Medicare Program; Changes to the Hospital Inpatient Prospective Payment Systems and Fiscal Year 2007 Rates; Final Fiscal Year 2007 Wage Indices and Payment Rates After Application of Revised Occupational Mix Adjustment to the Wage Index; Corrections, 569-574 [06-9976]
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Federal Register / Vol. 72, No. 3 / Friday, January 5, 2007 / Notices
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Michelle Shortt,
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Affairs.
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DEPARTMENT OF HEALTH AND
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Medicare Program; Changes to the
Hospital Inpatient Prospective
Payment Systems and Fiscal Year 2007
Rates; Final Fiscal Year 2007 Wage
Indices and Payment Rates After
Application of Revised Occupational
Mix Adjustment to the Wage Index;
Corrections
Centers for Medicare &
Medicaid Services (CMS), HHS.
ACTION: Correction of notice.
AGENCY:
SUMMARY: This document corrects wage
index and technical errors that appeared
in the notice published in the Federal
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569
Register on October 11, 2006 entitled
‘‘Medicare Program; Hospital Inpatient
Prospective Payment Systems and Fiscal
Year 2007 Rates.
DATES: Effective Date: Corrections listed
in items 10 through 12 of section III. of
this notice are effective as of October 1,
2006. The corrections to the wage index
listed in items 2a, 3 through 8a, and 9a
of section III. of this notice are effective
as of November 3, 2006. The corrections
to the wage index listed in items 1, 2b,
8b, and 9b of section III. of this notice
are effective as of November 21, 2006.
FOR FURTHER INFORMATION CONTACT:
Marc Hartstein, (410) 786–4548.
SUPPLEMENTARY INFORMATION:
I. Background
In FR Doc. 06–8471 of October 11,
2006 (71 FR 59886), the notice entitled
‘‘Hospital Inpatient Prospective
Payment Systems and Fiscal Year 2007
Rates: Final Fiscal Year 2007 Wage
Indices and Payment Rates After
Application of Revised Occupational
Mix Adjustment to Wage Index’’
(hereinafter referred to as the ‘‘FY 2007
IPPS notice’’), there were a number of
technical errors that are identified and
corrected in the Correction of Errors
section (items 10 through 12 of section
III. of this notice). These technical
corrections are effective October 1,
2006.
In addition, in October 2006, we
became aware of an error in the
calculation of the FY 2007 wage index
for a number of rural areas and several
hospitals that are reclassified to those
areas. The error also affected some
hospitals in urban areas that are
assigned the statewide rural wage index
floor. Section 412.64(k)(1) of the
regulations requires that wage index
corrections made after October 1 are
effective prospectively for the remainder
of the fiscal year from the date the fiscal
intermediaries are informed of the
correction. We recalculated the wage
indices for the affected hospitals, and on
November 3, 2006, sent a Joint Signature
Memorandum to the fiscal
intermediaries informing them to pay
hospitals using the corrected wage
indices. Subsequent to the November 3,
2006 Joint Signature Memorandum,
additional errors in the wage indices
were brought to our attention and were
corrected through a November 21, 2006
Joint Signature Memorandum.
Therefore, the corrected FY 2007 wage
indices are effective beginning
November 3, 2006 or November 21,
2006. Accordingly, the wage index
provisions of this correction notice are
corrections to the tabulation of the rates
paid to hospitals. We note that the
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Federal Register / Vol. 72, No. 3 / Friday, January 5, 2007 / Notices
corrections to the impact analysis (item
1 of section III. of this notice) are
effective as of November 3, 2006 since
the additional corrections made based
on the November 21, 2006 Joint
Signature Memorandum had no
significant effect on the impact analysis.
II. Summary of the Corrections to the
FY 2007 IPPS Notice
We made corrections to wage index
values and geographic adjustment
factors (GAFs) that were published in
Tables 2, 4A–1, 4A–2, 4B–1, 4B–2, 4C–
1, and 4C–2. In addition, we are making
technical corrections to— (1) the outmigration adjustments and qualifying
counties that were published in Table
4J; and (2) the list of diagnosis-related
groups (DRGs), relative weighting
factors, and geometric and arithmetic
mean length of stay (LOS) that were
published in Table 5.
III. Correction of Errors
In FR Doc. 06–8471 of October 11,
2006 (71 FR 59886), make the following
corrections:
1. On pages 59893 and 59894, in
Table I.—Impact Analysis of Changes
for FY 2007, the figures in the last
column (All FY 2007 changes 8) are
corrected to read as follows:
IMPACT ANALYSIS OF FINAL CHANGES
FOR FY 2007 OPERATING PROSPECTIVE PAYMENT SYSTEM
[Percent changes in payments per case]
sroberts on PROD1PC70 with NOTICES
All FY 2007
changes
(4)
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 ...........
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3.5
3.5
3.5
3.4
4
3.5
3.8
3.6
3.4
3.2
4.7
4.9
3.7
3.3
3.0
3.9
3.9
3.2
3.4
2.7
2.8
3.4
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IMPACT ANALYSIS OF FINAL CHANGES
FOR FY 2007 OPERATING PROSPECTIVE PAYMENT SYSTEM—Continued
IMPACT ANALYSIS OF FINAL CHANGES
FOR FY 2007 OPERATING PROSPECTIVE PAYMENT SYSTEM—Continued
[Percent changes in payments per case]
[Percent changes in payments per case]
All FY 2007
changes
(4)
All FY 2007
changes
(4)
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:
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:
RRC ..................................
SCH ...................................
MDH ..................................
SCH and RRC ..................
MDH and RRC ..................
Unknown.
Type of Ownership:
Voluntary ...........................
Proprietary .........................
Government ......................
Unknown ...............................
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.
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3.7
3.7
2.0
6.3
5.2
3.9
3.8
3.5
4.3
4.1
2.7
3.3
3.4
3.5
3.4
4.0
3.8
3.4
3.2
3.6
3.4
3.6
4.6
3.5
3.5
3.9
3.3
3.3
3.7
3.6
3.5
3.6
9.0
3.1
14.1
3.5
3.5
3.4
7.6
3.6
3.3
3.7
3.8
4.4
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 .......
Specialty Hospitals ............
Cardiac Specialty Hospitals ..............................
3.7
3.4
3.5
3.4
3.6
4.5
5.4
4.5
2
—
1.2
2. On pages 59903 through to 59968,
in 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, for the listed providers, the wage
indexes are corrected to read as follows:
a. Effective November 3, 2006
Provider No.
040039
040047
070002
070003
070004
070007
070008
070009
070011
070012
070015
070020
070021
070024
070025
070027
070029
070035
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..................................
05JAN1
FY 2007 wage
index
0.8341
0.8431
1.2452
1.2461
1.2452
1.2452
1.2452
1.2452
1.2452
1.2452
1.2452
1.2525
1.2461
1.2452
1.2452
1.2452
1.2452
1.2452
571
Federal Register / Vol. 72, No. 3 / Friday, January 5, 2007 / Notices
Provider No.
070038
100025
100026
100027
100048
100054
100062
100081
100093
100102
100106
100108
100118
100122
100124
100134
100142
100156
100160
100175
100212
100223
100231
100242
100266
100290
100292
230254
230257
230264
230269
230277
260004
260006
260015
260022
260024
260047
260059
260061
260070
260074
260078
260080
260097
260113
260116
260119
260142
260147
260160
..................................
..................................
..................................
..................................
..................................
..................................
..................................
..................................
..................................
..................................
..................................
..................................
..................................
..................................
..................................
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..................................
..................................
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..................................
..................................
..................................
..................................
..................................
..................................
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..................................
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..................................
..................................
..................................
..................................
..................................
..................................
..................................
..................................
..................................
..................................
..................................
..................................
..................................
..................................
..................................
..................................
FY 2007 wage
index
1.2452
0.8847
0.8847
0.8847
0.8847
0.8847
0.8907
0.8847
0.8847
0.8972
0.8847
0.8847
0.9245
0.8847
0.8847
0.8847
0.8847
0.8972
0.8847
0.9078
0.8907
0.8847
0.8847
0.8847
0.8847
0.9429
0.8847
1.0381
1.0381
1.0381
1.0381
1.0381
0.8341
0.8341
0.8345
0.8615
0.8341
0.8348
0.8341
0.8341
0.8341
0.8499
0.8341
0.8341
0.8766
0.8341
0.8341
0.8345
0.8341
0.8341
0.8341
FY 2007 wage
index
Provider No.
260163
260195
280061
340073
380002
380040
380052
380081
390044
390096
430094
470001
470005
470012
470024
500002
500007
500012
500019
500031
500033
500036
500037
500049
500053
500058
500148
530002
530006
530008
530009
530010
530011
530014
530017
530032
530008
530009
530010
530011
530014
530017
530032
..................................
..................................
..................................
..................................
..................................
..................................
..................................
..................................
..................................
..................................
..................................
..................................
..................................
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..................................
..................................
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..................................
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..................................
..................................
..................................
..................................
..................................
..................................
..................................
..................................
..................................
..................................
..................................
..................................
..................................
..................................
..................................
..................................
..................................
..................................
..................................
..................................
..................................
..................................
..................................
0.8341
0.8341
0.9048
0.9828
1.0282
1.0152
1.0152
1.0152
1.1196
1.1196
0.9048
1.0770
1.0383
1.0383
1.0383
1.0390
1.0598
1.0390
1.0603
1.0390
1.0390
1.0390
1.0390
1.0390
1.0390
1.0390
1.0390
0.9128
0.9128
0.9128
0.9128
0.9128
0.9128
0.9128
0.9128
0.9128
0.9057
0.9057
0.9057
0.9057
0.9057
0.9057
0.9057
230029
230047
230071
230130
230151
230195
230204
230207
230223
230227
230254
230257
230264
230269
230277
390065
390138
490005
..................................
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Note: Due to the expiration of section 508
of the MMA, the wage index values for some
hospitals will change in the second half of
the fiscal year. The wage index values in this
table reflect an average of the first half of FY
2007 (October 1, 2006–March 31, 2007) and
second half of FY 2007 (April 1–September
30, 2007).
b. Effective November 21, 2006.
4. On pages 59975 through to 59998,
in Table 4A–1.—Wage Index and
FY 2007 wage
Provider No.
Capital Geographic Adjustment Factor
index
(GAF) for Urban Areas by CBSA, for the
230013 ..................................
1.0381 listed CBSAs, the wage indexes and
230019 ..................................
1.0381 GAFs are corrected to read as follows:
Wage
index
Urban area (constituent counties)
15540 .....................................
Burlington-South Burlington, VT .........................................................................................
Chittenden County, VT 2 .....................................................................................................
Franklin County, VT ............................................................................................................
Grand Isle County, VT ........................................................................................................
Fort Walton Beach-Crestview-Destin, FL2 ..........................................................................
Okaloosa County, FL ..........................................................................................................
Hartford-West Hartford-East Hartford, CT 1 2 ......................................................................
Hartford County, CT ............................................................................................................
Litchfield County, CT ..........................................................................................................
Middlesex County, CT ........................................................................................................
Tolland County, CT .............................................................................................................
Kennewick-Richland-Pasco, WA2 .......................................................................................
Benton County, WA ............................................................................................................
Franklin County, WA ...........................................................................................................
Lewiston, ID–WA (WA Hospitals) 2 .....................................................................................
Nez Perce County, ID .........................................................................................................
Asotin County, WA ..............................................................................................................
sroberts on PROD1PC70 with NOTICES
25540 .....................................
28420 .....................................
30300 .....................................
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1.0381
1.0381
1.0381
1.0381
1.0381
1.0381
1.0381
1.0381
1.0381
1.0381
1.0381
1.0381
1.0381
1.0381
1.0381
1.0977
1.0977
1.0977
3. On page 59968 in 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, the table is corrected by adding
a note to the end of the table to read as
follows:
CBSA code
23020 .....................................
FY 2007 wage
index
Provider No.
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05JAN1
GAF
1.0383
1.0261
0.8847
0.9195
1.2452
1.1620
1.0390
1.0265
1.0390
1.0265
572
Federal Register / Vol. 72, No. 3 / Friday, January 5, 2007 / Notices
Wage
index
CBSA code
Urban area (constituent counties)
31020 .....................................
Longview, WA .....................................................................................................................
Cowlitz County, WA ............................................................................................................
Mount Vernon-Anacortes, WA ............................................................................................
Skagit County, WA ..............................................................................................................
New Haven-Milford, CT 3 ....................................................................................................
New Haven County, CT ......................................................................................................
Norwich-New London, CT ...................................................................................................
New London County, CT ....................................................................................................
Ocala, FL2 ...........................................................................................................................
Marion County, FL ..............................................................................................................
Panama City-Lynn Haven, FL ............................................................................................
Bay County, Fl ....................................................................................................................
Pensacola-Ferry Pass-Brent, FL ........................................................................................
Escambia County, FL .........................................................................................................
Santa Rosa County, FL ......................................................................................................
Wenatchee, WA ..................................................................................................................
Chelan County, WA ............................................................................................................
Douglas County, WA ..........................................................................................................
Yakima, WA ........................................................................................................................
Yakima County, WA ............................................................................................................
34580 .....................................
35300 .....................................
35980 .....................................
36100 .....................................
37460 .....................................
37860 .....................................
48300 .....................................
49420 .....................................
GAF
1.0390
1.0265
1.0390
1.0265
1.2452
1.1620
1.2452
1.1620
0.8847
0.9195
0.8847
0.9195
0.8847
0.9195
1.0390
1.0265
1.0390
1.0265
1 Large
urban area.
geographically located in the area are assigned the statewide rural wage index for FY 2007.
3 For this area, the wage index and GAF on this table are only 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.
2 Hospitals
5. On page 59998, in 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, for
the listed CBSAs, the wage indexes and
GAFs are corrected to read as follows:
CBSA code
Urban area (constituent counties)
16940 ..................................................
35300 ..................................................
Cheyenne, WY ................................................................................................
New Haven-Milford, CT ..................................................................................
6. On pages 59998 and 59999, in
Table 4B–1.—Wage Index and Capital
Geographic Adjustment Factor (GAF) for
Rural Areas by CBSA—FY 2007, for the
CBSA code
07
10
26
38
47
50
Wage index
7. On page 59999, in Table 4B–2.—
Wage Index and Capital Geographic
Adjustment Factor (GAF) for Certain
Wage index
Connecticut ......................................................................
Florida ..............................................................................
Missouri ............................................................................
Oregon 2 ...........................................................................
Vermont ............................................................................
Washington ......................................................................
Rural Areas by CBSA for the Period
April 1 Through September 30, 2007, for
Nonurban area
53 ......................................................................................
Wyoming ..........................................................................
Hospitals That Are Reclassified by
CBSA, for the listed CBSAs, the wage
sroberts on PROD1PC70 with NOTICES
CBSA code
23020
25540
27860
28420
38340
...................................
...................................
...................................
...................................
...................................
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Wage index
Frm 00050
Fmt 4703
Sfmt 4703
0.9057
Wage index
Fort Walton Beach-Crestview-Destin, FL ......................................................................
Hartford-West Hartford-East Hartford, CT (CT Hospitals) ............................................
Jonesboro, AR (MO Hospitals) .....................................................................................
Kennewick-Richland-Pasco, WA ...................................................................................
Pittsfield, MA ..................................................................................................................
PO 00000
1.1620
0.9195
0.8832
1.0104
1.0261
1.0265
GAF
0.9344
indexes and GAFs are corrected to read
as follows:
a. Effective November 3, 2006.
Area
Jkt 211001
1.2452
0.8847
0.8341
1.0152
1.0383
1.0390
GAF
the listed CBSA, the wage index and
GAF is corrected to read as follows:
CBSA code
8. On pages 59999 through to 60003,
in Table 4C–1.—Wage Index and Capital
Geographic Adjustment Factor (GAF) for
0.9344
1.1620
listed CBSAs, the wage indexes and
GAFs are corrected to read as follows:
Nonurban area
......................................................................................
......................................................................................
......................................................................................
......................................................................................
......................................................................................
......................................................................................
0.9057
1.2452
GAF
E:\FR\FM\05JAN1.SGM
05JAN1
0.8847
1.2452
0.8345
1.0390
1.0383
GAF
0.9195
1.1620
0.8835
1.0265
1.0261
573
Federal Register / Vol. 72, No. 3 / Friday, January 5, 2007 / Notices
CBSA code
07
10
14
16
26
30
38
50
53
Area
.........................................
.........................................
.........................................
.........................................
.........................................
.........................................
.........................................
.........................................
.........................................
Wage index
Connecticut ....................................................................................................................
Florida (FL Hospitals) ....................................................................................................
Illinois (MO Hospitals) ...................................................................................................
Iowa ...............................................................................................................................
Missouri .........................................................................................................................
New Hampshire .............................................................................................................
Oregon ...........................................................................................................................
Washington (WA Hospitals) ..........................................................................................
Wyoming ........................................................................................................................
GAF
1.2452
0.8847
0.8341
0.8615
0.8341
1.0770
1.0152
1.0390
0.9048
1.1620
0.9195
0.8832
0.9029
0.8832
1.0521
1.0104
1.0265
0.9338
b. Effective November 21, 2006.
CBSA code
Area
47894 ...................................
Washington-Arlington-Alexandria, DC–VA–MD–WV .....................................................
9. On page 60003, in Table 4C–2.—
Wage Index and Capital Geographic
Adjustment Factor (GAF) for Certain
Hospitals That Are Reclassified by
Wage index
CBSA for the Period April 1 Through
September 30, 2007*, CBSAs 35300 and
19804 are corrected and CBSA 47894 is
GAF
1.0977
1.0659
added. The wage indexes and GAFs are
corrected to read as follows:
a. Effective November 3, 2006.
CBSA code
Area
Wage index
19804 ..................................................
35300 ..................................................
Detroit-Livonia-Dearborn, MI ..........................................................................
New Haven-Milford, CT ..................................................................................
GAF
1.0381
1.2452
1.0192
1.1620
b. Effective November 21, 2006.
CBSA code
Area
47894 ..................................................
Washington–Arlington–Alexandria, DC–VA–MD–WV ....................................
10. On pages 60004 through to 60012,
in Table 4J.—Out-Migration
Adjustment—FY 2007, provider number
Wage index
010009 is corrected and provider
number 010010 is added to read as
follows:
Reclassified
between 10/1/06
and 3/31/07
Provider No.
010009 .............................................................................................
010010 .............................................................................................
11. On pages 60013 through to 60025,
in Table 5.—List of Diagnosis-Related
Groups (DRGS), Relative Weighting
FY 07 final
rule postacute care
DRG
FY 07 final
rule special
pay DRG
525 ........
544 ........
No .................
Yes ...............
No .................
Yes ...............
572 ........
sroberts on PROD1PC70 with NOTICES
DRG
Yes ...............
No .................
VerDate Aug<31>2005
17:29 Jan 04, 2007
Jkt 211001
Reclassified
between 4/1/07
and 9/30/07
*
*
DRG title
SURG
SURG
06
MED ..
Other Heart Assist System Implant
Major Joint Replacement or Reattachment of Lower Extremity.
Major Gastrointestinal Disorders
and Peritoneal Infections.
PO 00000
Frm 00051
Fmt 4703
Sfmt 4703
1.0659
0.0092
0.0259
Qualifying
county name
MORGAN.
MARSHALL.
544, and 572 are corrected to read as
follows:
a. Effective October 1, 2006.
Type
of Stay (LOS), the table is corrected by
adding the following notes to the end of
the table:
a. Effective October 1, 2006.
Out-migration
adjustment
*
*
05
08
12. On page 60025 in Table 5.—List
of Diagnosis-Related Groups (DRGs),
Relative Weighting Factors, and
Geometric and Arithmetic Mean Length
1.0977
a. Effective October 1, 2006.
Factors, and Geometric and Arithmetic
Mean Length of Stay (LOS), DRGs 525,
MDC
GAF
Weights
Geometric
mean LOS
Arithmetic
mean LOS
2.2268
1.9878
7.7
4.0
14.3
4.4
1.3378
5.6
7.1
Note: If there is an asterisk in the ‘‘Type’’
column this means that data is unavailable to
calculate weights for these low volume DRGs.
Therefore, last year’s weights have been
updated based on the percent change in
E:\FR\FM\05JAN1.SGM
05JAN1
574
Federal Register / Vol. 72, No. 3 / Friday, January 5, 2007 / Notices
normalization factors between FY 2006 and
FY 2007.
Note: If there is no value or dashes (that
is, ‘‘----’’) in either the geometric mean LOS
or the arithmetic mean LOS columns, the
volume of cases is insufficient to determine
a meaningful computation of these statistics.
IV. Discussion of Effective Date and
Notice and Comment Rulemaking
We ordinarily publish a notice of
proposed rulemaking in the Federal
Register to provide a period for public
comment before the provisions of a rule
take effect in accordance with section
553(b) of the Administrative Procedure
Act (APA) (5 U.S.C. 553(b)). In addition,
a final rule would ordinarily require a
30-day delay in effective date after the
date of publication in the Federal
Register. This correction of the rates
published in the FY 2007 IPPS notice
does not constitute a rule under the
Administrative Procedure Act, because,
in our FY 2007 IPPS final rule (71 FR
47870, August 18, 2006), we already
published the methodologies and
formulas we use for determining the
wage index, geographic adjustment
factors, and other rates. This notice does
not change our methodology or
formulas, but merely ensures that our
rules are implemented correctly. As this
notice is not a rule under the
Administrative Procedure Act, no notice
of proposed rulemaking or delay in
effective date is necessary.
(Catalog of Federal Domestic Assistance
Program No. 93.773, Medicare—Hospital
Insurance; and Program No. 93.774,
Medicare—Supplementary Medical
Insurance Program.)
Dated: December 28, 2006.
Ashley Files Flory,
Deputy Executive Secretary to the
Department.
[FR Doc. 06–9976 Filed 12–29–06; 1:29 pm]
regarding chemistry, manufacturing,
and controls (CMC) supplements and
other changes to approved marketing
applications for human drugs. FDA is
evaluating how it could revise its
regulations to allow for consideration of
risk-based approaches based on
manufacturing process understanding,
including prior knowledge of similar
products, and overall quality systems to
provide an enhanced risk-based
approach to the CMC regulatory process,
which would reduce the number of
supplements. We will consider the
input from the public meeting and
comments on the issues presented in
this document as we consider whether
to revise our regulations.
DATES: The public meeting will be held
on February 7, 2007, from 8:30 a.m. to
3:30 p.m. Anyone who wishes to speak
at the meeting must register and submit
a summary of the presentation by
January 24, 2007, and submit an
electronic copy of the presentation by
January 31, 2007. See section III of the
SUPPLEMENTARY INFORMATION section of
this document for details on how to
register. Submit written or electronic
comments by March 7, 2007.
ADDRESSES: The public meeting will be
held at the Food and Drug
Administration, Center for Drug
Evaluation and Research Conference
Room, 7519 Standish Pl., third floor, rm.
A, Rockville, MD 20855. There is
parking near the building. Photo
identification is required to clear
building security.
Submit written comments to the
Division of Dockets Management (HFA–
305), Food and Drug Administration,
5630 Fishers Lane, rm. 1061, Rockville,
MD 20852. Submit electronic comments
to https://www.fda.gov/dockets/
ecomments.
FOR FURTHER INFORMATION CONTACT:
David J. Cummings, Center for Drug
Evaluation and Research, Food and
Drug Administration, 10903 New
Hampshire Ave., Bldg. 21, rm. 3525,
Rockville, MD 20993–0002, 301–796–
2400, e-mail:
David.Cummings@fda.hhs.gov.
BILLING CODE 4120–01–P
DEPARTMENT OF HEALTH AND
HUMAN SERVICES
Food and Drug Administration
[Docket No. 2006N–0525]
SUPPLEMENTARY INFORMATION:
Supplements and Other Changes to an
Approved Application; Public Meeting
I. Background
AGENCY:
Food and Drug Administration,
HHS.
sroberts on PROD1PC70 with NOTICES
ACTION:
Notice of public meeting.
SUMMARY: The Food and Drug
Administration (FDA) is announcing a
public meeting to solicit comments on
issues that FDA should consider when
developing revisions to its regulations
VerDate Aug<31>2005
17:29 Jan 04, 2007
Jkt 211001
In the Federal Register of June 28,
1999 (64 FR 34608), FDA published a
proposed rule to implement section 116
of the Food and Drug Administration
Modernization Act (FDAMA)1 by
1 Section 116 of FDAMA (Public Law 105–115)
amended the Federal Food, Drug, and Cosmetic Act
(FDCA) by adding section 506A (21 U.S.C. 356a),
which describes requirements and procedures for
making and reporting manufacturing changes to
PO 00000
Frm 00052
Fmt 4703
Sfmt 4703
amending certain regulations including
§ 314.70 (21 CFR 314.70) regarding
supplements and other changes to
approved human new drug and
abbreviated new drug marketing
applications. In the Federal Register of
April 8, 2004 (69 FR 18728), FDA
published the final rule (final rule)
implementing these changes. Section
314.70, as amended, requires
manufacturers to assess the effects of
manufacturing changes on the identity,
strength, quality, purity, and potency of
a drug as those factors relate to the
safety or effectiveness of the product,
and categorizes all changes beyond the
established variations in an approved
NDA or ANDA into one of three
groups—major, moderate, or minor.
Major changes require an applicant to
submit and receive FDA approval of a
supplement before distribution of the
product made with the manufacturing
change. Moderate changes require an
applicant to submit a supplement at
least 30 days before distribution of the
product or, in some cases, submit a
supplement at the time of distribution.
Minor changes require an applicant to
notify FDA of the changes in an annual
report.
In August 2002, FDA introduced the
Pharmaceutical Current Good
Manufacturing Practices (CGMPs) for
the 21st Century Initiative (CGMP
Initiative, available on the Internet at
https://www.fda.gov/cder/gmp/
index.htm) to enhance and modernize
the regulation of pharmaceutical
manufacturing and product quality. In
September 2004 (after publication of the
final rule), FDA published a final report
on ‘‘Pharmaceutical CGMPs for the 21st
Century—A Risk-Based Approach’’
(https://www.fda.gov/cder/gmp/
gmp2004/GMP_finalreport2004.htm).
As explained in the report, FDA
regulates pharmaceutical manufacturing
to ensure that the drug supply in the
United States is of consistently high
quality. Because of critical public health
implications of drug manufacturing,
FDA traditionally has exercised
extensive control over virtually every
aspect of the manufacturing process.
This regulatory approach has
contributed to pharmaceutical
companies being reluctant to change
their manufacturing processes and
equipment. In recent years, significant
advances in pharmaceutical
manufacturing science, modern quality
management systems, and risk
management approaches have taken
place. This has yielded new tools that
certain approved marketing applications, including
new drug applications (NDAs) and abbreviated new
drug applications (ANDAs).
E:\FR\FM\05JAN1.SGM
05JAN1
]]>Agencies
[Federal Register Volume 72, Number 3 (Friday, January 5, 2007)]
[Notices]
[Pages 569-574]
From the Federal Register Online via the Government Printing Office [www.gpo.gov]
[FR Doc No: 06-9976]
-----------------------------------------------------------------------
DEPARTMENT OF HEALTH AND HUMAN SERVICES
Centers for Medicare & Medicaid Services
[CMS-1488-CN2]
RIN 0938-A012
Medicare Program; Changes to the Hospital Inpatient Prospective
Payment Systems and Fiscal Year 2007 Rates; Final Fiscal Year 2007 Wage
Indices and Payment Rates After Application of Revised Occupational Mix
Adjustment to the Wage Index; Corrections
AGENCY: Centers for Medicare & Medicaid Services (CMS), HHS.
ACTION: Correction of notice.
-----------------------------------------------------------------------
SUMMARY: This document corrects wage index and technical errors that
appeared in the notice published in the Federal Register on October 11,
2006 entitled ``Medicare Program; Hospital Inpatient Prospective
Payment Systems and Fiscal Year 2007 Rates.
DATES: Effective Date: Corrections listed in items 10 through 12 of
section III. of this notice are effective as of October 1, 2006. The
corrections to the wage index listed in items 2a, 3 through 8a, and 9a
of section III. of this notice are effective as of November 3, 2006.
The corrections to the wage index listed in items 1, 2b, 8b, and 9b of
section III. of this notice are effective as of November 21, 2006.
FOR FURTHER INFORMATION CONTACT: Marc Hartstein, (410) 786-4548.
SUPPLEMENTARY INFORMATION:
I. Background
In FR Doc. 06-8471 of October 11, 2006 (71 FR 59886), the notice
entitled ``Hospital Inpatient Prospective Payment Systems and Fiscal
Year 2007 Rates: Final Fiscal Year 2007 Wage Indices and Payment Rates
After Application of Revised Occupational Mix Adjustment to Wage
Index'' (hereinafter referred to as the ``FY 2007 IPPS notice''), there
were a number of technical errors that are identified and corrected in
the Correction of Errors section (items 10 through 12 of section III.
of this notice). These technical corrections are effective October 1,
2006.
In addition, in October 2006, we became aware of an error in the
calculation of the FY 2007 wage index for a number of rural areas and
several hospitals that are reclassified to those areas. The error also
affected some hospitals in urban areas that are assigned the statewide
rural wage index floor. Section 412.64(k)(1) of the regulations
requires that wage index corrections made after October 1 are effective
prospectively for the remainder of the fiscal year from the date the
fiscal intermediaries are informed of the correction. We recalculated
the wage indices for the affected hospitals, and on November 3, 2006,
sent a Joint Signature Memorandum to the fiscal intermediaries
informing them to pay hospitals using the corrected wage indices.
Subsequent to the November 3, 2006 Joint Signature Memorandum,
additional errors in the wage indices were brought to our attention and
were corrected through a November 21, 2006 Joint Signature Memorandum.
Therefore, the corrected FY 2007 wage indices are effective beginning
November 3, 2006 or November 21, 2006. Accordingly, the wage index
provisions of this correction notice are corrections to the tabulation
of the rates paid to hospitals. We note that the
[[Page 570]]
corrections to the impact analysis (item 1 of section III. of this
notice) are effective as of November 3, 2006 since the additional
corrections made based on the November 21, 2006 Joint Signature
Memorandum had no significant effect on the impact analysis.
II. Summary of the Corrections to the FY 2007 IPPS Notice
We made corrections to wage index values and geographic adjustment
factors (GAFs) that were published in Tables 2, 4A-1, 4A-2, 4B-1, 4B-2,
4C-1, and 4C-2. In addition, we are making technical corrections to--
(1) the out-migration adjustments and qualifying counties that were
published in Table 4J; and (2) the list of diagnosis-related groups
(DRGs), relative weighting factors, and geometric and arithmetic mean
length of stay (LOS) that were published in Table 5.
III. Correction of Errors
In FR Doc. 06-8471 of October 11, 2006 (71 FR 59886), make the
following corrections:
1. On pages 59893 and 59894, in Table I.--Impact Analysis of
Changes for FY 2007, the figures in the last column (All FY 2007
changes \8\) are corrected to read as follows:
Impact Analysis of Final Changes for FY 2007 Operating Prospective
Payment System
[Percent changes in payments per case]
------------------------------------------------------------------------
All FY 2007
changes (4)
------------------------------------------------------------------------
All Hospitals........................................... 3.5
By Geographic Location:
Urban hospitals....................................... 3.5
Large urban areas (populations over 1 million)........ 3.5
Other urban areas (populations of 1 million or fewer). 3.4
Rural hospitals....................................... 4
Bed Size (Urban):
0-99 beds............................................. 3.5
100-199 beds.......................................... 3.8
200-299 beds.......................................... 3.6
300-499 beds.......................................... 3.4
500 or more beds...................................... 3.2
Bed Size (Rural):
0-49 beds............................................. 4.7
50-99 beds............................................ 4.9
100-149 beds.......................................... 3.7
150-199 beds.......................................... 3.3
200 or more beds...................................... 3.0
Urban by Region:
New England........................................... 3.9
Middle Atlantic....................................... 3.9
South Atlantic........................................ 3.2
East North Central.................................... 3.4
East South Central.................................... 2.7
West North Central.................................... 2.8
West South Central.................................... 3.4
Mountain.............................................. 3.7
Pacific............................................... 3.7
Puerto Rico........................................... 2.0
Rural by Region:
New England........................................... 6.3
Middle Atlantic....................................... 5.2
South Atlantic........................................ 3.9
East North Central.................................... 3.8
East South Central.................................... 3.5
West North Central.................................... 4.3
West South Central.................................... 4.1
Mountain.............................................. 2.7
Pacific............................................... 3.3
By Payment Classification:
Urban hospitals....................................... 3.4
Large urban areas (populations over 1 million)........ 3.5
Other urban areas (populations of 1 million or fewer). 3.4
Rural areas........................................... 4.0
Teaching Status:
Non-teaching.......................................... 3.8
Fewer than 100 Residents.............................. 3.4
100 or more Residents................................. 3.2
Urban DSH:
Non-DSH............................................... 3.6
100 or more beds...................................... 3.4
Less than 100 beds.................................... 3.6
Rural DSH:
SCH................................................... 4.6
RRC................................................... 3.5
Other Rural:
100 or more beds...................................... 3.5
Less than 100 beds.................................... 3.9
Urban teaching and DSH:
Both teaching and DSH................................. 3.3
Teaching and no DSH................................... 3.3
No teaching and DSH................................... 3.7
No teaching and no DSH................................ 3.6
Rural Hospital Types:
RRC................................................... 3.5
SCH................................................... 3.6
MDH................................................... 9.0
SCH and RRC........................................... 3.1
MDH and RRC........................................... 14.1
Unknown.................................................
Type of Ownership:
Voluntary............................................. 3.5
Proprietary........................................... 3.5
Government............................................ 3.4
Unknown................................................. 7.6
Medicare Utilization as a Percent of Inpatient Days:
0-25.................................................. 3.6
25-50................................................. 3.3
50-65................................................. 3.7
Over 65............................................... 3.8
Unknown............................................... 4.4
Hospitals Reclassified by the Medicare Geographic
Classification Review Board:
FY 2005 Reclassifications.............................
Urban Hospitals Reclassified by the Medicare 3.7
Geographic Classification Review Board: First Half FY
2007 Reclassifications...............................
Urban Nonreclassified, First Half FY 2007............. 3.4
All Urban Hospitals Reclassified Second Half FY 2007.. 3.5
Urban Nonreclassified Hospitals Second Half FY 2007... 3.4
All Rural Hospitals Reclassified Second Half FY 2007.. 3.6
Rural Nonreclassified Hospitals Second Half FY 2007... 4.5
All Section 401 Reclassified Hospitals................ 5.4
Other Reclassified Hospitals (Section 1886(d)(8)(B)).. 4.5
Section 508 Hospitals................................. 2
Specialty Hospitals................................... --
Cardiac Specialty Hospitals........................... 1.2
------------------------------------------------------------------------
2. On pages 59903 through to 59968, in 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, for the listed providers, the wage
indexes are corrected to read as follows:
a. Effective November 3, 2006
------------------------------------------------------------------------
FY 2007 wage
Provider No. index
------------------------------------------------------------------------
040039.................................................. 0.8341
040047.................................................. 0.8431
070002.................................................. 1.2452
070003.................................................. 1.2461
070004.................................................. 1.2452
070007.................................................. 1.2452
070008.................................................. 1.2452
070009.................................................. 1.2452
070011.................................................. 1.2452
070012.................................................. 1.2452
070015.................................................. 1.2452
070020.................................................. 1.2525
070021.................................................. 1.2461
070024.................................................. 1.2452
070025.................................................. 1.2452
070027.................................................. 1.2452
070029.................................................. 1.2452
070035.................................................. 1.2452
[[Page 571]]
070038.................................................. 1.2452
100025.................................................. 0.8847
100026.................................................. 0.8847
100027.................................................. 0.8847
100048.................................................. 0.8847
100054.................................................. 0.8847
100062.................................................. 0.8907
100081.................................................. 0.8847
100093.................................................. 0.8847
100102.................................................. 0.8972
100106.................................................. 0.8847
100108.................................................. 0.8847
100118.................................................. 0.9245
100122.................................................. 0.8847
100124.................................................. 0.8847
100134.................................................. 0.8847
100142.................................................. 0.8847
100156.................................................. 0.8972
100160.................................................. 0.8847
100175.................................................. 0.9078
100212.................................................. 0.8907
100223.................................................. 0.8847
100231.................................................. 0.8847
100242.................................................. 0.8847
100266.................................................. 0.8847
100290.................................................. 0.9429
100292.................................................. 0.8847
230254.................................................. 1.0381
230257.................................................. 1.0381
230264.................................................. 1.0381
230269.................................................. 1.0381
230277.................................................. 1.0381
260004.................................................. 0.8341
260006.................................................. 0.8341
260015.................................................. 0.8345
260022.................................................. 0.8615
260024.................................................. 0.8341
260047.................................................. 0.8348
260059.................................................. 0.8341
260061.................................................. 0.8341
260070.................................................. 0.8341
260074.................................................. 0.8499
260078.................................................. 0.8341
260080.................................................. 0.8341
260097.................................................. 0.8766
260113.................................................. 0.8341
260116.................................................. 0.8341
260119.................................................. 0.8345
260142.................................................. 0.8341
260147.................................................. 0.8341
260160.................................................. 0.8341
260163.................................................. 0.8341
260195.................................................. 0.8341
280061.................................................. 0.9048
340073.................................................. 0.9828
380002.................................................. 1.0282
380040.................................................. 1.0152
380052.................................................. 1.0152
380081.................................................. 1.0152
390044.................................................. 1.1196
390096.................................................. 1.1196
430094.................................................. 0.9048
470001.................................................. 1.0770
470005.................................................. 1.0383
470012.................................................. 1.0383
470024.................................................. 1.0383
500002.................................................. 1.0390
500007.................................................. 1.0598
500012.................................................. 1.0390
500019.................................................. 1.0603
500031.................................................. 1.0390
500033.................................................. 1.0390
500036.................................................. 1.0390
500037.................................................. 1.0390
500049.................................................. 1.0390
500053.................................................. 1.0390
500058.................................................. 1.0390
500148.................................................. 1.0390
530002.................................................. 0.9128
530006.................................................. 0.9128
530008.................................................. 0.9128
530009.................................................. 0.9128
530010.................................................. 0.9128
530011.................................................. 0.9128
530014.................................................. 0.9128
530017.................................................. 0.9128
530032.................................................. 0.9128
530008.................................................. 0.9057
530009.................................................. 0.9057
530010.................................................. 0.9057
530011.................................................. 0.9057
530014.................................................. 0.9057
530017.................................................. 0.9057
530032.................................................. 0.9057
------------------------------------------------------------------------
b. Effective November 21, 2006.
------------------------------------------------------------------------
FY 2007 wage
Provider No. index
------------------------------------------------------------------------
230013.................................................. 1.0381
230019.................................................. 1.0381
230029.................................................. 1.0381
230047.................................................. 1.0381
230071.................................................. 1.0381
230130.................................................. 1.0381
230151.................................................. 1.0381
230195.................................................. 1.0381
230204.................................................. 1.0381
230207.................................................. 1.0381
230223.................................................. 1.0381
230227.................................................. 1.0381
230254.................................................. 1.0381
230257.................................................. 1.0381
230264.................................................. 1.0381
230269.................................................. 1.0381
230277.................................................. 1.0381
390065.................................................. 1.0977
390138.................................................. 1.0977
490005.................................................. 1.0977
------------------------------------------------------------------------
3. On page 59968 in 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, the table is corrected by adding a note to the end of the
table to read as follows:
Note: Due to the expiration of section 508 of the MMA, the wage
index values for some hospitals will change in the second half of
the fiscal year. The wage index values in this table reflect an
average of the first half of FY 2007 (October 1, 2006-March 31,
2007) and second half of FY 2007 (April 1-September 30, 2007).
4. On pages 59975 through to 59998, in Table 4A-1.--Wage Index and
Capital Geographic Adjustment Factor (GAF) for Urban Areas by CBSA, for
the listed CBSAs, the wage indexes and GAFs are corrected to read as
follows:
----------------------------------------------------------------------------------------------------------------
Wage
CBSA code Urban area (constituent counties) index GAF
----------------------------------------------------------------------------------------------------------------
15540...................................... Burlington-South Burlington, VT.............. 1.0383 1.0261
Chittenden County, VT \2\....................
Franklin County, VT..........................
Grand Isle County, VT........................
23020...................................... Fort Walton Beach-Crestview-Destin, FL\2\.... 0.8847 0.9195
Okaloosa County, FL..........................
25540...................................... Hartford-West Hartford-East Hartford, CT \1\ 1.2452 1.1620
\2\.
Hartford County, CT..........................
Litchfield County, CT........................
Middlesex County, CT.........................
Tolland County, CT...........................
28420...................................... Kennewick-Richland-Pasco, WA\2\.............. 1.0390 1.0265
Benton County, WA............................
Franklin County, WA..........................
30300...................................... Lewiston, ID-WA (WA Hospitals) \2\........... 1.0390 1.0265
Nez Perce County, ID.........................
Asotin County, WA............................
[[Page 572]]
31020...................................... Longview, WA................................. 1.0390 1.0265
Cowlitz County, WA...........................
34580...................................... Mount Vernon-Anacortes, WA................... 1.0390 1.0265
Skagit County, WA............................
35300...................................... New Haven-Milford, CT \3\.................... 1.2452 1.1620
New Haven County, CT.........................
35980...................................... Norwich-New London, CT....................... 1.2452 1.1620
New London County, CT........................
36100...................................... Ocala, FL\2\................................. 0.8847 0.9195
Marion County, FL............................
37460...................................... Panama City-Lynn Haven, FL................... 0.8847 0.9195
Bay County, Fl...............................
37860...................................... Pensacola-Ferry Pass-Brent, FL............... 0.8847 0.9195
Escambia County, FL..........................
Santa Rosa County, FL........................
48300...................................... Wenatchee, WA................................ 1.0390 1.0265
Chelan County, WA............................
Douglas County, WA...........................
49420...................................... Yakima, WA................................... 1.0390 1.0265
Yakima County, WA............................
----------------------------------------------------------------------------------------------------------------
\1\ Large urban area.
\2\ Hospitals geographically located in the area are assigned the statewide rural wage index for FY 2007.
\3\ For this area, the wage index and GAF on this table are only 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.
5. On page 59998, in 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, for the listed CBSAs, the wage
indexes and GAFs are corrected to read as follows:
----------------------------------------------------------------------------------------------------------------
CBSA code Urban area (constituent counties) Wage index GAF
----------------------------------------------------------------------------------------------------------------
16940......................................... Cheyenne, WY......................... 0.9057 0.9344
35300......................................... New Haven-Milford, CT................ 1.2452 1.1620
----------------------------------------------------------------------------------------------------------------
6. On pages 59998 and 59999, in Table 4B-1.--Wage Index and Capital
Geographic Adjustment Factor (GAF) for Rural Areas by CBSA--FY 2007,
for the listed CBSAs, the wage indexes and GAFs are corrected to read
as follows:
------------------------------------------------------------------------
CBSA code Nonurban area Wage index GAF
------------------------------------------------------------------------
07.......................... Connecticut.... 1.2452 1.1620
10.......................... Florida........ 0.8847 0.9195
26.......................... Missouri....... 0.8341 0.8832
38.......................... Oregon \2\..... 1.0152 1.0104
47.......................... Vermont........ 1.0383 1.0261
50.......................... Washington..... 1.0390 1.0265
------------------------------------------------------------------------
7. On page 59999, in Table 4B-2.--Wage Index and Capital Geographic
Adjustment Factor (GAF) for Certain Rural Areas by CBSA for the Period
April 1 Through September 30, 2007, for the listed CBSA, the wage index
and GAF is corrected to read as follows:
------------------------------------------------------------------------
CBSA code Nonurban area Wage index GAF
------------------------------------------------------------------------
53.......................... Wyoming........ 0.9057 0.9344
------------------------------------------------------------------------
8. On pages 59999 through to 60003, in Table 4C-1.--Wage Index and
Capital Geographic Adjustment Factor (GAF) for Hospitals That Are
Reclassified by CBSA, for the listed CBSAs, the wage indexes and GAFs
are corrected to read as follows:
a. Effective November 3, 2006.
----------------------------------------------------------------------------------------------------------------
CBSA code Area Wage index GAF
----------------------------------------------------------------------------------------------------------------
23020.................................... Fort Walton Beach-Crestview-Destin, FL.... 0.8847 0.9195
25540.................................... Hartford-West Hartford-East Hartford, CT 1.2452 1.1620
(CT Hospitals).
27860.................................... Jonesboro, AR (MO Hospitals).............. 0.8345 0.8835
28420.................................... Kennewick-Richland-Pasco, WA.............. 1.0390 1.0265
38340.................................... Pittsfield, MA............................ 1.0383 1.0261
[[Page 573]]
07....................................... Connecticut............................... 1.2452 1.1620
10....................................... Florida (FL Hospitals).................... 0.8847 0.9195
14....................................... Illinois (MO Hospitals)................... 0.8341 0.8832
16....................................... Iowa...................................... 0.8615 0.9029
26....................................... Missouri.................................. 0.8341 0.8832
30....................................... New Hampshire............................. 1.0770 1.0521
38....................................... Oregon.................................... 1.0152 1.0104
50....................................... Washington (WA Hospitals)................. 1.0390 1.0265
53....................................... Wyoming................................... 0.9048 0.9338
----------------------------------------------------------------------------------------------------------------
b. Effective November 21, 2006.
----------------------------------------------------------------------------------------------------------------
CBSA code Area Wage index GAF
----------------------------------------------------------------------------------------------------------------
47894.................................... Washington-Arlington-Alexandria, DC-VA-MD- 1.0977 1.0659
WV.
----------------------------------------------------------------------------------------------------------------
9. On page 60003, in 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*, CBSAs 35300
and 19804 are corrected and CBSA 47894 is added. The wage indexes and
GAFs are corrected to read as follows:
a. Effective November 3, 2006.
----------------------------------------------------------------------------------------------------------------
CBSA code Area Wage index GAF
----------------------------------------------------------------------------------------------------------------
19804......................................... Detroit-Livonia-Dearborn, MI......... 1.0381 1.0192
35300......................................... New Haven-Milford, CT................ 1.2452 1.1620
----------------------------------------------------------------------------------------------------------------
b. Effective November 21, 2006.
----------------------------------------------------------------------------------------------------------------
CBSA code Area Wage index GAF
----------------------------------------------------------------------------------------------------------------
47894......................................... Washington-Arlington-Alexandria, DC- 1.0977 1.0659
VA-MD-WV.
----------------------------------------------------------------------------------------------------------------
10. On pages 60004 through to 60012, in Table 4J.--Out-Migration
Adjustment--FY 2007, provider number 010009 is corrected and provider
number 010010 is added to read as follows:
a. Effective October 1, 2006.
----------------------------------------------------------------------------------------------------------------
Reclassified Reclassified
Provider No. between 10/1/06 between 4/1/07 Out-migration Qualifying county
and 3/31/07 and 9/30/07 adjustment name
----------------------------------------------------------------------------------------------------------------
010009........................... * * 0.0092 MORGAN.
010010........................... * * 0.0259 MARSHALL.
----------------------------------------------------------------------------------------------------------------
11. On pages 60013 through to 60025, in Table 5.--List of
Diagnosis-Related Groups (DRGS), Relative Weighting Factors, and
Geometric and Arithmetic Mean Length of Stay (LOS), DRGs 525, 544, and
572 are corrected to read as follows:
a. Effective October 1, 2006.
--------------------------------------------------------------------------------------------------------------------------------------------------------
FY 07 final rule
DRG post-acute care FY 07 final rule MDC Type DRG title Weights Geometric Arithmetic
DRG special pay DRG mean LOS mean LOS
--------------------------------------------------------------------------------------------------------------------------------------------------------
525.......................... No.............. No.............. 05 SURG........... Other Heart Assist 2.2268 7.7 14.3
System Implant.
544.......................... Yes............. Yes............. 08 SURG........... Major Joint 1.9878 4.0 4.4
Replacement or
Reattachment of
Lower Extremity.
572.......................... Yes............. No.............. 06 MED............ Major 1.3378 5.6 7.1
Gastrointestinal
Disorders and
Peritoneal
Infections.
--------------------------------------------------------------------------------------------------------------------------------------------------------
12. On page 60025 in Table 5.--List of Diagnosis-Related Groups
(DRGs), Relative Weighting Factors, and Geometric and Arithmetic Mean
Length of Stay (LOS), the table is corrected by adding the following
notes to the end of the table:
a. Effective October 1, 2006.
Note: If there is an asterisk in the ``Type'' column this means
that data is unavailable to calculate weights for these low volume
DRGs. Therefore, last year's weights have been updated based on the
percent change in
[[Page 574]]
normalization factors between FY 2006 and FY 2007.
Note: If there is no value or dashes (that is, ``----'') in
either the geometric mean LOS or the arithmetic mean LOS columns,
the volume of cases is insufficient to determine a meaningful
computation of these statistics.
IV. Discussion of Effective Date and Notice and Comment Rulemaking
We ordinarily publish a notice of proposed rulemaking in the
Federal Register to provide a period for public comment before the
provisions of a rule take effect in accordance with section 553(b) of
the Administrative Procedure Act (APA) (5 U.S.C. 553(b)). In addition,
a final rule would ordinarily require a 30-day delay in effective date
after the date of publication in the Federal Register. This correction
of the rates published in the FY 2007 IPPS notice does not constitute a
rule under the Administrative Procedure Act, because, in our FY 2007
IPPS final rule (71 FR 47870, August 18, 2006), we already published
the methodologies and formulas we use for determining the wage index,
geographic adjustment factors, and other rates. This notice does not
change our methodology or formulas, but merely ensures that our rules
are implemented correctly. As this notice is not a rule under the
Administrative Procedure Act, no notice of proposed rulemaking or delay
in effective date is necessary.
(Catalog of Federal Domestic Assistance Program No. 93.773,
Medicare--Hospital Insurance; and Program No. 93.774, Medicare--
Supplementary Medical Insurance Program.)
Dated: December 28, 2006.
Ashley Files Flory,
Deputy Executive Secretary to the Department.
[FR Doc. 06-9976 Filed 12-29-06; 1:29 pm]
BILLING CODE 4120-01-P
