O AMI SOI 1. PERCUTANEOUS CARDIOVASCULAR PROCEDURES W/O AMI SOI 2. PERCUTANEOUS CARDIOVASCULAR PROCEDURES W/O AMI SOI 3. CARDIAC PACEMAKER & DEFIBRILLATOR DEVICE REPLACEMENT SOI 1. CARDIAC PACEMAKER & DEFIBRILLATOR DEVICE REPLACEMENT SOI 2. CARDIAC PACEMAKER & DEFIBRILLATOR DEVICE REPLACEMENT SOI 3. CARDIAC PACEMAKER & DEFIBRILLATOR REVISION EXCEPT DEVICE REPLACEMENT SOI 1. E:\FR\FM\25APP2.SGM 25APP2 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules 24443 APPENDIX D.—CROSSWALK OF PROPOSED CONSOLIDATED SEVERITY-ADJUSTED DRGS TO RESPECTIVE APR DRGS— Continued TYPE Consolidated severity-adjusted DRG MDC 5 247 S ........ 5 248 S ........ 5 249 S ........ 5 250 S ........ 5 251 M ....... 5 252 M ....... 5 252 M ....... 5 252 M ....... 5 252 M ....... 5 252 M ....... 5 252 M ....... 5 252 M ....... 5 252 M ....... 5 252 M ....... 5 252 M ....... 5 252 M ....... 5 252 M ....... 5 252 M ....... 5 252 M ....... 5 252 M ....... 5 252 M ....... 5 253 M ....... 5 254 M ....... 5 255 M ....... 5 256 M ....... 5 257 M ....... wwhite on PROD1PC61 with PROPOSALS2 S ........ 5 258 M ....... 5 259 M ....... 5 260 M ....... 5 261 M ....... 5 262 VerDate Aug<31>2005 17:10 Apr 24, 2006 Consolidated severity-adjusted DRG description APR DRG SOI APR DRG description CARDIAC PACEMAKER & DEFIBRILLATOR REVISION EXCEPT DEVICE REPLACEMENT SOI 2. CARDIAC PACEMAKER & DEFIBRILLATOR REVISION EXCEPT DEVICE REPLACEMENT SOI 3. OTHER CIRCULATORY SYSTEM PROCEDURES SOI 1. OTHER CIRCULATORY SYSTEM PROCEDURES SOI 2. OTHER CIRCULATORY SYSTEM PROCEDURES SOI 3. CIRCULATORY SYSTEM DIAGNOSES SOI 4. CIRCULATORY SYSTEM DIAGNOSES SOI 4. 177 2 SYSTEM DIAGNOSES 192 4 SYSTEM DIAGNOSES 193 4 SYSTEM DIAGNOSES 194 4 CARDIAC PACEMAKER & DEFIBRILLATOR REVISION EXCEPT DEVICE REPLACEMENT SOI 2. CARDIAC PACEMAKER & DEFIBRILLATOR REVISION EXCEPT DEVICE REPLACEMENT SOI 3. OTHER CIRCULATORY SYSTEM PROCEDURES SOI 1. OTHER CIRCULATORY SYSTEM PROCEDURES SOI 2. OTHER CIRCULATORY SYSTEM PROCEDURES SOI 3. ACUTE MYOCARDIAL INFARCTION SOI 4. CARDIAC CATHETERIZATION W CIRC DISORD EXC ISCHEMIC HEART DISEASE SOI 4. CARDIAC CATHETERIZATION FOR ISCHEMIC HEART DISEASE SOI 4. ACUTE & SUBACUTE ENDOCARDITIS SOI 4. HEART FAILURE SOI 4. 177 3 180 1 180 2 180 3 190 4 191 4 CIRCULATORY SOI 4. CIRCULATORY SOI 4. CIRCULATORY SOI 4. CIRCULATORY SOI 4. CIRCULATORY SOI 4. CIRCULATORY SOI 4. CIRCULATORY SOI 4. CIRCULATORY SOI 4. CIRCULATORY SOI 4. CIRCULATORY SOI 4. CIRCULATORY SOI 4. CIRCULATORY SOI 4. CIRCULATORY SOI 4. SYSTEM DIAGNOSES 196 4 CARDIAC ARREST SOI 4. SYSTEM DIAGNOSES 197 4 SYSTEM DIAGNOSES 198 4 SYSTEM DIAGNOSES 199 4 PERIPHERAL & OTHER VASCULAR DISORDERS SOI 4. ANGINA PECTORIS & CORONARY ATHEROSCLEROSIS SOI 4. HYPERTENSION SOI 4. SYSTEM DIAGNOSES 200 4 SYSTEM DIAGNOSES 201 4 SYSTEM DIAGNOSES 203 4 CARDIAC STRUCTURAL & VALVULAR DISORDERS SOI 4. CARDIAC ARRHYTHMIA & CONDUCTION DISORDERS SOI 4. CHEST PAIN SOI 4. SYSTEM DIAGNOSES 204 4 SYNCOPE & COLLAPSE SOI 4. SYSTEM DIAGNOSES 205 4 CARDIOMYOPATHY SOI 4. SYSTEM DIAGNOSES 206 4 CIRCULATORY SYSTEM DIAGNOSES SOI 4. ACUTE MYOCARDIAL INFARCTION SOI 1. ACUTE MYOCARDIAL INFARCTION SOI 2. ACUTE MYOCARDIAL INFARCTION SOI 3. CARDIAC CATHETERIZATION W CIRC DISORD EXC ISCHEMIC HEART DISEASE SOI 1. CARDIAC CATHETERIZATION W CIRC DISORD EXC ISCHEMIC HEART DISEASE SOI 2. CARDIAC CATHETERIZATION W CIRC DISORD EXC ISCHEMIC HEART DISEASE SOI 3. CARDIAC CATHETERIZATION FOR ISCHEMIC HEART DISEASE SOI 1. CARDIAC CATHETERIZATION FOR ISCHEMIC HEART DISEASE SOI 2. CARDIAC CATHETERIZATION FOR ISCHEMIC HEART DISEASE SOI 3. ACUTE & SUBACUTE ENDOCARDITIS SOI 1. 207 4 190 1 190 2 190 3 191 1 191 2 191 3 192 1 192 2 192 3 193 1 MALFUNCTION, REACTION, COMP LICATION OF CARDIAC/VASC DEVICE OR PROCEDURE SOI 4. OTHER CIRCULATORY SYSTEM DIAGNOSES SOI 4. ACUTE MYOCARDIAL INFARCTION SOI 1. ACUTE MYOCARDIAL INFARCTION SOI 2. ACUTE MYOCARDIAL INFARCTION SOI 3. CARDIAC CATHETERIZATION W CIRC DISORD EXC ISCHEMIC HEART DISEASE SOI 1. CARDIAC CATHETERIZATION W CIRC DISORD EXC ISCHEMIC HEART DISEASE SOI 2. CARDIAC CATHETERIZATION W CIRC DISORD EXC ISCHEMIC HEART DISEASE SOI 3. CARDIAC CATHETERIZATION FOR ISCHEMIC HEART DISEASE SOI 1. CARDIAC CATHETERIZATION FOR ISCHEMIC HEART DISEASE SOI 2. CARDIAC CATHETERIZATION FOR ISCHEMIC HEART DISEASE SOI 3. ACUTE & SUBACUTE ENDOCARDITIS SOI 1. Jkt 208001 PO 00000 Frm 00449 Fmt 4701 Sfmt 4702 E:\FR\FM\25APP2.SGM 25APP2 24444 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules APPENDIX D.—CROSSWALK OF PROPOSED CONSOLIDATED SEVERITY-ADJUSTED DRGS TO RESPECTIVE APR DRGS— Continued TYPE Consolidated severity-adjusted DRG MDC 5 263 M ....... 5 264 M M M M M M M ....... ....... ....... ....... ....... ....... ....... 5 5 5 5 5 5 5 265 266 267 268 269 270 271 M ....... 5 272 M ....... 5 273 M ....... 5 274 M ....... 5 275 M ....... 5 276 M M M M ....... ....... ....... ....... 5 5 5 5 277 278 279 280 M ....... 5 281 M ....... 5 282 M ....... 5 283 M ....... 5 284 M ....... 5 285 M M M M M M M M M M ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... 5 5 5 5 5 5 5 5 5 5 286 287 288 289 290 291 292 293 294 295 M ....... 5 296 M ....... 5 297 M ....... 5 298 M ....... 5 299 M ....... wwhite on PROD1PC61 with PROPOSALS2 M ....... 5 300 S ........ 6 301 S ........ 6 301 S ........ 6 301 S ........ 6 301 VerDate Aug<31>2005 17:10 Apr 24, 2006 Consolidated severity-adjusted DRG description APR DRG ACUTE & SUBACUTE ENDOCARDITIS SOI 2. ACUTE & SUBACUTE ENDOCARDITIS SOI 3. HEART FAILURE SOI 1 .............................. HEART FAILURE SOI 2 .............................. HEART FAILURE SOI 3 .............................. CARDIAC ARREST SOI 1 ........................... CARDIAC ARREST SOI 2 ........................... CARDIAC ARREST SOI 3 ........................... PERIPHERAL & OTHER VASCULAR DISORDERS SOI 1. PERIPHERAL & OTHER VASCULAR DISORDERS SOI 2. PERIPHERAL & OTHER VASCULAR DISORDERS SOI 3. ANGINA PECTORIS & CORONARY ATHEROSCLEROSIS SOI 1. ANGINA PECTORIS & CORONARY ATHEROSCLEROSIS SOI 2. ANGINA PECTORIS & CORONARY ATHEROSCLEROSIS SOI 3. HYPERTENSION SOI 1 .............................. HYPERTENSION SOI 2 .............................. HYPERTENSION SOI 3 .............................. CARDIAC STRUCTURAL & VALVULAR DISORDERS SOI 1. CARDIAC STRUCTURAL & VALVULAR DISORDERS SOI 2. CARDIAC STRUCTURAL & VALVULAR DISORDERS SOI 3. CARDIAC ARRHYTHMIA & CONDUCTION DISORDERS SOI 1. CARDIAC ARRHYTHMIA & CONDUCTION DISORDERS SOI 2. CARDIAC ARRHYTHMIA & CONDUCTION DISORDERS SOI 3. CHEST PAIN SOI 1 ..................................... CHEST PAIN SOI 2 ..................................... CHEST PAIN SOI 3 ..................................... SYNCOPE & COLLAPSE SOI 1 ................. SYNCOPE & COLLAPSE SOI 2 ................. SYNCOPE & COLLAPSE SOI 3 ................. CARDIOMYOPATHY SOI 1 ........................ CARDIOMYOPATHY SOI 2 ........................ CARDIOMYOPATHY SOI 3 ........................ MALFUNCTION, REACTION, CO MPLICATION OF CARDIAC/VASC DEVICE OR PROCEDURE SOI 1. MALFUNCTION, REACTION, CO. MPLICATION OF CARDIAC/VASC DEVICE OR PROCEDURE SOI 2. MALFUNCTION, REACTION, CO. MPLICATION OF CARDIAC/VASC DEVICE OR PROCEDURE SOI 3. OTHER CIRCULATORY SYSTEM DIAGNOSES SOI 1. OTHER CIRCULATORY SYSTEM DIAGNOSES SOI 2. OTHER CIRCULATORY SYSTEM DIAGNOSES SOI 3. MAJOR GASTROINTESTINAL PROCEDURES SOI 4. MAJOR GASTROINTESTINAL PROCEDURES SOI 4. MAJOR GASTROINTESTINAL PROCEDURES SOI 4. MAJOR GASTROINTESTINAL PROCEDURES SOI 4. Jkt 208001 PO 00000 Frm 00450 Fmt 4701 Sfmt 4702 SOI APR DRG description 193 2 193 3 194 194 194 196 196 196 197 1 2 3 1 2 3 1 197 2 197 3 198 1 198 2 198 3 199 199 199 200 1 2 3 1 200 2 200 3 201 1 201 2 201 3 203 203 203 204 204 204 205 205 205 206 1 2 3 1 2 3 1 2 3 1 206 2 206 3 207 1 207 2 207 3 220 4 221 4 222 4 223 4 ACUTE & SUBACUTE ENDOCARDITIS SOI 2. ACUTE & SUBACUTE ENDOCARDITIS SOI 3. HEART FAILURE SOI 1. HEART FAILURE SOI 2. HEART FAILURE SOI 3. CARDIAC ARREST SOI 1. CARDIAC ARREST SOI 2. CARDIAC ARREST SOI 3. PERIPHERAL & OTHER VASCULAR DISORDERS SOI 1. PERIPHERAL & OTHER VASCULAR DISORDERS SOI 2. PERIPHERAL & OTHER VASCULAR DISORDERS SOI 3. ANGINA PECTORIS & CORONARY ATHEROSCLEROSIS SOI 1. ANGINA PECTORIS & CORONARY ATHEROSCLEROSIS SOI 2. ANGINA PECTORIS & CORONARY ATHEROSCLEROSIS SOI 3. HYPERTENSION SOI 1. HYPERTENSION SOI 2. HYPERTENSION SOI 3. CARDIAC STRUCTURAL & VALVULAR DISORDERS SOI 1. CARDIAC STRUCTURAL & VALVULAR DISORDERS SOI 2. CARDIAC STRUCTURAL & VALVULAR DISORDERS SOI 3. CARDIAC ARRHYTHMIA & CONDUCTION DISORDERS SOI 1. CARDIAC ARRHYTHMIA & CONDUCTION DISORDERS SOI 2. CARDIAC ARRHYTHMIA & CONDUCTION DISORDERS SOI 3. CHEST PAIN SOI 1. CHEST PAIN SOI 2. CHEST PAIN SOI 3. SYNCOPE & COLLAPSE SOI 1. SYNCOPE & COLLAPSE SOI 2. SYNCOPE & COLLAPSE SOI 3. CARDIOMYOPATHY SOI 1. CARDIOMYOPATHY SOI 2. CARDIOMYOPATHY SOI 3. MALFUNCTION, REACTION, COMP LICATION OF CARDIAC/VASC DEVICE OR PROCEDURE SOI 1. MALFUNCTION, REACTION, COMP LICATION OF CARDIAC/VASC DEVICE OR PROCEDURE SOI 2. MALFUNCTION, REACTION, COMP LICATION OF CARDIAC/VASC DEVICE OR PROCEDURE SOI 3. OTHER CIRCULATORY SYSTEM DIAGNOSES SOI 1. OTHER CIRCULATORY SYSTEM DIAGNOSES SOI 2. OTHER CIRCULATORY SYSTEM DIAGNOSES SOI 3. MAJOR STOMACH, ESOPHAGEAL & DUODENAL PROCEDURES SOI 4. MAJOR SMALL & LARGE BOWEL PROCEDURES SOI 4. OTHER STOMACH, ESOPHAGEAL & DUODENAL PROCEDURES SOI 4. OTHER SMALL & LARGE BOWEL PROCEDURES SOI 4. E:\FR\FM\25APP2.SGM 25APP2 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules 24445 APPENDIX D.—CROSSWALK OF PROPOSED CONSOLIDATED SEVERITY-ADJUSTED DRGS TO RESPECTIVE APR DRGS— Continued TYPE Consolidated severity-adjusted DRG MDC Consolidated severity-adjusted DRG description APR DRG 6 302 S ........ 6 302 S ........ 6 302 S ........ 6 302 S ........ 6 302 S ........ 6 302 S ........ 6 303 S ........ 6 304 S ........ 6 305 S ........ 6 306 S ........ 6 307 S ........ 6 308 S ........ 6 309 S ........ 6 310 S ........ 6 311 S ........ 6 312 S ........ 6 313 S ........ 6 314 S S S S S S S S S S ........ ........ ........ ........ ........ ........ ........ ........ ........ ........ 6 6 6 6 6 6 6 6 6 6 315 316 317 318 319 320 321 322 323 324 S ........ 6 325 S ........ 6 326 S ........ 6 327 S ........ 6 328 S ........ 6 329 S ........ 6 330 S ........ wwhite on PROD1PC61 with PROPOSALS2 S ........ 6 331 S ........ 6 332 M ....... M ....... M ....... 6 6 6 333 333 333 OTHER GASTROINTESTINAL & ABDOMINAL PROCEDURES SOI 4. OTHER GASTROINTESTINAL & ABDOMINAL PROCEDURES SOI 4. OTHER GASTROINTESTINAL & ABDOMINAL PROCEDURES SOI 4. OTHER GASTROINTESTINAL & ABDOMINAL PROCEDURES SOI 4. OTHER GASTROINTESTINAL & ABDOMINAL PROCEDURES SOI 4. OTHER GASTROINTESTINAL & ABDOMINAL PROCEDURES SOI 4. MAJOR STOMACH, ESOPHAGEAL & DUODENAL PROCEDURES SOI 1. MAJOR STOMACH, ESOPHAGEAL & DUODENAL PROCEDURES SOI 2. MAJOR STOMACH, ESOPHAGEAL & DUODENAL PROCEDURES SOI 3. MAJOR SMALL & LARGE BOWEL PROCEDURES SOI 1. MAJOR SMALL & LARGE BOWEL PROCEDURES SOI 2. MAJOR SMALL & LARGE BOWEL PROCEDURES SOI 3. OTHER STOMACH, ESOPHAGEAL & DUODENAL PROCEDURES SOI 1. OTHER STOMACH, ESOPHAGEAL & DUODENAL PROCEDURES SOI 2. OTHER STOMACH, ESOPHAGEAL & DUODENAL PROCEDURES SOI 3. OTHER SMALL & LARGE BOWEL PROCEDURES SOI 1. OTHER SMALL & LARGE BOWEL PROCEDURES SOI 2. OTHER SMALL & LARGE BOWEL PROCEDURES SOI 3. PERITONEAL ADHESIOLYSIS SOI 1 ........ PERITONEAL ADHESIOLYSIS SOI 2 ........ PERITONEAL ADHESIOLYSIS SOI 3 ........ APPENDECTOMY SOI 1 ............................ APPENDECTOMY SOI 2 ............................ APPENDECTOMY SOI 3 ............................ ANAL PROCEDURES SOI 1 ....................... ANAL PROCEDURES SOI 2 ....................... ANAL PROCEDURES SOI 3 ....................... HERNIA PROCEDURES EXCEPT INGUINAL, FEMORAL & UMBILICAL SOI 1. HERNIA PROCEDURES EXCEPT INGUINAL, FEMORAL & UMBILICAL SOI 2. HERNIA PROCEDURES EXCEPT INGUINAL, FEMORAL & UMBILICAL SOI 3. INGUINAL, FEMORAL & UMBILICAL HERNIA PROCEDURES SOI 1. INGUINAL, FEMORAL & UMBILICAL HERNIA PROCEDURES SOI 2. INGUINAL, FEMORAL & UMBILICAL HERNIA PROCEDURES SOI 3. OTHER DIGESTIVE SYSTEM & ABDOMINAL PROCEDURES SOI 1. OTHER DIGESTIVE SYSTEM & ABDOMINAL PROCEDURES SOI 2. OTHER DIGESTIVE SYSTEM & ABDOMINAL PROCEDURES SOI 3. DIGESTIVE SYSTEM DIAGNOSES SOI 4 DIGESTIVE SYSTEM DIAGNOSES SOI 4 DIGESTIVE SYSTEM DIAGNOSES SOI 4 M ....... 6 333 DIGESTIVE SYSTEM DIAGNOSES SOI 4 VerDate Aug<31>2005 17:10 Apr 24, 2006 Jkt 208001 PO 00000 Frm 00451 Fmt 4701 Sfmt 4702 SOI APR DRG description 224 4 PERITONEAL ADHESIOLYSIS SOI 4. 225 4 APPENDECTOMY SOI 4. 226 4 ANAL PROCEDURES SOI 4. 227 4 228 4 229 4 220 1 220 2 220 3 221 1 221 2 221 3 222 1 222 2 222 3 223 1 223 2 223 3 224 224 224 225 225 225 226 226 226 227 1 2 3 1 2 3 1 2 3 1 227 2 227 3 228 1 228 2 228 3 229 1 229 2 229 3 240 241 242 4 4 4 243 4 HERNIA PROCEDURES EXCEPT INGUINAL, FEMORAL & UMBILICAL SOI 4. INGUINAL, FEMORAL & UMBILICAL HERNIA PROCEDURES SOI 4. OTHER DIGESTIVE SYSTEM & ABDOMINAL PROCEDURES SOI 4. MAJOR STOMACH, ESOPHAGEAL & DUODENAL PROCEDURES SOI 1. MAJOR STOMACH, ESOPHAGEAL & DUODENAL PROCEDURES SOI 2. MAJOR STOMACH, ESOPHAGEAL & DUODENAL PROCEDURES SOI 3. MAJOR SMALL & LARGE BOWEL PROCEDURES SOI 1. MAJOR SMALL & LARGE BOWEL PROCEDURES SOI 2. MAJOR SMALL & LARGE BOWEL PROCEDURES SOI 3. OTHER STOMACH, ESOPHAGEAL & DUODENAL PROCEDURES SOI 1. OTHER STOMACH, ESOPHAGEAL & DUODENAL PROCEDURES SOI 2. OTHER STOMACH, ESOPHAGEAL & DUODENAL PROCEDURES SOI 3. OTHER SMALL & LARGE BOWEL PROCEDURES SOI 1. OTHER SMALL & LARGE BOWEL PROCEDURES SOI 2. OTHER SMALL & LARGE BOWEL PROCEDURES SOI 3. PERITONEAL ADHESIOLYSIS SOI 1. PERITONEAL ADHESIOLYSIS SOI 2. PERITONEAL ADHESIOLYSIS SOI 3. APPENDECTOMY SOI 1. APPENDECTOMY SOI 2. APPENDECTOMY SOI 3. ANAL PROCEDURES SOI 1. ANAL PROCEDURES SOI 2. ANAL PROCEDURES SOI 3. HERNIA PROCEDURES EXCEPT INGUINAL, FEMORAL & UMBILICAL SOI 1. HERNIA PROCEDURES EXCEPT INGUINAL, FEMORAL & UMBILICAL SOI 2. HERNIA PROCEDURES EXCEPT INGUINAL, FEMORAL & UMBILICAL SOI 3. INGUINAL, FEMORAL & UMBILICAL HERNIA PROCEDURES SOI 1. INGUINAL, FEMORAL & UMBILICAL HERNIA PROCEDURES SOI 2. INGUINAL, FEMORAL & UMBILICAL HERNIA PROCEDURES SOI 3. OTHER DIGESTIVE SYSTEM & ABDOMINAL PROCEDURES SOI 1. OTHER DIGESTIVE SYSTEM & ABDOMINAL PROCEDURES SOI 2. OTHER DIGESTIVE SYSTEM & ABDOMINAL PROCEDURES SOI 3. DIGESTIVE MALIGNANCY SOI 4. PEPTIC ULCER & GASTRITIS SOI 4. MAJOR ESOPHAGEAL DISORDERS SOI 4. OTHER ESOPHAGEAL DISORDERS SOI 4. E:\FR\FM\25APP2.SGM 25APP2 24446 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules APPENDIX D.—CROSSWALK OF PROPOSED CONSOLIDATED SEVERITY-ADJUSTED DRGS TO RESPECTIVE APR DRGS— Continued TYPE Consolidated severity-adjusted DRG MDC Consolidated severity-adjusted DRG description APR DRG SOI APR DRG description 6 333 DIGESTIVE SYSTEM DIAGNOSES SOI 4 244 4 M ....... 6 333 DIGESTIVE SYSTEM DIAGNOSES SOI 4 245 4 M ....... 6 333 DIGESTIVE SYSTEM DIAGNOSES SOI 4 246 4 M ....... M ....... 6 6 333 333 DIGESTIVE SYSTEM DIAGNOSES SOI 4 DIGESTIVE SYSTEM DIAGNOSES SOI 4 247 248 4 4 M ....... 6 333 DIGESTIVE SYSTEM DIAGNOSES SOI 4 249 4 M ....... M ....... 6 6 333 333 DIGESTIVE SYSTEM DIAGNOSES SOI 4 DIGESTIVE SYSTEM DIAGNOSES SOI 4 251 252 4 4 M ....... 6 333 DIGESTIVE SYSTEM DIAGNOSES SOI 4 253 4 M ....... 6 333 DIGESTIVE SYSTEM DIAGNOSES SOI 4 254 4 M M M M M M M ....... ....... ....... ....... ....... ....... ....... 6 6 6 6 6 6 6 334 335 336 337 338 339 340 1 2 3 1 2 3 1 6 341 242 2 M ....... 6 342 242 3 M ....... 6 343 243 1 M ....... 6 344 243 2 M ....... 6 345 243 3 M ....... 6 346 244 1 M ....... 6 347 244 2 M ....... 6 348 244 3 M ....... 6 349 DIGESTIVE MALIGNANCY SOI 1 .............. DIGESTIVE MALIGNANCY SOI 2 .............. DIGESTIVE MALIGNANCY SOI 3 .............. PEPTIC ULCER & GASTRITIS SOI 1 ........ PEPTIC ULCER & GASTRITIS SOI 2 ........ PEPTIC ULCER & GASTRITIS SOI 3 ........ MAJOR ESOPHAGEAL DISORDERS SOI 1. MAJOR ESOPHAGEAL DISORDERS SOI 2. MAJOR ESOPHAGEAL DISORDERS SOI 3. OTHER ESOPHAGEAL DISORDERS SOI 1. OTHER ESOPHAGEAL DISORDERS SOI 2. OTHER ESOPHAGEAL DISORDERS SOI 3. DIVERTICULITIS & DIVERTICULOSIS SOI 1. DIVERTICULITIS & DIVERTICULOSIS SOI 2. DIVERTICULITIS & DIVERTICULOSIS SOI 3. INFLAMMATORY BOWEL DISEASE SOI 1 240 240 240 241 241 241 242 M ....... 245 1 M ....... 6 350 INFLAMMATORY BOWEL DISEASE SOI 2 245 2 M ....... 6 351 INFLAMMATORY BOWEL DISEASE SOI 3 245 3 M ....... 6 352 1 6 353 246 2 M ....... 6 354 246 3 M M M M ....... ....... ....... ....... 6 6 6 6 355 356 357 358 247 247 247 248 1 2 3 1 M ....... 6 359 248 2 M ....... 6 360 248 3 M ....... 6 361 249 1 M ....... 6 362 GASTROINTESTINAL VASCULAR INSUFFICIENCY SOI 1. GASTROINTESTINAL VASCULAR INSUFFICIENCY SOI 2. GASTROINTESTINAL VASCULAR INSUFFICIENCY SOI 3. INTESTINAL OBSTRUCTION SOI 1 .......... INTESTINAL OBSTRUCTION SOI 2 .......... INTESTINAL OBSTRUCTION SOI 3 .......... MAJOR GASTROINTESTINAL & PERITONEAL INFECTIONS SOI 1. MAJOR GASTROINTESTINAL & PERITONEAL INFECTIONS SOI 2. MAJOR GASTROINTESTINAL & PERITONEAL INFECTIONS SOI 3. NON-BACTERIAL GASTROENTERITIS, NAUSEA & VOMITING SOI 1. NON-BACTERIAL GASTROENTERITIS, NAUSEA & VOMITING SOI 2. 246 M ....... wwhite on PROD1PC61 with PROPOSALS2 M ....... 249 2 VerDate Aug<31>2005 17:10 Apr 24, 2006 Jkt 208001 PO 00000 Frm 00452 Fmt 4701 Sfmt 4702 DIVERTICULITIS & DIVERTICULOSIS SOI 4. INFLAMMATORY BOWEL DISEASE SOI 4. GASTROINTESTINAL VASCULAR INSUFFICIENCY SOI 4. INTESTINAL OBSTRUCTION SOI 4. MAJOR GASTROINTESTINAL & PERITONEAL INFECTIONS SOI 4. NON-BACTERIAL GASTROENTERITIS, NAUSEA & VOMITING SOI 4. ABDOMINAL PAIN SOI 4. MALFUNCTION, REACTION & COMPLICATION OF GI DEVICE OR PROCEDURE SOI 4. OTHER & UNSPECIFIED GASTROINTESTINAL HEMORRHAGE SOI 4. OTHER DIGESTIVE SYSTEM DIAGNOSES SOI 4. DIGESTIVE MALIGNANCY SOI 1. DIGESTIVE MALIGNANCY SOI 2. DIGESTIVE MALIGNANCY SOI 3. PEPTIC ULCER & GASTRITIS SOI 1. PEPTIC ULCER & GASTRITIS SOI 2. PEPTIC ULCER & GASTRITIS SOI 3. MAJOR ESOPHAGEAL DISORDERS SOI 1. MAJOR ESOPHAGEAL DISORDERS SOI 2. MAJOR ESOPHAGEAL DISORDERS SOI 3. OTHER ESOPHAGEAL DISORDERS SOI 1. OTHER ESOPHAGEAL DISORDERS SOI 2. OTHER ESOPHAGEAL DISORDERS SOI 3. DIVERTICULITIS & DIVERTICULOSIS SOI 1. DIVERTICULITIS & DIVERTICULOSIS SOI 2. DIVERTICULITIS & DIVERTICULOSIS SOI 3. INFLAMMATORY BOWEL DISEASE SOI 1. INFLAMMATORY BOWEL DISEASE SOI 2. INFLAMMATORY BOWEL DISEASE SOI 3. GASTROINTESTINAL VASCULAR INSUFFICIENCY SOI 1. GASTROINTESTINAL VASCULAR INSUFFICIENCY SOI 2. GASTROINTESTINAL VASCULAR INSUFFICIENCY SOI 3. INTESTINAL OBSTRUCTION SOI 1. INTESTINAL OBSTRUCTION SOI 2. INTESTINAL OBSTRUCTION SOI 3. MAJOR GASTROINTESTINAL & PERITONEAL INFECTIONS SOI 1. MAJOR GASTROINTESTINAL & PERITONEAL INFECTIONS SOI 2. MAJOR GASTROINTESTINAL & PERITONEAL INFECTIONS SOI 3. NON-BACTERIAL GASTROENTERITIS, NAUSEA & VOMITING SOI 1. NON-BACTERIAL GASTROENTERITIS, NAUSEA & VOMITING SOI 2. E:\FR\FM\25APP2.SGM 25APP2 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules 24447 APPENDIX D.—CROSSWALK OF PROPOSED CONSOLIDATED SEVERITY-ADJUSTED DRGS TO RESPECTIVE APR DRGS— Continued TYPE Consolidated severity-adjusted DRG MDC 6 363 M M M M ....... ....... ....... ....... 6 6 6 6 364 365 366 367 M ....... 6 368 M ....... 6 369 M ....... 6 370 M ....... 6 371 M ....... 6 372 M ....... 6 373 M ....... 6 374 M ....... 6 375 S ........ 7 376 S ........ 7 376 S ........ 7 377 S ........ 7 377 S ........ 7 377 S ........ 7 378 S ........ 7 379 S ........ 7 380 S ........ 7 381 S ........ 7 382 S ........ 7 383 S ........ 7 384 S ........ 7 385 S ........ 7 386 S ........ 7 387 S ........ wwhite on PROD1PC61 with PROPOSALS2 M ....... 7 388 S ........ 7 389 S ........ 7 390 S ........ 7 391 S ........ 7 392 VerDate Aug<31>2005 17:10 Apr 24, 2006 Consolidated severity-adjusted DRG description APR DRG NON-BACTERIAL GASTROENTERITIS, NAUSEA & VOMITING SOI 3. ABDOMINAL PAIN SOI 1 ............................ ABDOMINAL PAIN SOI 2 ............................ ABDOMINAL PAIN SOI 3 ............................ MALFUNCTION, REACTION & COMPLICATION OF GI DEVICE OR PROCEDURE SOI 1. MALFUNCTION, REACTION & COMPLICATION OF GI DEVICE OR PROCEDURE SOI 2. MALFUNCTION, REACTION & COMPLICATION OF GI DEVICE OR PROCEDURE SOI 3. OTHER & UNSPECIFIED GASTROINTESTINAL HEMORRHAGE SOI 1. OTHER & UNSPECIFIED GASTROINTESTINAL HEMORRHAGE SOI 2. OTHER & UNSPECIFIED GASTROINTESTINAL HEMORRHAGE SOI 3. OTHER DIGESTIVE SYSTEM DIAGNOSES SOI 1. OTHER DIGESTIVE SYSTEM DIAGNOSES SOI 2. OTHER DIGESTIVE SYSTEM DIAGNOSES SOI 3. MAJOR HEPATOBILIARY, PANCREAS & LIVER PROCEDURES SOI 4. MAJOR HEPATOBILIARY, PANCREAS & LIVER PROCEDURES SOI 4. CHOLECYSTECTOMY AND OTHER HEPATOBILIARY, PANCREAS & ABDOMINAL PROCEDURES SOI 4. CHOLECYSTECTOMY AND OTHER HEPATOBILIARY, PANCREAS & ABDOMINAL PROCEDURES SOI 4. CHOLECYSTECTOMY AND OTHER HEPATOBILIARY, PANCREAS & ABDOMINAL PROCEDURES SOI 4. MAJOR PANCREAS, LIVER & SHUNT PROCEDURES SOI 1. MAJOR PANCREAS, LIVER & SHUNT PROCEDURES SOI 2. MAJOR PANCREAS, LIVER & SHUNT PROCEDURES SOI 3. MAJOR BILIARY TRACT PROCEDURES SOI 1. MAJOR BILIARY TRACT PROCEDURES SOI 2. MAJOR BILIARY TRACT PROCEDURES SOI 3. CHOLECYSTECTOMY EXCEPT LAPAROSCOPIC SOI 1. CHOLECYSTECTOMY EXCEPT LAPAROSCOPIC SOI 2. CHOLECYSTECTOMY EXCEPT LAPAROSCOPIC SOI 3. LAPAROSCOPIC CHOLECYSTECTOMY SOI 1. LAPAROSCOPIC CHOLECYSTECTOMY SOI 2. LAPAROSCOPIC CHOLECYSTECTOMY SOI 3. OTHER HEPATOBILIARY, PANCREAS & ABDOMINAL PROCEDURES SOI 1. OTHER HEPATOBILIARY, PANCREAS & ABDOMINAL PROCEDURES SOI 2. OTHER HEPATOBILIARY, PANCREAS & ABDOMINAL PROCEDURES SOI 3. Jkt 208001 PO 00000 Frm 00453 Fmt 4701 Sfmt 4702 SOI APR DRG description 249 3 NON-BACTERIAL GASTROENTERITIS, NAUSEA & VOMITING SOI 3. ABDOMINAL PAIN SOI 1. ABDOMINAL PAIN SOI 2. ABDOMINAL PAIN SOI 3. MALFUNCTION, REACTION & COMPLICATION OF GI DEVICE OR PROCEDURE SOI 1. MALFUNCTION, REACTION & COMPLICATION OF GI DEVICE OR PROCEDURE SOI 2. MALFUNCTION, REACTION & COMPLICATION OF GI DEVICE OR PROCEDURE SOI 3. OTHER & UNSPECIFIED GASTROINTESTINAL HEMORRHAGE SOI 1. OTHER & UNSPECIFIED GASTROINTESTINAL HEMORRHAGE SOI 2. OTHER & UNSPECIFIED GASTROINTESTINAL HEMORRHAGE SOI 3. OTHER DIGESTIVE SYSTEM DIAGNOSES SOI 1. OTHER DIGESTIVE SYSTEM DIAGNOSES SOI 2. OTHER DIGESTIVE SYSTEM DIAGNOSES SOI 3. MAJOR PANCREAS, LIVER & SHUNT PROCEDURES SOI 4. MAJOR BILIARY TRACT PROCEDURES SOI 4. CHOLECYSTECTOMY EXCEPT LAPAROSCOPIC SOI 4. 251 251 251 252 1 2 3 1 252 2 252 3 253 1 253 2 253 3 254 1 254 2 254 3 260 4 261 4 262 4 264 4 OTHER HEPATOBILIARY, PANCREAS & ABDOMINAL PROCEDURES SOI 4. 263 4 LAPAROSCOPIC SOI 4. 260 1 260 2 260 3 261 1 261 2 261 3 262 1 262 2 262 3 263 1 263 2 263 3 264 1 264 2 264 3 MAJOR PANCREAS, LIVER & SHUNT PROCEDURES SOI 1. MAJOR PANCREAS, LIVER & SHUNT PROCEDURES SOI 2. MAJOR PANCREAS, LIVER & SHUNT PROCEDURES SOI 3. MAJOR BILIARY TRACT PROCEDURES SOI 1. MAJOR BILIARY TRACT PROCEDURES SOI 2. MAJOR BILIARY TRACT PROCEDURES SOI 3. CHOLECYSTECTOMY EXCEPT LAPAROSCOPIC SOI 1. CHOLECYSTECTOMY EXCEPT LAPAROSCOPIC SOI 2. CHOLECYSTECTOMY EXCEPT LAPAROSCOPIC SOI 3. LAPAROSCOPIC CHOLECYSTECTOMY SOI 1. LAPAROSCOPIC CHOLECYSTECTOMY SOI 2. LAPAROSCOPIC CHOLECYSTECTOMY SOI 3. OTHER HEPATOBILIARY, PANCREAS & ABDOMINAL PROCEDURES SOI 1. OTHER HEPATOBILIARY, PANCREAS & ABDOMINAL PROCEDURES SOI 2. OTHER HEPATOBILIARY, PANCREAS & ABDOMINAL PROCEDURES SOI 3. E:\FR\FM\25APP2.SGM 25APP2 CHOLECYSTECTOMY 24448 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules APPENDIX D.—CROSSWALK OF PROPOSED CONSOLIDATED SEVERITY-ADJUSTED DRGS TO RESPECTIVE APR DRGS— Continued TYPE Consolidated severity-adjusted DRG MDC 7 393 M ....... 7 393 M ....... 7 393 M ....... 7 393 M ....... 7 393 M ....... 7 393 M ....... 7 394 M ....... 7 395 M ....... 7 396 M M M M ....... ....... ....... ....... 7 7 7 7 397 398 399 400 M ....... 7 401 M ....... 7 402 M ....... 7 403 M ....... 7 404 M ....... 7 405 M ....... 7 406 M ....... 7 407 M ....... 7 408 M ....... 7 409 M ....... 7 410 M ....... 7 411 S ........ 8 412 S ........ 8 412 S ........ 8 412 S ........ 8 412 S ........ 8 412 S ........ wwhite on PROD1PC61 with PROPOSALS2 M ....... 8 412 S ........ 8 412 S ........ 8 412 VerDate Aug<31>2005 17:10 Apr 24, 2006 Consolidated severity-adjusted DRG description APR DRG HEPATOBILIARY, PANCREAS & ABDOMINAL DIAGNOSES SOI 4. HEPATOBILIARY, PANCREAS & ABDOMINAL DIAGNOSES SOI 4. HEPATOBILIARY, PANCREAS & ABDOMINAL DIAGNOSES SOI 4. HEPATOBILIARY, PANCREAS & ABDOMINAL DIAGNOSES SOI 4. HEPATOBILIARY, PANCREAS & ABDOMINAL DIAGNOSES SOI 4. HEPATOBILIARY, PANCREAS & ABDOMINAL DIAGNOSES SOI 4. HEPATIC COMA & OTHER MAJOR ACUTE LIVER DISORDERS SOI 1. HEPATIC COMA & OTHER MAJOR ACUTE LIVER DISORDERS SOI 2. HEPATIC COMA & OTHER MAJOR ACUTE LIVER DISORDERS SOI 3. ALCOHOLIC LIVER DISEASE SOI 1 ......... ALCOHOLIC LIVER DISEASE SOI 2 ......... ALCOHOLIC LIVER DISEASE SOI 3 ......... MALIGNANCY OF HEPATOBILIARY SYSTEM & PANCREAS SOI 1. MALIGNANCY OF HEPATOBILIARY SYSTEM & PANCREAS SOI 2. MALIGNANCY OF HEPATOBILIARY SYSTEM & PANCREAS SOI 3. DISORDERS OF PANCREAS EXCEPT MALIGNANCY SOI 1. DISORDERS OF PANCREAS EXCEPT MALIGNANCY SOI 2. DISORDERS OF PANCREAS EXCEPT MALIGNANCY SOI 3. OTHER DISORDERS OF THE LIVER SOI 1. OTHER DISORDERS OF THE LIVER SOI 2. OTHER DISORDERS OF THE LIVER SOI 3. DISORDERS OF GALLBLADDER & BILIARY TRACT SOI 1. DISORDERS OF GALLBLADDER & BILIARY TRACT SOI 2. DISORDERS OF GALLBLADDER & BILIARY TRACT SOI 3. MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE PROCEDURES EXCEPT SPINAL FUSION SOI 4. MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE PROCEDURES EXCEPT SPINAL FUSION SOI 4. MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE PROCEDURES EXCEPT SPINAL FUSION SOI 4. MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE PROCEDURES EXCEPT SPINAL FUSION SOI 4. MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE PROCEDURES EXCEPT SPINAL FUSION SOI 4. MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE PROCEDURES EXCEPT SPINAL FUSION SOI 4. MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE PROCEDURES EXCEPT SPINAL FUSION SOI 4. MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE PROCEDURES EXCEPT SPINAL FUSION SOI 4. Jkt 208001 PO 00000 Frm 00454 Fmt 4701 Sfmt 4702 SOI APR DRG description 279 4 HEPATIC COMA & OTHER MAJOR ACUTE LIVER DISORDERS SOI 4. ALCOHOLIC LIVER DISEASE SOI 4. 280 4 281 4 282 4 283 4 284 4 279 1 279 2 279 3 280 280 280 281 1 2 3 1 281 2 281 3 282 1 282 2 282 3 283 1 283 2 283 3 284 1 284 2 284 3 301 4 MALIGNANCY OF HEPATOBILIARY SYSTEM & PANCREAS SOI 4. DISORDERS OF PANCREAS EXCEPT MALIGNANCY SOI 4. OTHER DISORDERS OF THE LIVER SOI 4. DISORDERS OF GALLBLADDER & BILIARY TRACT SOI 4. HEPATIC COMA & OTHER MAJOR ACUTE LIVER DISORDERS SOI 1. HEPATIC COMA & OTHER MAJOR ACUTE LIVER DISORDERS SOI 2. HEPATIC COMA & OTHER MAJOR ACUTE LIVER DISORDERS SOI 3. ALCOHOLIC LIVER DISEASE SOI 1. ALCOHOLIC LIVER DISEASE SOI 2. ALCOHOLIC LIVER DISEASE SOI 3. MALIGNANCY OF HEPATOBILIARY SYSTEM & PANCREAS SOI 1. MALIGNANCY OF HEPATOBILIARY SYSTEM & PANCREAS SOI 2. MALIGNANCY OF HEPATOBILIARY SYSTEM & PANCREAS SOI 3. DISORDERS OF PANCREAS EXCEPT MALIGNANCY SOI 1. DISORDERS OF PANCREAS EXCEPT MALIGNANCY SOI 2. DISORDERS OF PANCREAS EXCEPT MALIGNANCY SOI 3. OTHER DISORDERS OF THE LIVER SOI 1. OTHER DISORDERS OF THE LIVER SOI 2. OTHER DISORDERS OF THE LIVER SOI 3. DISORDERS OF GALLBLADDER & BILIARY TRACT SOI 1. DISORDERS OF GALLBLADDER & BILIARY TRACT SOI 2. DISORDERS OF GALLBLADDER & BILIARY TRACT SOI 3. HIP JOINT REPLACEMENT SOI 4. 302 4 KNEE JOINT REPLACEMENT SOI 4. 305 4 AMPUTATION OF LOWER LIMB EXCEPT TOES SOI 4. 308 4 309 4 310 4 HIP & FEMUR PROCEDURES FOR TRAUMA EXCEPT JOINT REPLACEMENT SOI 4. HIP & FEMUR PROCEDURES FOR NONTRAUMA EXCEPT JOINT REPLACEMENT SOI 4. INTERVERTEBRAL DISC EXCISION & DECOMPRESSION SOI 4. 313 4 KNEE & LOWER LEG PROCEDURES EXCEPT FOOT SOI 4. 314 4 FOOT & TOE PROCEDURES SOI 4. E:\FR\FM\25APP2.SGM 25APP2 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules 24449 APPENDIX D.—CROSSWALK OF PROPOSED CONSOLIDATED SEVERITY-ADJUSTED DRGS TO RESPECTIVE APR DRGS— Continued TYPE Consolidated severity-adjusted DRG MDC 8 412 S ........ 8 412 S ........ 8 412 S ........ 8 S ........ APR DRG SOI APR DRG description 315 4 SHOULDER, UPPER ARM & FOREARM PROCEDURES SOI 4. 316 4 HAND & WRIST PROCEDURES SOI 4. 317 4 TENDON, MUSCLE & OTHER SOFT TISSUE PROCEDURES SOI 4. 413 MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE PROCEDURES EXCEPT SPINAL FUSION SOI 4. MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE PROCEDURES EXCEPT SPINAL FUSION SOI 4. MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE PROCEDURES EXCEPT SPINAL FUSION SOI 4. SPINAL FUSION PROCEDURES SOI 4 .... 303 4 8 413 SPINAL FUSION PROCEDURES SOI 4 .... 304 4 S ........ 8 413 SPINAL FUSION PROCEDURES SOI 4 .... 321 4 S S S S S S S ........ ........ ........ ........ ........ ........ ........ 8 8 8 8 8 8 8 414 415 416 417 418 419 420 1 2 3 1 2 3 1 8 421 303 2 S ........ 8 422 303 3 S ........ 8 423 304 1 S ........ 8 424 304 2 S ........ 8 425 304 3 S ........ 8 426 305 1 S ........ 8 427 305 2 S ........ 8 428 305 3 S ........ 8 429 308 1 S ........ 8 430 308 2 S ........ 8 431 308 3 S ........ 8 432 309 1 S ........ 8 433 309 2 S ........ 8 434 309 3 S ........ 8 435 310 1 S ........ 8 436 310 2 S ........ 8 437 HIP JOINT REPLACEMENT SOI 1 ............. HIP JOINT REPLACEMENT SOI 2 ............. HIP JOINT REPLACEMENT SOI 3 ............. KNEE JOINT REPLACEMENT SOI 1 ......... KNEE JOINT REPLACEMENT SOI 2 ......... KNEE JOINT REPLACEMENT SOI 3 ......... DORSAL & LUMBAR FUSION PROC FOR CURVATURE OF BACK SOI 1. DORSAL & LUMBAR FUSION PROC FOR CURVATURE OF BACK SOI 2. DORSAL & LUMBAR FUSION PROC FOR CURVATURE OF BACK SOI 3. DORSAL & LUMBAR FUSION PROC EXCEPT FOR CURVATURE OF BACK SOI 1. DORSAL & LUMBAR FUSION PROC EXCEPT FOR CURVATURE OF BACK SOI 2. DORSAL & LUMBAR FUSION PROC EXCEPT FOR CURVATURE OF BACK SOI 3. AMPUTATION OF LOWER LIMB EXCEPT TOES SOI 1. AMPUTATION OF LOWER LIMB EXCEPT TOES SOI 2. AMPUTATION OF LOWER LIMB EXCEPT TOES SOI 3. HIP & FEMUR PROCEDURES FOR TRAUMA EXCEPT JOINT REPLACEMENT SOI 1. HIP & FEMUR PROCEDURES FOR TRAUMA EXCEPT JOINT REPLACEMENT SOI 2. HIP & FEMUR PROCEDURES FOR TRAUMA EXCEPT JOINT REPLACEMENT SOI 3. HIP & FEMUR PROCEDURES FOR NONTRAUMA EXCEPT JOINT REPLACEMENT SOI 1. HIP & FEMUR PROCEDURES FOR NONTRAUMA EXCEPT JOINT REPLACEMENT SOI 2. HIP & FEMUR PROCEDURES FOR NONTRAUMA EXCEPT JOINT REPLACEMENT SOI 3. INTERVERTEBRAL DISC EXCISION & DECOMPRESSION SOI 1. INTERVERTEBRAL DISC EXCISION & DECOMPRESSION SOI 2. INTERVERTEBRAL DISC EXCISION & DECOMPRESSION SOI 3. 301 301 301 302 302 302 303 S ........ wwhite on PROD1PC61 with PROPOSALS2 S ........ Consolidated severity-adjusted DRG description 310 3 DORSAL & LUMBAR FUSION PROC FOR CURVATURE OF BACK SOI 4. DORSAL & LUMBAR FUSION PROC EXCEPT FOR CURVATURE OF BACK SOI 4. CERVICAL SPINAL FUSION & OTHER BACK/NECK PROC EXC DISC EXCIS/ DECOMP SOI 4. HIP JOINT REPLACEMENT SOI 1. HIP JOINT REPLACEMENT SOI 2. HIP JOINT REPLACEMENT SOI 3. KNEE JOINT REPLACEMENT SOI 1. KNEE JOINT REPLACEMENT SOI 2. KNEE JOINT REPLACEMENT SOI 3. DORSAL & LUMBAR FUSION PROC FOR CURVATURE OF BACK SOI 1. DORSAL & LUMBAR FUSION PROC FOR CURVATURE OF BACK SOI 2. DORSAL & LUMBAR FUSION PROC FOR CURVATURE OF BACK SOI 3. DORSAL & LUMBAR FUSION PROC EXCEPT FOR CURVATURE OF BACK SOI 1. DORSAL & LUMBAR FUSION PROC EXCEPT FOR CURVATURE OF BACK SOI 2. DORSAL & LUMBAR FUSION PROC EXCEPT FOR CURVATURE OF BACK SOI 3. AMPUTATION OF LOWER LIMB EXCEPT TOES SOI 1. AMPUTATION OF LOWER LIMB EXCEPT TOES SOI 2. AMPUTATION OF LOWER LIMB EXCEPT TOES SOI 3. HIP & FEMUR PROCEDURES FOR TRAUMA EXCEPT JOINT REPLACEMENT SOI 1. HIP & FEMUR PROCEDURES FOR TRAUMA EXCEPT JOINT REPLACEMENT SOI 2. HIP & FEMUR PROCEDURES FOR TRAUMA EXCEPT JOINT REPLACEMENT SOI 3. HIP & FEMUR PROCEDURES FOR NONTRAUMA EXCEPT JOINT REPLACEMENT SOI 1. HIP & FEMUR PROCEDURES FOR NONTRAUMA EXCEPT JOINT REPLACEMENT SOI 2. HIP & FEMUR PROCEDURES FOR NONTRAUMA EXCEPT JOINT REPLACEMENT SOI 3. INTERVERTEBRAL DISC EXCISION & DECOMPRESSION SOI 1. INTERVERTEBRAL DISC EXCISION & DECOMPRESSION SOI 2. INTERVERTEBRAL DISC EXCISION & DECOMPRESSION SOI 3. VerDate Aug<31>2005 17:10 Apr 24, 2006 Jkt 208001 PO 00000 Frm 00455 Fmt 4701 Sfmt 4702 E:\FR\FM\25APP2.SGM 25APP2 24450 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules APPENDIX D.—CROSSWALK OF PROPOSED CONSOLIDATED SEVERITY-ADJUSTED DRGS TO RESPECTIVE APR DRGS— Continued TYPE Consolidated severity-adjusted DRG MDC 8 438 S ........ 8 439 S ........ 8 440 S ........ 8 441 S ........ 8 442 S ........ 8 443 S ........ 8 444 S S S S ........ ........ ........ ........ 8 8 8 8 445 446 447 448 S ........ 8 449 S ........ 8 450 S S S S ........ ........ ........ ........ 8 8 8 8 451 452 453 454 S ........ 8 455 S ........ 8 456 S ........ 8 457 S ........ 8 458 S ........ 8 459 S ........ 8 460 S ........ 8 461 S ........ 8 462 S ........ 8 463 M ....... 8 464 M ....... wwhite on PROD1PC61 with PROPOSALS2 S ........ 8 464 M ....... 8 464 M ....... 8 464 M ....... 8 464 VerDate Aug<31>2005 17:10 Apr 24, 2006 Consolidated severity-adjusted DRG description APR DRG SKIN GRAFT, EXCEPT HAND, FOR MUSCULOSKELETAL & CONNECTIVE TISSUE DIAGNOSES SOI 1. SKIN GRAFT, EXCEPT HAND, FOR MUSCULOSKELETAL & CONNECTIVE TISSUE DIAGNOSES SOI 2. SKIN GRAFT, EXCEPT HAND, FOR MUSCULOSKELETAL & CONNECTIVE TISSUE DIAGNOSES SOI 3. SKIN GRAFT, EXCEPT HAND, FOR MUSCULOSKELETAL & CONNECTIVE TISSUE DIAGNOSES SOI 4. KNEE & LOWER LEG PROCEDURES EXCEPT FOOT SOI 1. KNEE & LOWER LEG PROCEDURES EXCEPT FOOT SOI 2. KNEE & LOWER LEG PROCEDURES EXCEPT FOOT SOI 3. FOOT & TOE PROCEDURES SOI 1 .......... FOOT & TOE PROCEDURES SOI 2 .......... FOOT & TOE PROCEDURES SOI 3 .......... SHOULDER, UPPER ARM & FOREARM PROCEDURES SOI 1. SHOULDER, UPPER ARM & FOREARM PROCEDURES SOI 2. SHOULDER, UPPER ARM & FOREARM PROCEDURES SOI 3. HAND & WRIST PROCEDURES SOI 1 ..... HAND & WRIST PROCEDURES SOI 2 ..... HAND & WRIST PROCEDURES SOI 3 ..... TENDON, MUSCLE & OTHER SOFT TISSUE PROCEDURES SOI 1. TENDON, MUSCLE & OTHER SOFT TISSUE PROCEDURES SOI 2. TENDON, MUSCLE & OTHER SOFT TISSUE PROCEDURES SOI 3. OTHER MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE PROCEDURES SOI 1. OTHER MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE PROCEDURES SOI 2. OTHER MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE PROCEDURES SOI 3. OTHER MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE PROCEDURES SOI 4. CERVICAL SPINAL FUSION & OTHER BACK/NECK PROC EXC DISC EXCIS/ DECOMP SOI 1. CERVICAL SPINAL FUSION & OTHER BACK/NECK PROC EXC DISC EXCIS/ DECOMP SOI 2. CERVICAL SPINAL FUSION & OTHER BACK/NECK PROC EXC DISC EXCIS/ DECOMP SOI 3. MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE DIAGNOSES SOI 4. MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE DIAGNOSES SOI 4. MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE DIAGNOSES SOI 4. MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE DIAGNOSES SOI 4. MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE DIAGNOSES SOI 4. Jkt 208001 PO 00000 Frm 00456 Fmt 4701 Sfmt 4702 SOI APR DRG description 312 1 312 2 312 3 312 4 313 1 313 2 313 3 314 314 314 315 1 2 3 1 315 2 315 3 316 316 316 317 1 2 3 1 317 2 317 3 320 1 320 2 320 3 320 4 321 1 321 2 321 3 340 4 341 4 342 4 343 4 344 4 SKIN GRAFT, EXCEPT HAND, FOR MUSCULOSKELETAL & CONNECTIVE TISSUE DIAGNOSES SOI 1. SKIN GRAFT, EXCEPT HAND, FOR MUSCULOSKELETAL & CONNECTIVE TISSUE DIAGNOSES SOI 2. SKIN GRAFT, EXCEPT HAND, FOR MUSCULOSKELETAL & CONNECTIVE TISSUE DIAGNOSES SOI 3. SKIN GRAFT, EXCEPT HAND, FOR MUSCULOSKELETAL & CONNECTIVE TISSUE DIAGNOSES SOI 4. KNEE & LOWER LEG PROCEDURES EXCEPT FOOT SOI 1. KNEE & LOWER LEG PROCEDURES EXCEPT FOOT SOI 2. KNEE & LOWER LEG PROCEDURES EXCEPT FOOT SOI 3. FOOT & TOE PROCEDURES SOI 1. FOOT & TOE PROCEDURES SOI 2. FOOT & TOE PROCEDURES SOI 3. SHOULDER, UPPER ARM & FOREARM PROCEDURES SOI 1. SHOULDER, UPPER ARM & FOREARM PROCEDURES SOI 2. SHOULDER, UPPER ARM & FOREARM PROCEDURES SOI 3. HAND & WRIST PROCEDURES SOI 1. HAND & WRIST PROCEDURES SOI 2. HAND & WRIST PROCEDURES SOI 3. TENDON, MUSCLE & OTHER SOFT TISSUE PROCEDURES SOI 1. TENDON, MUSCLE & OTHER SOFT TISSUE PROCEDURES SOI 2. TENDON, MUSCLE & OTHER SOFT TISSUE PROCEDURES SOI 3. OTHER MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE PROCEDURES SOI 1. OTHER MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE PROCEDURES SOI 2. OTHER MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE PROCEDURES SOI 3. OTHER MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE PROCEDURES SOI 4. CERVICAL SPINAL FUSION & OTHER BACK/NECK PROC EXC DISC EXCIS/ DECOMP SOI 1. CERVICAL SPINAL FUSION & OTHER BACK/NECK PROC EXC DISC EXCIS/ DECOMP SOI 2. CERVICAL SPINAL FUSION & OTHER BACK/NECK PROC EXC DISC EXCIS/ DECOMP SOI 3. FRACTURE OF FEMUR SOI 4. FRACTURE OF PELVIS OR DISLOCATION OF HIP SOI 4. FRACTURES & DISLOCATIONS EXCEPT FEMUR, PELVIS & BACK SOI 4. MUSCULOSKELETAL MALIGNANCY & PATHOL FRACTURE D/T MUSCSKEL MALIG SOI 4. OSTEOMYELITIS, SEPTIC ARTHRITIS & OTHER MUSCULOSKELETAL INFECTIONS SOI 4. E:\FR\FM\25APP2.SGM 25APP2 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules 24451 APPENDIX D.—CROSSWALK OF PROPOSED CONSOLIDATED SEVERITY-ADJUSTED DRGS TO RESPECTIVE APR DRGS— Continued TYPE Consolidated severity-adjusted DRG MDC 8 464 M ....... 8 464 M ....... 8 464 M ....... 8 M M M M ....... ....... ....... ....... APR DRG SOI APR DRG description MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE DIAGNOSES SOI 4. MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE DIAGNOSES SOI 4. MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE DIAGNOSES SOI 4. 346 4 347 4 349 4 464 MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE DIAGNOSES SOI 4. 351 4 8 8 8 8 465 466 467 468 1 2 3 1 8 469 341 2 M ....... 8 470 341 3 M ....... 8 471 342 1 M ....... 8 472 342 2 M ....... 8 473 342 3 M ....... 8 474 343 1 M ....... 8 475 343 2 M ....... 8 476 343 3 M ....... 8 477 344 1 M ....... 8 478 344 2 M ....... 8 479 344 3 M ....... 8 480 346 1 M ....... 8 481 346 2 M ....... 8 482 346 3 M ....... 8 483 347 1 M ....... 8 484 347 2 M ....... 8 485 347 3 M ....... 8 486 349 1 M ....... 8 487 349 2 M ....... 8 488 349 3 M ....... 8 489 FRACTURE OF FEMUR SOI 1 ................... FRACTURE OF FEMUR SOI 2 ................... FRACTURE OF FEMUR SOI 3 ................... FRACTURE OF PELVIS OR DISLOCATION OF HIP SOI 1. FRACTURE OF PELVIS OR DISLOCATION OF HIP SOI 2. FRACTURE OF PELVIS OR DISLOCATION OF HIP SOI 3. FRACTURES & DISLOCATIONS EXCEPT FEMUR, PELVIS & BACK SOI 1. FRACTURES & DISLOCATIONS EXCEPT FEMUR, PELVIS & BACK SOI 2. FRACTURES & DISLOCATIONS EXCEPT FEMUR, PELVIS & BACK SOI 3. MUSCULOSKELETAL MALIGNANCY & PATHOL FRACTURE D/T MUSCSKEL MALIG SOI 1. MUSCULOSKELETAL MALIGNANCY & PATHOL FRACTURE D/T MUSCSKEL MALIG SOI 2. MUSCULOSKELETAL MALIGNANCY & PATHOL FRACTURE D/T MUSCSKEL MALIG SOI 3. OSTEOMYELITIS, SEPTIC ARTHRITIS & OTHER MUSCULOSKELETAL INFECTIONS SOI 1. OSTEOMYELITIS, SEPTIC ARTHRITIS & OTHER MUSCULOSKELETAL INFECTIONS SOI 2. OSTEOMYELITIS, SEPTIC ARTHRITIS & OTHER MUSCULOSKELETAL INFECTIONS SOI 3. CONNECTIVE TISSUE DISORDERS SOI 1. CONNECTIVE TISSUE DISORDERS SOI 2. CONNECTIVE TISSUE DISORDERS SOI 3. OTHER BACK & NECK DISORDERS, FRACTURES & INJURIES SOI 1. OTHER BACK & NECK DISORDERS, FRACTURES & INJURIES SOI 2. OTHER BACK & NECK DISORDERS, FRACTURES & INJURIES SOI 3. MALFUNCTION, REACTION, COMPLIC OF ORTHOPEDIC DEVICE OR PROCEDURE SOI 1. MALFUNCTION, REACTION, COMPLIC OF ORTHOPEDIC DEVICE OR PROCEDURE SOI 2. MALFUNCTION, REACTION, COMPLIC OF ORTHOPEDIC DEVICE OR PROCEDURE SOI 3. OTHER MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE DIAGNOSES SOI 1. 340 340 340 341 M ....... wwhite on PROD1PC61 with PROPOSALS2 M ....... Consolidated severity-adjusted DRG description 351 1 VerDate Aug<31>2005 17:10 Apr 24, 2006 Jkt 208001 PO 00000 Frm 00457 Fmt 4701 Sfmt 4702 CONNECTIVE TISSUE DISORDERS SOI 4. OTHER BACK & NECK DISORDERS, FRACTURES & INJURIES SOI 4. MALFUNCTION, REACTION, COMPLIC OF ORTHOPEDIC DEVICE OR PROCEDURE SOI 4. OTHER MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE DIAGNOSES SOI 4. FRACTURE OF FEMUR SOI 1. FRACTURE OF FEMUR SOI 2. FRACTURE OF FEMUR SOI 3. FRACTURE OF PELVIS OR DISLOCATION OF HIP SOI 1. FRACTURE OF PELVIS OR DISLOCATION OF HIP SOI 2. FRACTURE OF PELVIS OR DISLOCATION OF HIP SOI 3. FRACTURES & DISLOCATIONS EXCEPT FEMUR, PELVIS & BACK SOI 1. FRACTURES & DISLOCATIONS EXCEPT FEMUR, PELVIS & BACK SOI 2. FRACTURES & DISLOCATIONS EXCEPT FEMUR, PELVIS & BACK SOI 3. MUSCULOSKELETAL MALIGNANCY & PATHOL FRACTURE D/T MUSCSKEL MALIG SOI 1. MUSCULOSKELETAL MALIGNANCY & PATHOL FRACTURE D/T MUSCSKEL MALIG SOI 2. MUSCULOSKELETAL MALIGNANCY & PATHOL FRACTURE D/T MUSCSKEL MALIG SOI 3. OSTEOMYELITIS, SEPTIC ARTHRITIS & OTHER MUSCULOSKELETAL INFECTIONS SOI 1. OSTEOMYELITIS, SEPTIC ARTHRITIS & OTHER MUSCULOSKELETAL INFECTIONS SOI 2. OSTEOMYELITIS, SEPTIC ARTHRITIS & OTHER MUSCULOSKELETAL INFECTIONS SOI 3. CONNECTIVE TISSUE DISORDERS SOI 1. CONNECTIVE TISSUE DISORDERS SOI 2. CONNECTIVE TISSUE DISORDERS SOI 3. OTHER BACK & NECK DISORDERS, FRACTURES & INJURIES SOI 1. OTHER BACK & NECK DISORDERS, FRACTURES & INJURIES SOI 2. OTHER BACK & NECK DISORDERS, FRACTURES & INJURIES SOI 3. MALFUNCTION, REACTION, COMPLIC OF ORTHOPEDIC DEVICE OR PROCEDURE SOI 1. MALFUNCTION, REACTION, COMPLIC OF ORTHOPEDIC DEVICE OR PROCEDURE SOI 2. MALFUNCTION, REACTION, COMPLIC OF ORTHOPEDIC DEVICE OR PROCEDURE SOI 3. OTHER MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE DIAGNOSES SOI 1. E:\FR\FM\25APP2.SGM 25APP2 24452 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules APPENDIX D.—CROSSWALK OF PROPOSED CONSOLIDATED SEVERITY-ADJUSTED DRGS TO RESPECTIVE APR DRGS— Continued TYPE Consolidated severity-adjusted DRG MDC 8 490 M ....... 8 491 S ........ 9 492 S ........ 9 492 S ........ 9 492 S ........ 9 492 S ........ 9 493 S ........ 9 494 S ........ 9 495 S S S S ........ ........ ........ ........ 9 9 9 9 496 497 498 499 S ........ 9 500 S ........ 9 501 S ........ 9 502 S ........ 9 503 S ........ 9 504 M ....... 9 505 M ....... 9 505 M ....... 9 505 M ....... 9 505 M ....... 9 505 M ....... wwhite on PROD1PC61 with PROPOSALS2 M ....... 9 505 M M M M M M M M M M ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... 9 9 9 9 9 9 9 9 9 9 506 507 508 509 510 511 512 513 514 515 M ....... 9 516 M ....... 9 517 VerDate Aug<31>2005 17:10 Apr 24, 2006 Consolidated severity-adjusted DRG description APR DRG SOI APR DRG description OTHER MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE DIAGNOSES SOI 2. OTHER MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE DIAGNOSES SOI 3. SKIN, SUBCUTANEOUS TISSUE, BREAST & RELATED PROCEDURES SOI 4. SKIN, SUBCUTANEOUS TISSUE, BREAST & RELATED PROCEDURES SOI 4. SKIN, SUBCUTANEOUS TISSUE, BREAST & RELATED PROCEDURES SOI 4. SKIN, SUBCUTANEOUS TISSUE, BREAST & RELATED PROCEDURES SOI 4. SKIN GRAFT FOR SKIN & SUBCUTANEOUS TISSUE DIAGNOSES SOI 1. SKIN GRAFT FOR SKIN & SUBCUTANEOUS TISSUE DIAGNOSES SOI 2. SKIN GRAFT FOR SKIN & SUBCUTANEOUS TISSUE DIAGNOSES SOI 3. MASTECTOMY PROCEDURES SOI 1 ....... MASTECTOMY PROCEDURES SOI 2 ....... MASTECTOMY PROCEDURES SOI 3 ....... BREAST PROCEDURES EXCEPT MASTECTOMY SOI 1. BREAST PROCEDURES EXCEPT MASTECTOMY SOI 2. BREAST PROCEDURES EXCEPT MASTECTOMY SOI 3. OTHER SKIN, SUBCUTANEOUS TISSUE & RELATED PROCEDURES SOI 1. OTHER SKIN, SUBCUTANEOUS TISSUE & RELATED PROCEDURES SOI 2. OTHER SKIN, SUBCUTANEOUS TISSUE & RELATED PROCEDURES SOI 3. SKIN, SUBCUTANEOUS TISSUE & BREAST DIAGNOSES SOI 4. SKIN, SUBCUTANEOUS TISSUE & BREAST DIAGNOSES SOI 4. SKIN, SUBCUTANEOUS TISSUE & BREAST DIAGNOSES SOI 4. SKIN, SUBCUTANEOUS TISSUE & BREAST DIAGNOSES SOI 4. SKIN, SUBCUTANEOUS TISSUE & BREAST DIAGNOSES SOI 4. 351 2 351 3 361 4 362 4 MASTECTOMY PROCEDURES SOI 4. 363 4 BREAST PROCEDURES EXCEPT MASTECTOMY SOI 4. 364 4 OTHER SKIN, SUBCUTANEOUS TISSUE & RELATED PROCEDURES SOI 4. 361 1 361 2 361 3 362 362 362 363 1 2 3 1 363 2 363 3 364 1 364 2 364 3 380 4 SKIN GRAFT FOR SKIN & SUBCUTANEOUS TISSUE DIAGNOSES SOI 1. SKIN GRAFT FOR SKIN & SUBCUTANEOUS TISSUE DIAGNOSES SOI 2. SKIN GRAFT FOR SKIN & SUBCUTANEOUS TISSUE DIAGNOSES SOI 3. MASTECTOMY PROCEDURES SOI 1. MASTECTOMY PROCEDURES SOI 2. MASTECTOMY PROCEDURES SOI 3. BREAST PROCEDURES EXCEPT MASTECTOMY SOI 1. BREAST PROCEDURES EXCEPT MASTECTOMY SOI 2. BREAST PROCEDURES EXCEPT MASTECTOMY SOI 3. OTHER SKIN, SUBCUTANEOUS TISSUE & RELATED PROCEDURES SOI 1. OTHER SKIN, SUBCUTANEOUS TISSUE & RELATED PROCEDURES SOI 2. OTHER SKIN, SUBCUTANEOUS TISSUE & RELATED PROCEDURES SOI 3. SKIN ULCERS SOI 4. 381 4 MAJOR SKIN DISORDERS SOI 4. 382 4 MALIGNANT BREAST DISORDERS SOI 4. 383 4 384 4 SKIN, SUBCUTANEOUS TISSUE & BREAST DIAGNOSES SOI 4. SKIN ULCERS SOI 1 .................................. SKIN ULCERS SOI 2 .................................. SKIN ULCERS SOI 3 .................................. MAJOR SKIN DISORDERS SOI 1 .............. MAJOR SKIN DISORDERS SOI 2 .............. MAJOR SKIN DISORDERS SOI 3 .............. MALIGNANT BREAST DISORDERS SOI 1 MALIGNANT BREAST DISORDERS SOI 2 MALIGNANT BREAST DISORDERS SOI 3 CELLULITIS & OTHER BACTERIAL SKIN INFECTIONS SOI 1. CELLULITIS & OTHER BACTERIAL SKIN INFECTIONS SOI 2. CELLULITIS & OTHER BACTERIAL SKIN INFECTIONS SOI 3. 385 4 380 380 380 381 381 381 382 382 382 383 1 2 3 1 2 3 1 2 3 1 383 2 383 3 CELLULITIS & OTHER BACTERIAL SKIN INFECTIONS SOI 4. CONTUSION, OPEN WOUND & OTHER TRAUMA TO SKIN & SUBCUTANEOUS TISSUE SOI 4. OTHER SKIN, SUBCUTANEOUS TISSUE & BREAST DISORDERS SOI 4. SKIN ULCERS SOI 1. SKIN ULCERS SOI 2. SKIN ULCERS SOI 3. MAJOR SKIN DISORDERS SOI 1. MAJOR SKIN DISORDERS SOI 2. MAJOR SKIN DISORDERS SOI 3. MALIGNANT BREAST DISORDERS SOI 1. MALIGNANT BREAST DISORDERS SOI 2. MALIGNANT BREAST DISORDERS SOI 3. CELLULITIS & OTHER BACTERIAL SKIN INFECTIONS SOI 1. CELLULITIS & OTHER BACTERIAL SKIN INFECTIONS SOI 2. CELLULITIS & OTHER BACTERIAL SKIN INFECTIONS SOI 3. Jkt 208001 PO 00000 Frm 00458 Fmt 4701 Sfmt 4702 OTHER MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE DIAGNOSES SOI 2. OTHER MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE DIAGNOSES SOI 3. SKIN GRAFT FOR SKIN & SUBCUTANEOUS TISSUE DIAGNOSES SOI 4. E:\FR\FM\25APP2.SGM 25APP2 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules 24453 APPENDIX D.—CROSSWALK OF PROPOSED CONSOLIDATED SEVERITY-ADJUSTED DRGS TO RESPECTIVE APR DRGS— Continued TYPE Consolidated severity-adjusted DRG MDC 9 518 M ....... 9 519 M ....... 9 520 M ....... 9 521 M ....... 9 522 M ....... 9 523 S ........ 10 524 S ........ 10 524 S ........ 10 524 S ........ 10 524 S ........ 10 525 S ........ 10 526 S ........ 10 527 S S S S ........ ........ ........ ........ 10 10 10 10 528 529 530 531 S ........ 10 S ........ APR DRG SOI APR DRG description CONTUSION, OPEN WOUND & OTHER TRAUMA TO SKIN & SUBCUTANEOUS TISSUE SOI 1. CONTUSION, OPEN WOUND & OTHER TRAUMA TO SKIN & SUBCUTANEOUS TISSUE SOI 2. CONTUSION, OPEN WOUND & OTHER TRAUMA TO SKIN & SUBCUTANEOUS TISSUE SOI 3. OTHER SKIN, SUBCUTANEOUS TISSUE & BREAST DISORDERS SOI 1. OTHER SKIN, SUBCUTANEOUS TISSUE & BREAST DISORDERS SOI 2. OTHER SKIN, SUBCUTANEOUS TISSUE & BREAST DISORDERS SOI 3. PROCEDURES FOR ENDOCRINE, NUTRITIONAL & METABOLIC DISORDERS SOI 4. PROCEDURES FOR ENDOCRINE, NUTRITIONAL & METABOLIC DISORDERS SOI 4. PROCEDURES FOR ENDOCRINE, NUTRITIONAL & METABOLIC DISORDERS SOI 4. PROCEDURES FOR ENDOCRINE, NUTRITIONAL & METABOLIC DISORDERS SOI 4. PITUITARY & ADRENAL PROCEDURES SOI 1. PITUITARY & ADRENAL PROCEDURES SOI 2. PITUITARY & ADRENAL PROCEDURES SOI 3. PROCEDURES FOR OBESITY SOI 1 ........ PROCEDURES FOR OBESITY SOI 2 ........ PROCEDURES FOR OBESITY SOI 3 ........ THYROID, PARATHYROID & THYROGLOSSAL PROCEDURES SOI 1. 384 1 384 2 384 3 385 1 385 2 385 3 401 4 403 4 PROCEDURES FOR OBESITY SOI 4. 404 4 405 4 401 1 401 2 401 3 403 403 403 404 1 2 3 1 532 THYROID, PARATHYROID & THYROGLOSSAL PROCEDURES SOI 2. 404 2 10 533 THYROID, PARATHYROID & THYROGLOSSAL PROCEDURES SOI 3. 404 3 S ........ 10 534 1 10 535 405 2 S ........ 10 536 405 3 M ....... M ....... 10 10 537 537 OTHER PROCEDURES FOR ENDOCRINE, NUTRITIONAL & METABOLIC DISORDERS SOI 1. OTHER PROCEDURES FOR ENDOCRINE, NUTRITIONAL & METABOLIC DISORDERS SOI 2. OTHER PROCEDURES FOR ENDOCRINE, NUTRITIONAL & METABOLIC DISORDERS SOI 3. ENDOCRINE DIAGNOSES SOI 4 .............. ENDOCRINE DIAGNOSES SOI 4 .............. 405 S ........ 420 421 4 4 M ....... wwhite on PROD1PC61 with PROPOSALS2 M ....... Consolidated severity-adjusted DRG description 10 537 ENDOCRINE DIAGNOSES SOI 4 .............. 422 4 M ....... 10 537 ENDOCRINE DIAGNOSES SOI 4 .............. 423 4 M ....... M ....... 10 10 537 537 ENDOCRINE DIAGNOSES SOI 4 .............. ENDOCRINE DIAGNOSES SOI 4 .............. 424 425 4 4 M ....... M ....... M ....... 10 10 10 538 539 540 DIABETES SOI 1 ......................................... DIABETES SOI 2 ......................................... DIABETES SOI 3 ......................................... 420 420 420 1 2 3 THYROID, PARATHYROID & THYROGLOSSAL PROCEDURES SOI 4. OTHER PROCEDURES FOR ENDOCRINE, NUTRITIONAL & METABOLIC DISORDERS SOI 4. PITUITARY & ADRENAL PROCEDURES SOI 1. PITUITARY & ADRENAL PROCEDURES SOI 2. PITUITARY & ADRENAL PROCEDURES SOI 3. PROCEDURES FOR OBESITY SOI 1. PROCEDURES FOR OBESITY SOI 2. PROCEDURES FOR OBESITY SOI 3. THYROID, PARATHYROID & THYROGLOSSAL PROCEDURES SOI 1. THYROID, PARATHYROID & THYROGLOSSAL PROCEDURES SOI 2. THYROID, PARATHYROID & THYROGLOSSAL PROCEDURES SOI 3. OTHER PROCEDURES FOR ENDOCRINE, NUTRITIONAL & METABOLIC DISORDERS SOI 1. OTHER PROCEDURES FOR ENDOCRINE, NUTRITIONAL & METABOLIC DISORDERS SOI 2. OTHER PROCEDURES FOR ENDOCRINE, NUTRITIONAL & METABOLIC DISORDERS SOI 3. DIABETES SOI 4. MALNUTRITION, FAILURE TO THRIVE & OTHER NUTRITIONAL DISORDERS SOI 4. HYPOVOLEMIA & RELATED ELECTROLYTE DISORDERS SOI 4. INBORN ERRORS OF METABOLISM SOI 4. OTHER ENDOCRINE DISORDERS SOI 4. ELECTROLYTE DISORDERS EXCEPT HYPOVOLEMIA RELATED SOI 4. DIABETES SOI 1. DIABETES SOI 2. DIABETES SOI 3. VerDate Aug<31>2005 17:10 Apr 24, 2006 Jkt 208001 PO 00000 Frm 00459 Fmt 4701 Sfmt 4702 CONTUSION, OPEN WOUND & OTHER TRAUMA TO SKIN & SUBCUTANEOUS TISSUE SOI 1. CONTUSION, OPEN WOUND & OTHER TRAUMA TO SKIN & SUBCUTANEOUS TISSUE SOI 2. CONTUSION, OPEN WOUND & OTHER TRAUMA TO SKIN & SUBCUTANEOUS TISSUE SOI 3. OTHER SKIN, SUBCUTANEOUS TISSUE & BREAST DISORDERS SOI 1. OTHER SKIN, SUBCUTANEOUS TISSUE & BREAST DISORDERS SOI 2. OTHER SKIN, SUBCUTANEOUS TISSUE & BREAST DISORDERS SOI 3. PITUITARY & ADRENAL PROCEDURES SOI 4. E:\FR\FM\25APP2.SGM 25APP2 24454 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules APPENDIX D.—CROSSWALK OF PROPOSED CONSOLIDATED SEVERITY-ADJUSTED DRGS TO RESPECTIVE APR DRGS— Continued TYPE MDC Consolidated severity-adjusted DRG 10 541 M ....... 10 542 M ....... 10 543 M ....... 10 544 M ....... 10 545 M ....... 10 546 M ....... 10 547 M ....... 10 548 M ....... 10 549 M M M M ....... ....... ....... ....... 10 10 10 10 550 551 552 553 M ....... 10 554 M ....... 10 555 S ........ 11 556 S ........ 11 556 S ........ 11 556 S ........ 11 556 S ........ 11 556 S ........ 11 556 S ........ 11 556 S S S S S S S S wwhite on PROD1PC61 with PROPOSALS2 M ....... ........ ........ ........ ........ ........ ........ ........ ........ 11 11 11 11 11 11 11 11 557 558 559 560 561 562 563 564 S ........ 11 565 S ........ 11 566 S ........ 11 567 S ........ 11 568 VerDate Aug<31>2005 17:10 Apr 24, 2006 Consolidated severity-adjusted DRG description APR DRG MALNUTRITION, FAILURE TO THRIVE & OTHER NUTRITIONAL DISORDERS SOI 1. MALNUTRITION, FAILURE TO THRIVE & OTHER NUTRITIONAL DISORDERS SOI 2. MALNUTRITION, FAILURE TO THRIVE & OTHER NUTRITIONAL DISORDERS SOI 3. HYPOVOLEMIA & RELATED ELECTROLYTE DISORDERS SOI 1. HYPOVOLEMIA & RELATED ELECTROLYTE DISORDERS SOI 2. HYPOVOLEMIA & RELATED ELECTROLYTE DISORDERS SOI 3. INBORN ERRORS OF METABOLISM SOI 1. INBORN ERRORS OF METABOLISM SOI 2. INBORN ERRORS OF METABOLISM SOI 3. OTHER ENDOCRINE DISORDERS SOI 1 OTHER ENDOCRINE DISORDERS SOI 2 OTHER ENDOCRINE DISORDERS SOI 3 ELECTROLYTE DISORDERS EXCEPT HYPOVOLEMIA RELATED SOI 1. ELECTROLYTE DISORDERS EXCEPT HYPOVOLEMIA RELATED SOI 2. ELECTROLYTE DISORDERS EXCEPT HYPOVOLEMIA RELATED SOI 3. URINARY TRACT & RELATED PROCEDURES EXCEPT KIDNEY TRANSPLANT SOI 4. URINARY TRACT & RELATED PROCEDURES EXCEPT KIDNEY TRANSPLANT SOI 4. URINARY TRACT & RELATED PROCEDURES EXCEPT KIDNEY TRANSPLANT SOI 4. URINARY TRACT & RELATED PROCEDURES EXCEPT KIDNEY TRANSPLANT SOI 4. URINARY TRACT & RELATED PROCEDURES EXCEPT KIDNEY TRANSPLANT SOI 4. URINARY TRACT & RELATED PROCEDURES EXCEPT KIDNEY TRANSPLANT SOI 4. URINARY TRACT & RELATED PROCEDURES EXCEPT KIDNEY TRANSPLANT SOI 4. KIDNEY TRANSPLANT SOI 1 .................... KIDNEY TRANSPLANT SOI 2 .................... KIDNEY TRANSPLANT SOI 3 .................... KIDNEY TRANSPLANT SOI 4 .................... MAJOR BLADDER PROCEDURES SOI 1 MAJOR BLADDER PROCEDURES SOI 2 MAJOR BLADDER PROCEDURES SOI 3 KIDNEY & URINARY TRACT PROCEDURES FOR MALIGNANCY SOI 1. KIDNEY & URINARY TRACT PROCEDURES FOR MALIGNANCY SOI 2. KIDNEY & URINARY TRACT PROCEDURES FOR MALIGNANCY SOI 3. KIDNEY & URINARY TRACT PROCEDURES FOR NONMALIGNANCY SOI 1. KIDNEY & URINARY TRACT PROCEDURES FOR NONMALIGNANCY SOI 2. Jkt 208001 PO 00000 Frm 00460 Fmt 4701 Sfmt 4702 SOI APR DRG description 421 1 MALNUTRITION, FAILURE TO THRIVE & OTHER NUTRITIONAL DISORDERS SOI 1. MALNUTRITION, FAILURE TO THRIVE & OTHER NUTRITIONAL DISORDERS SOI 2. MALNUTRITION, FAILURE TO THRIVE & OTHER NUTRITIONAL DISORDERS SOI 3. HYPOVOLEMIA & RELATED ELECTROLYTE DISORDERS SOI 1. HYPOVOLEMIA & RELATED ELECTROLYTE DISORDERS SOI 2. HYPOVOLEMIA & RELATED ELECTROLYTE DISORDERS SOI 3. INBORN ERRORS OF METABOLISM SOI 1. INBORN ERRORS OF METABOLISM SOI 2. INBORN ERRORS OF METABOLISM SOI 3. OTHER ENDOCRINE DISORDERS SOI 1. OTHER ENDOCRINE DISORDERS SOI 2. OTHER ENDOCRINE DISORDERS SOI 3. ELECTROLYTE DISORDERS EXCEPT HYPOVOLEMIA RELATED SOI 1. ELECTROLYTE DISORDERS EXCEPT HYPOVOLEMIA RELATED SOI 2. ELECTROLYTE DISORDERS EXCEPT HYPOVOLEMIA RELATED SOI 3. MAJOR BLADDER PROCEDURES SOI 4. 421 2 421 3 422 1 422 2 422 3 423 1 423 2 423 3 424 424 424 425 1 2 3 1 425 2 425 3 441 4 442 4 KIDNEY & URINARY TRACT PROCEDURES FOR MALIGNANCY SOI 4. 443 4 KIDNEY & URINARY TRACT PROCEDURES FOR NONMALIGNANCY SOI 4. 444 4 RENAL DIALYSIS ACCESS DEVICE PROCEDURE ONLY SOI 4. 445 4 OTHER BLADDER PROCEDURES SOI 4. 446 4 URETHRAL & TRANSURETHRAL PROCEDURES SOI 4. 447 4 OTHER KIDNEY, URINARY TRACT & RELATED PROCEDURES SOI 4. 440 440 440 440 441 441 441 442 1 2 3 4 1 2 3 1 442 2 442 3 443 1 443 2 KIDNEY TRANSPLANT SOI 1. KIDNEY TRANSPLANT SOI 2. KIDNEY TRANSPLANT SOI 3. KIDNEY TRANSPLANT SOI 4. MAJOR BLADDER PROCEDURES SOI 1. MAJOR BLADDER PROCEDURES SOI 2. MAJOR BLADDER PROCEDURES SOI 3. KIDNEY & URINARY TRACT PROCEDURES FOR MALIGNANCY SOI 1. KIDNEY & URINARY TRACT PROCEDURES FOR MALIGNANCY SOI 2. KIDNEY & URINARY TRACT PROCEDURES FOR MALIGNANCY SOI 3. KIDNEY & URINARY TRACT PROCEDURES FOR NONMALIGNANCY SOI 1. KIDNEY & URINARY TRACT PROCEDURES FOR NONMALIGNANCY SOI 2. E:\FR\FM\25APP2.SGM 25APP2 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules 24455 APPENDIX D.—CROSSWALK OF PROPOSED CONSOLIDATED SEVERITY-ADJUSTED DRGS TO RESPECTIVE APR DRGS— Continued TYPE MDC Consolidated severity-adjusted DRG 11 569 S ........ 11 570 S ........ 11 571 S ........ 11 572 S S S S ........ ........ ........ ........ 11 11 11 11 573 574 575 576 S ........ 11 577 S ........ 11 578 S ........ 11 579 S ........ 11 580 S ........ 11 581 M ....... 11 582 M ....... 11 582 M ....... 11 582 M ....... 11 582 M ....... 11 582 M ....... 11 582 M ....... 11 M M M M ....... ....... ....... ....... APR DRG APR DRG description 443 3 444 1 444 2 444 3 445 445 445 446 1 2 3 1 446 2 446 3 447 1 447 2 447 3 460 4 461 4 462 4 463 4 465 4 KIDNEY & URINARY TRACT DIAGNOSES SOI 4. 466 4 582 KIDNEY & URINARY TRACT DIAGNOSES SOI 4. 468 4 11 11 11 11 583 584 585 586 460 460 460 461 1 2 3 1 11 587 461 2 M ....... 11 588 461 3 M M M M ....... ....... ....... ....... 11 11 11 11 589 590 591 592 462 462 462 463 1 2 3 1 M ....... 11 593 463 2 M ....... 11 594 463 3 M ....... 11 595 465 1 M ....... 11 596 465 2 M ....... 11 597 RENAL FAILURE SOI 1 .............................. RENAL FAILURE SOI 2 .............................. RENAL FAILURE SOI 3 .............................. KIDNEY & URINARY TRACT MALIGNANCY SOI 1. KIDNEY & URINARY TRACT MALIGNANCY SOI 2. KIDNEY & URINARY TRACT MALIGNANCY SOI 3. NEPHRITIS & NEPHROSIS SOI 1 ............. NEPHRITIS & NEPHROSIS SOI 2 ............. NEPHRITIS & NEPHROSIS SOI 3 ............. KIDNEY & URINARY TRACT INFECTIONS SOI 1. KIDNEY & URINARY TRACT INFECTIONS SOI 2. KIDNEY & URINARY TRACT INFECTIONS SOI 3. URINARY STONES & ACQUIRED UPPER URINARY TRACT OBSTRUCTION SOI 1. URINARY STONES & ACQUIRED UPPER URINARY TRACT OBSTRUCTION SOI 2. URINARY STONES & ACQUIRED UPPER URINARY TRACT OBSTRUCTION SOI 3. 465 3 VerDate Aug<31>2005 17:10 Apr 24, 2006 KIDNEY & URINARY TRACT PROCEDURES FOR NONMALIGNANCY SOI 3. RENAL DIALYSIS ACCESS DEVICE PROCEDURE ONLY SOI 1. RENAL DIALYSIS ACCESS DEVICE PROCEDURE ONLY SOI 2. RENAL DIALYSIS ACCESS DEVICE PROCEDURE ONLY SOI 3. OTHER BLADDER PROCEDURES SOI 1 OTHER BLADDER PROCEDURES SOI 2 OTHER BLADDER PROCEDURES SOI 3 URETHRAL & TRANSURETHRAL PROCEDURES SOI 1. URETHRAL & TRANSURETHRAL PROCEDURES SOI 2. URETHRAL & TRANSURETHRAL PROCEDURES SOI 3. OTHER KIDNEY, URINARY TRACT & RELATED PROCEDURES SOI 1. OTHER KIDNEY, URINARY TRACT & RELATED PROCEDURES SOI 2. OTHER KIDNEY, URINARY TRACT & RELATED PROCEDURES SOI 3. KIDNEY & URINARY TRACT DIAGNOSES SOI 4. KIDNEY & URINARY TRACT DIAGNOSES SOI 4. KIDNEY & URINARY TRACT DIAGNOSES SOI 4. KIDNEY & URINARY TRACT DIAGNOSES SOI 4. KIDNEY & URINARY TRACT DIAGNOSES SOI 4. SOI M ....... wwhite on PROD1PC61 with PROPOSALS2 S ........ Consolidated severity-adjusted DRG description Jkt 208001 PO 00000 Frm 00461 Fmt 4701 Sfmt 4702 KIDNEY & URINARY TRACT PROCEDURES FOR NONMALIGNANCY SOI 3. RENAL DIALYSIS ACCESS DEVICE PROCEDURE ONLY SOI 1. RENAL DIALYSIS ACCESS DEVICE PROCEDURE ONLY SOI 2. RENAL DIALYSIS ACCESS DEVICE PROCEDURE ONLY SOI 3. OTHER BLADDER PROCEDURES SOI 1. OTHER BLADDER PROCEDURES SOI 2. OTHER BLADDER PROCEDURES SOI 3. URETHRAL & TRANSURETHRAL PROCEDURES SOI 1. URETHRAL & TRANSURETHRAL PROCEDURES SOI 2. URETHRAL & TRANSURETHRAL PROCEDURES SOI 3. OTHER KIDNEY, URINARY TRACT & RELATED PROCEDURES SOI 1. OTHER KIDNEY, URINARY TRACT & RELATED PROCEDURES SOI 2. OTHER KIDNEY, URINARY TRACT & RELATED PROCEDURES SOI 3. RENAL FAILURE SOI 4. KIDNEY & URINARY TRACT MALIGNANCY SOI 4. NEPHRITIS & NEPHROSIS SOI 4. KIDNEY & URINARY TRACT INFECTIONS SOI 4. URINARY STONES & ACQUIRED UPPER URINARY TRACT OBSTRUCTION SOI 4. MALFUNCTION, REACTION, COMPLIC OF GENITOURINARY DEVICE OR PROC SOI 4. OTHER KIDNEY & URINARY TRACT DIAGNOSES, SIGNS & SYMPTOMS SOI 4. RENAL FAILURE SOI 1. RENAL FAILURE SOI 2. RENAL FAILURE SOI 3. KIDNEY & URINARY TRACT MALIGNANCY SOI 1. KIDNEY & URINARY TRACT MALIGNANCY SOI 2. KIDNEY & URINARY TRACT MALIGNANCY SOI 3. NEPHRITIS & NEPHROSIS SOI 1. NEPHRITIS & NEPHROSIS SOI 2. NEPHRITIS & NEPHROSIS SOI 3. KIDNEY & URINARY TRACT INFECTIONS SOI 1. KIDNEY & URINARY TRACT INFECTIONS SOI 2. KIDNEY & URINARY TRACT INFECTIONS SOI 3. URINARY STONES & ACQUIRED UPPER URINARY TRACT OBSTRUCTION SOI 1. URINARY STONES & ACQUIRED UPPER URINARY TRACT OBSTRUCTION SOI 2. URINARY STONES & ACQUIRED UPPER URINARY TRACT OBSTRUCTION SOI 3. E:\FR\FM\25APP2.SGM 25APP2 24456 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules APPENDIX D.—CROSSWALK OF PROPOSED CONSOLIDATED SEVERITY-ADJUSTED DRGS TO RESPECTIVE APR DRGS— Continued TYPE MDC Consolidated severity-adjusted DRG 11 598 M ....... 11 599 M ....... 11 600 M ....... 11 601 M ....... 11 M ....... APR DRG SOI APR DRG description MALFUNCTION, REACTION, COMPLIC OF GENITOURINARY DEVICE OR PROC SOI 1. MALFUNCTION, REACTION, COMPLIC OF GENITOURINARY DEVICE OR PROC SOI 2. MALFUNCTION, REACTION, COMPLIC OF GENITOURINARY DEVICE OR PROC SOI 3. OTHER KIDNEY & URINARY TRACT DIAGNOSES, SIGNS & SYMPTOMS SOI 1. 466 1 466 2 466 3 468 1 602 OTHER KIDNEY & URINARY TRACT DIAGNOSES, SIGNS & SYMPTOMS SOI 2. 468 2 11 603 OTHER KIDNEY & URINARY TRACT DIAGNOSES, SIGNS & SYMPTOMS SOI 3. 468 3 S ........ 12 604 4 12 604 481 4 S ........ 12 604 482 4 S ........ 12 604 483 4 S ........ 12 604 484 4 S ........ 12 605 480 1 S ........ 12 606 480 2 S ........ 12 607 480 3 S S S S ........ ........ ........ ........ 12 12 12 12 608 609 610 611 481 481 481 482 1 2 3 1 S ........ 12 612 482 2 S ........ 12 613 482 3 S ........ 12 614 483 1 S ........ 12 615 483 2 S ........ 12 616 483 3 S ........ 12 617 484 1 S ........ 12 618 484 2 S ........ 12 619 484 3 M ....... 12 620 500 4 M ....... 12 620 501 4 M ....... 12 621 500 1 M ....... 12 622 500 2 M ....... 12 623 500 3 M ....... 12 624 501 1 M ....... 12 625 MALE REPRODUCTIVE SYSTEM & RELATED PROCEDURES SOI 4. MALE REPRODUCTIVE SYSTEM & RELATED PROCEDURES SOI 4. MALE REPRODUCTIVE SYSTEM & RELATED PROCEDURES SOI 4. MALE REPRODUCTIVE SYSTEM & RELATED PROCEDURES SOI 4. MALE REPRODUCTIVE SYSTEM & RELATED PROCEDURES SOI 4. MAJOR MALE PELVIC PROCEDURES SOI 1. MAJOR MALE PELVIC PROCEDURES SOI 2. MAJOR MALE PELVIC PROCEDURES SOI 3. PENIS PROCEDURES SOI 1 ..................... PENIS PROCEDURES SOI 2 ..................... PENIS PROCEDURES SOI 3 ..................... TRANSURETHRAL PROSTATECTOMY SOI 1. TRANSURETHRAL PROSTATECTOMY SOI 2. TRANSURETHRAL PROSTATECTOMY SOI 3. TESTES & SCROTAL PROCEDURES SOI 1. TESTES & SCROTAL PROCEDURES SOI 2. TESTES & SCROTAL PROCEDURES SOI 3. OTHER MALE REPRODUCTIVE SYSTEM & RELATED PROCEDURES SOI 1. OTHER MALE REPRODUCTIVE SYSTEM & RELATED PROCEDURES SOI 2. OTHER MALE REPRODUCTIVE SYSTEM & RELATED PROCEDURES SOI 3. MALE REPRODUCTIVE SYSTEM DIAGNOSES SOI 4. MALE REPRODUCTIVE SYSTEM DIAGNOSES SOI 4. MALIGNANCY, MALE REPRODUCTIVE SYSTEM SOI 1. MALIGNANCY, MALE REPRODUCTIVE SYSTEM SOI 2. MALIGNANCY, MALE REPRODUCTIVE SYSTEM SOI 3. MALE REPRODUCTIVE SYSTEM DIAGNOSES EXCEPT MALIGNANCY SOI 1. MALE REPRODUCTIVE SYSTEM DIAGNOSES EXCEPT MALIGNANCY SOI 2. 480 S ........ wwhite on PROD1PC61 with PROPOSALS2 M ....... Consolidated severity-adjusted DRG description 501 2 VerDate Aug<31>2005 17:10 Apr 24, 2006 Jkt 208001 PO 00000 Frm 00462 Fmt 4701 Sfmt 4702 MALFUNCTION, REACTION, COMPLIC OF GENITOURINARY DEVICE OR PROC SOI 1. MALFUNCTION, REACTION, COMPLIC OF GENITOURINARY DEVICE OR PROC SOI 2. MALFUNCTION, REACTION, COMPLIC OF GENITOURINARY DEVICE OR PROC SOI 3. OTHER KIDNEY & URINARY TRACT DIAGNOSES, SIGNS & SYMPTOMS SOI 1. OTHER KIDNEY & URINARY TRACT DIAGNOSES, SIGNS & SYMPTOMS SOI 2. OTHER KIDNEY & URINARY TRACT DIAGNOSES, SIGNS & SYMPTOMS SOI 3. MAJOR MALE PELVIC PROCEDURES SOI 4. PENIS PROCEDURES SOI 4. TRANSURETHRAL PROSTATECTOMY SOI 4. TESTES & SCROTAL PROCEDURES SOI 4. OTHER MALE REPRODUCTIVE SYSTEM & RELATED PROCEDURES SOI 4. MAJOR MALE PELVIC PROCEDURES SOI 1. MAJOR MALE PELVIC PROCEDURES SOI 2. MAJOR MALE PELVIC PROCEDURES SOI 3. PENIS PROCEDURES SOI 1. PENIS PROCEDURES SOI 2. PENIS PROCEDURES SOI 3. TRANSURETHRAL PROSTATECTOMY SOI 1. TRANSURETHRAL PROSTATECTOMY SOI 2. TRANSURETHRAL PROSTATECTOMY SOI 3. TESTES & SCROTAL PROCEDURES SOI 1. TESTES & SCROTAL PROCEDURES SOI 2. TESTES & SCROTAL PROCEDURES SOI 3. OTHER MALE REPRODUCTIVE SYSTEM & RELATED PROCEDURES SOI 1. OTHER MALE REPRODUCTIVE SYSTEM & RELATED PROCEDURES SOI 2. OTHER MALE REPRODUCTIVE SYSTEM & RELATED PROCEDURES SOI 3. MALIGNANCY, MALE REPRODUCTIVE SYSTEM SOI 4. MALE REPRODUCTIVE SYSTEM DIAGNOSES EXCEPT MALIGNANCY SOI 4. MALIGNANCY, MALE REPRODUCTIVE SYSTEM SOI 1. MALIGNANCY, MALE REPRODUCTIVE SYSTEM SOI 2. MALIGNANCY, MALE REPRODUCTIVE SYSTEM SOI 3. MALE REPRODUCTIVE SYSTEM DIAGNOSES EXCEPT MALIGNANCY SOI 1. MALE REPRODUCTIVE SYSTEM DIAGNOSES EXCEPT MALIGNANCY SOI 2. E:\FR\FM\25APP2.SGM 25APP2 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules 24457 APPENDIX D.—CROSSWALK OF PROPOSED CONSOLIDATED SEVERITY-ADJUSTED DRGS TO RESPECTIVE APR DRGS— Continued TYPE MDC Consolidated severity-adjusted DRG 12 626 S ........ 13 S ........ APR DRG SOI APR DRG description 501 3 627 MALE REPRODUCTIVE SYSTEM DIAGNOSES EXCEPT MALIGNANCY SOI 3. FEMALE REPRODUCTIVE SYSTEM & RELATED PROCEDURES SOI 4. 510 4 13 627 FEMALE REPRODUCTIVE SYSTEM & RELATED PROCEDURES SOI 4. 511 4 S ........ 13 627 FEMALE REPRODUCTIVE SYSTEM & RELATED PROCEDURES SOI 4. 512 4 S ........ 13 627 FEMALE REPRODUCTIVE SYSTEM & RELATED PROCEDURES SOI 4. 513 4 S ........ 13 627 4 13 627 517 4 S ........ 13 627 518 4 S ........ 13 627 519 4 S ........ 13 628 510 1 S ........ 13 629 510 2 S ........ 13 630 510 3 S ........ 13 631 511 1 S ........ 13 632 511 2 S ........ 13 633 511 3 S ........ 13 634 512 1 S ........ 13 635 512 2 S ........ 13 636 512 3 S ........ 13 637 513 1 S ........ 13 638 513 2 S ........ 13 639 513 3 S ........ 13 640 514 1 S ........ 13 641 514 2 S ........ 13 642 514 3 S ........ 13 643 517 1 S ........ 13 644 FEMALE REPRODUCTIVE SYSTEM & RELATED PROCEDURES SOI 4. FEMALE REPRODUCTIVE SYSTEM & RELATED PROCEDURES SOI 4. FEMALE REPRODUCTIVE SYSTEM & RELATED PROCEDURES SOI 4. FEMALE REPRODUCTIVE SYSTEM & RELATED PROCEDURES SOI 4. PELVIC EVISCERATION, RADICAL HYSTERECTOMY & OTHER RADICAL GYN PROCS SOI 1. PELVIC EVISCERATION, RADICAL HYSTERECTOMY & OTHER RADICAL GYN PROCS SOI 2. PELVIC EVISCERATION, RADICAL HYSTERECTOMY & OTHER RADICAL GYN PROCS SOI 3. UTERINE & ADNEXA PROCEDURES FOR OVARIAN & ADNEXAL MALIGNANCY SOI 1. UTERINE & ADNEXA PROCEDURES FOR OVARIAN & ADNEXAL MALIGNANCY SOI 2. UTERINE & ADNEXA PROCEDURES FOR OVARIAN & ADNEXAL MALIGNANCY SOI 3. UTERINE & ADNEXA PROCEDURES FOR NON-OVARIAN & NON-ADNEXAL MALIG SOI 1. UTERINE & ADNEXA PROCEDURES FOR NON-OVARIAN & NON-ADNEXAL MALIG SOI 2. UTERINE & ADNEXA PROCEDURES FOR NON-OVARIAN & NON-ADNEXAL MALIG SOI 3. UTERINE & ADNEXA PROCEDURES FOR NON-MALIGNANCY EXCEPT LEIOMYOMA SOI 1. UTERINE & ADNEXA PROCEDURES FOR NON-MALIGNANCY EXCEPT LEIOMYOMA SOI 2. UTERINE & ADNEXA PROCEDURES FOR NON-MALIGNANCY EXCEPT LEIOMYOMA SOI 3. FEMALE REPRODUCTIVE SYSTEM RECONSTRUCTIVE PROCEDURES SOI 1. FEMALE REPRODUCTIVE SYSTEM RECONSTRUCTIVE PROCEDURES SOI 2. FEMALE REPRODUCTIVE SYSTEM RECONSTRUCTIVE PROCEDURES SOI 3. DILATION & CURETTAGE FOR NON-OBSTETRIC DIAGNOSES SOI 1. DILATION & CURETTAGE FOR NON-OBSTETRIC DIAGNOSES SOI 2. 514 S ........ wwhite on PROD1PC61 with PROPOSALS2 M ....... Consolidated severity-adjusted DRG description 517 2 VerDate Aug<31>2005 17:10 Apr 24, 2006 Jkt 208001 PO 00000 Frm 00463 Fmt 4701 Sfmt 4702 MALE REPRODUCTIVE SYSTEM DIAGNOSES EXCEPT MALIGNANCY SOI 3. PELVIC EVISCERATION, RADICAL HYSTERECTOMY & OTHER RADICAL GYN PROCS SOI 4. UTERINE & ADNEXA PROCEDURES FOR OVARIAN & ADNEXAL MALIGNANCY SOI 4. UTERINE & ADNEXA PROCEDURES FOR NON-OVARIAN & NON-ADNEXAL MALIG SOI 4. UTERINE & ADNEXA PROCEDURES FOR NON-MALIGNANCY EXCEPT LEIOMYOMA SOI 4. FEMALE REPRODUCTIVE SYSTEM RECONSTRUCTIVE PROCEDURES SOI 4. DILATION & CURETTAGE FOR NON-OBSTETRIC DIAGNOSES SOI 4. OTHER FEMALE REPRODUCTIVE SYSTEM & RELATED PROCEDURES SOI 4. UTERINE & ADNEXA PROCEDURES FOR LEIOMYOMA SOI 4. PELVIC EVISCERATION, RADICAL HYSTERECTOMY & OTHER RADICAL GYN PROCS SOI 1. PELVIC EVISCERATION, RADICAL HYSTERECTOMY & OTHER RADICAL GYN PROCS SOI 2. PELVIC EVISCERATION, RADICAL HYSTERECTOMY & OTHER RADICAL GYN PROCS SOI 3. UTERINE & ADNEXA PROCEDURES FOR OVARIAN & ADNEXAL MALIGNANCY SOI 1. UTERINE & ADNEXA PROCEDURES FOR OVARIAN & ADNEXAL MALIGNANCY SOI 2. UTERINE & ADNEXA PROCEDURES FOR OVARIAN & ADNEXAL MALIGNANCY SOI 3. UTERINE & ADNEXA PROCEDURES FOR NON-OVARIAN & NON-ADNEXAL MALIG SOI 1. UTERINE & ADNEXA PROCEDURES FOR NON-OVARIAN & NON-ADNEXAL MALIG SOI 2. UTERINE & ADNEXA PROCEDURES FOR NON-OVARIAN & NON-ADNEXAL MALIG SOI 3. UTERINE & ADNEXA PROCEDURES FOR NON-MALIGNANCY EXCEPT LEIOMYOMA SOI 1. UTERINE & ADNEXA PROCEDURES FOR NON-MALIGNANCY EXCEPT LEIOMYOMA SOI 2. UTERINE & ADNEXA PROCEDURES FOR NON-MALIGNANCY EXCEPT LEIOMYOMA SOI 3. FEMALE REPRODUCTIVE SYSTEM RECONSTRUCTIVE PROCEDURES SOI 1. FEMALE REPRODUCTIVE SYSTEM RECONSTRUCTIVE PROCEDURES SOI 2. FEMALE REPRODUCTIVE SYSTEM RECONSTRUCTIVE PROCEDURES SOI 3. DILATION & CURETTAGE FOR NON-OBSTETRIC DIAGNOSES SOI 1. DILATION & CURETTAGE FOR NON-OBSTETRIC DIAGNOSES SOI 2. E:\FR\FM\25APP2.SGM 25APP2 24458 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules APPENDIX D.—CROSSWALK OF PROPOSED CONSOLIDATED SEVERITY-ADJUSTED DRGS TO RESPECTIVE APR DRGS— Continued TYPE MDC Consolidated severity-adjusted DRG 13 645 S ........ 13 646 S ........ 13 647 S ........ 13 648 S ........ 13 649 S ........ 13 650 S ........ 13 651 M ....... 13 652 M ....... 13 652 M ....... 13 652 M ....... 13 653 M ....... 13 654 M ....... 13 655 M ....... 13 656 M ....... 13 657 M ....... 13 658 M ....... 13 659 M ....... 13 660 M ....... 13 661 S ........ 14 662 S ........ 14 662 S ........ 14 662 S ........ 14 662 S ........ 14 662 S S S S S ........ ........ ........ ........ ........ 14 14 14 14 14 663 664 665 666 667 S ........ wwhite on PROD1PC61 with PROPOSALS2 S ........ 14 667 S ........ 14 668 S ........ 14 S ........ 14 VerDate Aug<31>2005 Consolidated severity-adjusted DRG description APR DRG APR DRG description 517 3 518 1 518 2 518 3 519 1 519 2 519 3 530 4 531 4 532 4 530 1 530 2 530 3 531 1 531 2 531 3 532 1 532 2 532 3 541 4 542 4 544 4 545 4 546 4 540 540 540 540 541 1 2 3 4 1 542 1 541 2 668 VAGINAL DELIVERY PROCEDURES SOI 2. VAGINAL DELIVERY PROCEDURES SOI 2. 542 2 669 VAGINAL DELIVERY PROCEDURES SOI 3. 541 3 17:10 Apr 24, 2006 DILATION & CURETTAGE FOR NON-OBSTETRIC DIAGNOSES SOI 3. OTHER FEMALE REPRODUCTIVE SYSTEM & RELATED PROCEDURES SOI 1. OTHER FEMALE REPRODUCTIVE SYSTEM & RELATED PROCEDURES SOI 2. OTHER FEMALE REPRODUCTIVE SYSTEM & RELATED PROCEDURES SOI 3. UTERINE & ADNEXA PROCEDURES FOR LEIOMYOMA SOI 1. UTERINE & ADNEXA PROCEDURES FOR LEIOMYOMA SOI 2. UTERINE & ADNEXA PROCEDURES FOR LEIOMYOMA SOI 3. FEMALE REPRODUCTIVE SYSTEM DIAGNOSES SOI 4. FEMALE REPRODUCTIVE SYSTEM DIAGNOSES SOI 4. FEMALE REPRODUCTIVE SYSTEM DIAGNOSES SOI 4. FEMALE REPRODUCTIVE SYSTEM MALIGNANCY SOI 1. FEMALE REPRODUCTIVE SYSTEM MALIGNANCY SOI 2. FEMALE REPRODUCTIVE SYSTEM MALIGNANCY SOI 3. FEMALE REPRODUCTIVE SYSTEM INFECTIONS SOI 1. FEMALE REPRODUCTIVE SYSTEM INFECTIONS SOI 2. FEMALE REPRODUCTIVE SYSTEM INFECTIONS SOI 3. MENSTRUAL & OTHER FEMALE REPRODUCTIVE SYSTEM DISORDERS SOI 1. MENSTRUAL & OTHER FEMALE REPRODUCTIVE SYSTEM DISORDERS SOI 2. MENSTRUAL & OTHER FEMALE REPRODUCTIVE SYSTEM DISORDERS SOI 3. O.R. PROC FOR OBSTETRIC DIAGNOSES EXCEPT CESAREAN DELIVERY SOI 4. O.R. PROC FOR OBSTETRIC DIAGNOSES EXCEPT CESAREAN DELIVERY SOI 4. O.R. PROC FOR OBSTETRIC DIAGNOSES EXCEPT CESAREAN DELIVERY SOI 4. O.R. PROC FOR OBSTETRIC DIAGNOSES EXCEPT CESAREAN DELIVERY SOI 4. O.R. PROC FOR OBSTETRIC DIAGNOSES EXCEPT CESAREAN DELIVERY SOI 4. CESAREAN DELIVERY SOI 1 .................... CESAREAN DELIVERY SOI 2 .................... CESAREAN DELIVERY SOI 3 .................... CESAREAN DELIVERY SOI 4 .................... VAGINAL DELIVERY PROCEDURES SOI 1. VAGINAL DELIVERY PROCEDURES SOI 1. SOI Jkt 208001 PO 00000 Frm 00464 Fmt 4701 Sfmt 4702 DILATION & CURETTAGE FOR NON-OBSTETRIC DIAGNOSES SOI 3. OTHER FEMALE REPRODUCTIVE SYSTEM & RELATED PROCEDURES SOI 1. OTHER FEMALE REPRODUCTIVE SYSTEM & RELATED PROCEDURES SOI 2. OTHER FEMALE REPRODUCTIVE SYSTEM & RELATED PROCEDURES SOI 3. UTERINE & ADNEXA PROCEDURES FOR LEIOMYOMA SOI 1. UTERINE & ADNEXA PROCEDURES FOR LEIOMYOMA SOI 2. UTERINE & ADNEXA PROCEDURES FOR LEIOMYOMA SOI 3. FEMALE REPRODUCTIVE SYSTEM MALIGNANCY SOI 4. FEMALE REPRODUCTIVE SYSTEM INFECTIONS SOI 4. MENSTRUAL & OTHER FEMALE REPRODUCTIVE SYSTEM DISORDERS SOI 4. FEMALE REPRODUCTIVE SYSTEM MALIGNANCY SOI 1. FEMALE REPRODUCTIVE SYSTEM MALIGNANCY SOI 2. FEMALE REPRODUCTIVE SYSTEM MALIGNANCY SOI 3. FEMALE REPRODUCTIVE SYSTEM INFECTIONS SOI 1. FEMALE REPRODUCTIVE SYSTEM INFECTIONS SOI 2. FEMALE REPRODUCTIVE SYSTEM INFECTIONS SOI 3. MENSTRUAL & OTHER FEMALE REPRODUCTIVE SYSTEM DISORDERS SOI 1. MENSTRUAL & OTHER FEMALE REPRODUCTIVE SYSTEM DISORDERS SOI 2. MENSTRUAL & OTHER FEMALE REPRODUCTIVE SYSTEM DISORDERS SOI 3. VAGINAL DELIVERY W STERILIZATION &/OR D&C SOI 4. VAGINAL DELIVERY W COMPLICATING PROCEDURES EXC STERILIZATION &/ OR D&C SOI 4. D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY FOR OBSTETRIC DIAGNOSES SOI 4. ECTOPIC PREGNANCY PROCEDURE SOI 4. OTHER O.R. PROC FOR OBSTETRIC DIAGNOSES EXCEPT DELIVERY DIAGNOSES SOI 4. CESAREAN DELIVERY SOI 1. CESAREAN DELIVERY SOI 2. CESAREAN DELIVERY SOI 3. CESAREAN DELIVERY SOI 4. VAGINAL DELIVERY W STERILIZATION &/OR D&C SOI 1. VAGINAL DELIVERY W COMPLICATING PROCEDURES EXC STERILIZATION &/ OR D&C SOI 1. VAGINAL DELIVERY W STERILIZATION &/OR D&C SOI 2. VAGINAL DELIVERY W COMPLICATING PROCEDURES EXC STERILIZATION &/ OR D&C SOI 2. VAGINAL DELIVERY W STERILIZATION &/OR D&C SOI 3. E:\FR\FM\25APP2.SGM 25APP2 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules 24459 APPENDIX D.—CROSSWALK OF PROPOSED CONSOLIDATED SEVERITY-ADJUSTED DRGS TO RESPECTIVE APR DRGS— Continued TYPE MDC Consolidated severity-adjusted DRG Consolidated severity-adjusted DRG description APR DRG SOI APR DRG description 14 669 VAGINAL DELIVERY PROCEDURES SOI 3. 542 3 S ........ 14 670 1 14 670 545 1 S ........ 14 670 546 1 S ........ 14 671 544 2 S ........ 14 671 545 2 S ........ 14 671 546 2 S ........ 14 672 544 3 S ........ 14 672 545 3 S ........ 14 672 546 3 M ....... 14 673 561 4 M ....... 14 673 563 4 M ....... 14 673 OTHER PROCEDURES FOR OBSTETRIC DIAGNOSES EXCEPT DELIVERY DIAGNOSES SOI 1. OTHER PROCEDURES FOR OBSTETRIC DIAGNOSES EXCEPT DELIVERY DIAGNOSES SOI 1. OTHER PROCEDURES FOR OBSTETRIC DIAGNOSES EXCEPT DELIVERY DIAGNOSES SOI 1. OTHER PROCEDURES FOR OBSTETRIC DIAGNOSES EXCEPT DELIVERY DIAGNOSES SOI 2. OTHER PROCEDURES FOR OBSTETRIC DIAGNOSES EXCEPT DELIVERY DIAGNOSES SOI 2. OTHER PROCEDURES FOR OBSTETRIC DIAGNOSES EXCEPT DELIVERY DIAGNOSES SOI 2. OTHER PROCEDURES FOR OBSTETRIC DIAGNOSES EXCEPT DELIVERY DIAGNOSES SOI 3. OTHER PROCEDURES FOR OBSTETRIC DIAGNOSES EXCEPT DELIVERY DIAGNOSES SOI 3. OTHER PROCEDURES FOR OBSTETRIC DIAGNOSES EXCEPT DELIVERY DIAGNOSES SOI 3. ANTEPARTUM DIAGNOSES EXCEPT VAGINAL DELIVERY DIAGNOSIS SOI 4. ANTEPARTUM DIAGNOSES EXCEPT VAGINAL DELIVERY DIAGNOSIS SOI 4. ANTEPARTUM DIAGNOSES EXCEPT VAGINAL DELIVERY DIAGNOSIS SOI 4. 544 S ........ 564 4 M ....... 14 673 4 14 673 566 4 M M M M M ....... ....... ....... ....... ....... 14 14 14 14 14 674 675 676 677 678 560 560 560 560 561 1 2 3 4 1 M ....... 14 678 ANTEPARTUM DIAGNOSES EXCEPT VAGINAL DELIVERY DIAGNOSIS SOI 4. ANTEPARTUM DIAGNOSES EXCEPT VAGINAL DELIVERY DIAGNOSIS SOI 4. VAGINAL DELIVERY SOI 1 ........................ VAGINAL DELIVERY SOI 2 ........................ VAGINAL DELIVERY SOI 3 ........................ VAGINAL DELIVERY SOI 4 ........................ POSTPARTUM & ABORTION DIAGNOSES W/O PROCEDURE SOI 1. POSTPARTUM & ABORTION DIAGNOSES W/O PROCEDURE SOI 1. 565 M ....... 564 1 M ....... 14 679 2 14 679 POSTPARTUM & ABORTION DIAGNOSES W/O PROCEDURE SOI 2. POSTPARTUM & ABORTION DIAGNOSES W/O PROCEDURE SOI 2. 561 M ....... 564 2 M ....... 14 680 3 14 680 POSTPARTUM & ABORTION DIAGNOSES W/O PROCEDURE SOI 3. POSTPARTUM & ABORTION DIAGNOSES W/O PROCEDURE SOI 3. 561 M ....... wwhite on PROD1PC61 with PROPOSALS2 S ........ 564 3 M ....... M ....... M ....... 14 14 14 681 681 681 ANTEPARTUM DIAGNOSES SOI 1 ........... ANTEPARTUM DIAGNOSES SOI 1 ........... ANTEPARTUM DIAGNOSES SOI 1 ........... 563 565 566 1 1 1 M ....... M ....... M ....... 14 14 14 682 682 682 ANTEPARTUM DIAGNOSES SOI 2 ........... ANTEPARTUM DIAGNOSES SOI 2 ........... ANTEPARTUM DIAGNOSES SOI 2 ........... 563 565 566 2 2 2 M ....... 14 683 ANTEPARTUM DIAGNOSES SOI 3 ........... 563 3 VerDate Aug<31>2005 17:10 Apr 24, 2006 Jkt 208001 PO 00000 Frm 00465 Fmt 4701 Sfmt 4702 VAGINAL DELIVERY W COMPLICATING PROCEDURES EXC STERILIZATION &/ OR D&C SOI 3. D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY FOR OBSTETRIC DIAGNOSES SOI 1. ECTOPIC PREGNANCY PROCEDURE SOI 1. OTHER O.R. PROC FOR OBSTETRIC DIAGNOSES EXCEPT DELIVERY DIAGNOSES SOI 1. D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY FOR OBSTETRIC DIAGNOSES SOI 2. ECTOPIC PREGNANCY PROCEDURE SOI 2. OTHER O.R. PROC FOR OBSTETRIC DIAGNOSES EXCEPT DELIVERY DIAGNOSES SOI 2. D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY FOR OBSTETRIC DIAGNOSES SOI 3. ECTOPIC PREGNANCY PROCEDURE SOI 3. OTHER O.R. PROC FOR OBSTETRIC DIAGNOSES EXCEPT DELIVERY DIAGNOSES SOI 3. POSTPARTUM & POST ABORTION DIAGNOSES W/O PROCEDURE SOI 4. THREATENED ABORTION SOI 4. ABORTION W/O D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY SOI 4. FALSE LABOR SOI 4. OTHER ANTEPARTUM DIAGNOSES SOI 4. VAGINAL DELIVERY SOI 1. VAGINAL DELIVERY SOI 2. VAGINAL DELIVERY SOI 3. VAGINAL DELIVERY SOI 4. POSTPARTUM & POST ABORTION DIAGNOSES W/O PROCEDURE SOI 1. ABORTION W/O D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY SOI 1. POSTPARTUM & POST ABORTION DIAGNOSES W/O PROCEDURE SOI 2. ABORTION W/O D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY SOI 2. POSTPARTUM & POST ABORTION DIAGNOSES W/O PROCEDURE SOI 3. ABORTION W/O D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY SOI 3. THREATENED ABORTION SOI 1. FALSE LABOR SOI 1. OTHER ANTEPARTUM DIAGNOSES SOI 1. THREATENED ABORTION SOI 2. FALSE LABOR SOI 2. OTHER ANTEPARTUM DIAGNOSES SOI 2. THREATENED ABORTION SOI 3. E:\FR\FM\25APP2.SGM 25APP2 24460 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules APPENDIX D.—CROSSWALK OF PROPOSED CONSOLIDATED SEVERITY-ADJUSTED DRGS TO RESPECTIVE APR DRGS— Continued TYPE MDC Consolidated severity-adjusted DRG Consolidated severity-adjusted DRG description APR DRG SOI APR DRG description 14 14 683 683 ANTEPARTUM DIAGNOSES SOI 3 ........... ANTEPARTUM DIAGNOSES SOI 3 ........... 565 566 3 3 M ....... 15 684 1 15 684 580 2 M ....... 15 684 581 1 M ....... 15 684 581 2 M ....... 15 685 580 3 M ....... 15 685 580 4 M ....... 15 685 581 3 M ....... 15 685 581 4 M ....... 15 686 583 1 FALSE LABOR SOI 3. OTHER ANTEPARTUM DIAGNOSES SOI 3. NEONATE, TRANSFERRED <5 DAYS OLD, NOT BORN HERE SOI 1. NEONATE, TRANSFERRED <5 DAYS OLD, NOT BORN HERE SOI 2. NEONATE, TRANSFERRED <5 DAYS OLD, BORN HERE SOI 1. NEONATE, TRANSFERRED <5 DAYS OLD, BORN HERE SOI 2. NEONATE, TRANSFERRED <5 DAYS OLD, NOT BORN HERE SOI 3. NEONATE, TRANSFERRED <5 DAYS OLD, NOT BORN HERE SOI 4. NEONATE, TRANSFERRED <5 DAYS OLD, BORN HERE SOI 3. NEONATE, TRANSFERRED <5 DAYS OLD, BORN HERE SOI 4. NEONATE W ECMO SOI 1. M ....... 15 686 583 2 NEONATE W ECMO SOI 2. M ....... 15 686 588 1 NEONATE BWT <1500G W MAJOR PROCEDURE SOI 1. M ....... 15 686 588 2 NEONATE BWT <1500G W MAJOR PROCEDURE SOI 2. M ....... 15 686 589 1 NEONATE BWT <500G SOI 1. M ....... 15 686 589 2 NEONATE BWT <500G SOI 2. M ....... 15 686 591 1 NEONATE BIRTHWT 500-749G MAJOR PROCEDURE SOI 1. W/O M ....... 15 686 591 2 NEONATE BIRTHWT 500-749G MAJOR PROCEDURE SOI 2. W/O M ....... 15 686 593 1 NEONATE BIRTHWT 750-999G MAJOR PROCEDURE SOI 1. W/O M ....... 15 686 593 2 NEONATE BIRTHWT 750-999G MAJOR PROCEDURE SOI 2. W/O M ....... 15 687 583 3 NEONATE W ECMO SOI 3. M ....... 15 687 583 4 NEONATE W ECMO SOI 4. M ....... 15 687 588 3 NEONATE BWT <1500G W MAJOR PROCEDURE SOI 3. M ....... 15 687 588 4 NEONATE BWT <1500G W MAJOR PROCEDURE SOI 4. M ....... 15 687 589 3 NEONATE BWT <500G SOI 3. M ....... 15 687 NEONATE, TRANSFERRED <5 DAYS OLD SOI 1 & 2. NEONATE, TRANSFERRED <5 DAYS OLD SOI 1 & 2. NEONATE, TRANSFERRED <5 DAYS OLD SOI 1 & 2. NEONATE, TRANSFERRED <5 DAYS OLD SOI 1 & 2. NEONATE, TRANSFERRED <5 DAYS OLD SOI 3 & 4. NEONATE, TRANSFERRED <5 DAYS OLD SOI 3 & 4. NEONATE, TRANSFERRED <5 DAYS OLD SOI 3 & 4. NEONATE, TRANSFERRED <5 DAYS OLD SOI 3 & 4. EXTREME IMMATURITY OR RESPIRATORY DISTRESS SYNDROME, NEONATE SOI 1 & 2. EXTREME IMMATURITY OR RESPIRATORY DISTRESS SYNDROME, NEONATE SOI 1 & 2. EXTREME IMMATURITY OR RESPIRATORY DISTRESS SYNDROME, NEONATE SOI 1 & 2. EXTREME IMMATURITY OR RESPIRATORY DISTRESS SYNDROME, NEONATE SOI 1 & 2. EXTREME IMMATURITY OR RESPIRATORY DISTRESS SYNDROME, NEONATE SOI 1 & 2. EXTREME IMMATURITY OR RESPIRATORY DISTRESS SYNDROME, NEONATE SOI 1 & 2. EXTREME IMMATURITY OR RESPIRATORY DISTRESS SYNDROME, NEONATE SOI 1 & 2. EXTREME IMMATURITY OR RESPIRATORY DISTRESS SYNDROME, NEONATE SOI 1 & 2. EXTREME IMMATURITY OR RESPIRATORY DISTRESS SYNDROME, NEONATE SOI 1 & 2. EXTREME IMMATURITY OR RESPIRATORY DISTRESS SYNDROME, NEONATE SOI 1 & 2. EXTREME IMMATURITY OR RESPIRATORY DISTRESS SYNDROME, NEONATE SOI 3 & 4. EXTREME IMMATURITY OR RESPIRATORY DISTRESS SYNDROME, NEONATE SOI 3 & 4. EXTREME IMMATURITY OR RESPIRATORY DISTRESS SYNDROME, NEONATE SOI 3 & 4. EXTREME IMMATURITY OR RESPIRATORY DISTRESS SYNDROME, NEONATE SOI 3 & 4. EXTREME IMMATURITY OR RESPIRATORY DISTRESS SYNDROME, NEONATE SOI 3 & 4. EXTREME IMMATURITY OR RESPIRATORY DISTRESS SYNDROME, NEONATE SOI 3 & 4. 580 M ....... wwhite on PROD1PC61 with PROPOSALS2 M ....... M ....... 589 4 NEONATE BWT <500G SOI 4. VerDate Aug<31>2005 17:10 Apr 24, 2006 Jkt 208001 PO 00000 Frm 00466 Fmt 4701 Sfmt 4702 E:\FR\FM\25APP2.SGM 25APP2 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules 24461 APPENDIX D.—CROSSWALK OF PROPOSED CONSOLIDATED SEVERITY-ADJUSTED DRGS TO RESPECTIVE APR DRGS— Continued TYPE MDC Consolidated severity-adjusted DRG 15 687 M ....... 15 687 M ....... 15 687 M ....... 15 687 M ....... 15 688 M ....... 15 M ....... APR DRG SOI APR DRG description EXTREME IMMATURITY OR RESPIRATORY DISTRESS SYNDROME, NEONATE SOI 3 & 4. EXTREME IMMATURITY OR RESPIRATORY DISTRESS SYNDROME, NEONATE SOI 3 & 4. EXTREME IMMATURITY OR RESPIRATORY DISTRESS SYNDROME, NEONATE SOI 3 & 4. EXTREME IMMATURITY OR RESPIRATORY DISTRESS SYNDROME, NEONATE SOI 3 & 4. PREMAUTRITY WITH MAJOR PROBLEMS SOI 1 & 2. 591 3 NEONATE BIRTHWT 500-749G MAJOR PROCEDURE SOI 3. W/O 591 4 NEONATE BIRTHWT 500-749G MAJOR PROCEDURE SOI 4. W/O 593 3 NEONATE BIRTHWT 750-999G MAJOR PROCEDURE SOI 3. W/O 593 4 NEONATE BIRTHWT 750-999G MAJOR PROCEDURE SOI 4. W/O 602 1 688 PREMAUTRITY WITH LEMS SOI 1 & 2. MAJOR PROB- 602 2 15 688 PREMAUTRITY WITH LEMS SOI 1 & 2. MAJOR PROB- 607 1 M ....... 15 688 PREMAUTRITY WITH LEMS SOI 1 & 2. MAJOR PROB- 607 2 M ....... 15 688 609 1 688 MAJOR PROB- 609 2 M ....... 15 688 MAJOR PROB- 611 1 M ....... 15 688 MAJOR PROB- 611 2 M ....... 15 688 WITH 2. WITH 2. WITH 2. WITH 2. WITH 2. PROB- 15 PREMAUTRITY LEMS SOI 1 & PREMAUTRITY LEMS SOI 1 & PREMAUTRITY LEMS SOI 1 & PREMAUTRITY LEMS SOI 1 & PREMAUTRITY LEMS SOI 1 & MAJOR M ....... MAJOR PROB- 612 1 M ....... 15 688 PREMAUTRITY WITH LEMS SOI 1 amp; 2. MAJOR PROB- 612 2 M ....... 15 688 PREMAUTRITY WITH LEMS SOI 1 & 2. MAJOR PROB- 613 1 M ....... 15 688 PREMAUTRITY WITH LEMS SOI 1 & 2. MAJOR PROB- 613 2 M ....... 15 688 621 1 688 MAJOR PROB- 621 2 M ....... 15 688 WITH 2. WITH 2. WITH 2. PROB- 15 PREMAUTRITY LEMS SOI 1 & PREMAUTRITY LEMS SOI 1 & PREMAUTRITY LEMS SOI 1 & MAJOR M ....... MAJOR PROB- 622 1 M ....... 15 688 PREMAUTRITY WITH LEMS SOI 1 & 2. MAJOR PROB- 622 2 M ....... 15 688 PREMAUTRITY WITH LEMS SOI 1 & 2. MAJOR PROB- 623 1 M ....... 15 688 PREMAUTRITY WITH LEMS SOI 1 & 2. MAJOR PROB- 623 2 M ....... wwhite on PROD1PC61 with PROPOSALS2 M ....... Consolidated severity-adjusted DRG description 15 689 PREMAUTRITY WITH LEMS SOI 3 & 4. MAJOR PROB- 602 3 M ....... 15 689 PREMAUTRITY WITH LEMS SOI 3 & 4. MAJOR PROB- 602 4 M ....... 15 689 PREMAUTRITY WITH LEMS SOI 3 & 4. MAJOR PROB- 607 3 NEONATE BWT 1000-1249G W RESP DIST SYND/OTH MAJ RESP OR MAJ ANOM SOI 1. NEONATE BWT 1000-1249G W RESP DIST SYND/OTH MAJ RESP OR MAJ ANOM SOI 2. NEONATE BWT 1250-1499G W RESP DIST SYND/OTH MAJ RESP OR MAJ ANOM SOI 1. NEONATE BWT 1250-1499G W RESP DIST SYND/OTH MAJ RESP OR MAJ ANOM SOI 2. NEONATE BWT 1500-2499G W MAJOR PROCEDURE SOI 1. NEONATE BWT 1500-2499G W MAJOR PROCEDURE SOI 2. NEONATE BIRTHWT 1500-1999G W MAJOR ANOMALY SOI 1. NEONATE BIRTHWT 1500-1999G W MAJOR ANOMALY SOI 2. NEONATE BWT 1500-1999G W RESP DIST SYND/OTH MAJ RESP COND SOI 1. NEONATE BWT 1500-1999G W RESP DIST SYND/OTH MAJ RESP COND SOI 2. NEONATE BIRTHWT 1500-1999G W CONGENITAL/PERINATAL INFECTION SOI 1. NEONATE BIRTHWT 1500-1999G W CONGENITAL/PERINATAL INFECTION SOI 2. NEONATE BWT 2000-2499G W MAJOR ANOMALY SOI 1. NEONATE BWT 2000-2499G W MAJOR ANOMALY SOI 2. NEONATE BWT 2000-2499G W RESP DIST SYND/OTH MAJ RESP COND SOI 1. NEONATE BWT 2000-2499G W RESP DIST SYND/OTH MAJ RESP COND SOI 2. NEONATE BWT 2000-2499G W CONGENITAL/PERINATAL INFECTION SOI 1. NEONATE BWT 2000-2499G W CONGENITAL/PERINATAL INFECTION SOI 2. NEONATE BWT 1000-1249G W RESP DIST SYND/OTH MAJ RESP OR MAJ ANOM SOI 3. NEONATE BWT 1000-1249G W RESP DIST SYND/OTH MAJ RESP OR MAJ ANOM SOI 4. NEONATE BWT 1250-1499G W RESP DIST SYND/OTH MAJ RESP OR MAJ ANOM SOI 3. VerDate Aug<31>2005 17:10 Apr 24, 2006 Jkt 208001 PO 00000 Frm 00467 Fmt 4701 Sfmt 4702 E:\FR\FM\25APP2.SGM 25APP2 24462 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules APPENDIX D.—CROSSWALK OF PROPOSED CONSOLIDATED SEVERITY-ADJUSTED DRGS TO RESPECTIVE APR DRGS— Continued TYPE MDC Consolidated severity-adjusted DRG Consolidated severity-adjusted DRG description APR DRG SOI APR DRG description 15 689 PREMAUTRITY WITH LEMS SOI 3 & 4. MAJOR PROB- 607 4 M ....... 15 689 609 3 689 MAJOR PROB- 609 4 M ....... 15 689 MAJOR PROB- 611 3 M ....... 15 689 MAJOR PROB- 611 4 M ....... 15 689 WITH 4. WITH 4. WITH 4. WITH 4. WITH 4. PROB- 15 PREMAUTRITY LEMS SOI 3 & PREMAUTRITY LEMS SOI 3 & PREMAUTRITY LEMS SOI 3 & PREMAUTRITY LEMS SOI 3 & PREMAUTRITY LEMS SOI 3 & MAJOR M ....... MAJOR PROB- 612 3 M ....... 15 689 PREMAUTRITY WITH LEMS SOI 3 & 4. MAJOR PROB- 612 4 M ....... 15 689 PREMAUTRITY WITH LEMS SOI 3 & 4. MAJOR PROB- 613 3 M ....... 15 689 PREMAUTRITY WITH LEMS SOI 3 & 4. MAJOR PROB- 613 4 M ....... 15 689 621 3 689 MAJOR PROB- 621 4 M ....... 15 689 WITH 4. WITH 4. WITH 4. PROB- 15 PREMAUTRITY LEMS SOI 3 & PREMAUTRITY LEMS SOI 3 & PREMAUTRITY LEMS SOI 3 & MAJOR M ....... MAJOR PROB- 622 3 M ....... 15 689 PREMAUTRITY WITH LEMS SOI 3 & 4. MAJOR PROB- 622 4 M ....... 15 689 PREMAUTRITY WITH LEMS SOI 3 & 4. MAJOR PROB- 623 3 M ....... 15 689 PREMAUTRITY WITH LEMS SOI 3 & 4. MAJOR PROB- 623 4 M ....... 15 690 PREMAUTRITY WITHOUT MAJOR PROBLEMS SOI 1 & 2. 603 1 M ....... 15 690 PREMAUTRITY WITHOUT MAJOR PROBLEMS SOI 1 & 2. 603 2 M ....... 15 690 PREMAUTRITY WITHOUT MAJOR PROBLEMS SOI 1 & 2. 608 1 M ....... 15 690 PREMAUTRITY WITHOUT MAJOR PROBLEMS SOI 1 & 2. 608 2 M ....... 15 690 PREMAUTRITY WITHOUT MAJOR PROBLEMS SOI 1 & 2. 614 1 M ....... 15 690 PREMAUTRITY WITHOUT MAJOR PROBLEMS SOI 1 & 2. 614 2 M ....... wwhite on PROD1PC61 with PROPOSALS2 M ....... 15 690 625 1 M ....... 15 690 625 2 M ....... 15 691 PREMAUTRITY WITHOUT MAJOR PROBLEMS SOI 1 & 2. PREMAUTRITY WITHOUT MAJOR PROBLEMS SOI 1 & 2. PREMAUTRITY WITHOUT MAJOR PROBLEMS SOI 3 & 4. 603 3 M ....... 15 691 PREMAUTRITY WITHOUT MAJOR PROBLEMS SOI 3 & 4. 603 4 VerDate Aug<31>2005 17:10 Apr 24, 2006 Jkt 208001 PO 00000 Frm 00468 Fmt 4701 Sfmt 4702 NEONATE BWT 1250-1499G W RESP DIST SYND/OTH MAJ RESP OR MAJ ANOM SOI 4. NEONATE BWT 1500-2499G W MAJOR PROCEDURE SOI 3. NEONATE BWT 1500-2499G W MAJOR PROCEDURE SOI 4. NEONATE BIRTHWT 1500-1999G W MAJOR ANOMALY SOI 3. NEONATE BIRTHWT 1500-1999G W MAJOR ANOMALY SOI 4. NEONATE BWT 1500-1999G W RESP DIST SYND/OTH MAJ RESP COND SOI 3. NEONATE BWT 1500-1999G W RESP DIST SYND/OTH MAJ RESP COND SOI 4. NEONATE BIRTHWT 1500-1999G W CONGENITAL/PERINATAL INFECTION SOI 3. NEONATE BIRTHWT 1500-1999G W CONGENITAL/PERINATAL INFECTION SOI 4. NEONATE BWT 2000-2499G W MAJOR ANOMALY SOI 3. NEONATE BWT 2000-2499G W MAJOR ANOMALY SOI 4. NEONATE BWT 2000-2499G W RESP DIST SYND/OTH MAJ RESP COND SOI 3. NEONATE BWT 2000-2499G W RESP DIST SYND/OTH MAJ RESP COND SOI 4. NEONATE BWT 2000-2499G W CONGENITAL/PERINATAL INFECTION SOI 3. NEONATE BWT 2000-2499G W CONGENITAL/PERINATAL INFECTION SOI 4. NEONATE BIRTHWT 1000-1249G W OR W/O OTHER SIGNIFICANT CONDITION SOI 1. NEONATE BIRTHWT 1000-1249G W OR W/O OTHER SIGNIFICANT CONDITION SOI 2. NEONATE BWT 1250-1499G W OR W/O OTHER SIGNIFICANT CONDITION SOI 1. NEONATE BWT 1250-1499G W OR W/O OTHER SIGNIFICANT CONDITION SOI 2. NEONATE BWT 1500-1999G W OR W/O OTHER SIGNIFICANT CONDITION SOI 1. NEONATE BWT 1500-1999G W OR W/O OTHER SIGNIFICANT CONDITION SOI 2. NEONATE BWT 2000-2499G W OTHER SIGNIFICANT CONDITION SOI 1. NEONATE BWT 2000-2499G W OTHER SIGNIFICANT CONDITION SOI 2. NEONATE BIRTHWT 1000-1249G W OR W/O OTHER SIGNIFICANT CONDITION SOI 3. NEONATE BIRTHWT 1000-1249G W OR W/O OTHER SIGNIFICANT CONDITION SOI 4. E:\FR\FM\25APP2.SGM 25APP2 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules 24463 APPENDIX D.—CROSSWALK OF PROPOSED CONSOLIDATED SEVERITY-ADJUSTED DRGS TO RESPECTIVE APR DRGS— Continued TYPE MDC Consolidated severity-adjusted DRG Consolidated severity-adjusted DRG description APR DRG SOI APR DRG description 15 691 PREMAUTRITY WITHOUT MAJOR PROBLEMS SOI 3 & 4. 608 3 M ....... 15 691 PREMAUTRITY WITHOUT MAJOR PROBLEMS SOI 3 & 4. 608 4 M ....... 15 691 PREMAUTRITY WITHOUT MAJOR PROBLEMS SOI 3 & 4. 614 3 M ....... 15 691 PREMAUTRITY WITHOUT MAJOR PROBLEMS SOI 3 & 4. 614 4 M ....... 15 691 3 15 691 625 4 M ....... 15 692 PREMAUTRITY WITHOUT MAJOR PROBLEMS SOI 3 & 4. PREMAUTRITY WITHOUT MAJOR PROBLEMS SOI 3 & 4. FULL TERM NEONATE WITH MAJOR PROBLEMS SOI 1 & 2. 625 M ....... 630 1 M ....... 15 692 FULL TERM NEONATE WITH MAJOR PROBLEMS SOI 1 & 2. 630 2 M ....... 15 692 631 1 15 692 WITH MAJOR 631 2 M ....... 15 692 WITH MAJOR 633 1 M ....... 15 692 WITH MAJOR 633 2 M ....... 15 692 FULL TERM PROBLEMS FULL TERM PROBLEMS FULL TERM PROBLEMS FULL TERM PROBLEMS FULL TERM PROBLEMS WITH MAJOR M ....... WITH MAJOR 634 1 M ....... 15 692 FULL TERM NEONATE WITH MAJOR PROBLEMS SOI 1 & 2. 634 2 M ....... 15 692 FULL TERM NEONATE WITH MAJOR PROBLEMS SOI 1 & 2. 636 1 M ....... 15 692 FULL TERM NEONATE WITH MAJOR PROBLEMS SOI 1 & 2. 636 2 M ....... 15 693 FULL TERM NEONATE WITH MAJOR PROBLEMS SOI 3 & 4. 630 3 M ....... 15 693 FULL TERM NEONATE WITH MAJOR PROBLEMS SOI 3 & 4. 630 4 M ....... 15 693 631 3 15 693 WITH MAJOR 631 4 M ....... 15 693 WITH MAJOR 633 3 M ....... 15 693 WITH MAJOR 633 4 M ....... 15 693 FULL TERM PROBLEMS FULL TERM PROBLEMS FULL TERM PROBLEMS FULL TERM PROBLEMS FULL TERM PROBLEMS WITH MAJOR M ....... WITH MAJOR 634 3 M ....... wwhite on PROD1PC61 with PROPOSALS2 M ....... 15 693 FULL TERM NEONATE WITH MAJOR PROBLEMS SOI 3 & 4. 634 4 M ....... 15 693 FULL TERM NEONATE WITH MAJOR PROBLEMS SOI 3 & 4. 636 3 M ....... 15 693 FULL TERM NEONATE WITH MAJOR PROBLEMS SOI 3 & 4. 636 4 VerDate Aug<31>2005 17:10 Apr 24, 2006 Jkt 208001 NEONATE SOI 1 & 2. NEONATE SOI 1 & 2. NEONATE SOI 1 & 2. NEONATE SOI 1 & 2. NEONATE SOI 1 & 2. NEONATE SOI 3 & 4. NEONATE SOI 3 & 4. NEONATE SOI 3 & 4. NEONATE SOI 3 & 4. NEONATE SOI 3 & 4. PO 00000 Frm 00469 Fmt 4701 Sfmt 4702 NEONATE BWT 1250-1499G W OR W/O OTHER SIGNIFICANT CONDITION SOI 3. NEONATE BWT 1250-1499G W OR W/O OTHER SIGNIFICANT CONDITION SOI 4. NEONATE BWT 1500-1999G W OR W/O OTHER SIGNIFICANT CONDITION SOI 3. NEONATE BWT 1500-1999G W OR W/O OTHER SIGNIFICANT CONDITION SOI 4. NEONATE BWT 2000-2499G W OTHER SIGNIFICANT CONDITION SOI 3. NEONATE BWT 2000-2499G W OTHER SIGNIFICANT CONDITION SOI 4. NEONATE BIRTHWT >2499G W MAJOR CARDIOVASCULAR PROCEDURE SOI 1. NEONATE BIRTHWT >2499G W MAJOR CARDIOVASCULAR PROCEDURE SOI 2. NEONATE BIRTHWT >2499G W OTHER MAJOR PROCEDURE SOI 1. NEONATE BIRTHWT >2499G W OTHER MAJOR PROCEDURE SOI 2. NEONATE BIRTHWT >2499G W MAJOR ANOMALY SOI 1. NEONATE BIRTHWT >2499G W MAJOR ANOMALY SOI 2. NEONATE, BIRTHWT >2499G W RESP DIST SYND/OTH MAJ RESP COND SOI 1. NEONATE, BIRTHWT >2499G W RESP DIST SYND/OTH MAJ RESP COND SOI 2. NEONATE BIRTHWT >2499G W CONGENITAL/PERINATAL INFECTION SOI 1. NEONATE BIRTHWT >2499G W CONGENITAL/PERINATAL INFECTION SOI 2. NEONATE BIRTHWT >2499G W MAJOR CARDIOVASCULAR PROCEDURE SOI 3. NEONATE BIRTHWT >2499G W MAJOR CARDIOVASCULAR PROCEDURE SOI 4. NEONATE BIRTHWT >2499G W OTHER MAJOR PROCEDURE SOI 3. NEONATE BIRTHWT >2499G W OTHER MAJOR PROCEDURE SOI 4. NEONATE BIRTHWT >2499G W MAJOR ANOMALY SOI 3. NEONATE BIRTHWT >2499G W MAJOR ANOMALY SOI 4. NEONATE, BIRTHWT >2499G W RESP DIST SYND/OTH MAJ RESP COND SOI 3. NEONATE, BIRTHWT >2499G W RESP DIST SYND/OTH MAJ RESP COND SOI 4. NEONATE BIRTHWT >2499G W CONGENITAL/PERINATAL INFECTION SOI 3. NEONATE BIRTHWT >2499G W CONGENITAL/PERINATAL INFECTION SOI 4. E:\FR\FM\25APP2.SGM 25APP2 24464 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules APPENDIX D.—CROSSWALK OF PROPOSED CONSOLIDATED SEVERITY-ADJUSTED DRGS TO RESPECTIVE APR DRGS— Continued TYPE MDC Consolidated severity-adjusted DRG 15 694 M ....... 15 694 M ....... 15 695 M ....... 15 695 M ....... 15 696 M ....... 15 696 M ....... 15 M ....... APR DRG APR DRG description 639 1 639 2 639 3 639 4 626 1 NEONATE >2,000 GRAMS WITHOUT SIGNIFICANT PROBLEMS SOI 1 & 2. 626 2 696 NEONATE >2,000 GRAMS WITHOUT SIGNIFICANT PROBLEMS SOI 1 & 2. 640 1 15 696 NEONATE >2,000 GRAMS WITHOUT SIGNIFICANT PROBLEMS SOI 1 & 2. 640 2 15 697 NEONATE >2,000 GRAMS WITHOUT SIGNIFICANT PROBLEMS SOI 3 & 4. 626 3 M ....... 15 697 NEONATE >2,000 GRAMS WITHOUT SIGNIFICANT PROBLEMS SOI 3 & 4. 626 4 M ....... 15 697 NEONATE >2,000 GRAMS WITHOUT SIGNIFICANT PROBLEMS SOI 3 & 4. 640 3 M ....... 15 697 NEONATE >2,000 GRAMS WITHOUT SIGNIFICANT PROBLEMS SOI 3 & 4. 640 4 S ........ 16 698 650 4 S ........ 16 698 651 4 S S S S ........ ........ ........ ........ 16 16 16 16 699 700 701 702 650 650 650 651 1 2 3 1 S ........ 16 703 651 2 S ........ 16 704 651 3 M ....... 16 705 PROCEDURES OF BLOOD & BLOODFORMING ORGANS SOI 4. PROCEDURES OF BLOOD & BLOODFORMING ORGANS SOI 4. SPLENECTOMY SOI 1 ............................... SPLENECTOMY SOI 2 ............................... SPLENECTOMY SOI 3 ............................... OTHER PROCEDURES OF BLOOD & BLOOD-FORMING ORGANS SOI 1. OTHER PROCEDURES OF BLOOD & BLOOD-FORMING ORGANS SOI 2. OTHER PROCEDURES OF BLOOD & BLOOD-FORMING ORGANS SOI 3. ANEMIA & DIAGNOSES OF BLOOD & BLOOD-FORMING ORGANS SOI 4. 660 4 M ....... 16 705 4 16 705 662 4 M ....... 16 705 BLOOD & SOI 4. BLOOD & SOI 4. BLOOD & SOI 4. 661 M ....... ANEMIA & DIAGNOSES OF BLOOD-FORMING ORGANS ANEMIA & DIAGNOSES OF BLOOD-FORMING ORGANS ANEMIA & DIAGNOSES OF BLOOD-FORMING ORGANS 663 4 M ....... 16 706 660 1 M ....... 16 707 660 2 M ....... 16 708 660 3 M ....... 16 709 661 1 M ....... 16 710 MAJOR HEMATOLOGIC/IMMUNOLOGIC DIAG EXC SICKLE CELL CRISIS & COAGUL SOI 1. MAJOR HEMATOLOGIC/IMMUNOLOGIC DIAG EXC SICKLE CELL CRISIS & COAGUL SOI 2. MAJOR HEMATOLOGIC/IMMUNOLOGIC DIAG EXC SICKLE CELL CRISIS & COAGUL SOI 3. COAGULATION & PLATELET DISORDERS SOI 1. COAGULATION & PLATELET DISORDERS SOI 2. 661 2 VerDate Aug<31>2005 17:10 Apr 24, 2006 NEONATE WITH OTHER SIGNIFICANT PROBLEMS SOI 1 & 2. NEONATE WITH OTHER SIGNIFICANT PROBLEMS SOI 1 & 2. NEONATE WITH OTHER SIGNIFICANT PROBLEMS SOI 3 & 4. NEONATE WITH OTHER SIGNIFICANT PROBLEMS SOI 3 & 4. NEONATE >2,000 GRAMS WITHOUT SIGNIFICANT PROBLEMS SOI 1 & 2. SOI M ....... wwhite on PROD1PC61 with PROPOSALS2 M ....... Consolidated severity-adjusted DRG description Jkt 208001 PO 00000 Frm 00470 Fmt 4701 Sfmt 4702 NEONATE BIRTHWT >2499G W OTHER SIGNIFICANT CONDITION SOI 1. NEONATE BIRTHWT >2499G W OTHER SIGNIFICANT CONDITION SOI 2. NEONATE BIRTHWT >2499G W OTHER SIGNIFICANT CONDITION SOI 3. NEONATE BIRTHWT >2499G W OTHER SIGNIFICANT CONDITION SOI 4. NEONATE BWT 2000-2499G, NORMAL NEWBORN OR NEONATE W OTHER PROBLEM SOI 1. NEONATE BWT 2000-2499G, NORMAL NEWBORN OR NEONATE W OTHER PROBLEM SOI 2. NEONATE BIRTHWT >2499G, NORMAL NEWBORN OR NEONATE W OTHER PROBLEM SOI 1. NEONATE BIRTHWT >2499G, NORMAL NEWBORN OR NEONATE W OTHER PROBLEM SOI 2. NEONATE BWT 2000-2499G, NORMAL NEWBORN OR NEONATE W OTHER PROBLEM SOI 3. NEONATE BWT 2000-2499G, NORMAL NEWBORN OR NEONATE W OTHER PROBLEM SOI 4. NEONATE BIRTHWT >2499G, NORMAL NEWBORN OR NEONATE W OTHER PROBLEM SOI 3. NEONATE BIRTHWT >2499G, NORMAL NEWBORN OR NEONATE W OTHER PROBLEM SOI 4. SPLENECTOMY SOI 4. OTHER PROCEDURES OF BLOOD & BLOOD-FORMING ORGANS SOI 4. SPLENECTOMY SOI 1. SPLENECTOMY SOI 2. SPLENECTOMY SOI 3. OTHER PROCEDURES OF BLOOD & BLOOD-FORMING ORGANS SOI 1. OTHER PROCEDURES OF BLOOD & BLOOD-FORMING ORGANS SOI 2. OTHER PROCEDURES OF BLOOD & BLOOD-FORMING ORGANS SOI 3. MAJOR HEMATOLOGIC/IMMUNOLOGIC DIAG EXC SICKLE CELL CRISIS & COAGUL SOI 4. COAGULATION & PLATELET DISORDERS SOI 4. SICKLE CELL ANEMIA CRISIS SOI 4. OTHER ANEMIA & DISORDERS OF BLOOD & BLOOD-FORMING ORGANS SOI 4. MAJOR HEMATOLOGIC/IMMUNOLOGIC DIAG EXC SICKLE CELL CRISIS & COAGUL SOI 1. MAJOR HEMATOLOGIC/IMMUNOLOGIC DIAG EXC SICKLE CELL CRISIS & COAGUL SOI 2. MAJOR HEMATOLOGIC/IMMUNOLOGIC DIAG EXC SICKLE CELL CRISIS & COAGUL SOI 3. COAGULATION & PLATELET DISORDERS SOI 1. COAGULATION & PLATELET DISORDERS SOI 2. E:\FR\FM\25APP2.SGM 25APP2 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules 24465 APPENDIX D.—CROSSWALK OF PROPOSED CONSOLIDATED SEVERITY-ADJUSTED DRGS TO RESPECTIVE APR DRGS— Continued TYPE MDC Consolidated severity-adjusted DRG 16 711 M M M M ....... ....... ....... ....... 16 16 16 16 712 713 714 715 M ....... 16 716 M ....... 16 717 S ........ 17 718 S ........ 17 718 S ........ 17 719 S ........ 17 720 S ........ 17 721 S ........ 17 722 S ........ 17 723 S ........ 17 724 M ....... 17 725 M ....... 17 725 M ....... 17 725 M ....... 17 725 M M M M ....... ....... ....... ....... 17 17 17 17 726 727 728 729 M ....... 17 730 M ....... wwhite on PROD1PC61 with PROPOSALS2 M ....... 17 731 M M M M M M M 17 17 17 17 17 17 17 732 733 734 735 736 737 738 ....... ....... ....... ....... ....... ....... ....... VerDate Aug<31>2005 17:10 Apr 24, 2006 Consolidated severity-adjusted DRG description APR DRG COAGULATION & PLATELET DISORDERS SOI 3. SICKLE CELL ANEMIA CRISIS SOI 1 ....... SICKLE CELL ANEMIA CRISIS SOI 2 ....... SICKLE CELL ANEMIA CRISIS SOI 3 ....... OTHER ANEMIA & DISORDERS OF BLOOD & BLOOD-FORMING ORGANS SOI 1. OTHER ANEMIA & DISORDERS OF BLOOD & BLOOD-FORMING ORGANS SOI 2. OTHER ANEMIA & DISORDERS OF BLOOD & BLOOD-FORMING ORGANS SOI 3. PROCEDURES FOR LYMPHATIC/ HEMATOPOIETIC/OTHER NEOPLASMS SOI 4. PROCEDURES FOR LYMPHATIC/ HEMATOPOIETIC/OTHER NEOPLASMS SOI 4. MAJOR O.R. PROCEDURES FOR LYMPHATIC/HEMATOPOIETIC/OTHER NEOPLASMS SOI 1. MAJOR O.R. PROCEDURES FOR LYMPHATIC/HEMATOPOIETIC/OTHER NEOPLASMS SOI 2. MAJOR O.R. PROCEDURES FOR LYMPHATIC/HEMATOPOIETIC/OTHER NEOPLASMS SOI 3. OTHER O.R. PROCEDURES FOR LYMPHATIC/HEMATOPOIETIC/OTHER NEOPLASMS SOI 1. OTHER O.R. PROCEDURES FOR LYMPHATIC/HEMATOPOIETIC/OTHER NEOPLASMS SOI 2. OTHER O.R. PROCEDURES FOR LYMPHATIC/HEMATOPOIETIC/OTHER NEOPLASMS SOI 3. LEUKEMIA, LYMPHOMA, MYELOMA, CHEMOTHERAPY, AND RADIOTHERAPY SOI 4. LEUKEMIA, LYMPHOMA, MYELOMA, CHEMOTHERAPY, AND RADIOTHERAPY SOI 4. LEUKEMIA, LYMPHOMA, MYELOMA, CHEMOTHERAPY, AND RADIOTHERAPY SOI 4. LEUKEMIA, LYMPHOMA, MYELOMA, CHEMOTHERAPY, AND RADIOTHERAPY SOI 4. ACUTE LEUKEMIA SOI 1 ........................... ACUTE LEUKEMIA SOI 2 ........................... ACUTE LEUKEMIA SOI 3 ........................... LYMPHOMA, MYELOMA & NON-ACUTE LEUKEMIA SOI 1. LYMPHOMA, MYELOMA & NON-ACUTE LEUKEMIA SOI 2. LYMPHOMA, MYELOMA & NON-ACUTE LEUKEMIA SOI 3. RADIOTHERAPY SOI 1 .............................. RADIOTHERAPY SOI 2 .............................. RADIOTHERAPY SOI 3 .............................. CHEMOTHERAPY SOI 1 ............................ CHEMOTHERAPY SOI 2 ............................ CHEMOTHERAPY SOI 3 ............................ LYMPHATIC & OTHER MALIGNANCIES & NEOPLASMS OF UNCERTAIN BEHAVIOR SOI 1. Jkt 208001 PO 00000 Frm 00471 Fmt 4701 Sfmt 4702 SOI APR DRG description 661 3 COAGULATION & PLATELET DISORDERS SOI 3. SICKLE CELL ANEMIA CRISIS SOI 1. SICKLE CELL ANEMIA CRISIS SOI 2. SICKLE CELL ANEMIA CRISIS SOI 3. OTHER ANEMIA & DISORDERS OF BLOOD & BLOOD-FORMING ORGANS SOI 1. OTHER ANEMIA & DISORDERS OF BLOOD & BLOOD-FORMING ORGANS SOI 2. OTHER ANEMIA & DISORDERS OF BLOOD & BLOOD-FORMING ORGANS SOI 3. MAJOR O.R. PROCEDURES FOR LYMPHATIC/HEMATOPOIETIC/OTHER NEOPLASMS SOI 4. OTHER O.R. PROCEDURES FOR LYMPHATIC/HEMATOPOIETIC/OTHER NEOPLASMS SOI 4. MAJOR O.R. PROCEDURES FOR LYMPHATIC/HEMATOPOIETIC/OTHER NEOPLASMS SOI 1. MAJOR O.R. PROCEDURES FOR LYMPHATIC/HEMATOPOIETIC/OTHER NEOPLASMS SOI 2. MAJOR O.R. PROCEDURES FOR LYMPHATIC/HEMATOPOIETIC/OTHER NEOPLASMS SOI 3. OTHER O.R. PROCEDURES FOR LYMPHATIC/HEMATOPOIETIC/OTHER NEOPLASMS SOI 1. OTHER O.R. PROCEDURES FOR LYMPHATIC/HEMATOPOIETIC/OTHER NEOPLASMS SOI 2. OTHER O.R. PROCEDURES FOR LYMPHATIC/HEMATOPOIETIC/OTHER NEOPLASMS SOI 3. ACUTE LEUKEMIA SOI 4. 662 662 662 663 1 2 3 1 663 2 663 3 680 4 681 4 680 1 680 2 680 3 681 1 681 2 681 3 690 4 691 4 LYMPHOMA, MYELOMA & NON-ACUTE LEUKEMIA SOI 4. 692 4 RADIOTHERAPY SOI 4. 693 4 CHEMOTHERAPY SOI 4. 690 690 690 691 1 2 3 1 691 2 691 3 692 692 692 693 693 693 694 1 2 3 1 2 3 1 ACUTE LEUKEMIA SOI 1. ACUTE LEUKEMIA SOI 2. ACUTE LEUKEMIA SOI 3. LYMPHOMA, MYELOMA & NON-ACUTE LEUKEMIA SOI 1. LYMPHOMA, MYELOMA & NON-ACUTE LEUKEMIA SOI 2. LYMPHOMA, MYELOMA & NON-ACUTE LEUKEMIA SOI 3. RADIOTHERAPY SOI 1. RADIOTHERAPY SOI 2. RADIOTHERAPY SOI 3. CHEMOTHERAPY SOI 1. CHEMOTHERAPY SOI 2. CHEMOTHERAPY SOI 3. LYMPHATIC & OTHER MALIGNANCIES & NEOPLASMS OF UNCERTAIN BEHAVIOR SOI 1. E:\FR\FM\25APP2.SGM 25APP2 24466 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules APPENDIX D.—CROSSWALK OF PROPOSED CONSOLIDATED SEVERITY-ADJUSTED DRGS TO RESPECTIVE APR DRGS— Continued TYPE MDC Consolidated severity-adjusted DRG 17 739 M ....... 17 740 M ....... 17 741 S ........ 18 742 S ........ 18 S ........ APR DRG SOI APR DRG description LYMPHATIC & OTHER MALIGNANCIES & NEOPLASMS OF UNCERTAIN BEHAVIOR SOI 2. LYMPHATIC & OTHER MALIGNANCIES & NEOPLASMS OF UNCERTAIN BEHAVIOR SOI 3. LYMPHATIC & OTHER MALIGNANCIES & NEOPLASMS OF UNCERTAIN BEHAVIOR SOI 4. INFECTIOUS & PARASITIC DISEASES W O.R. PROCEDURE SOI 4. 694 2 694 3 694 4 710 4 742 INFECTIOUS & PARASITIC DISEASES W O.R. PROCEDURE SOI 4. 711 4 18 743 1 18 744 710 2 S ........ 18 745 710 3 S ........ 18 746 711 1 S ........ 18 747 711 2 S ........ 18 748 711 3 M ....... 18 749 720 4 M ....... 18 749 721 4 M ....... 18 749 722 4 LYMPHATIC & OTHER MALIGNANCIES & NEOPLASMS OF UNCERTAIN BEHAVIOR SOI 2. LYMPHATIC & OTHER MALIGNANCIES & NEOPLASMS OF UNCERTAIN BEHAVIOR SOI 3. LYMPHATIC & OTHER MALIGNANCIES & NEOPLASMS OF UNCERTAIN BEHAVIOR SOI 4. INFECTIOUS & PARASITIC DISEASES INCLUDING HIV W O.R. PROCEDURE SOI 4. POST-OP, POST-TRAUMA, OTHER DEVICE INFECTIONS W O.R. PROCEDURE SOI 4. INFECTIOUS & PARASITIC DISEASES INCLUDING HIV W O.R. PROCEDURE SOI 1. INFECTIOUS & PARASITIC DISEASES INCLUDING HIV W O.R. PROCEDURE SOI 2. INFECTIOUS & PARASITIC DISEASES INCLUDING HIV W O.R. PROCEDURE SOI 3. POST-OP, POST-TRAUMA, OTHER DEVICE INFECTIONS W O.R. PROCEDURE SOI 1. POST-OP, POST-TRAUMA, OTHER DEVICE INFECTIONS W O.R. PROCEDURE SOI 2. POST-OP, POST-TRAUMA, OTHER DEVICE INFECTIONS W O.R. PROCEDURE SOI 3. SEPTICEMIA & DISSEMINATED INFECTIONS SOI 4. POST-OPERATIVE, POST-TRAUMATIC, OTHER DEVICE INFECTIONS SOI 4. FEVER SOI 4. M ....... 18 749 723 4 VIRAL ILLNESS SOI 4. M ....... 18 749 724 4 M ....... 18 750 720 1 M ....... 18 751 720 2 M ....... 18 752 720 3 M ....... 18 753 721 1 M ....... 18 754 721 2 M ....... 18 755 721 3 M M M M M M M ....... ....... ....... ....... ....... ....... ....... 18 18 18 18 18 18 18 756 757 758 759 760 761 762 722 722 722 723 723 723 724 1 2 3 1 2 3 1 M ....... 18 763 724 2 M ....... 18 764 724 3 S ........ 19 765 INFECTIOUS & PARASITIC DISEASES INCLUDING HIV W O.R. PROCEDURE SOI 1. INFECTIOUS & PARASITIC DISEASES INCLUDING HIV W O.R. PROCEDURE SOI 2. INFECTIOUS & PARASITIC DISEASES INCLUDING HIV W O.R. PROCEDURE SOI 3. POST-OP, POST-TRAUMA, OTHER DEVICE INFECTIONS W O.R. PROCEDURE SOI 1. POST-OP, POST-TRAUMA, OTHER DEVICE INFECTIONS W O.R. PROCEDURE SOI 2. POST-OP, POST-TRAUMA, OTHER DEVICE INFECTIONS W O.R. PROCEDURE SOI 3. INFECTIOUS & PARASITIC DISEASES SOI 4. INFECTIOUS & PARASITIC DISEASES SOI 4. INFECTIOUS & PARASITIC DISEASES SOI 4. INFECTIOUS & PARASITIC DISEASES SOI 4. INFECTIOUS & PARASITIC DISEASES SOI 4. SEPTICEMIA & DISSEMINATED INFECTIONS SOI 1. SEPTICEMIA & DISSEMINATED INFECTIONS SOI 2. SEPTICEMIA & DISSEMINATED INFECTIONS SOI 3. POST-OPERATIVE, POST-TRAUMATIC, OTHER DEVICE INFECTIONS SOI 1. POST-OPERATIVE, POST-TRAUMATIC, OTHER DEVICE INFECTIONS SOI 2. POST-OPERATIVE, POST-TRAUMATIC, OTHER DEVICE INFECTIONS SOI 3. FEVER SOI 1 ............................................... FEVER SOI 2 ............................................... FEVER SOI 3 ............................................... VIRAL ILLNESS SOI 1 ................................ VIRAL ILLNESS SOI 2 ................................ VIRAL ILLNESS SOI 3 ................................ OTHER INFECTIOUS & PARASITIC DISEASES SOI 1. OTHER INFECTIOUS & PARASITIC DISEASES SOI 2. OTHER INFECTIOUS & PARASITIC DISEASES SOI 3. MENTAL ILLNESS DIAGNOSIS W O.R. PROCEDURE SOI 1. 710 S ........ wwhite on PROD1PC61 with PROPOSALS2 M ....... Consolidated severity-adjusted DRG description 740 1 OTHER INFECTIOUS & PARASITIC DISEASES SOI 4. SEPTICEMIA & DISSEMINATED INFECTIONS SOI 1. SEPTICEMIA & DISSEMINATED INFECTIONS SOI 2. SEPTICEMIA & DISSEMINATED INFECTIONS SOI 3. POST-OPERATIVE, POST-TRAUMATIC, OTHER DEVICE INFECTIONS SOI 1. POST-OPERATIVE, POST-TRAUMATIC, OTHER DEVICE INFECTIONS SOI 2. POST-OPERATIVE, POST-TRAUMATIC, OTHER DEVICE INFECTIONS SOI 3. FEVER SOI 1. FEVER SOI 2. FEVER SOI 3. VIRAL ILLNESS SOI 1. VIRAL ILLNESS SOI 2. VIRAL ILLNESS SOI 3. OTHER INFECTIOUS & PARASITIC DISEASES SOI 1. OTHER INFECTIOUS & PARASITIC DISEASES SOI 2. OTHER INFECTIOUS & PARASITIC DISEASES SOI 3. MENTAL ILLNESS DIAGNOSIS W O.R. PROCEDURE SOI 1. VerDate Aug<31>2005 17:10 Apr 24, 2006 Jkt 208001 PO 00000 Frm 00472 Fmt 4701 Sfmt 4702 E:\FR\FM\25APP2.SGM 25APP2 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules 24467 APPENDIX D.—CROSSWALK OF PROPOSED CONSOLIDATED SEVERITY-ADJUSTED DRGS TO RESPECTIVE APR DRGS— Continued TYPE MDC Consolidated severity-adjusted DRG 19 766 S ........ 19 767 S ........ 19 768 M ....... 19 769 M ....... 19 769 M ....... 19 769 M ....... 19 770 M ....... 19 770 M ....... 19 770 M ....... 19 771 M ....... 19 771 M ....... 19 771 M ....... 19 772 M ....... 19 772 M ....... 19 772 M ....... 19 773 M ....... 19 774 M ....... 19 775 M ....... 19 776 M ....... 19 777 M ....... 19 777 M ....... 19 777 M ....... 19 777 M ....... 19 777 M ....... 19 777 M ....... 19 777 M ....... 19 778 M ....... wwhite on PROD1PC61 with PROPOSALS2 S ........ 19 778 M ....... 19 778 M ....... 19 778 M ....... 19 778 VerDate Aug<31>2005 17:10 Apr 24, 2006 Consolidated severity-adjusted DRG description APR DRG SOI APR DRG description MENTAL ILLNESS DIAGNOSIS W O.R. PROCEDURE SOI 2. MENTAL ILLNESS DIAGNOSIS W O.R. PROCEDURE SOI 3. MENTAL ILLNESS DIAGNOSIS W O.R. PROCEDURE SOI 4. MAJOR DEPRESSIVE, SCHIZOPHRENIA & BIPOLAR DISORDERS SOI 1. MAJOR DEPRESSIVE, SCHIZOPHRENIA & BIPOLAR DISORDERS SOI 1. 740 2 740 3 740 4 750 1 751 1 MAJOR DEPRESSIVE, SCHIZOPHRENIA & BIPOLAR DISORDERS SOI 1. MAJOR DEPRESSIVE, SCHIZOPHRENIA & BIPOLAR DISORDERS SOI 2. MAJOR DEPRESSIVE, SCHIZOPHRENIA & BIPOLAR DISORDERS SOI 2. 753 1 MAJOR DEPRESSIVE DISORDERS & OTHER/UNSPECIFIED PSYCHOSES SOI 1. BIPOLAR DISORDERS SOI 1. 750 2 SCHIZOPHRENIA SOI 2. 751 2 MAJOR DEPRESSIVE, SCHIZOPHRENIA & BIPOLAR DISORDERS SOI 2. MAJOR DEPRESSIVE, SCHIZOPHRENIA & BIPOLAR DISORDERS SOI 3. MAJOR DEPRESSIVE, SCHIZOPHRENIA & BIPOLAR DISORDERS SOI 3. 753 2 MAJOR DEPRESSIVE DISORDERS & OTHER/UNSPECIFIED PSYCHOSES SOI 2. BIPOLAR DISORDERS SOI 2. 750 3 SCHIZOPHRENIA SOI 3. 751 3 MAJOR DEPRESSIVE, SCHIZOPHRENIA & BIPOLAR DISORDERS SOI 3. MAJOR DEPRESSIVE, SCHIZOPHRENIA & BIPOLAR DISORDERS SOI 4. MAJOR DEPRESSIVE, SCHIZOPHRENIA & BIPOLAR DISORDERS SOI 4. 753 3 MAJOR DEPRESSIVE DISORDERS & OTHER/UNSPECIFIED PSYCHOSES SOI 3. BIPOLAR DISORDERS SOI 3. 750 4 SCHIZOPHRENIA SOI 4. 751 4 MAJOR DEPRESSIVE, SCHIZOPHRENIA & BIPOLAR DISORDERS SOI 4. ORGANIC MENTAL HEALTH DISTURBANCES SOI 1. ORGANIC MENTAL HEALTH DISTURBANCES SOI 2. ORGANIC MENTAL HEALTH DISTURBANCES SOI 3. ORGANIC MENTAL HEALTH DISTURBANCES SOI 4. OTHER MENTAL HEALTH DISORDERS SOI 1. OTHER MENTAL HEALTH DISORDERS SOI 1. OTHER MENTAL HEALTH DISORDERS SOI 1. 753 4 MAJOR DEPRESSIVE DISORDERS & OTHER/UNSPECIFIED PSYCHOSES SOI 4. BIPOLAR DISORDERS SOI 4. 757 1 757 2 757 3 757 4 752 1 754 1 755 1 OTHER SOI 1. OTHER SOI 1. OTHER SOI 1. OTHER SOI 1. OTHER SOI 2. OTHER SOI 2. OTHER SOI 2. MENTAL HEALTH DISORDERS 756 1 MENTAL HEALTH DISORDERS 758 1 MENTAL HEALTH DISORDERS 759 1 MENTAL HEALTH DISORDERS 760 1 MENTAL HEALTH DISORDERS 752 2 MENTAL HEALTH DISORDERS 754 2 MENTAL HEALTH DISORDERS 755 2 OTHER MENTAL HEALTH DISORDERS SOI 2. OTHER MENTAL HEALTH DISORDERS SOI 2. 756 2 758 2 Jkt 208001 PO 00000 Frm 00473 Fmt 4701 Sfmt 4702 MENTAL ILLNESS DIAGNOSIS W O.R. PROCEDURE SOI 2. MENTAL ILLNESS DIAGNOSIS W O.R. PROCEDURE SOI 3. MENTAL ILLNESS DIAGNOSIS W O.R. PROCEDURE SOI 4. SCHIZOPHRENIA SOI 1. ORGANIC MENTAL HEALTH DISTURBANCES SOI 1. ORGANIC MENTAL HEALTH DISTURBANCES SOI 2. ORGANIC MENTAL HEALTH DISTURBANCES SOI 3. ORGANIC MENTAL HEALTH DISTURBANCES SOI 4. DISORDERS OF PERSONALITY & IMPULSE CONTROL SOI 1. DEPRESSION EXCEPT MAJOR DEPRESSIVE DISORDER SOI 1. ADJUSTMENT DISORDERS & NEUROSES EXCEPT DEPRESSIVE DIAGNOSES SOI 1. ACUTE ANXIETY & DELIRIUM STATES SOI 1. CHILDHOOD BEHAVIORAL DISORDERS SOI 1. EATING DISORDERS SOI 1. OTHER MENTAL HEALTH DISORDERS SOI 1. DISORDERS OF PERSONALITY & IMPULSE CONTROL SOI 2. DEPRESSION EXCEPT MAJOR DEPRESSIVE DISORDER SOI 2. ADJUSTMENT DISORDERS & NEUROSES EXCEPT DEPRESSIVE DIAGNOSES SOI 2. ACUTE ANXIETY & DELIRIUM STATES SOI 2. CHILDHOOD BEHAVIORAL DISORDERS SOI 2. E:\FR\FM\25APP2.SGM 25APP2 24468 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules APPENDIX D.—CROSSWALK OF PROPOSED CONSOLIDATED SEVERITY-ADJUSTED DRGS TO RESPECTIVE APR DRGS— Continued TYPE MDC Consolidated severity-adjusted DRG 19 778 M ....... 19 778 M ....... 19 779 M ....... 19 779 M ....... 19 779 M ....... 19 779 M ....... 19 779 M ....... 19 779 M ....... 19 779 M ....... 19 780 M ....... 19 780 M ....... 19 780 M ....... 19 780 M ....... 19 780 M ....... 19 780 M ....... 19 780 M ....... 20 781 M ....... 20 781 M ....... 20 782 M ....... 20 782 M ....... 20 783 M ....... 20 783 M ....... 20 783 M ....... 20 783 M ....... 20 783 M ....... wwhite on PROD1PC61 with PROPOSALS2 M ....... 20 784 M ....... 20 784 M ....... 20 784 M ....... 20 784 M ....... 20 784 VerDate Aug<31>2005 17:10 Apr 24, 2006 Consolidated severity-adjusted DRG description APR DRG SOI APR DRG description OTHER SOI 2. OTHER SOI 2. OTHER SOI 3. OTHER SOI 3. OTHER SOI 3. MENTAL HEALTH DISORDERS 759 2 EATING DISORDERS SOI 2. MENTAL HEALTH DISORDERS 760 2 MENTAL HEALTH DISORDERS 752 3 MENTAL HEALTH DISORDERS 754 3 MENTAL HEALTH DISORDERS 755 3 OTHER SOI 3. OTHER SOI 3. OTHER SOI 3. OTHER SOI 3. OTHER SOI 4. OTHER SOI 4. OTHER SOI 4. MENTAL HEALTH DISORDERS 756 3 MENTAL HEALTH DISORDERS 758 3 MENTAL HEALTH DISORDERS 759 3 OTHER MENTAL HEALTH DISORDERS SOI 2. DISORDERS OF PERSONALITY & IMPULSE CONTROL SOI 3. DEPRESSION EXCEPT MAJOR DEPRESSIVE DISORDER SOI 3. ADJUSTMENT DISORDERS & NEUROSES EXCEPT DEPRESSIVE DIAGNOSES SOI 3. ACUTE ANXIETY & DELIRIUM STATES SOI 3. CHILDHOOD BEHAVIORAL DISORDERS SOI 3. EATING DISORDERS SOI 3. MENTAL HEALTH DISORDERS 760 3 MENTAL HEALTH DISORDERS 752 4 MENTAL HEALTH DISORDERS 754 4 MENTAL HEALTH DISORDERS 755 4 OTHER MENTAL HEALTH DISORDERS SOI 4. OTHER MENTAL HEALTH DISORDERS SOI 4. OTHER MENTAL HEALTH DISORDERS SOI 4. OTHER MENTAL HEALTH DISORDERS SOI 4. DRUG & ALCOHOL ABUSE OR DEPENDENCE, LEFT AGAINST MEDICAL ADVICE SOI 1 & 2. DRUG & ALCOHOL ABUSE OR DEPENDENCE, LEFT AGAINST MEDICAL ADVICE SOI 1 & 2. DRUG & ALCOHOL ABUSE OR DEPENDENCE, LEFT AGAINST MEDICAL ADVICE SOI 3 & 4. DRUG & ALCOHOL ABUSE OR DEPENDENCE, LEFT AGAINST MEDICAL ADVICE SOI 3 & 4. DRUG ABUSE & DEPENDENCE DIAGNOSES SOI 1. 756 4 758 4 759 4 760 4 770 1 770 2 770 3 770 4 772 1 DRUG ABUSE & NOSES SOI 1. DRUG ABUSE & NOSES SOI 1. DRUG ABUSE & NOSES SOI 1. DRUG ABUSE & NOSES SOI 1. DRUG ABUSE & NOSES SOI 2. DEPENDENCE DIAG- 773 1 DEPENDENCE DIAG- 774 1 DEPENDENCE DIAG- 775 1 DEPENDENCE DIAG- 776 1 DEPENDENCE DIAG- 772 2 DRUG ABUSE & NOSES SOI 2. DRUG ABUSE & NOSES SOI 2. DRUG ABUSE & NOSES SOI 2. DRUG ABUSE & NOSES SOI 2. DEPENDENCE DIAG- 773 2 DEPENDENCE DIAG- 774 2 DEPENDENCE DIAG- 775 2 DEPENDENCE DIAG- 776 2 Jkt 208001 PO 00000 Frm 00474 Fmt 4701 Sfmt 4702 OTHER MENTAL HEALTH DISORDERS SOI 3. DISORDERS OF PERSONALITY & IMPULSE CONTROL SOI 4. DEPRESSION EXCEPT MAJOR DEPRESSIVE DISORDER SOI 4. ADJUSTMENT DISORDERS & NEUROSES EXCEPT DEPRESSIVE DIAGNOSES SOI 4. ACUTE ANXIETY & DELIRIUM STATES SOI 4. CHILDHOOD BEHAVIORAL DISORDERS SOI 4. EATING DISORDERS SOI 4. OTHER MENTAL HEALTH DISORDERS SOI 4. DRUG & ALCOHOL ABUSE OR DEPENDENCE, LEFT AGAINST MEDICAL ADVICE SOI 1. DRUG & ALCOHOL ABUSE OR DEPENDENCE, LEFT AGAINST MEDICAL ADVICE SOI 2. DRUG & ALCOHOL ABUSE OR DEPENDENCE, LEFT AGAINST MEDICAL ADVICE SOI 3. DRUG & ALCOHOL ABUSE OR DEPENDENCE, LEFT AGAINST MEDICAL ADVICE SOI 4. ALCOHOL & DRUG DEPENDENCE W REHAB OR REHAB/DETOX THERAPY SOI 1. OPIOID ABUSE & DEPENDENCE SOI 1. COCAINE ABUSE & DEPENDENCE SOI 1. ALCOHOL ABUSE & DEPENDENCE SOI 1. OTHER DRUG ABUSE & DEPENDENCE SOI 1. ALCOHOL & DRUG DEPENDENCE W REHAB OR REHAB/DETOX THERAPY SOI 2. OPIOID ABUSE & DEPENDENCE SOI 2. COCAINE ABUSE & DEPENDENCE SOI 2. ALCOHOL ABUSE & DEPENDENCE SOI 2. OTHER DRUG ABUSE & DEPENDENCE SOI 2. E:\FR\FM\25APP2.SGM 25APP2 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules 24469 APPENDIX D.—CROSSWALK OF PROPOSED CONSOLIDATED SEVERITY-ADJUSTED DRGS TO RESPECTIVE APR DRGS— Continued TYPE MDC Consolidated severity-adjusted DRG Consolidated severity-adjusted DRG description APR DRG SOI APR DRG description 20 785 DRUG ABUSE & DEPENDENCE DIAGNOSES SOI 3. 772 3 M ....... 20 785 773 3 20 785 DEPENDENCE DIAG- 774 3 M ....... 20 785 DEPENDENCE DIAG- 775 3 M ....... 20 785 DEPENDENCE DIAG- 776 3 M ....... 20 786 DRUG ABUSE & NOSES SOI 3. DRUG ABUSE & NOSES SOI 3. DRUG ABUSE & NOSES SOI 3. DRUG ABUSE & NOSES SOI 3. DRUG ABUSE & NOSES SOI 4. DEPENDENCE DIAG- M ....... DEPENDENCE DIAG- 772 4 M ....... 20 786 4 20 786 774 4 M ....... 20 786 775 4 M ....... 20 786 776 4 S ........ 21 787 791 1 S ........ 21 788 791 2 S ........ 21 789 791 3 S ........ 21 790 791 4 M ....... 21 791 811 4 M ....... 21 791 812 4 M ....... 21 791 813 4 M ....... 21 791 815 4 M ....... 21 791 816 4 M M M M ....... ....... ....... ....... 21 21 21 21 792 793 794 795 811 811 811 812 1 2 3 1 M ....... 21 796 812 2 M ....... 21 797 812 3 M ....... 21 798 813 1 M ....... 21 799 813 2 M ....... 21 800 813 3 M ....... 21 801 815 1 M ....... 21 801 816 1 M ....... 21 802 815 2 M ....... 21 802 816 2 M ....... 21 803 815 3 M ....... 21 803 816 3 S ........ 22 804 DRUG ABUSE & DEPENDENCE DIAGNOSES SOI 4. DRUG ABUSE & DEPENDENCE DIAGNOSES SOI 4. DRUG ABUSE & DEPENDENCE DIAGNOSES SOI 4. DRUG ABUSE & DEPENDENCE DIAGNOSES SOI 4. O.R. PROCEDURE FOR OTHER COMPLICATIONS OF TREATMENT SOI 1. O.R. PROCEDURE FOR OTHER COMPLICATIONS OF TREATMENT SOI 2. O.R. PROCEDURE FOR OTHER COMPLICATIONS OF TREATMENT SOI 3. O.R. PROCEDURE FOR OTHER COMPLICATIONS OF TREATMENT SOI 4. INJURIES, POISONINGS & TOXIC EFFECTS OF DRUGS DIAGNOSES SOI 4. INJURIES, POISONINGS & TOXIC EFFECTS OF DRUGS DIAGNOSES SOI 4. INJURIES, POISONINGS & TOXIC EFFECTS OF DRUGS DIAGNOSES SOI 4. INJURIES, POISONINGS & TOXIC EFFECTS OF DRUGS DIAGNOSES SOI 4. INJURIES, POISONINGS & TOXIC EFFECTS OF DRUGS DIAGNOSES SOI 4. ALLERGIC REACTIONS SOI 1 ................... ALLERGIC REACTIONS SOI 2 ................... ALLERGIC REACTIONS SOI 3 ................... POISONING OF MEDICINAL AGENTS SOI 1. POISONING OF MEDICINAL AGENTS SOI 2. POISONING OF MEDICINAL AGENTS SOI 3. OTHER COMPLICATIONS OF TREATMENT SOI 1. OTHER COMPLICATIONS OF TREATMENT SOI 2. OTHER COMPLICATIONS OF TREATMENT SOI 3. OTHER INJURY, POISONING & TOXIC EFFECT DIAGNOSES SOI 1. OTHER INJURY, POISONING & TOXIC EFFECT DIAGNOSES SOI 1. OTHER INJURY, POISONING & TOXIC EFFECT DIAGNOSES SOI 2. OTHER INJURY, POISONING & TOXIC EFFECT DIAGNOSES SOI 2. OTHER INJURY, POISONING & TOXIC EFFECT DIAGNOSES SOI 3. OTHER INJURY, POISONING & TOXIC EFFECT DIAGNOSES SOI 3. BURN PROCEDURES SOI 4 ...................... 773 M ....... wwhite on PROD1PC61 with PROPOSALS2 M ....... 841 4 VerDate Aug<31>2005 17:10 Apr 24, 2006 Jkt 208001 PO 00000 Frm 00475 Fmt 4701 Sfmt 4702 ALCOHOL & DRUG DEPENDENCE W REHAB OR REHAB/DETOX THERAPY SOI 3. OPIOID ABUSE & DEPENDENCE SOI 3. COCAINE ABUSE & DEPENDENCE SOI 3. ALCOHOL ABUSE & DEPENDENCE SOI 3. OTHER DRUG ABUSE & DEPENDENCE SOI 3. ALCOHOL & DRUG DEPENDENCE W REHAB OR REHAB/DETOX THERAPY SOI 4. OPIOID ABUSE & DEPENDENCE SOI 4. COCAINE ABUSE & DEPENDENCE SOI 4. ALCOHOL ABUSE & DEPENDENCE SOI 4. OTHER DRUG ABUSE & DEPENDENCE SOI 4. O.R. PROCEDURE FOR OTHER COMPLICATIONS OF TREATMENT SOI 1. O.R. PROCEDURE FOR OTHER COMPLICATIONS OF TREATMENT SOI 2. O.R. PROCEDURE FOR OTHER COMPLICATIONS OF TREATMENT SOI 3. O.R. PROCEDURE FOR OTHER COMPLICATIONS OF TREATMENT SOI 4. ALLERGIC REACTIONS SOI 4. POISONING OF MEDICINAL AGENTS SOI 4. OTHER COMPLICATIONS OF TREATMENT SOI 4. OTHER INJURY, POISONING & TOXIC EFFECT DIAGNOSES SOI 4. TOXIC EFFECTS OF NON-MEDICINAL SUBSTANCES SOI 4. ALLERGIC REACTIONS SOI 1. ALLERGIC REACTIONS SOI 2. ALLERGIC REACTIONS SOI 3. POISONING OF MEDICINAL AGENTS SOI 1. POISONING OF MEDICINAL AGENTS SOI 2. POISONING OF MEDICINAL AGENTS SOI 3. OTHER COMPLICATIONS OF TREATMENT SOI 1. OTHER COMPLICATIONS OF TREATMENT SOI 2. OTHER COMPLICATIONS OF TREATMENT SOI 3. OTHER INJURY, POISONING & TOXIC EFFECT DIAGNOSES SOI 1. TOXIC EFFECTS OF NON-MEDICINAL SUBSTANCES SOI 1. OTHER INJURY, POISONING & TOXIC EFFECT DIAGNOSES SOI 2. TOXIC EFFECTS OF NON-MEDICINAL SUBSTANCES SOI 2. OTHER INJURY, POISONING & TOXIC EFFECT DIAGNOSES SOI 3. TOXIC EFFECTS OF NON-MEDICINAL SUBSTANCES SOI 3. EXTENSIVE 3RD DEGREE BURNS W SKIN GRAFT SOI 4. E:\FR\FM\25APP2.SGM 25APP2 24470 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules APPENDIX D.—CROSSWALK OF PROPOSED CONSOLIDATED SEVERITY-ADJUSTED DRGS TO RESPECTIVE APR DRGS— Continued TYPE MDC Consolidated severity-adjusted DRG Consolidated severity-adjusted DRG description APR DRG SOI APR DRG description 22 804 BURN PROCEDURES SOI 4 ...................... 842 4 S ........ 22 805 841 1 22 805 842 1 FULL THICKNESS GRAFT SOI 1. S ........ 22 806 841 2 EXTENSIVE 3RD DEGREE BURNS W SKIN GRAFT SOI 2. S ........ 22 806 842 2 FULL THICKNESS GRAFT SOI 2. S ........ 22 807 841 3 EXTENSIVE 3RD DEGREE BURNS W SKIN GRAFT SOI 3. S ........ 22 807 842 3 FULL THICKNESS GRAFT SOI 3. M ....... 22 808 EXTENSIVE 3RD DEGREE OR FULL THICKNESS BURNS W SKIN GRAFT SOI 1. EXTENSIVE 3RD DEGREE OR FULL THICKNESS BURNS W SKIN GRAFT SOI 1. EXTENSIVE 3RD DEGREE OR FULL THICKNESS BURNS W SKIN GRAFT SOI 2. EXTENSIVE 3RD DEGREE OR FULL THICKNESS BURNS W SKIN GRAFT SOI 2. EXTENSIVE 3RD DEGREE OR FULL THICKNESS BURNS W SKIN GRAFT SOI 3. EXTENSIVE 3RD DEGREE OR FULL THICKNESS BURNS W SKIN GRAFT SOI 3. BURN DIAGNOSES SOI 4 .......................... FULL THICKNESS BURNS W SKIN GRAFT SOI 4. EXTENSIVE 3RD DEGREE BURNS W SKIN GRAFT SOI 1. S ........ 843 4 M ....... 22 808 BURN DIAGNOSES SOI 4 .......................... 844 4 M ....... 22 809 1 22 810 843 2 M ....... 22 811 843 3 M ....... 22 812 844 1 M ....... 22 813 844 2 M ....... 22 814 844 3 S ........ 23 815 850 1 S ........ 23 816 850 2 S ........ 23 817 850 3 S ........ 23 818 850 4 M ....... 23 819 860 4 EXTENSIVE 3RD DEGREE OR FULL THICKNESS BURNS W/O SKIN GRAFT SOI 4. PARTIAL THICKNESS BURNS W OR W/O SKIN GRAFT SOI 4. EXTENSIVE 3RD DEGREE OR FULL THICKNESS BURNS W/O SKIN GRAFT SOI 1. EXTENSIVE 3RD DEGREE OR FULL THICKNESS BURNS W/O SKIN GRAFT SOI 2. EXTENSIVE 3RD DEGREE OR FULL THICKNESS BURNS W/O SKIN GRAFT SOI 3. PARTIAL THICKNESS BURNS W OR W/O SKIN GRAFT SOI 1. PARTIAL THICKNESS BURNS W OR W/O SKIN GRAFT SOI 2. PARTIAL THICKNESS BURNS W OR W/O SKIN GRAFT SOI 3. PROCEDURE W DIAG OF REHAB, AFTERCARE OR OTH CONTACT W HEALTH SERVICE SOI 1. PROCEDURE W DIAG OF REHAB, AFTERCARE OR OTH CONTACT W HEALTH SERVICE SOI 2. PROCEDURE W DIAG OF REHAB, AFTERCARE OR OTH CONTACT W HEALTH SERVICE SOI 3. PROCEDURE W DIAG OF REHAB, AFTERCARE OR OTH CONTACT W HEALTH SERVICE SOI 4. REHABILITATION SOI 4. M ....... 23 819 861 4 SIGNS, SYMPTOMS & OTHER FACTORS INFLUENCING HEALTH STATUS SOI 4. M ....... 23 819 862 4 OTHER AFTERCARE CENCE SOI 4. M ....... 23 819 863 4 NEONATAL AFTERCARE SOI 4. M M M M 23 23 23 23 820 821 822 823 EXTENSIVE 3RD DEGREE OR FULL THICKNESS BURNS W/O SKIN GRAFT SOI 1. EXTENSIVE 3RD DEGREE OR FULL THICKNESS BURNS W/O SKIN GRAFT SOI 2. EXTENSIVE 3RD DEGREE OR FULL THICKNESS BURNS W/O SKIN GRAFT SOI 3. PARTIAL THICKNESS BURNS W OR W/O SKIN GRAFT SOI 1. PARTIAL THICKNESS BURNS W OR W/O SKIN GRAFT SOI 2. PARTIAL THICKNESS BURNS W OR W/O SKIN GRAFT SOI 3. PROCEDURE W DIAG OF REHAB, AFTERCARE OR OTH CONTACT W HEALTH SERVICE SOI 1. PROCEDURE W DIAG OF REHAB, AFTERCARE OR OTH CONTACT W HEALTH SERVICE SOI 2. PROCEDURE W DIAG OF REHAB, AFTERCARE OR OTH CONTACT W HEALTH SERVICE SOI 3. PROCEDURE W DIAG OF REHAB, AFTERCARE OR OTH CONTACT W HEALTH SERVICE SOI 4. REHABILITATION/AFTERCARE/CONVALESCENCE EXCEPT NEONATAL AFTERCARE SOI 4. REHABILITATION/AFTERCARE/CONVALESCENCE EXCEPT NEONATAL AFTERCARE SOI 4. REHABILITATION/AFTERCARE/CONVALESCENCE EXCEPT NEONATAL AFTERCARE SOI 4. REHABILITATION/AFTERCARE/CONVALESCENCE EXCEPT NEONATAL AFTERCARE SOI 4. REHABILITATION SOI 1 ............................. REHABILITATION SOI 2 ............................. REHABILITATION SOI 3 ............................. SIGNS, SYMPTOMS & OTHER FACTORS INFLUENCING HEALTH STATUS SOI 1. 843 M ....... wwhite on PROD1PC61 with PROPOSALS2 S ........ 860 860 860 861 1 2 3 1 REHABILITATION SOI 1. REHABILITATION SOI 2. REHABILITATION SOI 3. SIGNS, SYMPTOMS & OTHER FACTORS INFLUENCING HEALTH STATUS SOI 1. ....... ....... ....... ....... VerDate Aug<31>2005 17:10 Apr 24, 2006 Jkt 208001 PO 00000 Frm 00476 Fmt 4701 Sfmt 4702 E:\FR\FM\25APP2.SGM 25APP2 BURNS BURNS BURNS & W W W SKIN SKIN SKIN CONVALES- Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules 24471 APPENDIX D.—CROSSWALK OF PROPOSED CONSOLIDATED SEVERITY-ADJUSTED DRGS TO RESPECTIVE APR DRGS— Continued TYPE MDC Consolidated severity-adjusted DRG Consolidated severity-adjusted DRG description APR DRG 23 824 M ....... 23 825 M ....... 23 826 M ....... 23 826 M ....... 23 827 M ....... 23 827 M ....... 23 828 M ....... 23 828 M ....... 24 829 SIGNS, SYMPTOMS & OTHER FACTORS INFLUENCING HEALTH STATUS SOI 2. SIGNS, SYMPTOMS & OTHER FACTORS INFLUENCING HEALTH STATUS SOI 3. OTHER AFTERCARE & CONVALESCENCE SOI 1. OTHER AFTERCARE & CONVALESCENCE SOI 1. OTHER AFTERCARE & CONVALESCENCE SOI 2. OTHER AFTERCARE & CONVALESCENCE SOI 2. OTHER AFTERCARE & CONVALESCENCE SOI 3. OTHER AFTERCARE & CONVALESCENCE SOI 3. HIV DIAGNOSES SOI 4 .............................. M ....... 24 829 M ....... 24 M ....... APR DRG description 861 2 861 3 862 1 863 1 862 2 863 2 862 3 863 3 890 4 HIV DIAGNOSES SOI 4 .............................. 892 4 829 HIV DIAGNOSES SOI 4 .............................. 893 4 24 829 HIV DIAGNOSES SOI 4 .............................. 894 4 M ....... 24 830 1 24 830 890 2 M ....... 24 831 890 3 M ....... 24 832 892 1 M ....... 24 832 892 2 M ....... 24 833 892 3 M ....... 24 834 893 1 M ....... 24 834 893 2 M ....... 24 835 893 3 M ....... 24 836 894 1 M ....... 24 837 894 2 M ....... 24 838 894 3 S ........ 25 839 910 4 S ........ 25 839 HIV W MULTIPLE MAJOR HIV RELATED CONDITIONS SOI 1 & 2. HIV W MULTIPLE MAJOR HIV RELATED CONDITIONS SOI 1 & 2. HIV W MULTIPLE MAJOR HIV RELATED CONDITIONS SOI 3. HIV W MAJOR HIV RELATED CONDITION SOI 1 & 2. HIV W MAJOR HIV RELATED CONDITION SOI 1 & 2. HIV W MAJOR HIV RELATED CONDITION SOI 3. HIV W MULTIPLE SIGNIFICANT HIV RELATED CONDITIONS SOI 1 & 2. HIV W MULTIPLE SIGNIFICANT HIV RELATED CONDITIONS SOI 1 & 2. HIV W MULTIPLE SIGNIFICANT HIV RELATED CONDITIONS SOI 3. HIV W ONE SIGNIF HIV COND OR W/O SIGNIF RELATED COND SOI 1. HIV W ONE SIGNIF HIV COND OR W/O SIGNIF RELATED COND SOI 2. HIV W ONE SIGNIF HIV COND OR W/O SIGNIF RELATED COND SOI 3. MULTIPLE SIGNIFICANT TRAUMA PROCEDURES SOI 4. MULTIPLE SIGNIFICANT TRAUMA PROCEDURES SOI 4. 890 M ....... 911 4 S ........ 25 839 MULTIPLE SIGNIFICANT TRAUMA PROCEDURES SOI 4. 912 4 S ........ 25 840 1 25 840 910 2 S ........ 25 841 910 3 S ........ 25 842 911 1 S ........ 25 842 CRANIOTOMY FOR MULTIPLE SIGNIFICANT TRAUMA SOI 1 & 2. CRANIOTOMY FOR MULTIPLE SIGNIFICANT TRAUMA SOI 1 & 2. CRANIOTOMY FOR MULTIPLE SIGNIFICANT TRAUMA SOI 3. EXTENSIVE ABDOMINAL/THORACIC PROCEDURES FOR MULT SIGNIFICANT TRAUMA SOI 1 & 2. EXTENSIVE ABDOMINAL/THORACIC PROCEDURES FOR MULT SIGNIFICANT TRAUMA SOI 1 & 2. 910 S ........ wwhite on PROD1PC61 with PROPOSALS2 M ....... SOI 911 2 VerDate Aug<31>2005 17:10 Apr 24, 2006 Jkt 208001 PO 00000 Frm 00477 Fmt 4701 Sfmt 4702 SIGNS, SYMPTOMS & OTHER FACTORS INFLUENCING HEALTH STATUS SOI 2. SIGNS, SYMPTOMS & OTHER FACTORS INFLUENCING HEALTH STATUS SOI 3. OTHER AFTERCARE & CONVALESCENCE SOI 1. NEONATAL AFTERCARE SOI 1. OTHER AFTERCARE & CONVALESCENCE SOI 2. NEONATAL AFTERCARE SOI 2. OTHER AFTERCARE & CONVALESCENCE SOI 3. NEONATAL AFTERCARE SOI 3. HIV W MULTIPLE MAJOR HIV RELATED CONDITIONS SOI 4. HIV W MAJOR HIV RELATED CONDITION SOI 4. HIV W MULTIPLE SIGNIFICANT HIV RELATED CONDITIONS SOI 4. HIV W ONE SIGNIF HIV COND OR W/O SIGNIF RELATED COND SOI 4. HIV W MULTIPLE MAJOR HIV RELATED CONDITIONS SOI 1. HIV W MULTIPLE MAJOR HIV RELATED CONDITIONS SOI 2. HIV W MULTIPLE MAJOR HIV RELATED CONDITIONS SOI 3. HIV W MAJOR HIV RELATED CONDITION SOI 1. HIV W MAJOR HIV RELATED CONDITION SOI 2. HIV W MAJOR HIV RELATED CONDITION SOI 3. HIV W MULTIPLE SIGNIFICANT HIV RELATED CONDITIONS SOI 1. HIV W MULTIPLE SIGNIFICANT HIV RELATED CONDITIONS SOI 2. HIV W MULTIPLE SIGNIFICANT HIV RELATED CONDITIONS SOI 3. HIV W ONE SIGNIF HIV COND OR W/O SIGNIF RELATED COND SOI 1. HIV W ONE SIGNIF HIV COND OR W/O SIGNIF RELATED COND SOI 2. HIV W ONE SIGNIF HIV COND OR W/O SIGNIF RELATED COND SOI 3. CRANIOTOMY FOR MULTIPLE SIGNIFICANT TRAUMA SOI 4. EXTENSIVE ABDOMINAL/THORACIC PROCEDURES FOR MULT SIGNIFICANT TRAUMA SOI 4. MUSCULOSKELETAL & OTHER PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA SOI 4. CRANIOTOMY FOR MULTIPLE SIGNIFICANT TRAUMA SOI 1. CRANIOTOMY FOR MULTIPLE SIGNIFICANT TRAUMA SOI 2. CRANIOTOMY FOR MULTIPLE SIGNIFICANT TRAUMA SOI 3. EXTENSIVE ABDOMINAL/THORACIC PROCEDURES FOR MULT SIGNIFICANT TRAUMA SOI 1. EXTENSIVE ABDOMINAL/THORACIC PROCEDURES FOR MULT SIGNIFICANT TRAUMA SOI 2. E:\FR\FM\25APP2.SGM 25APP2 24472 Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / Proposed Rules APPENDIX D.—CROSSWALK OF PROPOSED CONSOLIDATED SEVERITY-ADJUSTED DRGS TO RESPECTIVE APR DRGS— Continued TYPE MDC Consolidated severity-adjusted DRG S ........ 25 843 S ........ 25 844 S ........ 25 844 S ........ 25 845 M ....... 25 846 M ....... 25 846 M ....... 25 847 M ....... 25 848 S ........ 25 987 S ........ 25 988 S ........ 25 989 S ........ 25 990 S ........ 25 991 S ........ 25 991 S ........ 25 992 S ........ 25 993 S ........ 25 994 S ........ 25 995 S ........ 25 996 S ........ 25 997 26 998 26 999 Consolidated severity-adjusted DRG description APR DRG EXTENSIVE ABDOMINAL/THORACIC PROCEDURES FOR MULT SIGNIFICANT TRAUMA SOI 3. MUSCULOSKELETAL & OTHER PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA SOI 1 & 2. MUSCULOSKELETAL & OTHER PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA SOI 1 & 2. MUSCULOSKELETAL & OTHER PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA SOI 3. MULTIPLE SIGNIFICANT TRAUMA W/O O.R. PROCEDURE SOI 1 & 2. MULTIPLE SIGNIFICANT TRAUMA W/O O.R. PROCEDURE SOI 1 & 2. MULTIPLE SIGNIFICANT TRAUMA W/O O.R. PROCEDURE SOI 3. MULTIPLE SIGNIFICANT TRAUMA W/O O.R. PROCEDURE SOI 4. EXTENSIVE PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS SOI 1. EXTENSIVE PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS SOI 2. EXTENSIVE PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS SOI 3. EXTENSIVE PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS SOI 4. NON MAJOR PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS SOI 4. SOI APR DRG description 911 3 912 1 912 2 912 3 930 1 930 2 930 3 930 4 950 1 950 2 950 3 950 4 951 4 NON MAJOR PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS SOI 4. 952 4 MODERATELY EXTENSIVE PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS SOI 1. MODERATELY EXTENSIVE PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS SOI 2. MODERATELY EXTENSIVE PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS SOI 3. NONEXTENSIVE PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS SOI 1. NONEXTENSIVE PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS SOI 2. NONEXTENSIVE PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS SOI 3. PRINCIPAL DIAGNOSIS INVALID AS DISCHARGE DIAGNOSIS. UNGROUPABLE .......................................... 951 1 951 2 951 3 952 1 952 2 952 3 955 0 956 0 EXTENSIVE ABDOMINAL/THORACIC PROCEDURES FOR MULT SIGNIFICANT TRAUMA SOI 3. MUSCULOSKELETAL & OTHER PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA SOI 1. MUSCULOSKELETAL & OTHER PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA SOI 2. MUSCULOSKELETAL & OTHER PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA SOI 3. MULTIPLE SIGNIFICANT TRAUMA W/O O.R. PROCEDURE SOI 1. MULTIPLE SIGNIFICANT TRAUMA W/O O.R. PROCEDURE SOI 2. MULTIPLE SIGNIFICANT TRAUMA W/O O.R. PROCEDURE SOI 3. MULTIPLE SIGNIFICANT TRAUMA W/O O.R. PROCEDURE SOI 4. EXTENSIVE PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS SOI 1. EXTENSIVE PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS SOI 2. EXTENSIVE PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS SOI 3. EXTENSIVE PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS SOI 4. MODERATELY EXTENSIVE PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS SOI 4. NONEXTENSIVE PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS SOI 4. MODERATELY EXTENSIVE PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS SOI 1. MODERATELY EXTENSIVE PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS SOI 2. MODERATELY EXTENSIVE PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS SOI 3. NONEXTENSIVE PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS SOI 1. NONEXTENSIVE PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS SOI 2. NONEXTENSIVE PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS SOI 3. PRINCIPAL DIAGNOSIS INVALID AS DISCHARGE DIAGNOSIS. UNGROUPABLE. wwhite on PROD1PC61 with PROPOSALS2 M = Medical. S = Surgical. SOI = Severity of Illness Subclass [FR Doc. 06–3629 Filed 4–12–06; 4:22 pm] BILLING CODE 4120–01–P VerDate Aug<31>2005 17:10 Apr 24, 2006 Jkt 208001 PO 00000 Frm 00478 Fmt 4701 Sfmt 4702 E:\FR\FM\25APP2.SGM 25APP2

Agencies

[Federal Register Volume 71, Number 79 (Tuesday, April 25, 2006)]
[Proposed Rules]
[Pages 23996-24472]
From the Federal Register Online via the Government Printing Office [www.gpo.gov]
[FR Doc No: 06-3629]



[[Page 23995]]

-----------------------------------------------------------------------

Part II

Book 2 of 2 Books

Pages 23995-24550





Department of Health and Human Services





-----------------------------------------------------------------------



Centers for Medicare & Medicaid Services



-----------------------------------------------------------------------



42 CFR Parts 409, 410 et al.



Medicare Program; Proposed Changes to the Hospital Inpatient 
Prospective Payment Systems and Fiscal Year 2007 Rates; Proposed Rule

Federal Register / Vol. 71, No. 79 / Tuesday, April 25, 2006 / 
Proposed Rules

[[Page 23996]]


-----------------------------------------------------------------------

DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare & Medicaid Services

42 CFR Parts 409, 410, 412, 413, 424, 485, and 489

[CMS-1488-P]
RIN 0938-AO12


Medicare Program; Proposed Changes to the Hospital Inpatient 
Prospective Payment Systems and Fiscal Year 2007 Rates

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

ACTION: Proposed rule.

-----------------------------------------------------------------------

SUMMARY: We are proposing to revise the Medicare hospital inpatient 
prospective payment systems (IPPS) for operating and capital-related 
costs to implement changes arising from our continuing experience with 
these systems, and to implement a number of changes made by the Deficit 
Reduction Act of 2005 (Pub. L. 109-171). In addition, in the Addendum 
to this proposed rule, we describe the proposed changes to the amounts 
and factors used to determine the rates for Medicare hospital inpatient 
services for operating costs and capital-related costs. We also are 
setting forth proposed rate-of-increase limits as well as proposed 
policy changes for hospitals and hospital units excluded from the IPPS 
that are paid in full or in part on a reasonable cost basis subject to 
these limits. These proposed changes would be applicable to discharges 
occurring on or after October 1, 2006.
    In this proposed rule, we discuss our proposals to refine the 
diagnosis-related group (DRG) system under the IPPS to better recognize 
severity of illness among patients--for FY 2007, we are proposing to 
use a hospital-specific relative value cost center weighting 
methodology to adjust DRG relative weights and in FY 2008 (if not 
earlier), to implement consolidated severity-adjusted DRGs or 
alternative severity adjustment methods.
    Among the other policy changes that we are proposing to make are 
changes related to: limited revisions of the reclassification of cases 
to DRGs; the long-term care (LTC)-DRGs and relative weights; the wage 
data, including the occupational mix data, used to compute the wage 
index; applications for new technologies and medical services add-on 
payments; payments to hospitals for the direct and indirect costs of 
graduate medical education; submission of hospital quality data; 
payments to sole community hospitals and Medicare-dependent, small 
rural hospitals; and provisions governing emergency services under the 
Emergency Medical Treatment and Labor Act of 1986 (EMTALA).
    We are also inviting comments on a number of issues including 
performance-based hospital payments for services and health information 
technology, as well as how to improve data transparency for consumers.

DATES: To be assured consideration, comments must be received at one of 
the addresses provided below, no later than 5 p.m. on June 12, 2006.

ADDRESSES: In commenting, please refer to file code CMS-1488-P. Because 
of staff and resource limitations, we cannot accept comments by 
facsimile (FAX) transmission.
    You may submit comments in one of three ways (no duplicates, 
please):
    1. Electronically. You may submit electronic comments on specific 
issues in this regulation to https://www.cms.hhs.gov/eRulemaking. Click 
on the link ``Submit electronic comments on CMS regulations with an 
open comment period''. (Attachments should be in Microsoft Word, 
WordPerfect, or Excel; however, we prefer Microsoft Word.)
    2. By regular mail. You may mail written comments (one original and 
two copies) to the following address ONLY: Centers for Medicare & 
Medicaid Services, Department of Health and Human Services, Attention: 
CMS-1488-P, P.O. Box 8011, Baltimore, MD 21244-1850.
    Please allow sufficient time for mailed comments to be received 
before the close of the comment period.
    3. By express or overnight mail. You may send written comments (one 
original and two copies) to the following address ONLY: Centers for 
Medicare & Medicaid Services, Department of Health and Human Services, 
Attention: CMS-1488-P, Mail Stop C4-26-05, 7500 Security Boulevard, 
Baltimore, MD 21244-1850.
    4. By hand or courier. If you prefer, you may deliver (by hand or 
courier) your written comments (one original and two copies) before the 
close of the comment period to one of the following addresses. If you 
intend to deliver your comments to the Baltimore address, please call 
telephone number (410) 786-7195 in advance to schedule your arrival 
with one of our staff members. Room 445-G, Hubert H. Humphrey Building, 
200 Independence Avenue, SW., Washington, DC 20201, or 7500 Security 
Boulevard, Baltimore, MD 21244-1850.

(Because access to the interior of the Hubert H. Humphrey Building is 
not readily available to persons without Federal Government 
identification, commenters are encouraged to leave their comments in 
the CMS drop slots located in the main lobby of the building. A stamp-
in clock is available for persons wishing to retain proof of filing by 
stamping in and retaining an extra copy of the comments being filed.)

    Comments mailed to the addresses indicated as appropriate for hand 
or courier delivery may be delayed and received after the comment 
period.
    Submission of comments on paperwork requirements. You may submit 
comments on this document's paperwork requirements by mailing your 
comments to the addresses provided at the end of the ``Collection of 
Information Requirements'' section in this document.
    For information on viewing public comments, see the beginning of 
the SUPPLEMENTARY INFORMATION section.

FOR FURTHER INFORMATION CONTACT: 

Marc Hartstein, (410) 786-4548, Operating Prospective Payment, 
Diagnosis-Related Groups (DRGs), Wage Index, New Medical Services and 
Technology Add-On Payments, Hospital Geographic Reclassifications, Sole 
Community Hospital, Disproportionate Share Hospital, and Medicare-
Dependent, Small Rural Hospital Issues.
Tzvi Hefter, (410) 786-4487, Capital Prospective Payment, Excluded 
Hospitals, Graduate Medical Education, Critical Access Hospitals, and 
Long-Term Care (LTC)-DRG Issues.
Siddhartha Mazumdar, (410) 786-6673, Rural Community Hospital 
Demonstration Issues.
Sheila Blackstock, (410) 786-3502, Quality Data for Annual Payment 
Update Issues.
Thomas Valuck, (410) 786-7479, Hospital Value-Based Purchasing Issues.
Frederick Grabau, (410) 786-0206, Services in Foreign Hospitals Issues.
Brian Reitz, (410) 786-5001, Obsolete Paper Claims Forms Issues.

SUPPLEMENTARY INFORMATION: Submitting Comments: We welcome comments 
from the public on all issues set forth in this rule to assist us in 
fully considering issues and developing policies. You can assist us by 
referencing the file code CMS-1488-P and the specific ``issue 
identifier'' that precedes the section on which you choose to comment.
    Inspection of Public Comments: All comments received before the 
close of

[[Page 23997]]

the comment period are available for viewing by the public, including 
any personally identifiable or confidential business information that 
is included in a comment. We post all comments received before the 
close of the comment period on the following Web site as soon as 
possible after they have been received: https://www.cms.hhs.gov/
eRulemaking. Click on the link ``Electronic Comments on CMS 
Regulations'' on that Web site to view public comments.
    Comments received timely will also be available for public 
inspection as they are received, generally beginning approximately 3 
weeks after publication of a document, at the headquarters of the 
Centers for Medicare & Medicaid Services, 7500 Security Boulevard, 
Baltimore, Maryland 21244, Monday through Friday of each week from 8:30 
a.m. to 4 p.m. To schedule an appointment to view public comments, 
phone 1-800-743-3951.

Electronic Access

    This Federal Register document is also available from the Federal 
Register online database through GPO Access, a service of the U.S. 
Government Printing Office. Free public access is available on a Wide 
Area Information Server (WAIS) through the Internet and via 
asynchronous dial-in. Internet users can access the database by using 
the World Wide Web; the Superintendent of Documents' home page address 
is https://www.gpoaccess.gov/, by using local WAIS client software, or 
by telnet to swais.access.gpo.gov, then login as guest (no password 
required). Dial-in users should use communications software and modem 
to call (202) 512-1661; type swais, then login as guest (no password 
required).

Acronyms

AHA American Hospital Association
AHIMA American Health Information Management Association
AHRO Agency for Health Care Research and Quality
AMI Acute myocardial infarction
AOA American Osteopathic Association
APR DRG All Patient Refined Diagnosis Related Group System
ASC Ambulatory surgical center
ASP Average sales price
AWP Average wholesale price
BBA Balanced Budget Act of 1997, Public Law 105-33
BBRA Medicare, Medicaid, and SCHIP [State Children's Health Insurance 
Program] Balanced Budget Refinement Act of 1999, Public Law 106-113
BIPA Medicare, Medicaid, and SCHIP [State Children's Health Insurance 
Program] Benefits Improvement and Protection Act of 2000, Public Law 
106-554
BLS Bureau of Labor Statistics
CAH Critical access hospital
CART CMS Abstraction & Reporting Tool
CBSAs Core-based statistical areas
CC Complication or comorbidity
CDAC Clinical Data Abstraction Center
CIPI Capital input price index
CPI Consumer price index
CMI Case-mix index
CMS Centers for Medicare & Medicaid Services
CMSA Consolidated Metropolitan Statistical Area
COBRA Consolidated Omnibus Reconciliation Act of 1985, Public Law 99-
272
CPI Consumer price index
CRNA Certified registered nurse anesthetist
CY Calendar year
DRA Deficit Reduction Act of 2005, Public Law 109-171
DRG Diagnosis-related group
DSH Disproportionate share hospital
ECI Employment cost index
EMR Electronic medical record
EMTALA Emergency Medical Treatment and Labor Act of 1986, Public Law 
99-272
FDA Food and Drug Administration
FFY Federal fiscal year
FIPS Federal information processing standards
FQHC Federally qualified health center
FTE Full-time equivalent
FY Fiscal year
GAAP Generally Accepted Accounting Principles
GAF Geographic Adjustment Factor
GME Graduate medical education
HCAHPS Hospital Consumer Assessment of Healthcare Providers and Systems
HCFA Health Care Financing Administration
HCRIS Hospital Cost Report Information System
HHA Home health agency
HHS Department of Health and Human Services
HIC Health insurance card
HIPAA Health Insurance Portability and Accountability Act of 1996, 
Public Law 104-191
HIPC Health Information Policy Council
HIS Health information system
HIT Health information technology
HMO Health maintenance organization
HSA Health savings account
HSCRC Maryland Health Services Cost Review Commission
HSRV Hospital-specific relative value
HSRVcc Hospital-specific relative value cost center
HQA Hospital Quality Alliance
HQI Hospital Quality Initiative
HwH Hospital-within-a-hospital
ICD-9-CM International Classification of Diseases, Ninth Revision, 
Clinical Modification
ICD-10-PCS International Classification of Diseases, Tenth Edition, 
Procedure Coding System
ICU Intensive care unit
IHS Indian Health Service
IME Indirect medical education
IOM Institute of Medicine
IPF Inpatient psychiatric facility
IPPS Acute care hospital inpatient prospective payment system
IRF Inpatient rehabilitation facility
JCAHO Joint Commission on Accreditation of Healthcare Organizations
LAMCs Large area metropolitan counties
LTC-DRG Long-term care diagnosis-related group
LTCH Long-term care hospital
MCE Medicare Code Editor
MCO Managed care organization
MCV Major cardiovascular condition
MDC Major diagnostic category
MDH Medicare-dependent, small rural hospital
MedPAC Medicare Payment Advisory Commission
MedPAR Medicare Provider Analysis and Review File
MEI Medicare Economic Index
MGCRB Medicare Geographic Classification Review Board
MMA Medicare Prescription Drug, Improvement, and Modernization Act of 
2003, Public Law 108-173
MRHFP Medicare Rural Hospital Flexibility Program
MSA Metropolitan Statistical Area
NAICS North American Industrial Classification System
NCD National coverage determination
NCHS National Center for Health Statistics
NCQA National Committee for Quality Assurance
NCVHS National Committee on Vital and Health Statistics
NECMA New England County Metropolitan Areas
NICU Neonatal intensive care unit
NQF National Quality Forum
NTIS National Technical Information Service
NVHRI National Voluntary Hospital Reporting Initiative
OES Occupational employment statistics
OIG Office of the Inspector General
OMB Executive Office of Management and Budget
O.R. Operating room

[[Page 23998]]

OSCAR Online Survey Certification and Reporting (System)
PRM Provider Reimbursement Manual
PPI Producer price index
PMSAs Primary metropolitan statistical areas
PPS Prospective payment system
PRA Per resident amount
ProPAC Prospective Payment Assessment Commission
PRRB Provider Reimbursement Review Board
PS&R Provider Statistical and Reimbursement (System)
QIG Quality Improvement Group, CMS
QIO Quality Improvement Organization
RHC Rural health clinic
RHQDAPU Reporting hospital quality data for annual payment update
RNHCI Religious Nonmedical Health care Institution
RRC Rural referral center
RUCAs Rural-urban commuting area codes
RY Rate year
SAF Standard Analytic File
SCH Sole community hospital
SFY State fiscal year
SIC Standard Industrial Classification
SNF Skilled nursing facility
SOCs Standard occupational classifications
SOM State Operations Manual
SSA Social Security Administration
SSI Supplemental Security Income
TAG Technical Advisory Group
TEFRA Tax Equity and Fiscal Responsibility Act of 1982, Pub. L. 97-248
UHDDS Uniform hospital discharge data set

Table of Contents

I. Background
    A. Summary
    1. Acute Care Hospital Inpatient Prospective Payment System 
(IPPS)
    2. Hospitals and Hospital Units Excluded From the IPPS
    a. Inpatient Rehabilitation Facilities (IRFs)
    b. Long-Term Care Hospitals (LTCHs)
    c. Inpatient Psychiatric Facilities (IPFs)
    3. Critical Access Hospitals (CAHs)
    4. Payments for Graduate Medical Education (GME)
    B. Provisions of the Deficit Reduction Act of 2005 (DRA)
    C. Major Contents of this Proposed Rule
    1. Proposed DRG Reclassifications and Recalibrations of Relative 
Weights
    2. Proposed Changes to the Hospital Wage Index
    3. Other Decisions and Proposed Changes to the IPPS for 
Operating Costs and GME Costs
    4. Proposed Changes to the PPS for Capital-Related Costs
    5. Proposed Changes for Hospitals and Hospital Units Excluded 
From the IPPS
    6. Payment for Services Furnished Outside the United States
    7. Payment for Blood Clotting Factor Administered to Inpatients 
With Hemophilia
    8. Limitation on Payments to Skilled Nursing Facilities for Bad 
Debt
    9. Determining Proposed Prospective Payment Operating and 
Capital Rates and Rate-of-Increase Limits
    10. Impact Analysis
    11. Recommendation of Update Factors for Operating Cost Rates of 
Payment for Inpatient Hospital Services
    12. Discussion of Medicare Payment Advisory Commission 
Recommendations
    13. Appendix C--Combinations of Consolidated Severity-Adjusted 
DRGs and Appendix D--Crosswalk of Consolidated Severity-Adjusted 
DRGs to Respective APR DRGs
II. Proposed Changes to DRG Classifications and Relative Weights
    A. Background
    B. DRG Reclassifications
    1. General
    2. Yearly Review for Making DRG Changes
    3. Refinement of DRGs Based on Severity of Illness
    C. Proposals for Revisions to the DRG System Used Under the IPPS
    1. MedPAC Recommendations
    2. Refinement of the Relative Weight Calculation
    3. Refinement of DRGs Based on Severity of Illness
    a. Comparison of the CMS DRG System and the APR DRG System
    b. Consolidated Severity-Adjusted DRGs for Use in the IPPS
    c. Changes to Case-Mix Index (CMI) From a New DRG System
    4. Effect of Consolidated Severity-Adjusted DRGs on the Outlier 
Threshold
    5. Impact of Refinement of DRG System on Payments
    6. Conclusions
    D. Proposed Changes to Specific DRG Classifications
    1. Pre-MDCs: Pancreas Transplants
    2. MDC 1 (Diseases and Disorders of the Nervous System)
    a. Implantation of Intracranial Neurostimulator System for Deep 
Brain Stimulation (DBS)
    b. Carotid Artery Stents
    3. MDC 5 (Diseases and Disorders of the Circulatory System)
    a. Insertion of Epicardial Leads for Defibrillator Devices
    b. Application of Major Cardiovascular Diagnoses (MCVs) List to 
Defibrillator DRGs
    4. MDC 8 (Diseases and Disorders of the Musculoskeletal System 
and Connective Tissue)
    a. Hip and Knee Replacements
    b. Spinal Fusion
    c. Charite^TM Spinal Disc Replacement Device
    5. MDC 18 (Infectious and Parasitic Diseases (Systemic or 
Unspecified Sites)): Severe Sepsis
    6. Medicare Code Editor (MCE) Changes
    a. Newborn Diagnoses Edit
    b. Diagnoses Allowed for Females Only Edit
    c. Diagnoses Allowed for Males Only Edit
    d. Manifestations Not Allowed as Principal Diagnosis Edit
    e. Nonspecific Principal Diagnosis Edit
    f. Unacceptable Principal Diagnosis Edit
    g. Nonspecific O.R. Procedures Edit
    h. Noncovered Procedures Edit
    i. Bilateral Procedure Edit
    7. Surgical Hierarchies
    8. Refinement of Complications and Comorbidities (CC) List
    a. Background
    b. Comprehensive Review of the CC List
    c. CC Exclusions List Proposed for FY 2007
    9. Review of Procedure Codes in DRGs 468, 476, and 477
    a. Moving Procedure Codes From DRG 468 or DRG 477 to MDCs
    b. Reassignment of Procedures Among DRGs 468, 476, and 477
    c. Adding Diagnosis or Procedure Codes to MDCs
    10. Changes to the ICD-9-CM Coding System
    E. Proposed Recalibration of DRG Weights
    F. Proposed LTC-DRG Reclassifications and Relative Weights for 
LTCHs for FY 2007
    1. Background
    2. Proposed Changes in the LTC-DRG Classifications
    a. Background
    b. Patient Classifications into DRGs
    3. Development of the Proposed FY 2007 LTC-DRG Relative Weights
    a. General Overview of Development of the LTC-DRG Relative 
Weights
    b. Data
    c. Hospital-Specific Relative Value Methodology
    d. Proposed Low-Volume LTC-DRGs
    4. Steps for Determining the Proposed FY 2007 LTC-DRG Relative 
Weights
    G. Proposed Add-On Payments for New Services and Technologies
    1. Background
    2. Public Input Before Publication of This Notice of Proposed 
Rulemaking on Add-On Payments
    3. FY 2007 Status of Technologies Approved for FY 2006 Add-On 
Payments
    a. Kinetra[supreg] Implantable Neurostimulator for Deep Brain 
Stimulation
    b. Endovascular Graft Repair of the Thoracic Aorta
    c. Restore[supreg] Rechargeable Implantable Neurostimulator
    4. FY 2007 Applicants for New Technology Add-On Payments
    a. C-Port[supreg] Distal Anastomosis System
    b. NovoSeven[supreg] for Intracerebral Hemorrhage
    c. X STOP Interspinous Process Decompression System
III. Proposed Changes to the Hospital Wage Index
    A. Background
    B. Core-Based Statistical Areas for the Proposed Hospital Wage 
Index
    C. Proposed Occupational Mix Adjustment to the Proposed FY 2007 
Index
    1. Development of Data for the Proposed Occupational Mix 
Adjustment
    2. Calculation of the Proposed FY 2007 Occupational Mix 
Adjustment Factor and the Proposed FY 2007 Occupational Mix Adjusted 
Wage Index

[[Page 23999]]

    D. Worksheet S-3 Wage Data for the Proposed FY 2007 Wage Index 
Update
    E. Verification of Worksheet S-3 Wage Data
    F. Computation of the Proposed FY 2007 Unadjusted Wage Index
    G. Computation of the Proposed FY 2007 Blended Wage Index
    H. Proposed Revisions to the Wage Index Based on Hospital 
Redesignations
    1. General
    2. Effects of Reclassification
    3. FY 2007 MGCRB Reclassifications
    4. Proposed FY 2007 Redesignations Under Section 1886(d)(8)(B) 
of the Act
    5. Reclassifications Under Section 508 of Pub. L. 108-173
    6. Proposed Wage Indices for Reclassified Hospitals and Proposed 
Reclassification Budget Neutrality Factor
    I. Proposed FY 2007 Wage Index Adjustment Based on Commuting 
Patterns of Hospital Employees
    J. Process for Requests for Wage Index Data Corrections
    K. Labor-Related Share for the Wage Index for FY 2007
    L. Proxy for the Hospital Market Basket
IV. Other Decisions and Proposed Changes to the IPPS for Operating 
Costs and GME Costs
    A. Reporting of Hospital Quality Data for Annual Hospital 
Payment Update
    1. Background
    2. New Procedures for Hospital Reporting of Quality Data
    3. Electronic Medical Records
    B. Value-Based Purchasing
    1. Introduction
    2. Premier Hospital Quality Incentive Demonstration
    3. RHQDAPU Program
    a. Section 501(b) of Pub. L. 108-173 (MMA)
    b. Section 5001(a) of Pub. L. 109-171 (DRA)
    4. Plan for Implementing Hospital Value-Based Purchasing 
Beginning With FY 2009
    a. Measure Development and Refinement
    b. Data Infrastructure
    c. Incentive Methodology
    d. Public Reporting
    5. Considerations Related to Certain Conditions, Including 
Hospital-Acquired Infections
    6. Promoting Effective Use of Health Information Technology
    C. Sole Community Hospitals (SCHs) and Medicare-Dependent, Small 
Rural Hospitals (MDHs)
    1. Background
    2. Volume Decrease Adjustment for SCHs and MDHs
    a. HAS/Monitrend Data
    b. HAS/Monitrend Data Book Replacement Alternative
    3. Mandatory Reporting Requirements for Any Changes in the 
Circumstances Under Which a Hospital Was Designated as an SCH or MDH
    4. Proposed Payment Changes for MDHs Under the DRA of 2005
    a. Background
    b. Proposed Regulation Changes
    5. Proposed Technical Change
    D. Rural Referral Centers
    1. Case-Mix Index
    2. Discharges
    E. Indirect Medical Education (IME) Adjustment
    1. Background
    2. IME Adjustment Factor for FY 2007
    3. Technical Change to Revise Cross-Reference
    F. Payment Adjustment for Disproportionate Share Hospitals 
(DSHs)
    1. Background
    2. Technical Corrections
    3. Proposed Reinstatement of Inadvertently Deleted Provisions on 
DSH Payment Adjustment Factors
    4. Enhanced DSH Adjustment for MDHs
    G. Geographic Reclassifications
    1. Background
    2. Reclassifications under Section 508 of Pub. L. 108-173
    3. Multicampus Hospitals
    4. Urban Group Hospital Reclassifications
    5. Effect of Change of Ownership on Urban County Group 
Reclassifications
    6. Requested Reclassification for Hospitals Located in a Single 
Hospital MSA Surrounded by Rural Counties
    H. Payment for Direct Graduate Medical Education
    1. Background
    2. Determination of Weighted Average Per Resident Amounts (PRAs) 
for Merged Teaching Hospitals
    3. Determination of Per Resident Amounts (PRAs) for New Teaching 
Hospitals
    4. Requirements for Counting and Appropriate Documentation of 
FTE Residents: Clarification
    5. Resident Time Spent in Nonpatient Care Activities as Part of 
Approved Residency Programs
    6. Medicare GME Affiliated Groups: Technical Changes to 
Regulations
    I. Payment for the Costs of Nursing and Allied Health Education 
Activities: Clarification
    J. Hospital Emergency Services Under EMTALA
    1. Background
    2. Role of the EMTALA Technical Advisory Group (TAG)
    3. Definition of ``Labor''
    4. Application of EMTALA Requirements to Hospitals Without 
Dedicated Emergency Departments
    5. Clarification of Reference to ``Referral Centers''
    K. Other Proposed Technical Changes
    1. Proposed Cross-Reference Correction in Regulations on 
Limitations on Beneficiary Charges
    2. Proposed Cross-Reference Corrections in Regulations on 
Payment Denials Based on Admissions and Quality Reviews
    3. Proposed Cross-Reference Correction in Regulations on Outlier 
Payments
    4. Removing References to Two Paper Claims Forms
    L. Rural Community Hospital Demonstration Program
    M. Health Care Information Transparency Initiative
V. Proposed Changes to the PPS for Capital-Related Costs
    A. Background
    B. Treatment of Certain Urban Hospitals Reclassified as Rural 
Hospitals Under Sec.  412.103
    C. Other Technical Corrections Relating to the Capital PPS 
Geographic Adjustment Factors
VI. Proposed Changes for Hospitals and Hospital Units Excluded From 
the IPPS
    A. Payments to Existing Hospitals and Hospital Units
    1. Payments to Existing Excluded Hospitals and Hospital Units
    2. Separate PPS for IRFs
    3. Separate PPS for LTCHs
    4. Separate PPS for IPFs
    5. Grandfathering of Hospitals-Within-Hospitals (HwHs) and 
Satellite Facilities
    6. Proposed Changes to the Methodology for Determining LTCH 
Cost-to-Charge Ratios (CCRs) and the Reconciliation of High-Cost and 
Short-Stay Outlier Payments Under the LTCH PPS
    a. Background
    b. High-Cost Outliers
    c. Short-Stay Outliers
    7. Technical Corrections Relating to LTCHs
    8. Proposed Cross-Reference Correction in Authority Citations 
for 42 CFR 412 and 413
    B. Critical Access Hospitals (CAHs)
    1. Background
    2. Sunset of Designation of CAHs as Necessary Providers: 
Technical Correction
VII. Payment for Services Furnished Outside the United States
    A. Background
    B. Proposed Clarification of Regulations
VIII. Payment for Blood Clotting Factor Administered to Inpatients 
With Hemophilia
IX. Limitation on Payments to Skilled Nursing Facilities for Bad 
Debt
    A. Background
    B. Changes Made by Section 5004 of the DRA
    C. Proposed Regulation Changes
X. MedPAC Recommendations
XI. Other Required Information
    A. Requests for Data From the Public
    B. Collection of Information Requirements
    C. Public Comments
XII. Regulation Text
Addendum--Proposed Schedule of Standardized Amounts Effective With 
Discharges Occurring On or After October 1, 2006 and Update Factors 
and Rate-of-Increase Percentages Effective With Cost Reporting 
Periods Beginning on or After October 1, 2006
I. Summary and Background
II. Proposed Changes to Prospective Payment Rates for Hospital 
Inpatient Operating Costs for FY 2007
    A. Calculation of the Adjusted Standardized Amount
    1. Standardization of Base-Year Costs or Target Amounts
    2. Computing the Average Standardized Amount
    3. Updating the Average Standardized Amount
    4. Other Adjustments to the Average Standardized Amount
    a. Recalibration of DRG Weights and Updated Wage Index--Budget 
Neutrality Adjustment

[[Page 24000]]

    b. Reclassified Hospitals--Budget Neutrality Adjustment
    c. Outliers
    d. Rural Community Hospital Demonstration Program Adjustment 
(Section 410A of Pub. L. 108-173)
    5. Proposed FY 2007 Standardized Amount
    B. Adjustments for Area Wage Levels and Cost-of-Living
    1. Adjustment for Area Wage Levels
    2. Adjustment for Cost-of-Living in Alaska and Hawaii
    C. DRG Relative Weights
    D. Calculation of the Proposed Prospective Payment Rates for FY 
2007
    1. Federal Rate
    2. Hospital-Specific Rate (Applicable Only to SCHs and MDHs)
    a. Calculation of Hospital-Specific Rate
    b. Updating the FY 1982, FY 1987, FY 1996, and FY 2002 Hospital-
Specific Rates for FY 2007
    3. General Formula for Calculation of Proposed Prospective 
Payment Rates for Hospitals Located in Puerto Rico Beginning On or 
After October 1, 2006 and Before October 1, 2007
    a. Puerto Rico Rate
    b. National Rate
III. Proposed Changes to Payment Rates for Acute Care Hospital 
Inpatient Capital-Related Costs for FY 2007
    A. Determination of Proposed Federal Hospital Inpatient Capital-
Related Prospective Payment Rate Update
    1. Projected Capital Standard Federal Rate Update
    a. Description of the Update Framework
    b. Comparison of CMS and MedPAC Update Recommendation
    2. Proposed Outlier Payment Adjustment Factor
    3. Proposed Budget Neutrality Adjustment Factor for Changes in 
DRG Classifications and Weights and the GAF
    4. Proposed Exceptions Payment Adjustment Factor
    5. Proposed Capital Standard Federal Rate for FY 2007
    6. Proposed Special Capital Rate for Puerto Rico Hospitals
    B. Calculation of the Proposed Inpatient Capital-Related 
Prospective Payments for FY 2007
    C. Capital Input Price Index
    1. Background
    2. Forecast of the CIPI for FY 2007
IV. Payment Rates for Excluded Hospitals and Hospital Units: 
Proposed Rate-of-Increase Percentages
    A. Payments to Existing Excluded Hospitals and Units
    B. New Excluded Hospitals and Units
V. Proposed Payment for Blood Clotting Factor Administered to 
Inpatients With Hemophilia
Tables
    Table 1A--National Adjusted Operating Standardized Amounts, 
Labor/Nonlabor (69.7 Percent Labor Share/30.3 Percent Nonlabor Share 
If Wage Index Is Greater Than 1)
    Table 1B--National Adjusted Operating Standardized Amounts, 
Labor/Nonlabor (62 Percent Labor Share/38 Percent Nonlabor Share If 
Wage Index Is Less Than or Equal to 1)
    Table 1C--Adjusted Operating Standardized Amounts for Puerto 
Rico, Labor/Nonlabor
    Table 1D--Capital Standard Federal Payment Rate
    Table 2--Hospital Case-Mix Indexes for Discharges Occurring in 
Federal Fiscal Year 2005; Hospital Wage Indexes for Federal Fiscal 
Year 2007; Hospital Average Hourly Wage for Federal Fiscal Years 
2005 (2001 Wage Data), 2006 (2002 Wage Data), and 2007 (2003 Wage 
Data); Wage Indexes and 3-Year Average of Hospital Average Hourly 
Wages
    Table 3A--FY 2007 and 3-Year Average Hourly Wage for Urban Areas 
by CBSA
    Table 3B--FY 2007 and 3-Year Average Hourly Wage for Rural Areas 
by CBSA
    Table 4A-1--Wage Index and Capital Geographic Adjustment Factor 
(GAF) for Urban Areas by CBSA--FY2007
    Table 4A-2--Wage Index and Capital Geographic Adjustment Factor 
(GAF) for Certain Urban Areas by CBSA for the Period April 1 through 
September 30, 2007
    Table 4B--Wage Index and Capital Geographic Adjustment Factor 
(GAF) for Rural Areas by CBSA--FY 2007
    Table 4C-1--Wage Index and Capital Geographic Adjustment Factor 
(GAF) for Hospitals That Are Reclassified by CBSA--FY 2007
    Table 4C-2--Wage Index and Capital Geographic Adjustment Factor 
(GAF) for Certain Hospitals That Are Reclassified by CBSA for the 
Period April 1 Through September 30, 2007
    Table 4F--Puerto Rico Wage Index and Capital Geographic 
Adjustment Factor (GAF) by CBSA--FY 2007
    Table 4J--Out-Migration Wage Adjustment--FY 2007
    Table 5--List of Diagnosis-Related Groups (DRGs), Relative 
Weighting Factors, and Geometric and Arithmetic Mean Length of Stay 
(LOS)
    Table 6A--New Diagnosis Codes
    Table 6B--New Procedure Codes
    Table 6C--Invalid Diagnosis Codes
    Table 6D--Invalid Procedure Codes
    Table 6E--Revised Diagnosis Code Titles
    Table 6F--Revised Procedure Code Titles
    Table 6G--Additions to the CC Exclusions List
    Table 6H--Deletions from the CC Exclusions List
    Table 7A--Medicare Prospective Payment System Selected 
Percentile Lengths of Stay: FY 2005 MedPAR Update December 2005 
GROUPER V23.0
    Table 7B--Medicare Prospective Payment System Selected 
Percentile Lengths of Stay: FY 2005 MedPAR Update December 2005 
GROUPER V24.0
    Table 8A--Statewide Average Operating Cost-to-Charge Ratios--
March 2006
    Table 8B--Statewide Average Capital Cost-to-Charge Ratios--March 
2006
    Table 8C--Proposed Statewide Average Total Cost-to-Charge Ratios 
for LTCHs--March 2006
    Table 9A--Hospital Reclassifications and Redesignations by 
Individual Hospital and CBSA--FY 2007
    Table 9B--Hospital Reclassifications and Redesignation by 
Individual Hospital Under Section 508 of Pub. L. 108-173--FY 2007
    Table 9C--Hospitals Redesignated as Rural Under Section 
1886(d)(8)(E) of the Act--FY 2007
    Table 10--Geometric Mean Plus the Lesser of .75 of the National 
Adjusted Operating Standardized Payment Amount (Increased to Reflect 
the Difference Between Costs and Charges) or .75 of One Standard 
Deviation of Mean Charges by Diagnosis-Related Groups (DRGs)--March 
2006
    Table 11--Proposed FY 2007 LTC-DRGs, Relative Weights, Geometric 
Average Length of Stay, and \5/6\ths of the Geometric Average Length 
of Stay
Appendix A--Regulatory Impact Analysis
I. Overall Impact
II. Objectives
III. Limitations on Our Analysis
IV. Hospitals Included In and Excluded From the IPPS
V. Effects on Excluded Hospitals and Hospital Units
VI. Quantitative Effects of the Proposed Policy Changes Under the 
IPPS for Operating Costs
    A. Basis and Methodology of Estimates
    B. Analysis of Table I
    C. Effects on the Hospitals that Failed the Quality Data 
Submission Process (Column 2)
    D. Effects of the DRA Provision Related to MDHs (Column 3)
    E. Effects of the Changes to the DRG Reclassifications and 
Relative Cost-Based Weights (Column 4)
    F. Effects of Proposed Wage Index Changes (Column 5)
    G. Combined Effects of Proposed DRG and Wage Index Changes, 
Including Budget Neutrality Adjustment (Column 6)
    H. Effects of the 3-Year Provision Allowing Urban Hospitals that 
Were Converted to Rural as a Result of the FY 2005 Labor Market Area 
Changes to Maintain the Wage Index of the Urban Labor Market Area in 
Which They Were Formerly Located (Column 7)
    I. Effects of MGCRB Reclassifications (Column 8)
    J. Effects of the Proposed Wage Index Adjustment for Out-
Migration (Column 9)
    K. Effects of All Changes (Column 10)
    L. Effects of Policy on Payment Adjustments for Low-Volume 
Hospitals
    M. Impact Analysis of Table II
VII. Effects of Other Proposed Policy Changes
    A. Effects of LTC-DRG Reclassifications and Relative Weights for 
LTCHs
    B. Effects of Proposed New Technology Add-On Payments
    C. Effects of Requirements for Hospital Reporting of Quality 
Data for Annual Hospital Payment Update
    D. Effects of Other Proposed Policy Changes Affecting Sole 
Community Hospitals (SCHs) and Medicare-Dependent, Small Rural 
Hospitals (MDHs)
    E. Effects of Proposed Policy on Payment for Direct Costs of 
Graduate Medical Education

[[Page 24001]]

    1. Determination of Weighted Average GME PRAs for Merged 
Teaching Hospitals
    2. Determination of PRAs for New Teaching Hospitals
    3. Requirements for Counting and Appropriate Documentation of 
FTE Residents
    4. Resident Time Spent in Nonpatient Care Activities as Part of 
an Approved Residency Program
    F. Effects of Proposed Policy Changes Relating to Emergency 
Services Under EMTALA
    G. Effects of Policy on Rural Community Hospital Demonstration 
Program
    H. Effects of Proposed Policy on Hospitals-Within-Hospitals and 
Satellite Facilities
    I. Effects of Proposed Policy Changes to the Methodology for 
Determining LTCH CCRs and the Reconciliation LTCH PPS Outlier 
Payments
    J. Effects of Proposed Policy on Payment for Services Furnished 
Outside the United States
    K. Effects of Proposed Policy on Limitation on Payments to SNFs
VIII. Effects of Proposed Changes in the Capital PPS
    A. General Considerations
    B. Results
IX. Alternatives Considered
X. Overall Conclusion
XI. Accounting Statement
XII. Executive Order 12866
Appendix B--Recommendation of Update Factors for Operating Cost 
Rates of Payment for Inpatient Hospital Services
I. Background
II. Inpatient Hospital Update for FY 2007
III. Secretary's Recommendation
IV. MedPAC Recommendation for Assessing Payment Adequacy and 
Updating Payments in Traditional Medicare
Appendix C--Combinations of Proposed Consolidated Severity-Adjusted 
DRGs
Appendix D--Crosswalk of Proposed Consolidated Severity-Adjusted 
DRGs to Respective APR DRGs

I. Background

A. Summary

1. Acute Care Hospital Inpatient Prospective Payment System (IPPS)
    Section 1886(d) of the Social Security Act (the Act) sets forth a 
system of payment for the operating costs of acute care hospital 
inpatient stays under Medicare Part A (Hospital Insurance) based on 
prospectively set rates. Section 1886(g) of the Act requires the 
Secretary to pay for the capital-related costs of hospital inpatient 
stays under a prospective payment system (PPS). Under these PPSs, 
Medicare payment for hospital inpatient operating and capital-related 
costs is made at predetermined, specific rates for each hospital 
discharge. Discharges are classified according to a list of diagnosis-
related groups (DRGs).
    The base payment rate is comprised of a standardized amount that is 
divided into a labor-related share and a nonlabor-related share. The 
labor-related share is adjusted by the wage index applicable to the 
area where the hospital is located; and if the hospital is located in 
Alaska or Hawaii, the nonlabor-related share is adjusted by a cost-of-
living adjustment factor. This base payment rate is multiplied by the 
DRG relative weight.
    If the hospital treats a high percentage of low-income patients, it 
receives a percentage add-on payment applied to the DRG-adjusted base 
payment rate. This add-on payment, known as the disproportionate share 
hospital (DSH) adjustment, provides for a percentage increase in 
Medicare payments to hospitals that qualify under either of two 
statutory formulas designed to identify hospitals that serve a 
disproportionate share of low-income patients. For qualifying 
hospitals, the amount of this adjustment may vary based on the outcome 
of the statutory calculations.
    If the hospital is an approved teaching hospital, it receives a 
percentage add-on payment for each case paid under the IPPS, known as 
the indirect medical education (IME) adjustment. This percentage 
varies, depending on the ratio of residents to beds.
    Additional payments may be made for cases that involve new 
technologies or medical services that have been approved for special 
add-on payments. To qualify, a new technology or medical service must 
demonstrate that it is a substantial clinical improvement over 
technologies or services otherwise available, and that, absent an add-
on payment, it would be inadequately paid under the regular DRG 
payment.
    The costs incurred by the hospital for a case are evaluated to 
determine whether the hospital is eligible for an additional payment as 
an outlier case. This additional payment is designed to protect the 
hospital from large financial losses due to unusually expensive cases. 
Any outlier payment due is added to the DRG-adjusted base payment rate, 
plus any DSH, IME, and new technology or medical service add-on 
adjustments.
    Although payments to most hospitals under the IPPS are made on the 
basis of the standardized amounts, some categories of hospitals are 
paid the higher of a hospital-specific rate based on their costs in a 
base year (the higher of FY 1982, FY 1987, FY 1996, or FY 2002) or the 
IPPS rate based on the standardized amount. For example, sole community 
hospitals (SCHs) are the sole source of care in their areas, and 
Medicare-dependent, small rural hospitals (MDHs) are a major source of 
care for Medicare beneficiaries in their areas. Both of these 
categories of hospitals are afforded this special payment protection in 
order to maintain access to services for beneficiaries. (Until FY 2007, 
an MDH has received the IPPS rate plus 50 percent of the difference 
between the IPPS rate and its hospital-specific rate if the hospital-
specific rate is higher than the IPPS rate. In addition, an MDH does 
not have the option of using FY 1996 as the base year for its hospital-
specific rate. As discussed below, for discharges occurring on or after 
October 1, 2007, but before October 1, 2011, an MDH will receive the 
IPPS rate plus 75 percent of the difference between the IPPS rate and 
its hospital-specific rate, if the hospital-specific rate is higher 
than the IPPS rate.)
    Section 1886(g) of the Act requires the Secretary to pay for the 
capital-related costs of inpatient hospital services ``in accordance 
with a prospective payment system established by the Secretary.'' The 
basic methodology for determining capital prospective payments is set 
forth in our regulations at 42 CFR 412.308 and 412.312. Under the 
capital PPS, payments are adjusted by the same DRG for the case as they 
are under the operating IPPS. Capital PPS payments are also adjusted 
for IME and DSH, similar to the adjustments made under the operating 
IPPS. In addition, hospitals may receive outlier payments for those 
cases that have unusually high costs.
    The existing regulations governing payments to hospitals under the 
IPPS are located in 42 CFR Part 412, Subparts A through M.
2. Hospitals and Hospital Units Excluded From the IPPS
    Under section 1886(d)(1)(B) of the Act, as amended, certain 
specialty hospitals and hospital units are excluded from the IPPS. 
These hospitals and units are: rehabilitation hospitals and units; 
long-term care hospitals (LTCHs); psychiatric hospitals and units; 
children's hospitals; and cancer hospitals. Religious nonmedical health 
care institutions (RNHCIs) are also excluded from the IPPS. Various 
sections of the Balanced Budget Act of 1997 (Pub. L. 105-33), the 
Medicare, Medicaid and SCHIP [State Children's Health Insurance 
Program] Balanced Budget Refinement Act of 1999 (Pub. L. 106-113), and 
the Medicare, Medicaid, and SCHIP Benefits Improvement and Protection 
Act of 2000 (Pub. L. 106-554) provide for the implementation of PPSs 
for rehabilitation hospitals and units (referred to as inpatient 
rehabilitation facilities (IRFs)), LTCHs, and psychiatric hospitals and 
units (referred to as

[[Page 24002]]

inpatient psychiatric facilities (IPFs)), as discussed below. 
Children's hospitals, cancer hospitals, and RNHCIs continue to be paid 
solely under a reasonable cost-based system.
    The existing regulations governing payments to excluded hospitals 
and hospital units are located in 42 CFR Parts 412 and 413.
a. Inpatient Rehabilitation Facilities (IRFs)
    Under section 1886(j) of the Act, as amended, rehabilitation 
hospitals and units (IRFs) have been transitioned from payment based on 
a blend of reasonable cost reimbursement subject to a hospital-specific 
annual limit under section 1886(b) of the Act and the adjusted facility 
Federal prospective payment rate for cost reporting periods beginning 
on or after January 1, 2002 through September 30, 2002, to payment at 
100 percent of the Federal rate effective for cost reporting periods 
beginning on or after October 1, 2002. IRFs subject to the blend were 
also permitted to elect payment based on 100 percent of the Federal 
rate. The existing regulations governing payments under the IRF PPS are 
located in 42 CFR Part 412, Subpart P.
b. Long-Term Care Hospitals (LTCHs)
    Under the authority of sections 123(a) and (c) of Pub. L. 106-113 
and section 307(b)(1) of Pub. L. 106-554, LTCHs that do not meet the 
definition of ``new'' under Sec.  412.23(e)(4) are being transitioned 
from being paid for inpatient hospital services based on a blend of 
reasonable cost-based reimbursement under section 1886(b) of the Act to 
100 percent of the Federal rate during a 5-year period, beginning with 
cost reporting periods that start on or after October 1, 2002. These 
LTCHs that do not meet the definition of ``new'' may elect to be paid 
based on 100 percent of the Federal prospective payment rate instead of 
a blended payment in any year during the 5-year transition. For cost 
reporting periods beginning on or after October 1, 2006, LTCHs will be 
paid 100 percent of the Federal rate. The existing regulations 
governing payment under the LTCH PPS are located in 42 CFR Part 412, 
Subpart O.
c. Inpatient Psychiatric Facilities (IPFs)
    Under the authority of sections 124(a) and (c) of Pub. L. 106-113, 
inpatient psychiatric facilities (IPFs) (formerly psychiatric hospitals 
and psychiatric units of acute care hospitals) are paid under the IPF 
PPS. Under the IPF PPS, some IPFs are transitioning from being paid for 
inpatient hospital services based on a blend of reasonable cost-based 
payment and a Federal per diem payment rate, effective for cost 
reporting periods beginning on or after January 1, 2005 (November 15, 
2004 IPF PPS final rule (69 FR 66922) and January 23, 2006 IPF PPS 
proposed rule (71 FR 3616)). For cost reporting periods beginning on or 
after January 1, 2008, all IPFs will be paid 100 percent of the Federal 
per diem payment amount. The existing regulations governing payment 
under the IPF PPS are located in 42 CFR 412, Subpart N.
3. Critical Access Hospitals (CAHs)
    Under sections 1814, 1820, and 1834(g) of the Act, payments are 
made to critical access hospitals (CAHs) (that is, rural hospitals or 
facilities that meet certain statutory requirements) for inpatient and 
outpatient services based on 101 percent of reasonable cost. Reasonable 
cost is determined under the provisions of section 1861(v)(1)(A) of the 
Act and existing regulations under 42 CFR Parts 413 and 415.
4. Payments for Graduate Medical Education (GME)
    Under section 1886(a)(4) of the Act, costs of approved educational 
activities are excluded from the operating costs of inpatient hospital 
services. Hospitals with approved graduate medical education (GME) 
programs are paid for the direct costs of GME in accordance with 
section 1886(h) of the Act; the amount of payment for direct GME costs 
for a cost reporting period is based on the hospital's number of 
residents in that period and the hospital's costs per resident in a 
base year. The existing regulations governing payments to the various 
types of hospitals are located in 42 CFR Part 413.

B. Provisions of the Deficit Reduction Act of 2005 (DRA)

    On February 8, 2006, the Deficit Reduction Act of 2005 (DRA), Pub. 
L. 109-171, was enacted. Pub. L. 109-171 made a number of changes to 
the Act relating to prospective payments to hospitals and other 
providers for inpatient services. This proposed rule would implement 
amendments made by the following sections of Pub. L. 109-171:
     Section 5001(a), which, effective for FY 2007 and 
subsequent years, expands the requirements for hospital quality data 
reporting.
     Section 5003, which makes various improvements to the MDH 
program. It extends special payment provisions, requires MDHs to use FY 
2002 as their base year for determining whether use of their hospital-
specific rate enhances payment (but permits them to continue to use 
either their 1982 or 1987 hospital-specific rate if using either of 
those rates results in higher payments), and removes the application of 
the 12-percent cap on the DSH payment adjustment factor for MDHs.
     Section 5004, which reduces certain allowable SNF bad debt 
payments by 30 percent. Payments for the bad debts of full-benefit, 
dual eligible individuals are not reduced.
    In this proposed rule, we also discuss and invite comments on the 
requirements of section 5001(b) of Pub. L. 109-171, which require us to 
develop a plan to implement, beginning with FY 2009, a value-based 
purchasing plan for section 1886(d) hospitals. This discussion also 
includes the provisions of section 5001(c) of Pub. L. 109-171, which 
requires a quality adjustment in DRG payments for certain hospital-
acquired conditions, effective for FY 2008.

C. Major Contents of This Proposed Rule

    In this proposed rule, we are setting forth proposed changes to the 
Medicare IPPS for operating costs and for capital-related costs in FY 
2007. We also are setting forth proposed changes relating to payments 
for GME costs, payments to certain hospitals and units that continue to 
be excluded from the IPPS and paid on a reasonable cost basis, and 
payments for SCHs and MDHs. The changes being proposed would be 
effective for discharges occurring on or after October 1, 2006, unless 
otherwise noted.
    The following is a summary of the major changes that we are 
proposing to make:
1. Proposed DRG Reclassifications and Recalibrations of Relative 
Weights
    In section II. of the preamble to this proposed rule, as required 
by section 1886(d)(4)(C) of the Act, we are proposing limited revisions 
to the DRG classifications structure. In this section, we respond to 
several recommendations made by MedPAC intended to improve the DRG 
system. We are also proposing to use, for FY 2007, hospital-specific 
relative values for 10 cost centers to compute DRG relative weights. In 
addition, we are proposing to use consolidated severity-adjusted DRGs 
or alternative severity adjustment methods in FY 2008 (if not earlier).
    We also are presenting our reevaluation of certain FY 2006 
applicants for add-on payments for high-cost new medical services and 
technologies, and our analysis of FY 2007 applicants (including public 
input,

[[Page 24003]]

as directed by Pub. L. 108-173, obtained in a town hall meeting).
    We are proposing the annual update of the long-term care diagnosis-
related group (LTC-DRG) classifications and relative weights for use 
under the LTCH PPS for FY 2007.
2. Proposed Changes to the Hospital Wage Index
    In section III. of the preamble to this proposed rule, we are 
proposing revisions to the wage index and the annual update of the wage 
data. Specific issues addressed include the following:
     The FY 2007 wage index update, using wage data from cost 
reporting periods that began during FY 2003.
     The proposed FY 2007 occupational mix adjustment to the 
wage index.
     The proposed revisions to the wage index based on hospital 
redesignations and reclassifications.
     The proposed adjustment to the wage index for FY 2007 
based on commuting patterns of hospital employees who reside in a 
county and work in a different area with a higher wage index.
     The timetable for reviewing and verifying the wage data 
that will be in effect for the proposed FY 2007 wage index.
     The labor-related share for the FY 2007 wage index, 
including the labor-related share for Puerto Rico.
3. Other Decisions and Proposed Changes to the IPPS for Operating 
Costs, GME Costs, and Promoting Hospitals' Effective Use of Health 
Information Technology
    In section IV. of the preamble to this proposed rule, we discuss a 
number of provisions of the regulations in 42 CFR Parts 412 and 413 
including the following:
     The reporting of hospital quality data as a condition for 
receiving the full annual payment update increase.
     Proposed changes in payments to SCHs and MDHs.
     Proposed updated national and regional case-mix values and 
discharges for purposes of determining rural referral center status.
     The statutorily-required IME adjustment factor for FY 
2007.
     Proposed changes relating to hospitals' geographic 
classifications, including reclassifications under section 508 of Pub. 
L. 108-173, multicampus hospitals, urban group hospital 
reclassification and the effect of change in ownership on urban county 
group reclassifications.
     Proposed changes and clarifications relating to GME that 
address determining the per resident amounts (PRAs) for merged 
hospitals and new teaching hospitals, counting and appropriate 
documentation of FTE residents, and counting of resident time spent in 
nonpatient care activities as part of approved residency programs.
     Proposed changes relating to payment for costs of nursing 
and allied health education programs.
     Proposed changes relating to requirements for emergency 
services for hospitals under EMTALA.
     Discussion of the third year of implementation of the 
Rural Community Hospital Demonstration Program.
    We also are inviting comments on promoting hospitals' effective use 
of health information technology.
4. Proposed Changes to the PPS for Capital-Related Costs
    In section V. of the preamble to this proposed rule, we discuss the 
payment policy requirements for capital-related costs and capital 
payments to hospitals and propose several technical corrections to the 
regulations.
5. Proposed Changes for Hospitals and Hospital Units Excluded From the 
IPPS
    In section VI. of the preamble to this proposed rule, we discuss 
payments to excluded hospitals and hospital units, proposed policy 
changes regarding increases or decreases in square footage or decreases 
in the number of beds of the ``grandfathering'' HwHs and satellite 
facilities, proposed changes to the methodology for determining LTCH 
CCRs and the reconciliation of high-cost and short-stay outlier 
payments under the LTCH PPS, and a proposed technical change relating 
to the designation of CAHs as necessary providers.
6. Payments for Services Furnished Outside the United States
    In section VII. of the preamble to this proposed rule, we set forth 
proposed changes to clarify what is considered ``outside the United 
States'' for Medicare payment purposes.
7. Payment for Blood Clotting Factor Administered to Inpatients With 
Hemophilia
    In section VIII. of the preamble to this proposed rule, we discuss 
the proposed changes in payment for blood clotting factor administered 
to Medicare beneficiaries with hemophilia for FY 2007.
8. Limitation on Payments to Skilled Nursing Facilities for Bad Debt
    In section IX. of the preamble to this proposed rule, we propose to 
implement section 5004 of Pub. L. 109-171 relating to reduction in 
payments to SNFs for bad debt.
9. Determining Proposed Prospective Payment Operating and Capital Rates 
and Rate-of-Increase Limits
    In the Addendum to this proposed rule, we set forth proposed 
changes to the amounts and factors for determining the FY 2007 
prospective payment rates for operating costs and capital-related 
costs. We also establish the proposed threshold amounts for outlier 
cases. In addition, we address the proposed update factors for 
determining the rate-of-increase limits for cost reporting periods 
beginning in FY 2007 for hospitals and hospital units excluded from the 
PPS.
10. Impact Analysis
    In Appendix A of this proposed rule, we set forth an analysis of 
the impact that the proposed changes would have on affected hospitals.
11. Recommendation of Update Factors for Operating Cost Rates of 
Payment for Inpatient Hospital Services
    In Appendix B of this proposed rule, as required by sections 
1886(e)(4) and (e)(5) of the Act, we provided our recommendations of 
the appropriate percentage changes for FY 2007 for the following:
     A single average standardized amount for all areas for 
hospital inpatient services paid under the IPPS for operating costs 
(and hospital-specific rates applicable to SCHs and MDHs).
     Target rate-of-increase limits to the allowable operating 
costs of hospital inpatient services furnished by hospitals and 
hospital units excluded from the IPPS.
12. Discussion of Medicare Payment Advisory Commission Recommendations
    Under section 1805(b) of the Act, MedPAC is required to submit a 
report to Congress, no later than March 1 of each year, in which MedPAC 
reviews and makes recommendations on Medicare payment policies. 
MedPAC's March 2006 recommendation concerning hospital inpatient 
payment policies addressed the update factor for inpatient hospital 
operating costs and capital-related costs under the IPPS and for 
hospitals and distinct part hospital units excluded from the IPPS. This 
recommendation is addressed in Appendix B of this proposed rule. For 
further information relating specifically to the MedPAC March 2006 
reports or to obtain a copy of the reports, contact MedPAC at (202) 
220-3700 or visit

[[Page 24004]]

MedPAC's Web site at: www.medpac.gov.
13. Appendix C and Appendix D
    In Appendix C of this proposed rule, we list the combinations of 
the consolidated severity-adjusted DRGs that we are proposing to 
implement on FY 2008 (if not earlier), as discussed in section II.C. of 
the preamble of this proposed rule. In Appendix D of this proposed 
rule, we provide a crosswalk of the proposed consolidated severity-
adjusted DRG system to the respective All Patient Related Diagnosis-
Related Group (APR DRG) system.

II. Proposed Changes to DRG Classifications and Relative Weights

    (If you choose to comment on issues in this section, please include 
the caption ``DRG Reclassifications'' at the beginning of your 
comment.)

A. Background

    Section 1886(d) of the Act specifies that the Secretary shall 
establish a classification system (referred to as DRGs) for inpatient 
discharges and adjust payments under the IPPS based on appropriate 
weighting factors assigned to each DRG. Therefore, under the IPPS, we 
pay for inpatient hospital services on a rate per discharge basis that 
varies according to the DRG to which a beneficiary's stay is assigned. 
The formula used to calculate payment for a specific case multiplies an 
individual hospital's payment rate per case by the weight of the DRG to 
which the case is assigned. Each DRG weight represents the average 
resources required to care for cases in that particular DRG, relative 
to the average resources used to treat cases in all DRGs.
    Congress recognized that it would be necessary to recalculate the 
DRG relative weights periodically to account for changes in resource 
consumption. Accordingly, section 1886(d)(4)(C) of the Act requires 
that the Secretary adjust the DRG classifications and relative weights 
at least annually. These adjustments are made to reflect changes in 
treatment patterns, technology, and any other factors that may change 
the relative use of hospital resources.

B. DRG Reclassifications

1. General
    For FY 2007, we are proposing only limited changes to the current 
DRG classifications, as discussed in section II.D. of the preamble to 
this proposed rule, that would be applicable to discharges occurring on 
or after October 1, 2006. We are limiting our proposed changes because, 
as discussed in detail in section II.C. of the preamble to this 
proposed rule, we are focusing our efforts on addressing the 
recommendations made last year by MedPAC to refine the entire CMS DRG 
system by taking into account severity of illness (if not earlier) and 
applying hospital-specific relative value (HSRV) weights to DRGs.
    Currently, cases are classified into CMS DRGs for payment under the 
IPPS based on the principal diagnosis, up to eight additional 
diagnoses, and up to six procedures performed during the stay. In a 
small number of DRGs, classification is also based on the age, sex, and 
discharge status of the patient. The diagnosis and procedure 
information is reported by the hospital using codes from the 
International Classification of Diseases, Ninth Revision, Clinical 
Modification (ICD-9-CM).
    The process of forming the DRGs was begun by dividing all possible 
principal diagnoses into mutually exclusive principal diagnosis areas, 
referred to as Major Diagnostic Categories (MDCs). The MDCs were formed 
by physician panels as the first step toward ensuring that the DRGs 
would be clinically coherent. The diagnoses in each MDC correspond to a 
single organ system or etiology and, in general, are associated with a 
particular medical specialty. Thus, in order to maintain the 
requirement of clinical coherence, no final DRG could contain patients 
in different MDCs. Most MDCs are based on a particular organ system of 
the body. For example, MDC 6 is Diseases and Disorders of the Digestive 
System. This approach is used because clinical care is generally 
organized in accordance with the organ system affected. However, some 
MDCs are not constructed on this basis because they involve multiple 
organ systems (for example, MDC 22 (Burns)). For FY 2006, cases are 
assigned to one of 526 DRGs in 25 MDCs. The table below lists the 25 
MDCs.

                   Major Diagnostic Categories (MDCs)
------------------------------------------------------------------------
 
------------------------------------------------------------------------
1.................................  Diseases and Disorders of the
                                     Nervous System.
2.................................  Diseases and Disorders of the Eye.
3.................................  Diseases and Disorders of the Ear,
                                     Nose, Mouth, and Throat.
4.................................  Diseases and Disorders of the
                                     Respiratory System.
5.................................  Diseases and Disorders of the
                                     Circulatory System.
6.................................  Diseases and Disorders of the
                                     Digestive System.
7.................................  Diseases and Disorders of the
                                     Hepatobiliary System and Pancreas.
8.................................  Diseases and Disorders of the
                                     Musculoskeletal System and
                                     Connective Tissue.
9.................................  Diseases and Disorders of the Skin,
                                     Subcutaneous Tissue and Breast.
10................................  Endocrine, Nutritional and Metabolic
                                     Diseases and Disorders.
11................................  Diseases and Disorders of the Kidney
                                     and Urinary Tract.
12................................  Diseases and Disorders of the Male
                                     Reproductive System.
13................................  Diseases and Disorders of the Female
                                     Reproductive System.
14................................  Pregnancy, Childbirth, and the
                                     Puerperium.
15................................  Newborns and Other Neonates with
                                     Conditions Originating in the
                                     Perinatal Period.
16................................  Diseases and Disorders of the Blood
                                     and Blood Forming Organs and
                                     Immunological Disorders.
17................................  Myeloproliferative Diseases and
                                     Disorders and Poorly Differentiated
                                     Neoplasms.
18................................  Infectious and Parasitic Diseases
                                     (Systemic or Unspecified Sites).
19................................  Mental Diseases and Disorders.
20................................  Alcohol/Drug Use and Alcohol/Drug
                                     Induced Organic Mental Disorders.
21................................  Injuries, Poisonings, and Toxic
                                     Effects of Drugs.
22................................  Burns.
23................................  Factors Influencing Health Status
                                     and Other Contacts with Health
                                     Services.
24................................  Multiple Significant Trauma.
25................................  Human Immunodeficiency Virus
                                     Infections.
------------------------------------------------------------------------


[[Page 24005]]

    In general, cases are assigned to an MDC based on the patient's 
principal diagnosis before assignment to a DRG. However, for FY 2006, 
there are nine DRGs to which cases are directly assigned on the basis 
of ICD-9-CM procedure codes. These DRGs are for heart transplant or 
implant of heart assist systems, liver and/or intestinal transplants, 
bone marrow transplants, lung transplants, simultaneous pancreas/kidney 
transplants, and pancreas transplants, and for tracheostomies. Cases 
are assigned to these DRGs before they are classified to an MDC. The 
table below lists the nine current pre-MDCs.

               Pre-Major Diagnostic Categories (Pre-MDCs)
-------------------

This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply.