Medicare Program; Prospective Payment System and Consolidated Billing for Skilled Nursing Facilities; Corrections, 55085-55089 [E7-18732]

Download as PDF Federal Register / Vol. 72, No. 188 / Friday, September 28, 2007 / Rules and Regulations I 2. Section 180.634 is added to subpart C to read as follows: DEPARTMENT OF HEALTH AND HUMAN SERVICES §180.634 Tembotrione; tolerances for residues. Centers for Medicare & Medicaid Services (a) General. Tolerances are established for residues of the herbicide, tembotrione, 2-[2-chloro-4-(methyl sulfonyl)-3-[(2,2,2-trifluoro ethoxy)methyl]benzoyl]-1,3-cyclo hexanedione and its metabolite 2-[2chloro-4-(methylsulfonyl)-3-[(2,2,2trifluoroethoxy)methyl]benzoyl]-4,6dihydroxycyclohexane-1,3-dione in or on the following commodities: [CMS–1545–CN] Commodity Parts per million Cattle, liver ............................ Cattle, meat byproducts, except liver ............................ Corn, field, forage ................. Corn, field, grain ................... Corn, field, stover ................. Corn, pop, grain .................... Corn, pop, stover .................. Corn, sweet, forage .............. Corn, sweet, kernel plus cob with husks removed .......... Corn, sweet, stover .............. Goat, liver ............................. Goat, meat byproducts, except liver ............................ Horse, liver ........................... Horse, meat byproducts, except liver ............................ Poultry, liver .......................... Sheep, liver ........................... Sheep, meat byproducts, except liver ............................ 0.40 0.07 0.60 0.02 0.45 0.02 0.35 1.0 0.04 1.2 0.40 42 CFR Part 409 RIN 0938–AM46 Medicare Program; Prospective Payment System and Consolidated Billing for Skilled Nursing Facilities; Corrections Centers for Medicare & Medicaid Services (CMS), HHS. ACTION: Final rule; correction notice. AGENCY: SUMMARY: This document corrects technical errors that appeared in the August 3, 2007 Federal Register, entitled ‘‘Medicare Program; Prospective Payment System and Consolidated Billing for Skilled Nursing Facilities for FY 2008; Final Rule.’’ DATES: Effective Date: This correction is effective October 1, 2007. FOR FURTHER INFORMATION CONTACT: Bill Ullman, (410) 786–5667. SUPPLEMENTARY INFORMATION: rwilkins on PROD1PC63 with RULES I. Background FR Doc. 07–3784 of August 3, 2007 (72 FR 43412) contained technical errors that this notice serves to identify and 0.07 correct. The first involves the 0.07 construction of the 2004 skilled nursing 0.40 facility (SNF) market basket update. In 0.07 the SNF prospective payment system (PPS) proposed rule for fiscal year (FY) 2008 (72 FR 25552, May 4, 2007), we (b) Section 18 emergency exemptions. proposed to discontinue the previous, [Reserved] 1997-based market basket’s use of the Producer Price Index (PPI) for Industrial (c) Tolerances with regional Chemicals, in favor of using a blended registrations. [Reserved] PPI composed of the PPIs for soap and (d) Indirect or inadvertent residues. other detergent manufacturing (North [Reserved] American Industrial Classification [FR Doc. E7–19230 Filed 9–27–07; 8:45 am] System (NAICS) 325611), polish and BILLING CODE 6560–50–S other sanitation good manufacturing (NAICS 325612), and all other miscellaneous chemical product and preparation manufacturing (NAICS 325998) in the 2004-based market basket, which we believed would better reflect SNF purchasing patterns. In the FY 2008 SNF PPS final rule, we finalized this proposal ‘‘* * * to revise the market basket to reflect more appropriate, industry-specific price proxies (such as the blended VerDate Aug<31>2005 18:21 Sep 27, 2007 0.07 0.40 Jkt 211001 PO 00000 Frm 00075 Fmt 4700 Sfmt 4700 55085 compensation and chemical price proxies)’’ (72 FR 43426, 43436). However, in performing the actual calculations in the final rule, we inadvertently proxied the chemicals cost weight by the PPI for Industrial Chemicals rather than by the appropriate blended chemical price proxy. We note that this error did not affect the final market basket update factor of 3.3 percent, but did affect the labor-related share. The corrected laborrelated share is 70.249, which is slightly higher than the 70.152 figure published in the FY 2008 SNF PPS final rule. Accordingly, in this notice, we are republishing corrected versions of Tables 6, 7, 10, 13, and 14 (as well as revising the corresponding portions of the final rule’s preamble text) in order to reflect the final, corrected laborrelated share. In addition, we have determined that in the process of developing the most recent hospital wage index, two inpatient hospital providers with wage data that belonged in the Hartford–West Hartford–East Hartford, CT core-based statistical area (CBSA) were inadvertently included in rural Connecticut instead. Accordingly, in Table 8, we are revising the wage index value for CBSA Code 25540 (Hartford– West Hartford–East Hartford, CT) from 1.0937 to the corrected value of 1.0930. Similarly, in Table 9, we are revising the wage index value for CBSA Code 7 (rural Connecticut) from 1.1283 to the corrected value of 1.1711. As we are revising only a single entry in each of these two tables, we are not republishing Tables 8 and 9 in their entirety in this notice; however, we note that the corrected versions of both tables are available online on the SNF PPS Web site, at https://www.cms.hhs.gov/ SNFPPS/04_WageIndex.asp. Moreover, we note that the corrected version of Table 14 that we are republishing in this notice also reflects these corrected values. We are also correcting a typographical error in the final rule’s version of that table, which had inadvertently displayed the wage data update for rural New England incorrectly as a negative value. II. Correction of Errors In FR Doc. 07–3784 (72 FR 43412), make the following corrections: 1. On page 43421, Table 6 is corrected to read as follows: E:\FR\FM\28SER1.SGM 28SER1 55086 Federal Register / Vol. 72, No. 188 / Friday, September 28, 2007 / Rules and Regulations TABLE 6.—RUG–53 [Case-Mix Adjusted Federal Rates for Urban SNFs by Labor and Non-Labor Component.] RUG–III category Total rate RUX ......................................................................................................................................................... RUL .......................................................................................................................................................... RVX .......................................................................................................................................................... RVL .......................................................................................................................................................... RHX ......................................................................................................................................................... RHL .......................................................................................................................................................... RMX ......................................................................................................................................................... RML ......................................................................................................................................................... RLX .......................................................................................................................................................... RUC ......................................................................................................................................................... RUB ......................................................................................................................................................... RUA ......................................................................................................................................................... RVC ......................................................................................................................................................... RVB .......................................................................................................................................................... RVA .......................................................................................................................................................... RHC ......................................................................................................................................................... RHB ......................................................................................................................................................... RHA ......................................................................................................................................................... RMC ......................................................................................................................................................... RMB ......................................................................................................................................................... RMA ......................................................................................................................................................... RLB .......................................................................................................................................................... RLA .......................................................................................................................................................... SE3 .......................................................................................................................................................... SE2 .......................................................................................................................................................... SE1 .......................................................................................................................................................... SSC .......................................................................................................................................................... SSB .......................................................................................................................................................... SSA .......................................................................................................................................................... CC2 .......................................................................................................................................................... CC1 .......................................................................................................................................................... CB2 .......................................................................................................................................................... CB1 .......................................................................................................................................................... CA2 .......................................................................................................................................................... CA1 .......................................................................................................................................................... IB2 ............................................................................................................................................................ IB1 ............................................................................................................................................................ IA2 ............................................................................................................................................................ IA1 ............................................................................................................................................................ BB2 .......................................................................................................................................................... BB1 .......................................................................................................................................................... BA2 .......................................................................................................................................................... BA1 .......................................................................................................................................................... PE2 .......................................................................................................................................................... PE1 .......................................................................................................................................................... PD2 .......................................................................................................................................................... PD1 .......................................................................................................................................................... PC2 .......................................................................................................................................................... PC1 .......................................................................................................................................................... PB2 .......................................................................................................................................................... PB1 .......................................................................................................................................................... PA2 .......................................................................................................................................................... PA1 .......................................................................................................................................................... 601.90 528.59 456.34 425.55 386.84 379.51 442.85 406.19 314.39 510.99 468.47 446.48 410.89 390.37 350.78 357.52 341.39 316.46 328.48 319.69 312.35 289.47 246.95 362.08 307.83 274.11 269.71 255.05 250.65 268.25 244.79 233.06 222.79 221.33 206.67 197.87 194.94 178.81 171.48 196.40 190.54 177.34 165.61 214.00 209.60 203.73 200.80 193.47 190.54 170.01 168.54 167.08 162.68 Labor portion 422.83 371.33 320.57 298.94 271.75 266.60 311.10 285.34 220.86 358.97 329.10 313.65 288.65 274.23 246.42 251.15 239.82 222.31 230.75 224.58 219.42 203.35 173.48 254.36 216.25 192.56 189.47 179.17 176.08 188.44 171.96 163.72 156.51 155.48 145.18 139.00 136.94 125.61 120.46 137.97 133.85 124.58 116.34 150.33 147.24 143.12 141.06 135.91 133.85 119.43 118.40 117.37 114.28 Non-labor portion 179.07 157.26 135.77 126.61 115.09 112.91 131.75 120.85 93.53 152.02 139.37 132.83 122.24 116.14 104.36 106.37 101.57 94.15 97.73 95.11 92.93 86.12 73.47 107.72 91.58 81.55 80.24 75.88 74.57 79.81 72.83 69.34 66.28 65.85 61.49 58.87 58.00 53.20 51.02 58.43 56.69 52.76 49.27 63.67 62.36 60.61 59.74 57.56 56.69 50.58 50.14 49.71 48.40 2. On page 43422, Table 7 is corrected to read as follows: TABLE 7.—RUG–53 [Case-Mix Adjusted Federal Rates for Rural SNFs by Labor and Non-Labor Component.] rwilkins on PROD1PC63 with RULES RUG–III category RUX RUL RVX RVL Total rate ......................................................................................................................................................... .......................................................................................................................................................... .......................................................................................................................................................... .......................................................................................................................................................... VerDate Aug<31>2005 18:21 Sep 27, 2007 Jkt 211001 PO 00000 Frm 00076 Fmt 4700 Sfmt 4700 E:\FR\FM\28SER1.SGM 628.90 558.86 471.49 442.08 28SER1 Labor portion 441.80 392.59 331.22 310.56 Non-labor portion 187.10 166.27 140.27 131.52 55087 Federal Register / Vol. 72, No. 188 / Friday, September 28, 2007 / Rules and Regulations TABLE 7.—RUG–53—Continued [Case-Mix Adjusted Federal Rates for Rural SNFs by Labor and Non-Labor Component.] RUG–III category Total rate RHX ......................................................................................................................................................... RHL .......................................................................................................................................................... RMX ......................................................................................................................................................... RML ......................................................................................................................................................... RLX .......................................................................................................................................................... RUC ......................................................................................................................................................... RUB ......................................................................................................................................................... RUA ......................................................................................................................................................... RVC ......................................................................................................................................................... RVB .......................................................................................................................................................... RVA .......................................................................................................................................................... RHC ......................................................................................................................................................... RHB ......................................................................................................................................................... RHA ......................................................................................................................................................... RMC ......................................................................................................................................................... RMB ......................................................................................................................................................... RMA ......................................................................................................................................................... RLB .......................................................................................................................................................... RLA .......................................................................................................................................................... SE3 .......................................................................................................................................................... SE2 .......................................................................................................................................................... SE1 .......................................................................................................................................................... SSC .......................................................................................................................................................... SSB .......................................................................................................................................................... SSA .......................................................................................................................................................... CC2 .......................................................................................................................................................... CC1 .......................................................................................................................................................... CB2 .......................................................................................................................................................... CB1 .......................................................................................................................................................... CA2 .......................................................................................................................................................... CA1 .......................................................................................................................................................... IB2 ............................................................................................................................................................ IB1 ............................................................................................................................................................ IA2 ............................................................................................................................................................ IA1 ............................................................................................................................................................ BB2 .......................................................................................................................................................... BB1 .......................................................................................................................................................... BA2 .......................................................................................................................................................... BA1 .......................................................................................................................................................... PE2 .......................................................................................................................................................... PE1 .......................................................................................................................................................... PD2 .......................................................................................................................................................... PD1 .......................................................................................................................................................... PC2 .......................................................................................................................................................... PC1 .......................................................................................................................................................... PB2 .......................................................................................................................................................... PB1 .......................................................................................................................................................... PA2 .......................................................................................................................................................... PA1 .......................................................................................................................................................... 3. On page 43424, third column, first full paragraph, line 7, the figure ‘‘$29,758’’ is corrected to read ‘‘$29,755’’. 394.83 387.83 444.62 409.60 314.47 542.05 501.43 480.42 428.07 408.46 370.64 366.82 351.41 327.60 335.36 326.96 319.95 290.66 250.04 352.30 300.47 268.25 264.05 250.04 245.84 262.65 240.23 229.03 219.22 217.82 203.81 195.41 192.61 177.20 170.19 194.01 188.41 175.80 164.59 210.82 206.62 201.01 198.21 191.21 188.41 168.79 167.39 165.99 161.79 Labor portion Non-labor portion 277.36 272.45 312.34 287.74 220.91 380.78 352.25 337.49 300.71 286.94 260.37 257.69 246.86 230.14 235.59 229.69 224.76 204.19 175.65 247.49 211.08 188.44 185.49 175.65 172.70 184.51 168.76 160.89 154.00 153.02 143.17 137.27 135.31 124.48 119.56 136.29 132.36 123.50 115.62 148.10 145.15 141.21 139.24 134.32 132.36 118.57 117.59 116.61 113.66 117.47 115.38 132.28 121.86 93.56 161.27 149.18 142.93 127.36 121.52 110.27 109.13 104.55 97.46 99.77 97.27 95.19 86.47 74.39 104.81 89.39 79.81 78.56 74.39 73.14 78.14 71.47 68.14 65.22 64.80 60.64 58.14 57.30 52.72 50.63 57.72 56.05 52.30 48.97 62.72 61.47 59.80 58.97 56.89 56.05 50.22 49.80 49.38 48.13 4. On page 43424, Table 10 is corrected to read as follows: TABLE 10.—RUG–53 [SNF XYZ: Located in Cedar Rapids, IA (Urban CBSA 16300) Wage Index: 0.8852] rwilkins on PROD1PC63 with RULES RUG group RVX .................................. RLX .................................. RHA .................................. CC2 .................................. IA2 .................................... VerDate Aug<31>2005 18:21 Sep 27, 2007 Labor $320.57 220.86 222.31 188.44 125.61 Jkt 211001 Wage index Adj. labor 0.8852 0.8852 0.8852 0.8852 0.8852 PO 00000 Frm 00077 $283.77 195.51 196.79 166.81 111.19 Fmt 4700 Non-labor $135.77 93.53 94.15 79.81 53.20 Sfmt 4700 Adj. rate Percent adj. $419.54 289.04 290.94 246.62 164.39 E:\FR\FM\28SER1.SGM $419.54 289.04 290.94 *562.29 164.39 28SER1 Medicare days 14 30 16 10 30 Payment $5,874.00 8,671.00 4,655.00 5,623.00 4,932.00 55088 Federal Register / Vol. 72, No. 188 / Friday, September 28, 2007 / Rules and Regulations TABLE 10.—RUG–53—Continued [SNF XYZ: Located in Cedar Rapids, IA (Urban CBSA 16300) Wage Index: 0.8852] RUG group Total .......................... Labor Wage index Adj. labor Non-labor Adj. rate Percent adj. .................... .................... .................... .................... .................... Medicare days .................... Payment 100 29,755.00 * Reflects a 128 percent adjustment from section 511 of the MMA. 5. On page 43430, Table 13 is corrected to read as follows: TABLE 13.—LABOR-RELATED RELATIVE IMPORTANCE, FY 2007 AND FY 2008 Relative importance, labor-related, FY 2007 (1997-based index) 06:2 forecast Relative importance, labor-related, FY 2008 (2004-based index) 07:2 forecast Wages and salaries ............................................................................................................................................. Employee benefits ............................................................................................................................................... Nonmedical professional fees ............................................................................................................................. Labor-intensive services ...................................................................................................................................... Capital-related (.391) ........................................................................................................................................... 54.231 11.903 2.721 4.035 2.949 51.218 11.72 1.333 3.456 2.522 Total .............................................................................................................................................................. 75.839 70.249 6. On page 43434, third column, final paragraph, line 19, the figure ‘‘9.6 percent’’ is corrected to read ‘‘9.5 percent’’. 7. On page 43435, Table 14 is corrected to read as follows: TABLE 14.—PROJECTED IMPACT TO THE SNF PPS FOR FY 2008 rwilkins on PROD1PC63 with RULES Number of facilities Total ............................................................................................................................................. Urban ........................................................................................................................................... Rural ............................................................................................................................................ Hospital based urban ................................................................................................................... Freestanding urban ...................................................................................................................... Hospital based rural ..................................................................................................................... Freestanding rural ........................................................................................................................ Urban by region: New England ........................................................................................................................ Middle Atlantic ...................................................................................................................... South Atlantic ....................................................................................................................... East North Central ................................................................................................................ East South Central ............................................................................................................... West North Central ............................................................................................................... West South Central .............................................................................................................. Mountain ............................................................................................................................... Pacific ................................................................................................................................... Outlying1 ............................................................................................................................... Rural by region: New England ........................................................................................................................ Middle Atlantic ...................................................................................................................... South Atlantic ....................................................................................................................... East North Central ................................................................................................................ East South Central ............................................................................................................... West North Central ............................................................................................................... West South Central .............................................................................................................. Mountain ............................................................................................................................... Pacific ................................................................................................................................... Outlying1 ............................................................................................................................... Ownership: Government .......................................................................................................................... Proprietary ............................................................................................................................ VerDate Aug<31>2005 18:21 Sep 27, 2007 Jkt 211001 PO 00000 Frm 00078 Fmt 4700 Sfmt 4700 Update wage data (percent) Total FY 2008 change (percent) 15,325 10,476 4,849 1,450 9,026 1,130 3,719 0.0 ¥.0.2 1.0 0.0 ¥0.2 1.2 1.0 3.3 3.1 4.3 3.3 3.1 4.5 4.3 865 1,482 1,735 2,004 524 823 1,146 470 1,419 8 ¥0.3 ¥0.9 0.0 ¥0.2 0.0 0.4 0.2 0.1 ¥0.2 6.0 3.0 2.4 3.3 3.1 3.3 3.7 3.5 3.4 3.1 9.5 130 260 608 927 556 1,134 818 262 152 2 0.5 1.5 0.9 0.9 1.1 0.9 1.3 1.3 1.3 ¥3.2 3.8 4.8 4.2 4.2 4.4 4.2 4.6 4.6 4.6 0.0 675 11,178 0.1 0.0 3.4 3.3 E:\FR\FM\28SER1.SGM 28SER1 55089 Federal Register / Vol. 72, No. 188 / Friday, September 28, 2007 / Rules and Regulations TABLE 14.—PROJECTED IMPACT TO THE SNF PPS FOR FY 2008—Continued Update wage data (percent) Number of facilities Voluntary ............................................................................................................................... Total FY 2008 change (percent) ¥0.1 3,472 3.2 1 The Outlying region includes the following, noncontiguous jurisdictions referenced as States in §§ 1861(x) and 210(h) of the Social Security Act: Puerto Rico, the Virgin Islands, American Samoa, and Guam. 8. On page 43436, third column, lines 4–5, the figure ‘‘9.6 percent’’ is corrected to read ‘‘9.5 percent’’. 9. On page 43446, the entry of ‘‘1.0937’’ that is displayed in Table 8 as the wage index value for CBSA Code 25540 (Hartford–West Hartford–East Hartford, CT) is corrected to read ‘‘1.0930’’. 10. On page 43462, the entry of ‘‘1.1283’’ that is displayed in Table 9 as the wage index value for CBSA Code 7 (rural Connecticut) is corrected to read ‘‘1.1711’’. rwilkins on PROD1PC63 with RULES III. Waiver of Proposed Rulemaking and Delayed Effective Date We ordinarily publish a notice of proposed rulemaking in the Federal Register to provide a period for public comment before the provisions of a notice such as this take effect in accordance with section 553(b) of the Administrative Procedure Act (APA) (5 U.S.C. 553(b)). We also ordinarily provide a 30-day delay in the effective date of the provisions of a notice in accordance with section 553(d) of the APA (5 U.S.C. 553(d)). However, we can waive both the notice and comment procedure and the 30-day delay in effective date if the Secretary finds, for good cause, that a notice and comment process is impracticable, unnecessary or contrary to the public interest, and incorporates a statement of the finding and the reasons therefore in the notice. We find for good cause that it is unnecessary to undertake notice and comment rulemaking because this notice merely provides technical corrections to the regulations. We are not making substantive changes to our payment methodologies or policies, but rather, are simply implementing correctly the payment methodologies and policies that we previously proposed, received comment on, and subsequently finalized. The public has already had the opportunity to comment on these payment methodologies and policies, and this correction notice is intended solely to ensure that the FY 2008 SNF PPS final rule accurately reflects them. Therefore, we believe that undertaking further notice and comment procedures to incorporate these corrections into the update notice is VerDate Aug<31>2005 18:21 Sep 27, 2007 Jkt 211001 unnecessary and contrary to the public interest. Further, we believe a delayed effective date is unnecessary because this correction notice merely corrects inadvertent technical errors. The changes noted above do not make any substantive changes to the SNF PPS payment methodologies or policies. Moreover, we regard imposing a delay in the effective date as being contrary to the public interest. We believe that it is in the public interest for providers to receive appropriate SNF PPS payments in as timely a manner as possible and to ensure that the FY 2008 SNF PPS final rule accurately reflects our payment methodologies, payment rates, and policies. Therefore, we find good cause to waive notice and comment procedures, as well as the 30-day delay in effective date. (Catalog of Federal Domestic Assistance Program No. 93.773, Medicare—Hospital Insurance; and Program No. 93.774, Medicare—Supplementary Medical Insurance Program) Dated: September 17, 2007. Ann C. Agnew, Executive Secretary to the Department. [FR Doc. E7–18732 Filed 9–27–07; 8:45 am] BILLING CODE 4120–01–P DEPARTMENT OF HOMELAND SECURITY FEDERAL COMMUNICATIONS COMMISSION 47 CFR Part 0 Commission Organization CFR Correction In Title 47 of the Code of Federal Regulations, Parts 0 to 19, revised as of October 1, 2006, on page 45, in § 0.406, in paragraph (b)(2), the eighth sentence, beginning with ‘‘Additional procedures applicable . . .’’, is removed and a sentence is added following the sixth sentence to read as follows: § 0.406 The rules and regulations. * * * * * (b) * * * (2) * * * Part 1, subpart E, of this chapter contains general rules and procedures applicable to common carriers. * * * * * * * * [FR Doc. 07–55514 Filed 9–27–07; 8:45 am] BILLING CODE 1505–01–D DEPARTMENT OF DEFENSE GENERAL SERVICES ADMINISTRATION NATIONAL AERONAUTICS AND SPACE ADMINISTRATION 48 CFR Part 52 Federal Emergency Management Agency Solicitation Provisions and Contract Clauses 44 CFR Part 64 CFR Correction In Title 48 of the Code of Federal Regulations, Chapter I (Parts 52 to 99), revised as of October 1, 2006, on page 80, in section 52.215–15, correct paragraph (b) and the source note to read as follows: Communities Eligible for the Sale of Insurance CFR Correction In Title 44 of the Code of Federal Regulations, revised as of October 1, 2006, on page 339, in § 64.4, paragraph (b), in the fourth sentence, remove the words ‘‘within the newly-month period,’’ and add the words ‘‘within the newly-acquired area the requirements of § 60.3(b) of this subchapter. During the six month period,’’ in their place. [FR Doc. 07–55516 Filed 9–27–07; 8:45 am] BILLING CODE 1505–01–D PO 00000 Frm 00079 Fmt 4700 Sfmt 4700 52.215–15 Pension adjustments and asset reversions. * * * * * (b) For segment closings, pension plan terminations, or curtailment of benefits, the amount of the adjustment shall be— (1) For contracts and subcontracts that are subject to full coverage under the Cost Accounting Standards (CAS) Board rules and regulations (48 CFR Chapter 99), the amount E:\FR\FM\28SER1.SGM 28SER1

Agencies

[Federal Register Volume 72, Number 188 (Friday, September 28, 2007)]
[Rules and Regulations]
[Pages 55085-55089]
From the Federal Register Online via the Government Printing Office [www.gpo.gov]
[FR Doc No: E7-18732]


=======================================================================
-----------------------------------------------------------------------

DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare & Medicaid Services

[CMS-1545-CN]

42 CFR Part 409

RIN 0938-AM46


Medicare Program; Prospective Payment System and Consolidated 
Billing for Skilled Nursing Facilities; Corrections

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

ACTION: Final rule; correction notice.

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

SUMMARY: This document corrects technical errors that appeared in the 
August 3, 2007 Federal Register, entitled ``Medicare Program; 
Prospective Payment System and Consolidated Billing for Skilled Nursing 
Facilities for FY 2008; Final Rule.''

DATES: Effective Date: This correction is effective October 1, 2007.

FOR FURTHER INFORMATION CONTACT: Bill Ullman, (410) 786-5667.

SUPPLEMENTARY INFORMATION:

I. Background

    FR Doc. 07-3784 of August 3, 2007 (72 FR 43412) contained technical 
errors that this notice serves to identify and correct. The first 
involves the construction of the 2004 skilled nursing facility (SNF) 
market basket update. In the SNF prospective payment system (PPS) 
proposed rule for fiscal year (FY) 2008 (72 FR 25552, May 4, 2007), we 
proposed to discontinue the previous, 1997-based market basket's use of 
the Producer Price Index (PPI) for Industrial Chemicals, in favor of 
using a blended PPI composed of the PPIs for soap and other detergent 
manufacturing (North American Industrial Classification System (NAICS) 
325611), polish and other sanitation good manufacturing (NAICS 325612), 
and all other miscellaneous chemical product and preparation 
manufacturing (NAICS 325998) in the 2004-based market basket, which we 
believed would better reflect SNF purchasing patterns. In the FY 2008 
SNF PPS final rule, we finalized this proposal ``* * * to revise the 
market basket to reflect more appropriate, industry-specific price 
proxies (such as the blended compensation and chemical price proxies)'' 
(72 FR 43426, 43436).
    However, in performing the actual calculations in the final rule, 
we inadvertently proxied the chemicals cost weight by the PPI for 
Industrial Chemicals rather than by the appropriate blended chemical 
price proxy. We note that this error did not affect the final market 
basket update factor of 3.3 percent, but did affect the labor-related 
share. The corrected labor-related share is 70.249, which is slightly 
higher than the 70.152 figure published in the FY 2008 SNF PPS final 
rule. Accordingly, in this notice, we are republishing corrected 
versions of Tables 6, 7, 10, 13, and 14 (as well as revising the 
corresponding portions of the final rule's preamble text) in order to 
reflect the final, corrected labor-related share.
    In addition, we have determined that in the process of developing 
the most recent hospital wage index, two inpatient hospital providers 
with wage data that belonged in the Hartford-West Hartford-East 
Hartford, CT core-based statistical area (CBSA) were inadvertently 
included in rural Connecticut instead. Accordingly, in Table 8, we are 
revising the wage index value for CBSA Code 25540 (Hartford-West 
Hartford-East Hartford, CT) from 1.0937 to the corrected value of 
1.0930. Similarly, in Table 9, we are revising the wage index value for 
CBSA Code 7 (rural Connecticut) from 1.1283 to the corrected value of 
1.1711. As we are revising only a single entry in each of these two 
tables, we are not republishing Tables 8 and 9 in their entirety in 
this notice; however, we note that the corrected versions of both 
tables are available online on the SNF PPS Web site, at https://
www.cms.hhs.gov/SNFPPS/04_WageIndex.asp. Moreover, we note that the 
corrected version of Table 14 that we are republishing in this notice 
also reflects these corrected values. We are also correcting a 
typographical error in the final rule's version of that table, which 
had inadvertently displayed the wage data update for rural New England 
incorrectly as a negative value.

II. Correction of Errors

    In FR Doc. 07-3784 (72 FR 43412), make the following corrections:
    1. On page 43421, Table 6 is corrected to read as follows:

[[Page 55086]]



                            Table 6.--RUG-53
 [Case-Mix Adjusted Federal Rates for Urban SNFs by Labor and Non-Labor
                               Component.]
------------------------------------------------------------------------
                                                   Labor      Non-labor
         RUG-III category           Total rate    portion      portion
------------------------------------------------------------------------
RUX..............................       601.90       422.83       179.07
RUL..............................       528.59       371.33       157.26
RVX..............................       456.34       320.57       135.77
RVL..............................       425.55       298.94       126.61
RHX..............................       386.84       271.75       115.09
RHL..............................       379.51       266.60       112.91
RMX..............................       442.85       311.10       131.75
RML..............................       406.19       285.34       120.85
RLX..............................       314.39       220.86        93.53
RUC..............................       510.99       358.97       152.02
RUB..............................       468.47       329.10       139.37
RUA..............................       446.48       313.65       132.83
RVC..............................       410.89       288.65       122.24
RVB..............................       390.37       274.23       116.14
RVA..............................       350.78       246.42       104.36
RHC..............................       357.52       251.15       106.37
RHB..............................       341.39       239.82       101.57
RHA..............................       316.46       222.31        94.15
RMC..............................       328.48       230.75        97.73
RMB..............................       319.69       224.58        95.11
RMA..............................       312.35       219.42        92.93
RLB..............................       289.47       203.35        86.12
RLA..............................       246.95       173.48        73.47
SE3..............................       362.08       254.36       107.72
SE2..............................       307.83       216.25        91.58
SE1..............................       274.11       192.56        81.55
SSC..............................       269.71       189.47        80.24
SSB..............................       255.05       179.17        75.88
SSA..............................       250.65       176.08        74.57
CC2..............................       268.25       188.44        79.81
CC1..............................       244.79       171.96        72.83
CB2..............................       233.06       163.72        69.34
CB1..............................       222.79       156.51        66.28
CA2..............................       221.33       155.48        65.85
CA1..............................       206.67       145.18        61.49
IB2..............................       197.87       139.00        58.87
IB1..............................       194.94       136.94        58.00
IA2..............................       178.81       125.61        53.20
IA1..............................       171.48       120.46        51.02
BB2..............................       196.40       137.97        58.43
BB1..............................       190.54       133.85        56.69
BA2..............................       177.34       124.58        52.76
BA1..............................       165.61       116.34        49.27
PE2..............................       214.00       150.33        63.67
PE1..............................       209.60       147.24        62.36
PD2..............................       203.73       143.12        60.61
PD1..............................       200.80       141.06        59.74
PC2..............................       193.47       135.91        57.56
PC1..............................       190.54       133.85        56.69
PB2..............................       170.01       119.43        50.58
PB1..............................       168.54       118.40        50.14
PA2..............................       167.08       117.37        49.71
PA1..............................       162.68       114.28        48.40
------------------------------------------------------------------------

    2. On page 43422, Table 7 is corrected to read as follows:

                            Table 7.--RUG-53
 [Case-Mix Adjusted Federal Rates for Rural SNFs by Labor and Non-Labor
                               Component.]
------------------------------------------------------------------------
                                                   Labor      Non-labor
         RUG-III category           Total rate    portion      portion
------------------------------------------------------------------------
RUX..............................       628.90       441.80       187.10
RUL..............................       558.86       392.59       166.27
RVX..............................       471.49       331.22       140.27
RVL..............................       442.08       310.56       131.52

[[Page 55087]]

 
RHX..............................       394.83       277.36       117.47
RHL..............................       387.83       272.45       115.38
RMX..............................       444.62       312.34       132.28
RML..............................       409.60       287.74       121.86
RLX..............................       314.47       220.91        93.56
RUC..............................       542.05       380.78       161.27
RUB..............................       501.43       352.25       149.18
RUA..............................       480.42       337.49       142.93
RVC..............................       428.07       300.71       127.36
RVB..............................       408.46       286.94       121.52
RVA..............................       370.64       260.37       110.27
RHC..............................       366.82       257.69       109.13
RHB..............................       351.41       246.86       104.55
RHA..............................       327.60       230.14        97.46
RMC..............................       335.36       235.59        99.77
RMB..............................       326.96       229.69        97.27
RMA..............................       319.95       224.76        95.19
RLB..............................       290.66       204.19        86.47
RLA..............................       250.04       175.65        74.39
SE3..............................       352.30       247.49       104.81
SE2..............................       300.47       211.08        89.39
SE1..............................       268.25       188.44        79.81
SSC..............................       264.05       185.49        78.56
SSB..............................       250.04       175.65        74.39
SSA..............................       245.84       172.70        73.14
CC2..............................       262.65       184.51        78.14
CC1..............................       240.23       168.76        71.47
CB2..............................       229.03       160.89        68.14
CB1..............................       219.22       154.00        65.22
CA2..............................       217.82       153.02        64.80
CA1..............................       203.81       143.17        60.64
IB2..............................       195.41       137.27        58.14
IB1..............................       192.61       135.31        57.30
IA2..............................       177.20       124.48        52.72
IA1..............................       170.19       119.56        50.63
BB2..............................       194.01       136.29        57.72
BB1..............................       188.41       132.36        56.05
BA2..............................       175.80       123.50        52.30
BA1..............................       164.59       115.62        48.97
PE2..............................       210.82       148.10        62.72
PE1..............................       206.62       145.15        61.47
PD2..............................       201.01       141.21        59.80
PD1..............................       198.21       139.24        58.97
PC2..............................       191.21       134.32        56.89
PC1..............................       188.41       132.36        56.05
PB2..............................       168.79       118.57        50.22
PB1..............................       167.39       117.59        49.80
PA2..............................       165.99       116.61        49.38
PA1..............................       161.79       113.66        48.13
------------------------------------------------------------------------

    3. On page 43424, third column, first full paragraph, line 7, the 
figure ``$29,758'' is corrected to read ``$29,755''.
    4. On page 43424, Table 10 is corrected to read as follows:

                                                                    Table 10.--RUG-53
                                      [SNF XYZ: Located in Cedar Rapids, IA (Urban CBSA 16300) Wage Index: 0.8852]
--------------------------------------------------------------------------------------------------------------------------------------------------------
                                                                                                                     Percent      Medicare
                    RUG group                        Labor      Wage index   Adj. labor   Non-labor    Adj. rate       adj.         days       Payment
--------------------------------------------------------------------------------------------------------------------------------------------------------
RVX.............................................      $320.57       0.8852      $283.77      $135.77      $419.54      $419.54           14    $5,874.00
RLX.............................................       220.86       0.8852       195.51        93.53       289.04       289.04           30     8,671.00
RHA.............................................       222.31       0.8852       196.79        94.15       290.94       290.94           16     4,655.00
CC2.............................................       188.44       0.8852       166.81        79.81       246.62      *562.29           10     5,623.00
IA2.............................................       125.61       0.8852       111.19        53.20       164.39       164.39           30     4,932.00
                                                 -------------------------------------------------------------------------------------------------------

[[Page 55088]]

 
    Total.......................................  ...........  ...........  ...........  ...........  ...........  ...........          100   29,755.00
--------------------------------------------------------------------------------------------------------------------------------------------------------
* Reflects a 128 percent adjustment from section 511 of the MMA.

    5. On page 43430, Table 13 is corrected to read as follows:

    Table 13.--Labor-related Relative Importance, FY 2007 and FY 2008
------------------------------------------------------------------------
                                             Relative        Relative
                                            importance,     importance,
                                          labor-related,  labor-related,
                                          FY 2007 (1997-  FY 2008 (2004-
                                           based index)    based index)
                                           06:2 forecast   07:2 forecast
------------------------------------------------------------------------
Wages and salaries......................          54.231          51.218
Employee benefits.......................          11.903          11.72
Nonmedical professional fees............           2.721           1.333
Labor-intensive services................           4.035           3.456
Capital-related (.391)..................           2.949           2.522
                                         -------------------------------
    Total...............................          75.839          70.249
------------------------------------------------------------------------

    6. On page 43434, third column, final paragraph, line 19, the 
figure ``9.6 percent'' is corrected to read ``9.5 percent''.
    7. On page 43435, Table 14 is corrected to read as follows:

                             Table 14.--Projected Impact to the SNF PPS for FY 2008
----------------------------------------------------------------------------------------------------------------
                                                                                                   Total FY 2008
                                                                     Number of      Update wage       change
                                                                    facilities    data (percent)     (percent)
----------------------------------------------------------------------------------------------------------------
Total...........................................................          15,325             0.0             3.3
Urban...........................................................          10,476           -.0.2             3.1
Rural...........................................................           4,849             1.0             4.3
Hospital based urban............................................           1,450             0.0             3.3
Freestanding urban..............................................           9,026            -0.2             3.1
Hospital based rural............................................           1,130             1.2             4.5
Freestanding rural..............................................           3,719             1.0             4.3
Urban by region:
    New England.................................................             865            -0.3             3.0
    Middle Atlantic.............................................           1,482            -0.9             2.4
    South Atlantic..............................................           1,735             0.0             3.3
    East North Central..........................................           2,004            -0.2             3.1
    East South Central..........................................             524             0.0             3.3
    West North Central..........................................             823             0.4             3.7
    West South Central..........................................           1,146             0.2             3.5
    Mountain....................................................             470             0.1             3.4
    Pacific.....................................................           1,419            -0.2             3.1
    Outlying\1\.................................................               8             6.0             9.5
Rural by region:
    New England.................................................             130             0.5             3.8
    Middle Atlantic.............................................             260             1.5             4.8
    South Atlantic..............................................             608             0.9             4.2
    East North Central..........................................             927             0.9             4.2
    East South Central..........................................             556             1.1             4.4
    West North Central..........................................           1,134             0.9             4.2
    West South Central..........................................             818             1.3             4.6
    Mountain....................................................             262             1.3             4.6
    Pacific.....................................................             152             1.3             4.6
    Outlying\1\.................................................               2            -3.2             0.0
Ownership:
    Government..................................................             675             0.1             3.4
    Proprietary.................................................          11,178             0.0             3.3

[[Page 55089]]

 
    Voluntary...................................................           3,472            -0.1             3.2
----------------------------------------------------------------------------------------------------------------
\1\ The Outlying region includes the following, noncontiguous jurisdictions referenced as States in Sec.  Sec.
  1861(x) and 210(h) of the Social Security Act: Puerto Rico, the Virgin Islands, American Samoa, and Guam.

    8. On page 43436, third column, lines 4-5, the figure ``9.6 
percent'' is corrected to read ``9.5 percent''.
    9. On page 43446, the entry of ``1.0937'' that is displayed in 
Table 8 as the wage index value for CBSA Code 25540 (Hartford-West 
Hartford-East Hartford, CT) is corrected to read ``1.0930''.
    10. On page 43462, the entry of ``1.1283'' that is displayed in 
Table 9 as the wage index value for CBSA Code 7 (rural Connecticut) is 
corrected to read ``1.1711''.

III. Waiver of Proposed Rulemaking and Delayed Effective Date

    We ordinarily publish a notice of proposed rulemaking in the 
Federal Register to provide a period for public comment before the 
provisions of a notice such as this take effect in accordance with 
section 553(b) of the Administrative Procedure Act (APA) (5 U.S.C. 
553(b)). We also ordinarily provide a 30-day delay in the effective 
date of the provisions of a notice in accordance with section 553(d) of 
the APA (5 U.S.C. 553(d)). However, we can waive both the notice and 
comment procedure and the 30-day delay in effective date if the 
Secretary finds, for good cause, that a notice and comment process is 
impracticable, unnecessary or contrary to the public interest, and 
incorporates a statement of the finding and the reasons therefore in 
the notice.
    We find for good cause that it is unnecessary to undertake notice 
and comment rulemaking because this notice merely provides technical 
corrections to the regulations. We are not making substantive changes 
to our payment methodologies or policies, but rather, are simply 
implementing correctly the payment methodologies and policies that we 
previously proposed, received comment on, and subsequently finalized. 
The public has already had the opportunity to comment on these payment 
methodologies and policies, and this correction notice is intended 
solely to ensure that the FY 2008 SNF PPS final rule accurately 
reflects them. Therefore, we believe that undertaking further notice 
and comment procedures to incorporate these corrections into the update 
notice is unnecessary and contrary to the public interest.
    Further, we believe a delayed effective date is unnecessary because 
this correction notice merely corrects inadvertent technical errors. 
The changes noted above do not make any substantive changes to the SNF 
PPS payment methodologies or policies. Moreover, we regard imposing a 
delay in the effective date as being contrary to the public interest. 
We believe that it is in the public interest for providers to receive 
appropriate SNF PPS payments in as timely a manner as possible and to 
ensure that the FY 2008 SNF PPS final rule accurately reflects our 
payment methodologies, payment rates, and policies. Therefore, we find 
good cause to waive notice and comment procedures, as well as the 30-
day delay in effective date.

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

    Dated: September 17, 2007.
Ann C. Agnew,
Executive Secretary to the Department.
[FR Doc. E7-18732 Filed 9-27-07; 8:45 am]
BILLING CODE 4120-01-P

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