Justia Department Of Health And Human Services Centers For Medicare & Medicaid Services Medicare and Medicaid Programs: Hospital Outpatient Prospective Payment and Ambulatory Surgical Center Payment Systems and Quality Reporting Programs; Hospital Value-Based Purchasing Program; Organ Procurement Organizations; Quality Improvement Organizations; Electronic Health Records (EHR) Incentive Program; Provider Reimbursement Determinations and Appeals; Correction and Limited Extension of Comment Period, 54842-54849 [2013-21849]

Medicare and Medicaid Programs: Hospital Outpatient Prospective Payment and Ambulatory Surgical Center Payment Systems and Quality Reporting Programs; Hospital Value-Based Purchasing Program; Organ Procurement Organizations; Quality Improvement Organizations; Electronic Health Records (EHR) Incentive Program; Provider Reimbursement Determinations and Appeals; Correction and Limited Extension of Comment Period, 54842-54849 [2013-21849]

Download as PDF 54842 Federal Register / Vol. 78, No. 173 / Friday, September 6, 2013 / Proposed Rules DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Medicare & Medicaid Services 42 CFR Parts 405, 410, 412, 416, 419, 475, 476, 486, and 495 [CMS–1601–CN] RIN 0938–AR54 Medicare and Medicaid Programs: Hospital Outpatient Prospective Payment and Ambulatory Surgical Center Payment Systems and Quality Reporting Programs; Hospital ValueBased Purchasing Program; Organ Procurement Organizations; Quality Improvement Organizations; Electronic Health Records (EHR) Incentive Program; Provider Reimbursement Determinations and Appeals; Correction and Limited Extension of Comment Period Centers for Medicare & Medicaid Services (CMS), HHS. ACTION: Correction and limited extension of comment period for proposed rule. AGENCY: This document corrects technical errors that appeared in the proposed rule published in the Federal Register on July 19, 2013, entitled ‘‘Medicare and Medicaid Programs: Hospital Outpatient Prospective Payment and Ambulatory Surgical Center Payment Systems and Quality Reporting Programs; Hospital ValueBased Purchasing Program; Organ Procurement Organizations; Quality Improvement Organizations; Electronic Health Records (EHR) Incentive Program; Provider Reimbursement Determinations and Appeals.’’ This document extends the comment period for 10 days for the technical corrections set forth in this correcting document. DATES: Comment Period: The comment period, for the technical corrections set forth in this correcting document, is extended to 5 p.m. E.S.T. on September 16, 2013. FOR FURTHER INFORMATION CONTACT: Erick Chuang, (410) 786–1816. SUPPLEMENTARY INFORMATION: ehiers on DSK2VPTVN1PROD with PROPOSALS-1 SUMMARY: I. Background In FR. Doc. 2013–16555 of July 19, 2013 (78 FR 43534), (hereinafter referred to as the CY 2014 OPPS/ASC proposed rule), there were a number of technical errors that are discussed in the Summary of Errors, and further identified and corrected in the Correction of Errors sections. The CY VerDate Mar<15>2010 14:34 Sep 05, 2013 Jkt 229001 2014 OPPS/ASC proposed rule proposes to revise the Medicare hospital outpatient prospective payment system (OPPS) and the Medicare ambulatory surgical center (ASC) payment system for calendar year (CY) 2014 to implement applicable statutory requirements and policy changes. In the CY 2014 OPPS/ASC proposed rule, we described proposed changes to the amounts and factors used to determine the payment rates for Medicare services paid under the OPPS and ASC payment system. Since the publication of the CY 2014 OPPS/ASC proposed rule, we have reviewed the data on which the CY 2014 proposed OPPS and ASC payment rates were developed, and discovered that in the process of applying our established and proposed methodologies to develop the CY 2014 proposed OPPS and ASC payment rates, specific cost estimation errors occurred in the OPPS modeling process. The errors resulting from the cost modeling used to develop the CY 2014 proposed OPPS payment rates are isolated to a few specific ambulatory payment classifications (APCs). However, because the OPPS is a budget neutral payment system, there is a resulting impact on other proposed OPPS payment rates. The technical errors corrected in this document do not implicate any of the proposed methodologies or other proposed policies described in the CY 2014 OPPS/ASC proposed rule. In the CY 2014 OPPS/ASC proposed rule, we proposed to continue our policy of basing the ASC relative payment weights and rates on APC groups and the OPPS relative payment weights, and because this document corrects technical errors related to cost modeling conducted in developing the proposed OPPS relative payment weights, the proposed CY 2014 ASC relative payment weights are being corrected. As we noted previously, the technical errors corrected in this document do not implicate any of the proposed methodologies or other proposed policies described in the CY 2014 OPPS/ASC proposed rule. II. Limited Extension of Comment Period We are extending the comment period, for the limited purpose of providing the public an opportunity to comment on the technical corrections noted in this correcting document, for an additional 10 days, to September 16, 2013. PO 00000 Frm 00054 Fmt 4702 Sfmt 4702 III. Summary of Errors and Corrections Posted on the CMS Web Site A. Outpatient Prospective Payment System Payment System Corrections In the CY 2014 OPPS/ASC proposed rule, we announced a number of proposals that would affect the CY 2014 OPPS. One of the policy changes we proposed was a reconfiguration of how the visit APCs would be coded and paid in the CY 2014 OPPS (78 FR 43614). Separately, for the CY 2014 OPPS, we proposed to package certain clinical diagnostic laboratory tests that were previously paid to hospitals at the Clinical Lab Fee Schedule payment rates (78 FR 43572). Following the standard methodology we use to develop OPPS payment rates described in the proposed rule, we modeled the relevant data to develop the proposed new visit APCs (78 FR 43615 through 43616). Subsequently, in reviewing how the cost modeling occurred in developing the proposed new visit APCs contained in the CY 2014 OPPS/ASC proposed rule, we discovered that a programming error caused the packaged costs associated with the CY 2014 clinical diagnostic laboratory test packaging proposal to be excluded. To accurately reflect the interaction of these two CY 2014 OPPS proposed policies, in this correcting document, we have fixed this programming issue and developed proposed APC relative payment weights for the following proposed new visit APCs: 0634 (Hospital Clinic Visits), 0635 (Type A Emergency Visits), and 0636 (Type B Emergency Visits). As a result of the proposed coding and payment changes to the visit APCs, we proposed a new composite APC 8009 (Extended Assessment and Management Composite) for the CY 2014 OPPS (78 FR 43562 through 43563). Additionally, we proposed to expand the line item trim to also include clinical diagnostic laboratory tests that did not receive payment in the claims year in our cost modeling process for the CY 2014 OPPS (78 FR 43551). Upon reviewing the cost data used to develop this proposed APC, we discovered that the line item trim was not correctly applied to the proposed new composite APC 8009 in our cost modeling process. In this correcting document, we are correctly applying the proposed line item trim for clinical diagnostic laboratory tests that did not receive payment in the claims year in estimating the costs associated with proposed new composite APC 8009. For the CY 2014 OPPS, we proposed to recognize the CPT codes for stereotactic radiosurgery (77371, 77372, E:\FR\FM\06SEP1.SGM 06SEP1 ehiers on DSK2VPTVN1PROD with PROPOSALS-1 Federal Register / Vol. 78, No. 173 / Friday, September 6, 2013 / Proposed Rules and 77373) while no longer recognizing the G-codes that had previously been used to identify certain stereotactic radiosurgery services (G0173, G0251, G0339, and G0340) (78 FR 43593 through 43594). However, following our established and proposed methodologies, in developing the estimated costs on which the proposed CY 2014 OPPS payment rates were based, we neglected to include the data from those G-codes in calculating the proposed geometric mean costs of the stereotactic radiosurgery APCs. In this correcting document, we have included the claims data from those G-codes in calculating the proposed APC relative payment weights for the proposed stereotactic radiosurgery APCs 0066 (Level I Stereotactic Radiosurgery) and 0067 (Level II Stereotactic Radiosurgery). In our review, we also discovered an error with the calculation of the proposed CY 2014 budget neutrality adjustment factor used to calculate the proposed CY 2014 cancer hospital payment adjustment. As noted in the CY 2014 OPPS/ASC proposed rule, the proposed CY 2014 budget neutrality adjustment factor is calculated by comparing the estimated total CY 2014 OPPS payments including the proposed CY 2014 cancer hospital payment adjustment to the estimated total CY 2014 OPPS payments using the CY 2013 cancer hospital payment adjustment. We miscalculated the proposed CY 2014 cancer hospital adjustment payment weights for purposes of this comparison when converting estimated CY 2014 cancer hospital adjustment payments into payment weights. Correctly developing this proposed CY 2014 cancer hospital adjustment payment weight for this comparison requires a corresponding correction to the proposed budget neutrality adjustment associated with the proposed CY 2014 cancer hospital payment adjustment from the 1.0001 published in the CY 2014 OPPS/ASC proposed rule (78 FR 43577) to 1.0003. As a result of the correction to the proposed CY 2014 cancer hospital payment adjustment for budget neutrality, the proposed CY 2014 OPPS conversion factor is also corrected in this correcting document from the $72.728 published in the CY 2014 OPPS/ASC proposed rule (78 FR 43578) to $72.743. While the technical corrections described previously are generally isolated to specific APCs, because the OPPS is a budget neutral payment system, we recalculated the proposed CY 2014 budget neutral weight scaler. As discussed in the CY 2014 OPPS/ASC proposed rule, the budget neutral VerDate Mar<15>2010 14:34 Sep 05, 2013 Jkt 229001 weight scaler is calculated by comparing aggregate CY 2013 OPPS payment weight to unscaled aggregate CY 2014 OPPS payment weight. As a result of the technical corrections previously described, several of the estimated costs on which the proposed unscaled CY 2014 payment weights are developed require correlating corrections. Those corrections to the proposed payment weights then affect the proposed aggregate unscaled CY 2014 OPPS payment weights which are then used to determine the appropriate proposed budget neutrality adjustment. Using the corrected proposed unscaled relative payment weights, the proposed CY 2014 budget neutrality weight scaler changes from 1.2143 as originally proposed (see 78 FR 43576) to 1.3315. As previously stated, the technical corrections discussed previously result in corrections to the proposed OPPS relative payment weights and the proposed CY 2014 OPPS conversion factor, both of which are used to calculate the proposed CY 2014 OPPS payment rates. Outlier payments are made based on the relationship between APC payments and estimated cost, so corrections to the proposed APC payment rates would affect the appropriate fixed-dollar outlier threshold applied to achieve the estimated OPPS outlier spending target of 1.0 percent (78 FR 43583 through 43584). Using the corrected proposed CY 2014 OPPS relative payment weights and conversion factor, the proposed CY 2014 OPPS/ASC fixed-dollar outlier threshold changes from $2,775, as originally proposed (see 78 FR 43583 through 43584), to $2,900. We are also making technical corrections to Table 39—Estimated Impact of the Proposed CY 2014 Changes for the Hospital Outpatient Prospective Payments System (78 FR 43692) and the correlating preamble language (78 FR 43689). As noted previously, because the OPPS is a budget neutral system, and while the impact of the technical corrections discussed previously on APC payment is generally concentrated within specific APCs that were modified for significant proposals in CY 2014, there are resulting technical corrections necessary with respect to all other proposed CY 2014 OPPS payment weights and rates within the system. The corrections to this impact table (78 FR 43692) relative to the impact table originally published in the CY 2014 OPPS/ASC proposed rule correspond to the case mix of services furnished by providers and how they are affected by the technical corrections in this document. PO 00000 Frm 00055 Fmt 4702 Sfmt 4702 54843 B. Ambulatory Surgical Center Payment System Corrections ASC payment rates are based on the OPPS relative payment weights for the majority of items and services that are provided at ASCs. Therefore, corrections to the proposed CY 2014 OPPS relative payment weights also have an impact on the proposed CY 2014 ASC relative payment weights and ASC payment rates. Due to the corrections made to the proposed CY 2014 OPPS relative payment weights, we recalculated the proposed CY 2014 budget neutral ASC weight scaler (see 78 FR 43640 and 43641). Using the proposed corrected scaled CY 2014 OPPS relative weights, the proposed CY 2014 budget neutrality ASC weight scaler changes from 0.8961, as originally proposed (78 FR 43641), to 0.9102. The corrected proposed CY 2014 ASC relative payment weights and the proposed CY 2014 budget neutral ASC weight scaler have no impact on the proposed CY 2014 ASC conversion factor. C. Summary of Errors in and Corrections to Addenda Posted on the CMS Web Site 1. Outpatient Prospective Payment System Payment System Addenda We are making several minor technical corrections to the OPPS addenda. We are correcting the OPPS status indicators for CPT codes 93619, 93620 and 93650 to ‘‘J1’’ to accurately reflect our CY 2014 proposal to establish APC 0085 as a comprehensive APC. We are also correcting the displayed assignment of CPT code 33233 to APC 0106 to fix a discrepancy between our addenda and the cost statistics files we make available to the public. As a result of these corrections, Addendum A, B, C, and M will also be corrected. To view the corrected proposed CY 2014 OPPS payment rates that result from the corrected geometric mean costs and other technical corrections, we refer readers to the Addenda and supporting files that are posted on the CMS Web site at: https://www.cms.gov/Medicare/ Medicare-Fee-for-Service-Payment/ HospitalOutpatientPPS/. Select ‘‘CMS–1601–CN’’ from the list of regulations. All corrected Addenda for this correcting document are contained in the zipped folder entitled, ‘‘2014 OPPS NPRM Addenda’’ at the bottom of the page for CMS–1601–CN. The corrected CY 2014 OPPS file of geometric mean costs is found under supporting documentation for CMS– 1601–CN. E:\FR\FM\06SEP1.SGM 06SEP1 54844 Federal Register / Vol. 78, No. 173 / Friday, September 6, 2013 / Proposed Rules 2. Ambulatory Surgical Center Payment System Addenda To view the corrected proposed CY 2014 ASC payment rates that result from the corrected proposed CY 2014 ASC relative payment weights, see the ASC addenda that are posted on the CMS Web site at: https://www.cms.gov/ Medicare/Medicare-Fee-for-ServicePayment/ASCPayment/ASCRegulations-and-Notices.html. Select ‘‘CMS–1601–CN’’ from the list of regulations. All corrected ASC addenda for this correcting document are contained in the zipped folder entitled ‘‘Addendum AA, BB, DD1, DD2, and EE’’ at the bottom of the page for CMS– 1601–CN. IV. Waiver of 60-Day Comment Period We ordinarily permit a 60-day comment period on notices of proposed rulemaking in the Federal Register, as provided in section 1871(b)(1) of the Act. However, this period may be shortened, as provided under section 1871(b)(2)(C) of the Act, when the Secretary finds good cause that a 60-day comment period would be impracticable, unnecessary, or contrary to the public interest and incorporates a statement of the finding and its reasons in the rule issued. Because the corrections in this document do not make any changes to the substantive policies proposed in the CY 2014 OPPS/ ASC proposed rule, but merely correct underlying data errors that impact certain components of the payment systems to conform to the proposed policies clearly intended in the preamble of the proposed rule, this correcting document does not constitute agency rulemaking, and therefore the 60-day comment period does not apply. In addition, we believe it is important for the public to have the corrected information as soon as possible and find no reason to delay dissemination of it. For the reasons stated previously, we find it both unnecessary and contrary to the public interest to undertake further notice and comment procedures with respect to this correcting document. V. Correction of Errors In FR Doc. 2013–16555 of July 19, 2013 (78 FR 43534), make the following corrections: 1. On page 43562, third column, first full paragraph, in line 4, the figure ‘‘$1,357’’ is corrected to read ‘‘$1,348’’. ■ 2. On page 43571, ■ a. Table 8—CY 2013 Separate Payment Versus CY 2014 Proposed Packaged Payment For MPI, the table is corrected to read as follows: ■ TABLE 8—CY 2013 SEPARATE PAYMENT VERSUS CY 2014 PROPOSED PACKAGED PAYMENT FOR MPI Service or supply CY 2013 Separate payment for MPI components CY 2013 Separate payment for MPI components CY 2013 Separate payment for MPI components CY 2013 Separate payment for MPI components CY 2014 Proposed packaged payment for MPI 78452 .................................................................... 93017 .................................................................... Exercise or Stress Agent ¥ .................................... Radiopharmaceutical ............................................ $680 ................. $177 ................. Exercise—$0 .... P ....................... $680 ................. $177 ................. J1245–P ........... P ....................... $680 ................. $177 ................. J2785–$215 ...... P ....................... $680 ................. $177 ................. J0152–$219* .... P ....................... $1,216 PÖ P P Total ............................................................... $857 ................. $857 ................. $1,072 .............. $1,076 .............. $1,216 P = Packaged. Ö The stress test described by CPT code 93017 is proposed to be conditionally packaged as a result of the proposal described below to conditionally package ancillary services. ¥ April 2013 ASP Drug Pricing File. * 70 kg patient. b. First column, first paragraph, in line 4, the figure ‘‘14’’ is corrected to read ‘‘12’’. ■ 3. On page 43576, third column, second full paragraph, in line 17, the figure ‘‘1.2143’’ is corrected to read ‘‘1.3315’’. ■ 4. On page 43577, third column, third full paragraph, in line 27, the figure ‘‘1.0001’’ is corrected to read ‘‘1.0003’’. ■ 5. On page 43578, ■ a. First column, ■ (1) First full paragraph, ■ (a) In line 13, the figure ‘‘1.0001’’ is corrected to read ‘‘1.0003’’. ■ (b) In line 18, the figure ‘‘$72.728’’ is corrected to read ‘‘$72.743’’. ■ (2) Second full paragraph, in line 34, the figure ‘‘$71.273’’ is corrected to read ‘‘$71.288’’. ■ b. Second column, first paragraph, ■ (1) In line 3, the figure ‘‘$72.728’’ is corrected to read ‘‘$72.743’’. ■ (2) In line 16, the figure ‘‘$71.273’’ is corrected to read ‘‘$71.288’’. ■ 6. On page 43584, ■ a. First column, under the heading ‘‘2. Proposed Outlier Calculation’’, second ehiers on DSK2VPTVN1PROD with PROPOSALS-1 ■ VerDate Mar<15>2010 14:34 Sep 05, 2013 Jkt 229001 paragraph, in line 11, the figure ‘‘$2,775’’ is corrected to read ‘‘$2,900’’. ■ b. Third column, first partial paragraph, ■ (1) In line 8, the figure ‘‘$2,775’’ is corrected to read ‘‘$2,900’’. ■ (2) In line 21, the figure ‘‘$2,775’’ is corrected to read ‘‘$2,900’’. ■ 7. On page 43586, ■ a. First column, in the fourth full paragraph, ■ (1) In line 17, the figure ‘‘$345.75’’ is corrected to read ‘‘$340.56’’. ■ (2) In line 21, the figure ‘‘$338.84’’ is corrected to read ‘‘$333.75’’. ■ (3) In line 30, the figure ‘‘$272.96’’ is corrected to read ‘‘$268.87’’ and the figure ‘‘$345.75’’ is corrected to read ‘‘$340.56’’. ■ (4) In line 33, the figure ‘‘$267.51’’ is corrected to read ‘‘$263.49’’. ■ (5) In line 34, the figure ‘‘$338.84’’ is corrected to read ‘‘$333.75’’. ■ (6) In line 37, the figure ‘‘$138.30’’ is corrected to read ‘‘$133.50’’ and ‘‘$345.75’’ is corrected to read ‘‘$340.56’’. PO 00000 Frm 00056 Fmt 4702 Sfmt 4702 b. Second column, first partial paragraph, ■ (1) In line 2, the figure ‘‘$135.54’’ is corrected to read ‘‘$133.50’’. ■ (2) In line 3, the figure ‘‘$338.84’’ is corrected to read ‘‘$333.75’’. ■ (3) In line 6, the figure ‘‘$411.26’’ is corrected to read ‘‘$405.09’’ and ‘‘$272.96’’ is corrected to read ‘‘$268.87’’. ■ (4) In line 7, the figure ‘‘$138.30’’ is corrected to read ‘‘$136.22’’. ■ (5) In line 9, the figure ‘‘$403.05’’ is corrected to read ‘‘$396.99’’ and ‘‘$267.51’’ is corrected to read ‘‘$263.49’’. ■ (6) In line 10, the figure ‘‘$135.54’’ is corrected to read ‘‘$133.50’’. ■ c. Third column, under the heading ‘‘3. Proposed Calculation of an Adjusted Copayment Amount for an APC Group’’, second full paragraph, ■ (1) In line 6, the figure ‘‘$69.15’’ is corrected to read ‘‘$68.12’’. ■ (2) In line 8, the figure ‘‘$345.75’’ is corrected to read ‘‘$340.56’’. ■ 8. On page 43590, Table 14—New Category III CPT Codes Implemented In ■ E:\FR\FM\06SEP1.SGM 06SEP1 54845 Federal Register / Vol. 78, No. 173 / Friday, September 6, 2013 / Proposed Rules July 2013, the fifth column titled, ‘‘Proposed CY 2014 Payment Rate’’ is corrected to read as follows: TABLE 14—NEW CATEGORY III CPT CODES IMPLEMENTED IN JULY 2013 Proposed CY 2014 status indicator CY 2013 CPT Code CY 2013 Long descriptor 0329T .......... Proposed CY 2014 APC Proposed CY 2014 payment rate E N/A N/A S S 0230 0398 $51.05 391.36 S 0398 391.36 E T N/A 0208 N/A 4,108.96 Monitoring of intraocular pressure for 24 hours or longer, unilateral or bilateral, with interpretation and report. Tear film imaging, unilateral or bilateral, with interpretation and report ............ Myocardial sympathetic innervation imaging, planar qualitative and quantitative assessment. Myocardial sympathetic innervation imaging, planar qualitative and quantitative assessment; with tomographic SPECT. Visual evoked potential, screening of visual acuity, automated ........................ Sacroiliac joint stabilization for arthrodesis, percutaneous or minimally invasive (indirect visualization), includes obtaining and applying autograft or allograft (structural or morselized), when performed, includes image guidance when performed (that is, CT or fluoroscopic). 0330T .......... 0331T .......... 0332T .......... 0333T .......... 0334T .......... 9. On page 43630, Table 34–New Level II HCPCS Codes for Covered Surgical Procedures or Covered Ancillary Services Implemented in July ■ 2013, the table is corrected to read as follows: TABLE 34—NEW LEVEL II HCPCS CODES FOR COVERED SURGICAL PROCEDURES OR COVERED ANCILLARY SERVICES IMPLEMENTED IN JULY 2013 Proposed CY 2014 payment indicator CY 2013 HCPCS Code CY 2013 Long descriptor C9131 ............. C9736 ............. Injection, ado-trastuzumab emtansine, 1 mg ............................................................................. Laparoscopy, surgical, radiofrequency ablation of uterine fibroid(s), including intraoperative guidance and monitoring, when performed. Influenza Vaccine, Recombinant Himagglutinin Antigens, for Intramuscular Use (Flublok) ..... Injection, Doxorubicin Hydrochloride, Liposomal, Not Otherwise Specified, 10 mg .................. Injection, Zoledronic Acid, Not Otherwise Specified, 1 mg ........................................................ Q2033 ............. Q2050 * ........... Q2051 * ........... Proposed CY 2014 payment rate K2 G2 $29.40 2,010.57 L1 K2 K2 N/A 545.44 196.42 * Note: HCPCS code Q2050 replaced code J9002 and HCPCS code Q2051 replaced HCPCS codes J3487 and J3488 beginning July 1, 2013. 10. On page 43631, Table 35–New Category III CPT Codes Implemented in July 2013 as ASC Covered Ancillary ■ Services, the table is corrected to read as follows: TABLE 35—NEW CATEGORY III CPT CODES IMPLEMENTED IN JULY 2013 AS ASC COVERED ANCILLARY SERVICES Proposed CY 2014 payment indicator CY 2013 CPT Code CY 2013 Long descriptor 0331T .............. 0332T .............. Myocardial sympathetic innervation imaging, planar qualitative and quantitative assessment Myocardial sympathetic innervation imaging, planar qualitative and quantitative assessment; with tomographic SPECT. 11. On page 43641, first column, first partial paragraph, in line 12, the figure ‘‘0.8961’’ is corrected to read ‘‘0.9102’’. ■ 12. On page 43652, third column, first partial paragraph, ehiers on DSK2VPTVN1PROD with PROPOSALS-1 ■ VerDate Mar<15>2010 14:34 Sep 05, 2013 Jkt 229001 a. In line 6, the figure ‘‘$71.273’’ is corrected to read ‘‘$71.288’’. ■ b. In line 7, the figure ‘‘$72.728’’ is corrected to read ‘‘$72.743’’. ■ 13. On pages 43692 through 43693, Table 39—Estimated Impact of the ■ PO 00000 Frm 00057 Fmt 4702 Sfmt 4702 Proposed CY 2014 payment rate Z2 Z2 $212.14 $212.14 Proposed CY 2014 Changes for the Hospital Outpatient Prospective Payment System, the table is corrected to read as follows: E:\FR\FM\06SEP1.SGM 06SEP1 54846 Federal Register / Vol. 78, No. 173 / Friday, September 6, 2013 / Proposed Rules TABLE 39—ESTIMATED IMPACT OF THE PROPOSED CY 2014 CHANGES FOR THE HOSPITAL OUTPATIENT PROSPECTIVE PAYMENT SYSTEM ALL FACILITIES * ............ ALL HOSPITALS ............. (excludes hospitals permanently held harmless and CMHCs) URBAN HOSPITALS ....... LARGE URBAN (GT 1 MILL.) ................. OTHER URBAN (LE 1 MILL.) ................. RURAL HOSPITALS ........ SOLE COMMUNITY OTHER RURAL ........ BEDS (URBAN) 0–99 BEDS ............... 100–199 BEDS ......... 200–299 BEDS ......... 300–499 BEDS ......... 500 + BEDS .............. BEDS (RURAL) 0–49 BEDS ............... 50–100 BEDS ........... 101–149 BEDS ......... 150–199 BEDS ......... 200 + BEDS .............. VOLUME (URBAN) LT 5,000 Lines .......... 5,000–10,999 Lines .. 11,000–20,999 Lines 21,000–42,999 Lines 42,999–89,999 Lines GT 89,999 Lines ....... VOLUME (RURAL) LT 5,000 Lines .......... 5,000–10,999 Lines .. 11,000–20,999 Lines 21,000–42,999 Lines GT 42,999 Lines ....... REGION (URBAN) NEW ENGLAND ....... MIDDLE ATLANTIC .. SOUTH ATLANTIC ... EAST NORTH CENT. EAST SOUTH CENT. WEST NORTH CENT. .................... WEST SOUTH CENT. .................... MOUNTAIN ............... PACIFIC .................... PUERTO RICO ......... REGION (RURAL) NEW ENGLAND ....... MIDDLE ATLANTIC .. SOUTH ATLANTIC ... EAST NORTH CENT. EAST SOUTH CENT. WEST NORTH CENT. .................... WEST SOUTH CENT. .................... MOUNTAIN ............... PACIFIC .................... TEACHING STATUS NON–TEACHING ..... MINOR ...................... VerDate Mar<15>2010 14:34 Sep 05, 2013 APC recalibration (all changes) (%) New wage index and provider adjustments (%) Combined cols 2,3 with market basket update Column 4 with frontier wage index adjustment (%) All proposed changes (%) (1) ehiers on DSK2VPTVN1PROD with PROPOSALS-1 Number of hospitals (2) (3) (4) (5) (6) 3,953 3,791 0.0 0.0 0.0 0.0 1.8 1.8 1.9 1.9 1.8 1.8 2,859 0.0 0.0 1.9 2.0 1.9 1,566 0.3 0.2 2.3 2.3 2.3 1,293 932 389 543 ¥0.3 ¥0.3 0.3 ¥0.8 ¥0.1 ¥0.3 ¥0.3 ¥0.2 1.4 1.3 1.9 0.8 1.7 1.5 2.3 0.9 1.5 1.4 1.9 0.8 959 831 454 407 208 0.1 ¥0.2 ¥0.4 0.1 0.4 0.1 ¥0.1 0.0 0.0 0.2 1.9 1.5 1.4 1.9 2.4 2.1 1.6 1.6 2.1 2.4 2.0 1.6 1.5 2.0 2.4 352 342 133 61 44 ¥0.7 0.4 ¥0.6 ¥1.0 ¥0.3 ¥0.6 ¥0.1 ¥0.5 ¥0.1 ¥0.2 0.6 2.1 0.8 0.7 1.3 0.8 2.4 1.0 1.1 1.3 0.6 2.2 0.9 0.7 1.5 485 109 132 262 517 1,354 ¥0.5 0.3 0.1 ¥0.1 0.2 0.0 0.2 –0.1 0.0 ¥0.2 0.1 0.0 1.5 1.9 1.9 1.5 2.1 1.9 1.7 2.4 2.1 1.6 2.1 2.0 1.6 1.4 1.9 1.6 2.1 1.9 31 34 67 182 618 0.1 2.1 1.8 0.8 ¥0.4 ¥0.4 ¥0.5 ¥0.7 ¥0.3 ¥0.2 1.5 3.3 2.8 2.3 1.2 6.1 3.4 3.0 2.9 1.4 1.6 3.4 2.7 2.2 1.3 150 342 432 459 172 1.1 0.2 ¥0.5 ¥0.1 ¥0.5 0.6 0.7 ¥0.3 ¥0.2 ¥0.3 3.5 2.7 1.0 1.5 1.0 3.5 2.7 1.0 1.5 1.0 3.4 2.7 1.1 1.5 1.1 193 1.7 ¥0.3 3.1 4.3 3.3 487 194 385 45 ¥1.1 0.5 0.3 4.2 ¥0.2 ¥0.3 0.6 0.6 0.6 2.0 2.7 6.6 0.6 2.3 2.7 6.6 0.7 2.0 2.6 7.0 25 68 158 124 170 2.7 ¥1.3 ¥1.0 ¥0.9 ¥0.9 0.6 ¥0.3 ¥0.4 ¥0.4 ¥0.6 5.1 0.3 0.4 0.5 0.3 5.1 0.3 0.4 0.5 0.3 5.0 0.3 0.5 0.6 0.5 99 1.0 ¥0.1 2.7 3.9 2.8 196 63 29 ¥0.7 0.4 2.4 ¥0.4 0.2 0.7 0.7 2.5 4.9 0.8 4.0 5.0 0.9 2.0 5.0 2,792 686 ¥0.5 ¥0.2 ¥0.1 0.0 1.2 1.6 1.3 1.9 1.3 1.7 Jkt 229001 PO 00000 Frm 00058 Fmt 4702 Sfmt 4702 E:\FR\FM\06SEP1.SGM 06SEP1 Federal Register / Vol. 78, No. 173 / Friday, September 6, 2013 / Proposed Rules 54847 TABLE 39—ESTIMATED IMPACT OF THE PROPOSED CY 2014 CHANGES FOR THE HOSPITAL OUTPATIENT PROSPECTIVE PAYMENT SYSTEM—Continued Number of hospitals New wage index and provider adjustments (%) Combined cols 2,3 with market basket update Column 4 with frontier wage index adjustment (%) All proposed changes (%) (1) MAJOR ..................... DSH PATIENT PERCENT 0 ................................ GT 0–0.10 ................. 0.10–0.16 .................. 0.16–0.23 .................. 0.23–0.35 .................. GE 0.35 ..................... DSH NOT AVAILABLE ** .................. URBAN TEACHING/DSH TEACHING & DSH ... NO TEACHING/DSH NO TEACHING/NO DSH ....................... DSH NOT AVAILABLE ** .................. TYPE OF OWNERSHIP VOLUNTARY ............ PROPRIETARY ........ GOVERNMENT ........ CMHCs ............................. APC recalibration (all changes) (%) (2) (3) (4) (5) (6) 313 1.2 0.2 3.2 3.2 3.1 12 349 334 680 1,045 831 ¥1.3 0.1 0.0 0.0 0.0 ¥0.1 ¥0.1 0.1 0.1 0.0 0.0 0.0 0.4 2.0 1.9 1.8 1.8 1.7 0.4 2.1 2.1 2.0 1.9 1.7 0.2 2.0 2.0 1.9 1.8 1.7 540 1.7 0.0 3.5 3.5 3.2 909 1,429 0.4 ¥0.6 0.1 0.0 2.3 1.2 2.5 1.3 2.3 1.3 12 ¥1.3 ¥0.1 0.4 0.4 0.2 509 1.6 0.1 3.5 3.6 3.2 2,004 1,250 537 100 0.1 ¥0.5 ¥0.3 ¥7.1 0.1 ¥0.1 ¥0.2 ¥0.2 2.0 1.2 1.3 ¥5.6 2.2 1.3 1.3 ¥5.5 2.1 1.2 1.4 ¥5.2 Column (1) shows total hospitals and/or CMHCs. Column (2) includes all CY 2014 OPPS proposals and compares those to the CY 2013 OPPS (which includes outpatient lab services previously paid at CLFS rates). Column (3) shows the budget neutral impact of updating the wage index by applying the FY 2014 hospital inpatient wage index. The proposed rural adjustment continues our current policy of 7.1 percent so the budget neutrality factor is 1. Similarly, the differential in estimated cancer hospital payments for the proposed adjustment is minimal and thus results in a budget neutrality factor of 1.0003. Column (4) shows the impact of all budget neutrality adjustments and the proposed addition of the 1.8 percent OPD fee schedule update factor (2.5 percent reduced by 0.4 percentage points for the proposed productivity adjustment and further reduced by 0.3 percentage point in order to satisfy statutory requirements set forth in the Affordable Care Act). Column (5) shows the non-budget neutral impact of applying the frontier State wage adjustment. Column (6) shows the additional adjustments to the conversion factor resulting from a change in the pass-through estimate, adding estimated outlier payments, and applying payment wage indexes. * These 3,953 providers include children and cancer hospitals, which are held harmless to pre-BBA amounts, and CMHCs. Payments for lab services at CLFS rates, which we are proposing to package in the CY 2014 OPPS, are included in the columns where appropriate. ** Complete DSH numbers are not available for providers that are not paid under IPPS, including rehabilitation, psychiatric, and long-term care hospitals. 14. On page 43696, a. First column, first full paragraph, in line 9, the figure ‘‘0.8961’’ is corrected to read ‘‘0.9102’’. ■ b. Third column, ■ ■ (1) Fourth paragraph, in line 8, the phrase ‘‘a 1 percent increase’’ is corrected to read ‘‘no change’’. ■ (2) Fifth paragraph, in line 13, the phrase ‘‘7 percent’’ is corrected to read ‘‘8 percent’’. 15. On page 43697, Table 40— Estimated Impact of the Proposed CY 2014 Update to the ASC Payment System on Aggregate CY 2014 Medicare Program Payments by Surgical Specialty or Ancillary Items and Services Group, the table is corrected to read as follows: ■ TABLE 40—ESTIMATED IMPACT OF THE PROPOSED CY 2014 UPDATE TO THE ASC PAYMENT SYSTEM ON AGGREGATE CY 2014 MEDICARE PROGRAM PAYMENTS BY SURGICAL SPECIALTY OR ANCILLARY ITEMS AND SERVICES GROUP Estimated CY 2013 ASC payments (in millions) (2) ehiers on DSK2VPTVN1PROD with PROPOSALS-1 Surgical specialty group (1) Total ................................................................................................................................................................. Eye and ocular adnexa .................................................................................................................................... Digestive system .............................................................................................................................................. Nervous system ............................................................................................................................................... Musculoskeletal system ................................................................................................................................... Genitourinary system ....................................................................................................................................... Integumentary system ..................................................................................................................................... Respiratory system .......................................................................................................................................... Cardiovascular system .................................................................................................................................... Ancillary items and services ............................................................................................................................ VerDate Mar<15>2010 14:34 Sep 05, 2013 Jkt 229001 PO 00000 Frm 00059 Fmt 4702 Sfmt 4702 E:\FR\FM\06SEP1.SGM $3,625 1,496 743 540 441 159 130 46 32 20 06SEP1 Estimated CY 2014 percent change (3) 1% ¥3 8 0 ¥1 5 8 7 ¥3 ¥12 54848 Federal Register / Vol. 78, No. 173 / Friday, September 6, 2013 / Proposed Rules TABLE 40—ESTIMATED IMPACT OF THE PROPOSED CY 2014 UPDATE TO THE ASC PAYMENT SYSTEM ON AGGREGATE CY 2014 MEDICARE PROGRAM PAYMENTS BY SURGICAL SPECIALTY OR ANCILLARY ITEMS AND SERVICES GROUP— Continued Estimated CY 2013 ASC payments (in millions) (2) Surgical specialty group (1) Auditory system ............................................................................................................................................... Hematologic & lymphatic systems ................................................................................................................... 16. On pages 43697 through 43698, Table 41—Estimated Impact of the Proposed CY 2014 Update to the ASC Payment System on Aggregate Payments ■ Estimated CY 2014 percent change (3) 12 5 4 17 for Selected Procedures, the table is corrected to read as follows: TABLE 41—ESTIMATED IMPACT OF THE PROPOSED CY 2014 UPDATE TO THE ASC PAYMENT SYSTEM ON AGGREGATE PAYMENTS FOR SELECTED PROCEDURES Estimated CY 2013 ASC payments (in millions) (3) CPT/HCPCS code * (1) Short descriptor (2) 66984 .............................. 43239 .............................. 45380 .............................. 45385 .............................. 66982 .............................. 45378 .............................. 64483 .............................. 62311 .............................. 66821 .............................. G0105 ............................. 15823 .............................. 64493 .............................. 63650 .............................. G0121 ............................. 29827 .............................. 64590 .............................. 64721 .............................. 63685 .............................. 64636 ** .......................... 29881 .............................. 64635 .............................. 29880 .............................. 43235 .............................. 45384 .............................. 52000 .............................. 62310 .............................. 29823 .............................. 67042 .............................. 28285 .............................. 50590 .............................. Cataract surg w/iol, 1 stage ............................................................................... Upper GI endoscopy, biopsy .............................................................................. Colonoscopy and biopsy .................................................................................... Lesion removal colonoscopy .............................................................................. Cataract surgery, complex ................................................................................. Diagnostic colonoscopy ...................................................................................... Inj foramen epidural l/s ....................................................................................... Inject spine l/s (cd) ............................................................................................. After cataract laser surgery ................................................................................ Colorectal scrn; hi risk ind .................................................................................. Revision of upper eyelid ..................................................................................... Inj paravert f jnt l/s 1 lev ..................................................................................... Implant neuroelectrodes ..................................................................................... Colon ca scrn not hi rsk ind ............................................................................... Arthroscop rotator cuff repr ................................................................................ Insrt/redo pn/gastr stimul .................................................................................... Carpal tunnel surgery ......................................................................................... Insrt/redo spine n generator ............................................................................... Destroy l/s facet jnt addl ..................................................................................... Knee arthroscopy/surgery .................................................................................. Destroy lumb/sac facet jnt .................................................................................. Knee arthroscopy/surgery .................................................................................. Uppr gi endoscopy diagnosis ............................................................................. Lesion remove colonoscopy ............................................................................... Cystoscopy ......................................................................................................... Inject spine c/t .................................................................................................... Shoulder arthroscopy/surgery ............................................................................ Vit for macular hole ............................................................................................ Repair of hammertoe .......................................................................................... Fragmenting of kidney stone .............................................................................. Estimated CY 2014 percent change (4) $1,107 163 154 98 89 80 79 71 59 42 40 40 39 36 34 33 31 31 31 30 26 25 23 22 21 20 19 19 18 18 ¥3% 13 7 7 ¥3 7 14 14 ¥1 1 2 14 3 1 5 4 ¥1 4 ¥100 ¥3 73 ¥3 13 7 5 14 5 0 5 2 * Note that HCPCS codes we are proposing to delete for CY 2014 are not displayed in this table. ** The 100 decrease in estimated payment reflects our CY 2014 proposal to package the payment for CPT code 64636. ehiers on DSK2VPTVN1PROD with PROPOSALS-1 (Catalog of Federal Domestic Assistance Program No. 93.778, Medical Assistance Program); (Catalog of Federal Domestic Assistance Program No. 93.773, Medicare— Hospital Insurance; and Program No. 93.774, Medicare—Supplementary Medical Insurance Program) Dated: September 4, 2013. Jennifer M. Cannistra, Executive Secretary to the Department, Department of Health and Human Services. [FR Doc. 2013–21849 Filed 9–5–13; 8:45 am] BILLING CODE 4120–01–P VerDate Mar<15>2010 17:58 Sep 05, 2013 Jkt 229001 PO 00000 Frm 00060 Fmt 4702 Sfmt 4702 E:\FR\FM\06SEP1.SGM 06SEP1 Federal Register / Vol. 78, No. 173 / Friday, September 6, 2013 / Proposed Rules DEPARTMENT OF TRANSPORTATION Pipeline and Hazardous Materials Safety Administration 49 CFR Parts 173, 174, 178, 179, and 180 [Docket No. PHMSA–2012–0082 (HM–251)] RIN 2137–AE91 Hazardous Materials: Rail Petitions and Recommendations To Improve the Safety of Railroad Tank Car Transportation (RRR) Pipeline and Hazardous Materials Safety Administration (PHMSA), DOT. ACTION: Advance Notice of Proposed Rulemaking (ANPRM). AGENCY: PHMSA is considering revisions to the Hazardous Materials Regulations (HMR) to improve the regulations applicable to the transportation of hazardous materials by rail. The revisions are based on eight petitions received from the regulated community and four National Transportation Safety Board (NTSB) Recommendations which are referenced by a petition. In this ANPRM, we outline the petitions and NTSB recommendations, identify a preliminary estimate of costs and benefits from the petitions, pose several questions, and solicit comments and data from the public. Under Executive Order 13563, Federal agencies were asked to periodically review existing regulations. The questions posed in this ANPRM and responses by commenters will be used in conjunction with a retrospective review of existing requirements aimed to modify, streamline, expand, or repeal existing rules that are outmoded, ineffective, insufficient, or excessively burdensome. DATES: Comments must be received by November 5, 2013. ADDRESSES: You may submit comments identified by the docket number PHMSA–2012–0082 (HM–251) and the relevant petition number by any of the following methods: • Federal eRulemaking Portal: https:// www.regulations.gov. Follow the instructions for submitting comments. • Fax: 1–202–493–2251. • Mail: Docket Management System; U.S. Department of Transportation, West Building, Ground Floor, Room W12–140, Routing Symbol M–30, 1200 ehiers on DSK2VPTVN1PROD with PROPOSALS-1 SUMMARY: VerDate Mar<15>2010 17:58 Sep 05, 2013 Jkt 229001 New Jersey Avenue SE., Washington, DC 20590. • Hand Delivery: To the Docket Management System; Room W12–140 on the ground floor of the West Building, 1200 New Jersey Avenue SE., Washington, DC 20590, between 9 a.m. and 5 p.m., Monday through Friday, except Federal holidays. Instructions: All submissions must include the agency name and docket number for this notice at the beginning of the comment. To avoid duplication, please use only one of these four methods. All comments received will be posted without change to https:// www.regulations.gov and will include any personal information you provide. All comments received will be posted without change to the Federal Docket Management System (FDMS), including any personal information. Docket: For access to the dockets to read background documents or comments received, go to https:// www.regulations.gov or DOT’s Docket Operations Office located at U.S. Department of Transportation, West Building, Ground Floor, Room W12– 140, Routing Symbol M–30, 1200 New Jersey Avenue SE., Washington, DC 20590. Privacy Act: Anyone is able to search the electronic form of all comments received into any of our dockets by the name of the individual submitting the comments (or signing the comment, if submitted on behalf of an association, business, labor union, etc.). You may review DOT’s complete Privacy Act Statement in the Federal Register published on April 11, 2000 (Volume 65, Number 70; Pages 19477–78) which may be viewed at: https://www.gpo.gov/ fdsys/pkg/FR-2000-04-11/pdf/008505.pdf. Karl Alexy, (202) 493–6245, Office of Safety Assurance and Compliance, Federal Railroad Administration or Ben Supko, (202) 366–8553, Standards and Rulemaking Division, Pipeline and Hazardous Materials Safety Administration, U.S. Department of Transportation, 1200 New Jersey Ave. SE., Washington, DC 20590–0001. SUPPLEMENTARY INFORMATION: FOR FURTHER INFORMATION CONTACT: Table of Contents I. Executive Summary II. Background III. Review of Amendments Considered A. Petition P–1507 B. Petition P–1519 PO 00000 Frm 00061 Fmt 4702 Sfmt 4702 54849 C. Petition P–1547 D. Petition P–1548 E. Petition P–1577 F. Petition P–1587 G. Petition P–1595 H. Petition P–1612 IV. Regulatory Review and Notices A. Executive Order 12866, Executive Order 13563, Executive Order 13610, and DOT Regulatory Policies and Procedures B. Executive Order 13132 C. Executive Order 13175 D. Regulatory Flexibility Act, Executive Order 13272, and DOT Policies and Procedures E. Paperwork Reduction Act F. Environmental Assessment G. Privacy Act H. International Trade Analysis I. Statutory/Legal Authority for This Rulemaking J. Regulation Identifier Number (RIN) I. Executive Summary PHMSA has received eight petitions for rulemaking and four NTSB recommendations proposing amendments to the Hazardous Materials Regulations (HMR; 49 CFR parts 171– 180) applicable to the transportation of hazardous materials in commerce by rail. PHMSA is seeking public comments on whether the proposed amendments would enhance safety, revise, and clarify the HMR with regard to rail transport. Specifically, these amendments propose to: (1) Relax regulatory requirements to afford the Federal Railroad Administration (FRA) greater discretion to authorize the movement of non-conforming tank cars; (2) impose additional requirements that would correct an unsafe condition associated with pressure relief valves (PRV) on rail cars transporting carbon dioxide, refrigerated liquid; (3) relax regulatory requirements applicable to the repair and maintenance of DOT Specification 110, DOT Specification 106, and ICC 27 tank car tanks (ton tanks); (4) relax regulatory requirement for the removal of rupture discs for inspection if the removal process would damage, change, or alter the intended operation of the device; and (5) impose additional requirements that would enhance the standards for DOT Specification 111 tank cars used to transport Packing Group (PG) I and II hazardous materials. The NTSB recommendations directly relate to the enhancement of DOT Specification 111 tank cars. PHMSA looks forward to reviewing the public’s comments pertaining to the potential economic, E:\FR\FM\06SEP1.SGM 06SEP1

Agencies

[Federal Register Volume 78, Number 173 (Friday, September 6, 2013)]
[Proposed Rules]
[Pages 54842-54849]
From the Federal Register Online via the Government Printing Office [www.gpo.gov]
[FR Doc No: 2013-21849]

[[Page 54842]]

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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare & Medicaid Services

42 CFR Parts 405, 410, 412, 416, 419, 475, 476, 486, and 495

[CMS-1601-CN]
RIN 0938-AR54

Medicare and Medicaid Programs: Hospital Outpatient Prospective
Payment and Ambulatory Surgical Center Payment Systems and Quality
Reporting Programs; Hospital Value-Based Purchasing Program; Organ
Procurement Organizations; Quality Improvement Organizations;
Electronic Health Records (EHR) Incentive Program; Provider
Reimbursement Determinations and Appeals; Correction and Limited
Extension of Comment Period

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

ACTION: Correction and limited extension of comment period for proposed
rule.

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

SUMMARY: This document corrects technical errors that appeared in the
proposed rule published in the Federal Register on July 19, 2013,
entitled ``Medicare and Medicaid Programs: Hospital Outpatient
Prospective Payment and Ambulatory Surgical Center Payment Systems and
Quality Reporting Programs; Hospital Value-Based Purchasing Program;
Organ Procurement Organizations; Quality Improvement Organizations;
Electronic Health Records (EHR) Incentive Program; Provider
Reimbursement Determinations and Appeals.''
This document extends the comment period for 10 days for the
technical corrections set forth in this correcting document.

DATES: Comment Period: The comment period, for the technical
corrections set forth in this correcting document, is extended to 5
p.m. E.S.T. on September 16, 2013.

FOR FURTHER INFORMATION CONTACT: Erick Chuang, (410) 786-1816.

SUPPLEMENTARY INFORMATION:

I. Background

In FR. Doc. 2013-16555 of July 19, 2013 (78 FR 43534), (hereinafter
referred to as the CY 2014 OPPS/ASC proposed rule), there were a number
of technical errors that are discussed in the Summary of Errors, and
further identified and corrected in the Correction of Errors sections.
The CY 2014 OPPS/ASC proposed rule proposes to revise the Medicare
hospital outpatient prospective payment system (OPPS) and the Medicare
ambulatory surgical center (ASC) payment system for calendar year (CY)
2014 to implement applicable statutory requirements and policy changes.
In the CY 2014 OPPS/ASC proposed rule, we described proposed changes to
the amounts and factors used to determine the payment rates for
Medicare services paid under the OPPS and ASC payment system.
Since the publication of the CY 2014 OPPS/ASC proposed rule, we
have reviewed the data on which the CY 2014 proposed OPPS and ASC
payment rates were developed, and discovered that in the process of
applying our established and proposed methodologies to develop the CY
2014 proposed OPPS and ASC payment rates, specific cost estimation
errors occurred in the OPPS modeling process. The errors resulting from
the cost modeling used to develop the CY 2014 proposed OPPS payment
rates are isolated to a few specific ambulatory payment classifications
(APCs). However, because the OPPS is a budget neutral payment system,
there is a resulting impact on other proposed OPPS payment rates. The
technical errors corrected in this document do not implicate any of the
proposed methodologies or other proposed policies described in the CY
2014 OPPS/ASC proposed rule.
In the CY 2014 OPPS/ASC proposed rule, we proposed to continue our
policy of basing the ASC relative payment weights and rates on APC
groups and the OPPS relative payment weights, and because this document
corrects technical errors related to cost modeling conducted in
developing the proposed OPPS relative payment weights, the proposed CY
2014 ASC relative payment weights are being corrected. As we noted
previously, the technical errors corrected in this document do not
implicate any of the proposed methodologies or other proposed policies
described in the CY 2014 OPPS/ASC proposed rule.

II. Limited Extension of Comment Period

We are extending the comment period, for the limited purpose of
providing the public an opportunity to comment on the technical
corrections noted in this correcting document, for an additional 10
days, to September 16, 2013.

III. Summary of Errors and Corrections Posted on the CMS Web Site

A. Outpatient Prospective Payment System Payment System Corrections

In the CY 2014 OPPS/ASC proposed rule, we announced a number of
proposals that would affect the CY 2014 OPPS. One of the policy changes
we proposed was a reconfiguration of how the visit APCs would be coded
and paid in the CY 2014 OPPS (78 FR 43614). Separately, for the CY 2014
OPPS, we proposed to package certain clinical diagnostic laboratory
tests that were previously paid to hospitals at the Clinical Lab Fee
Schedule payment rates (78 FR 43572). Following the standard
methodology we use to develop OPPS payment rates described in the
proposed rule, we modeled the relevant data to develop the proposed new
visit APCs (78 FR 43615 through 43616). Subsequently, in reviewing how
the cost modeling occurred in developing the proposed new visit APCs
contained in the CY 2014 OPPS/ASC proposed rule, we discovered that a
programming error caused the packaged costs associated with the CY 2014
clinical diagnostic laboratory test packaging proposal to be excluded.
To accurately reflect the interaction of these two CY 2014 OPPS
proposed policies, in this correcting document, we have fixed this
programming issue and developed proposed APC relative payment weights
for the following proposed new visit APCs: 0634 (Hospital Clinic
Visits), 0635 (Type A Emergency Visits), and 0636 (Type B Emergency
Visits).
As a result of the proposed coding and payment changes to the visit
APCs, we proposed a new composite APC 8009 (Extended Assessment and
Management Composite) for the CY 2014 OPPS (78 FR 43562 through 43563).
Additionally, we proposed to expand the line item trim to also include
clinical diagnostic laboratory tests that did not receive payment in
the claims year in our cost modeling process for the CY 2014 OPPS (78
FR 43551). Upon reviewing the cost data used to develop this proposed
APC, we discovered that the line item trim was not correctly applied to
the proposed new composite APC 8009 in our cost modeling process. In
this correcting document, we are correctly applying the proposed line
item trim for clinical diagnostic laboratory tests that did not receive
payment in the claims year in estimating the costs associated with
proposed new composite APC 8009.
For the CY 2014 OPPS, we proposed to recognize the CPT codes for
stereotactic radiosurgery (77371, 77372,

[[Page 54843]]

and 77373) while no longer recognizing the G-codes that had previously
been used to identify certain stereotactic radiosurgery services
(G0173, G0251, G0339, and G0340) (78 FR 43593 through 43594). However,
following our established and proposed methodologies, in developing the
estimated costs on which the proposed CY 2014 OPPS payment rates were
based, we neglected to include the data from those G-codes in
calculating the proposed geometric mean costs of the stereotactic
radiosurgery APCs. In this correcting document, we have included the
claims data from those G-codes in calculating the proposed APC relative
payment weights for the proposed stereotactic radiosurgery APCs 0066
(Level I Stereotactic Radiosurgery) and 0067 (Level II Stereotactic
Radiosurgery).
In our review, we also discovered an error with the calculation of
the proposed CY 2014 budget neutrality adjustment factor used to
calculate the proposed CY 2014 cancer hospital payment adjustment. As
noted in the CY 2014 OPPS/ASC proposed rule, the proposed CY 2014
budget neutrality adjustment factor is calculated by comparing the
estimated total CY 2014 OPPS payments including the proposed CY 2014
cancer hospital payment adjustment to the estimated total CY 2014 OPPS
payments using the CY 2013 cancer hospital payment adjustment. We
miscalculated the proposed CY 2014 cancer hospital adjustment payment
weights for purposes of this comparison when converting estimated CY
2014 cancer hospital adjustment payments into payment weights.
Correctly developing this proposed CY 2014 cancer hospital adjustment
payment weight for this comparison requires a corresponding correction
to the proposed budget neutrality adjustment associated with the
proposed CY 2014 cancer hospital payment adjustment from the 1.0001
published in the CY 2014 OPPS/ASC proposed rule (78 FR 43577) to
1.0003. As a result of the correction to the proposed CY 2014 cancer
hospital payment adjustment for budget neutrality, the proposed CY 2014
OPPS conversion factor is also corrected in this correcting document
from the $72.728 published in the CY 2014 OPPS/ASC proposed rule (78 FR
43578) to $72.743.
While the technical corrections described previously are generally
isolated to specific APCs, because the OPPS is a budget neutral payment
system, we recalculated the proposed CY 2014 budget neutral weight
scaler. As discussed in the CY 2014 OPPS/ASC proposed rule, the budget
neutral weight scaler is calculated by comparing aggregate CY 2013 OPPS
payment weight to unscaled aggregate CY 2014 OPPS payment weight. As a
result of the technical corrections previously described, several of
the estimated costs on which the proposed unscaled CY 2014 payment
weights are developed require correlating corrections. Those
corrections to the proposed payment weights then affect the proposed
aggregate unscaled CY 2014 OPPS payment weights which are then used to
determine the appropriate proposed budget neutrality adjustment. Using
the corrected proposed unscaled relative payment weights, the proposed
CY 2014 budget neutrality weight scaler changes from 1.2143 as
originally proposed (see 78 FR 43576) to 1.3315.
As previously stated, the technical corrections discussed
previously result in corrections to the proposed OPPS relative payment
weights and the proposed CY 2014 OPPS conversion factor, both of which
are used to calculate the proposed CY 2014 OPPS payment rates. Outlier
payments are made based on the relationship between APC payments and
estimated cost, so corrections to the proposed APC payment rates would
affect the appropriate fixed-dollar outlier threshold applied to
achieve the estimated OPPS outlier spending target of 1.0 percent (78
FR 43583 through 43584). Using the corrected proposed CY 2014 OPPS
relative payment weights and conversion factor, the proposed CY 2014
OPPS/ASC fixed-dollar outlier threshold changes from $2,775, as
originally proposed (see 78 FR 43583 through 43584), to $2,900.
We are also making technical corrections to Table 39--Estimated
Impact of the Proposed CY 2014 Changes for the Hospital Outpatient
Prospective Payments System (78 FR 43692) and the correlating preamble
language (78 FR 43689). As noted previously, because the OPPS is a
budget neutral system, and while the impact of the technical
corrections discussed previously on APC payment is generally
concentrated within specific APCs that were modified for significant
proposals in CY 2014, there are resulting technical corrections
necessary with respect to all other proposed CY 2014 OPPS payment
weights and rates within the system. The corrections to this impact
table (78 FR 43692) relative to the impact table originally published
in the CY 2014 OPPS/ASC proposed rule correspond to the case mix of
services furnished by providers and how they are affected by the
technical corrections in this document.

B. Ambulatory Surgical Center Payment System Corrections

ASC payment rates are based on the OPPS relative payment weights
for the majority of items and services that are provided at ASCs.
Therefore, corrections to the proposed CY 2014 OPPS relative payment
weights also have an impact on the proposed CY 2014 ASC relative
payment weights and ASC payment rates. Due to the corrections made to
the proposed CY 2014 OPPS relative payment weights, we recalculated the
proposed CY 2014 budget neutral ASC weight scaler (see 78 FR 43640 and
43641). Using the proposed corrected scaled CY 2014 OPPS relative
weights, the proposed CY 2014 budget neutrality ASC weight scaler
changes from 0.8961, as originally proposed (78 FR 43641), to 0.9102.
The corrected proposed CY 2014 ASC relative payment weights and the
proposed CY 2014 budget neutral ASC weight scaler have no impact on the
proposed CY 2014 ASC conversion factor.

C. Summary of Errors in and Corrections to Addenda Posted on the CMS
Web Site

1. Outpatient Prospective Payment System Payment System Addenda
We are making several minor technical corrections to the OPPS
addenda. We are correcting the OPPS status indicators for CPT codes
93619, 93620 and 93650 to ``J1'' to accurately reflect our CY 2014
proposal to establish APC 0085 as a comprehensive APC. We are also
correcting the displayed assignment of CPT code 33233 to APC 0106 to
fix a discrepancy between our addenda and the cost statistics files we
make available to the public. As a result of these corrections,
Addendum A, B, C, and M will also be corrected.
To view the corrected proposed CY 2014 OPPS payment rates that
result from the corrected geometric mean costs and other technical
corrections, we refer readers to the Addenda and supporting files that
are posted on the CMS Web site at: https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/HospitalOutpatientPPS/.
Select ``CMS-1601-CN'' from the list of regulations. All corrected
Addenda for this correcting document are contained in the zipped folder
entitled, ``2014 OPPS NPRM Addenda'' at the bottom of the page for CMS-
1601-CN. The corrected CY 2014 OPPS file of geometric mean costs is
found under supporting documentation for CMS-1601-CN.

[[Page 54844]]

2. Ambulatory Surgical Center Payment System Addenda
To view the corrected proposed CY 2014 ASC payment rates that
result from the corrected proposed CY 2014 ASC relative payment
weights, see the ASC addenda that are posted on the CMS Web site at:
https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/ASCPayment/ASC-Regulations-and-Notices.html. Select ``CMS-1601-CN''
from the list of regulations. All corrected ASC addenda for this
correcting document are contained in the zipped folder entitled
``Addendum AA, BB, DD1, DD2, and EE'' at the bottom of the page for
CMS-1601-CN.

IV. Waiver of 60-Day Comment Period

We ordinarily permit a 60-day comment period on notices of proposed
rulemaking in the Federal Register, as provided in section 1871(b)(1)
of the Act. However, this period may be shortened, as provided under
section 1871(b)(2)(C) of the Act, when the Secretary finds good cause
that a 60-day comment period would be impracticable, unnecessary, or
contrary to the public interest and incorporates a statement of the
finding and its reasons in the rule issued. Because the corrections in
this document do not make any changes to the substantive policies
proposed in the CY 2014 OPPS/ASC proposed rule, but merely correct
underlying data errors that impact certain components of the payment
systems to conform to the proposed policies clearly intended in the
preamble of the proposed rule, this correcting document does not
constitute agency rulemaking, and therefore the 60-day comment period
does not apply. In addition, we believe it is important for the public
to have the corrected information as soon as possible and find no
reason to delay dissemination of it.
For the reasons stated previously, we find it both unnecessary and
contrary to the public interest to undertake further notice and comment
procedures with respect to this correcting document.

V. Correction of Errors

In FR Doc. 2013-16555 of July 19, 2013 (78 FR 43534), make the
following corrections:

0
1. On page 43562, third column, first full paragraph, in line 4, the
figure ``$1,357'' is corrected to read ``$1,348''.
0
2. On page 43571,
0
a. Table 8--CY 2013 Separate Payment Versus CY 2014 Proposed Packaged
Payment For MPI, the table is corrected to read as follows:

Table 8--CY 2013 Separate Payment Versus CY 2014 Proposed Packaged Payment for MPI
--------------------------------------------------------------------------------------------------------------------------------------------------------
CY 2013 Separate CY 2013 Separate CY 2013 Separate CY 2013 Separate CY 2014 Proposed
Service or supply payment for MPI payment for MPI payment for MPI payment for MPI packaged payment for
components components components components MPI
--------------------------------------------------------------------------------------------------------------------------------------------------------
78452.......................... $680................... $680.................. $680.................. $680.................. $1,216
93017.......................... $177................... $177.................. $177.................. $177.................. P [seuro]
Exercise or Stress Agent [syen] Exercise--$0........... J1245-P............... J2785-$215............ J0152-$219*........... P
Radiopharmaceutical............ P...................... P..................... P..................... P..................... P
------------------------------------------------------------------------------------------------------------------------
Total...................... $857................... $857.................. $1,072................ $1,076................ $1,216
--------------------------------------------------------------------------------------------------------------------------------------------------------
P = Packaged.
[seuro] The stress test described by CPT code 93017 is proposed to be conditionally packaged as a result of the proposal described below to
conditionally package ancillary services.
[syen] April 2013 ASP Drug Pricing File.
* 70 kg patient.

0
b. First column, first paragraph, in line 4, the figure ``14'' is
corrected to read ``12''.
0
3. On page 43576, third column, second full paragraph, in line 17, the
figure ``1.2143'' is corrected to read ``1.3315''.
0
4. On page 43577, third column, third full paragraph, in line 27, the
figure ``1.0001'' is corrected to read ``1.0003''.
0
5. On page 43578,
0
a. First column,
0
(1) First full paragraph,
0
(a) In line 13, the figure ``1.0001'' is corrected to read ``1.0003''.
0
(b) In line 18, the figure ``$72.728'' is corrected to read
``$72.743''.
0
(2) Second full paragraph, in line 34, the figure ``$71.273'' is
corrected to read ``$71.288''.
0
b. Second column, first paragraph,
0
(1) In line 3, the figure ``$72.728'' is corrected to read ``$72.743''.
0
(2) In line 16, the figure ``$71.273'' is corrected to read
``$71.288''.
0
6. On page 43584,
0
a. First column, under the heading ``2. Proposed Outlier Calculation'',
second paragraph, in line 11, the figure ``$2,775'' is corrected to
read ``$2,900''.
0
b. Third column, first partial paragraph,
0
(1) In line 8, the figure ``$2,775'' is corrected to read ``$2,900''.
0
(2) In line 21, the figure ``$2,775'' is corrected to read ``$2,900''.
0
7. On page 43586,
0
a. First column, in the fourth full paragraph,
0
(1) In line 17, the figure ``$345.75'' is corrected to read
``$340.56''.
0
(2) In line 21, the figure ``$338.84'' is corrected to read
``$333.75''.
0
(3) In line 30, the figure ``$272.96'' is corrected to read ``$268.87''
and the figure ``$345.75'' is corrected to read ``$340.56''.
0
(4) In line 33, the figure ``$267.51'' is corrected to read
``$263.49''.
0
(5) In line 34, the figure ``$338.84'' is corrected to read
``$333.75''.
0
(6) In line 37, the figure ``$138.30'' is corrected to read ``$133.50''
and ``$345.75'' is corrected to read ``$340.56''.
0
b. Second column, first partial paragraph,
0
(1) In line 2, the figure ``$135.54'' is corrected to read ``$133.50''.
0
(2) In line 3, the figure ``$338.84'' is corrected to read ``$333.75''.
0
(3) In line 6, the figure ``$411.26'' is corrected to read ``$405.09''
and ``$272.96'' is corrected to read ``$268.87''.
0
(4) In line 7, the figure ``$138.30'' is corrected to read ``$136.22''.
0
(5) In line 9, the figure ``$403.05'' is corrected to read ``$396.99''
and ``$267.51'' is corrected to read ``$263.49''.
0
(6) In line 10, the figure ``$135.54'' is corrected to read
``$133.50''.
0
c. Third column, under the heading ``3. Proposed Calculation of an
Adjusted Copayment Amount for an APC Group'', second full paragraph,
0
(1) In line 6, the figure ``$69.15'' is corrected to read ``$68.12''.
0
(2) In line 8, the figure ``$345.75'' is corrected to read ``$340.56''.
0
8. On page 43590, Table 14--New Category III CPT Codes Implemented In

[[Page 54845]]

July 2013, the fifth column titled, ``Proposed CY 2014 Payment Rate''
is corrected to read as follows:

Table 14--New Category III CPT Codes Implemented in July 2013
----------------------------------------------------------------------------------------------------------------
Proposed CY Proposed CY
CY 2013 CPT Code CY 2013 Long descriptor 2014 status Proposed CY 2014 payment
indicator 2014 APC rate
----------------------------------------------------------------------------------------------------------------
0329T........................... Monitoring of intraocular E N/A N/A
pressure for 24 hours or
longer, unilateral or
bilateral, with
interpretation and report.
0330T........................... Tear film imaging, unilateral S 0230 $51.05
or bilateral, with
interpretation and report.
0331T........................... Myocardial sympathetic S 0398 391.36
innervation imaging, planar
qualitative and quantitative
assessment.
0332T........................... Myocardial sympathetic S 0398 391.36
innervation imaging, planar
qualitative and quantitative
assessment; with tomographic
SPECT.
0333T........................... Visual evoked potential, E N/A N/A
screening of visual acuity,
automated.
0334T........................... Sacroiliac joint stabilization T 0208 4,108.96
for arthrodesis, percutaneous
or minimally invasive
(indirect visualization),
includes obtaining and
applying autograft or
allograft (structural or
morselized), when performed,
includes image guidance when
performed (that is, CT or
fluoroscopic).
----------------------------------------------------------------------------------------------------------------

0
9. On page 43630, Table 34-New Level II HCPCS Codes for Covered
Surgical Procedures or Covered Ancillary Services Implemented in July
2013, the table is corrected to read as follows:

Table 34--New Level II HCPCS Codes for Covered Surgical Procedures or
Covered Ancillary Services Implemented in July 2013
------------------------------------------------------------------------
Proposed CY Proposed CY
CY 2013 HCPCS Code CY 2013 Long 2014 payment 2014 payment
descriptor indicator rate
------------------------------------------------------------------------
C9131............. Injection, ado- K2 $29.40
trastuzumab
emtansine, 1 mg.
C9736............. Laparoscopy, G2 2,010.57
surgical,
radiofrequency
ablation of uterine
fibroid(s),
including
intraoperative
guidance and
monitoring, when
performed.
Q2033............. Influenza Vaccine, L1 N/A
Recombinant
Himagglutinin
Antigens, for
Intramuscular Use
(Flublok).
Q2050 *........... Injection, K2 545.44
Doxorubicin
Hydrochloride,
Liposomal, Not
Otherwise
Specified, 10 mg.
Q2051 *........... Injection, K2 196.42
Zoledronic Acid,
Not Otherwise
Specified, 1 mg.
------------------------------------------------------------------------
* Note: HCPCS code Q2050 replaced code J9002 and HCPCS code Q2051
replaced HCPCS codes J3487 and J3488 beginning July 1, 2013.

0
10. On page 43631, Table 35-New Category III CPT Codes Implemented in
July 2013 as ASC Covered Ancillary Services, the table is corrected to
read as follows:

Table 35--New Category III CPT Codes Implemented in July 2013 as ASC
Covered Ancillary Services
------------------------------------------------------------------------
Proposed CY Proposed CY
CY 2013 CPT Code CY 2013 Long 2014 payment 2014 payment
descriptor indicator rate
------------------------------------------------------------------------
0331T............. Myocardial Z2 $212.14
sympathetic
innervation
imaging, planar
qualitative and
quantitative
assessment.
0332T............. Myocardial Z2 $212.14
sympathetic
innervation
imaging, planar
qualitative and
quantitative
assessment; with
tomographic SPECT.
------------------------------------------------------------------------

0
11. On page 43641, first column, first partial paragraph, in line 12,
the figure ``0.8961'' is corrected to read ``0.9102''.
0
12. On page 43652, third column, first partial paragraph,
0
a. In line 6, the figure ``$71.273'' is corrected to read ``$71.288''.
0
b. In line 7, the figure ``$72.728'' is corrected to read ``$72.743''.
0
13. On pages 43692 through 43693, Table 39--Estimated Impact of the
Proposed CY 2014 Changes for the Hospital Outpatient Prospective
Payment System, the table is corrected to read as follows:

[[Page 54846]]

Table 39--Estimated Impact of the Proposed CY 2014 Changes for the Hospital Outpatient Prospective Payment System
--------------------------------------------------------------------------------------------------------------------------------------------------------
APC Column 4 with
Number of recalibration New wage index Combined cols frontier wage All proposed
hospitals (all changes) and provider 2,3 with market index adjustment changes (%)
(%) adjustments (%) basket update (%)
(1) (2) (3) (4) (5) (6)
--------------------------------------------------------------------------------------------------------------------------------------------------------
ALL FACILITIES *............................ 3,953 0.0 0.0 1.8 1.9 1.8
ALL HOSPITALS............................... 3,791 0.0 0.0 1.8 1.9 1.8
(excludes hospitals permanently held
harmless and CMHCs)
URBAN HOSPITALS............................. 2,859 0.0 0.0 1.9 2.0 1.9
LARGE URBAN (GT 1 MILL.)................ 1,566 0.3 0.2 2.3 2.3 2.3
OTHER URBAN (LE 1 MILL.)................ 1,293 -0.3 -0.1 1.4 1.7 1.5
RURAL HOSPITALS............................. 932 -0.3 -0.3 1.3 1.5 1.4
SOLE COMMUNITY.......................... 389 0.3 -0.3 1.9 2.3 1.9
OTHER RURAL............................. 543 -0.8 -0.2 0.8 0.9 0.8
BEDS (URBAN)
0-99 BEDS............................... 959 0.1 0.1 1.9 2.1 2.0
100-199 BEDS............................ 831 -0.2 -0.1 1.5 1.6 1.6
200-299 BEDS............................ 454 -0.4 0.0 1.4 1.6 1.5
300-499 BEDS............................ 407 0.1 0.0 1.9 2.1 2.0
500 + BEDS.............................. 208 0.4 0.2 2.4 2.4 2.4
BEDS (RURAL)
0-49 BEDS............................... 352 -0.7 -0.6 0.6 0.8 0.6
50-100 BEDS............................. 342 0.4 -0.1 2.1 2.4 2.2
101-149 BEDS............................ 133 -0.6 -0.5 0.8 1.0 0.9
150-199 BEDS............................ 61 -1.0 -0.1 0.7 1.1 0.7
200 + BEDS.............................. 44 -0.3 -0.2 1.3 1.3 1.5
VOLUME (URBAN)
LT 5,000 Lines.......................... 485 -0.5 0.2 1.5 1.7 1.6
5,000-10,999 Lines...................... 109 0.3 -0.1 1.9 2.4 1.4
11,000-20,999 Lines..................... 132 0.1 0.0 1.9 2.1 1.9
21,000-42,999 Lines..................... 262 -0.1 -0.2 1.5 1.6 1.6
42,999-89,999 Lines..................... 517 0.2 0.1 2.1 2.1 2.1
GT 89,999 Lines......................... 1,354 0.0 0.0 1.9 2.0 1.9
VOLUME (RURAL)
LT 5,000 Lines.......................... 31 0.1 -0.4 1.5 6.1 1.6
5,000-10,999 Lines...................... 34 2.1 -0.5 3.3 3.4 3.4
11,000-20,999 Lines..................... 67 1.8 -0.7 2.8 3.0 2.7
21,000-42,999 Lines..................... 182 0.8 -0.3 2.3 2.9 2.2
GT 42,999 Lines......................... 618 -0.4 -0.2 1.2 1.4 1.3
REGION (URBAN)
NEW ENGLAND............................. 150 1.1 0.6 3.5 3.5 3.4
MIDDLE ATLANTIC......................... 342 0.2 0.7 2.7 2.7 2.7
SOUTH ATLANTIC.......................... 432 -0.5 -0.3 1.0 1.0 1.1
EAST NORTH CENT......................... 459 -0.1 -0.2 1.5 1.5 1.5
EAST SOUTH CENT......................... 172 -0.5 -0.3 1.0 1.0 1.1
WEST NORTH CENT......................... 193 1.7 -0.3 3.1 4.3 3.3
WEST SOUTH CENT......................... 487 -1.1 -0.2 0.6 0.6 0.7
MOUNTAIN................................ 194 0.5 -0.3 2.0 2.3 2.0
PACIFIC................................. 385 0.3 0.6 2.7 2.7 2.6
PUERTO RICO............................. 45 4.2 0.6 6.6 6.6 7.0
REGION (RURAL)
NEW ENGLAND............................. 25 2.7 0.6 5.1 5.1 5.0
MIDDLE ATLANTIC......................... 68 -1.3 -0.3 0.3 0.3 0.3
SOUTH ATLANTIC.......................... 158 -1.0 -0.4 0.4 0.4 0.5
EAST NORTH CENT......................... 124 -0.9 -0.4 0.5 0.5 0.6
EAST SOUTH CENT......................... 170 -0.9 -0.6 0.3 0.3 0.5
WEST NORTH CENT......................... 99 1.0 -0.1 2.7 3.9 2.8
WEST SOUTH CENT......................... 196 -0.7 -0.4 0.7 0.8 0.9
MOUNTAIN................................ 63 0.4 0.2 2.5 4.0 2.0
PACIFIC................................. 29 2.4 0.7 4.9 5.0 5.0
TEACHING STATUS
NON-TEACHING............................ 2,792 -0.5 -0.1 1.2 1.3 1.3
MINOR................................... 686 -0.2 0.0 1.6 1.9 1.7

[[Page 54847]]

MAJOR................................... 313 1.2 0.2 3.2 3.2 3.1
DSH PATIENT PERCENT
0....................................... 12 -1.3 -0.1 0.4 0.4 0.2
GT 0-0.10............................... 349 0.1 0.1 2.0 2.1 2.0
0.10-0.16............................... 334 0.0 0.1 1.9 2.1 2.0
0.16-0.23............................... 680 0.0 0.0 1.8 2.0 1.9
0.23-0.35............................... 1,045 0.0 0.0 1.8 1.9 1.8
GE 0.35................................. 831 -0.1 0.0 1.7 1.7 1.7
DSH NOT AVAILABLE **.................... 540 1.7 0.0 3.5 3.5 3.2
URBAN TEACHING/DSH
TEACHING & DSH.......................... 909 0.4 0.1 2.3 2.5 2.3
NO TEACHING/DSH......................... 1,429 -0.6 0.0 1.2 1.3 1.3
NO TEACHING/NO DSH...................... 12 -1.3 -0.1 0.4 0.4 0.2
DSH NOT AVAILABLE **.................... 509 1.6 0.1 3.5 3.6 3.2
TYPE OF OWNERSHIP
VOLUNTARY............................... 2,004 0.1 0.1 2.0 2.2 2.1
PROPRIETARY............................. 1,250 -0.5 -0.1 1.2 1.3 1.2
GOVERNMENT.............................. 537 -0.3 -0.2 1.3 1.3 1.4
CMHCs....................................... 100 -7.1 -0.2 -5.6 -5.5 -5.2
--------------------------------------------------------------------------------------------------------------------------------------------------------
Column (1) shows total hospitals and/or CMHCs.
Column (2) includes all CY 2014 OPPS proposals and compares those to the CY 2013 OPPS (which includes outpatient lab services previously paid at CLFS
rates).
Column (3) shows the budget neutral impact of updating the wage index by applying the FY 2014 hospital inpatient wage index. The proposed rural
adjustment continues our current policy of 7.1 percent so the budget neutrality factor is 1. Similarly, the differential in estimated cancer hospital
payments for the proposed adjustment is minimal and thus results in a budget neutrality factor of 1.0003.
Column (4) shows the impact of all budget neutrality adjustments and the proposed addition of the 1.8 percent OPD fee schedule update factor (2.5
percent reduced by 0.4 percentage points for the proposed productivity adjustment and further reduced by 0.3 percentage point in order to satisfy
statutory requirements set forth in the Affordable Care Act).
Column (5) shows the non-budget neutral impact of applying the frontier State wage adjustment.
Column (6) shows the additional adjustments to the conversion factor resulting from a change in the pass-through estimate, adding estimated outlier
payments, and applying payment wage indexes.
* These 3,953 providers include children and cancer hospitals, which are held harmless to pre-BBA amounts, and CMHCs. Payments for lab services at CLFS
rates, which we are proposing to package in the CY 2014 OPPS, are included in the columns where appropriate.
** Complete DSH numbers are not available for providers that are not paid under IPPS, including rehabilitation, psychiatric, and long-term care
hospitals.

0
14. On page 43696,
0
a. First column, first full paragraph, in line 9, the figure ``0.8961''
is corrected to read ``0.9102''.
0
b. Third column,
(1) Fourth paragraph, in line 8, the phrase ``a 1 percent
increase'' is corrected to read ``no change''.
0
(2) Fifth paragraph, in line 13, the phrase ``7 percent'' is corrected
to read ``8 percent''.
0
15. On page 43697, Table 40--Estimated Impact of the Proposed CY 2014
Update to the ASC Payment System on Aggregate CY 2014 Medicare Program
Payments by Surgical Specialty or Ancillary Items and Services Group,
the table is corrected to read as follows:

Table 40--Estimated Impact of the Proposed CY 2014 Update to the ASC
Payment System on Aggregate CY 2014 Medicare Program Payments by
Surgical Specialty or Ancillary Items and Services Group
------------------------------------------------------------------------
Estimated CY
2013 ASC Estimated CY
Surgical specialty group (1) payments (in 2014 percent
millions) (2) change (3)
------------------------------------------------------------------------
Total............................... $3,625 1%
Eye and ocular adnexa............... 1,496 -3
Digestive system.................... 743 8
Nervous system...................... 540 0
Musculoskeletal system.............. 441 -1
Genitourinary system................ 159 5
Integumentary system................ 130 8
Respiratory system.................. 46 7
Cardiovascular system............... 32 -3
Ancillary items and services........ 20 -12

[[Page 54848]]

Auditory system..................... 12 4
Hematologic & lymphatic systems..... 5 17
------------------------------------------------------------------------

0
16. On pages 43697 through 43698, Table 41--Estimated Impact of the
Proposed CY 2014 Update to the ASC Payment System on Aggregate Payments
for Selected Procedures, the table is corrected to read as follows:

Table 41--Estimated Impact of the Proposed CY 2014 Update to the ASC Payment System on Aggregate Payments for
Selected Procedures
----------------------------------------------------------------------------------------------------------------
Estimated CY
2013 ASC Estimated CY
CPT/HCPCS code * (1) Short descriptor (2) payments (in 2014 percent
millions) (3) change (4)
----------------------------------------------------------------------------------------------------------------
66984...................................... Cataract surg w/iol, 1 stage... $1,107 -3%
43239...................................... Upper GI endoscopy, biopsy..... 163 13
45380...................................... Colonoscopy and biopsy......... 154 7
45385...................................... Lesion removal colonoscopy..... 98 7
66982...................................... Cataract surgery, complex...... 89 -3
45378...................................... Diagnostic colonoscopy......... 80 7
64483...................................... Inj foramen epidural l/s....... 79 14
62311...................................... Inject spine l/s (cd).......... 71 14
66821...................................... After cataract laser surgery... 59 -1
G0105...................................... Colorectal scrn; hi risk ind... 42 1
15823...................................... Revision of upper eyelid....... 40 2
64493...................................... Inj paravert f jnt l/s 1 lev... 40 14
63650...................................... Implant neuroelectrodes........ 39 3
G0121...................................... Colon ca scrn not hi rsk ind... 36 1
29827...................................... Arthroscop rotator cuff repr... 34 5
64590...................................... Insrt/redo pn/gastr stimul..... 33 4
64721...................................... Carpal tunnel surgery.......... 31 -1
63685...................................... Insrt/redo spine n generator... 31 4
64636 **................................... Destroy l/s facet jnt addl..... 31 -100
29881...................................... Knee arthroscopy/surgery....... 30 -3
64635...................................... Destroy lumb/sac facet jnt..... 26 73
29880...................................... Knee arthroscopy/surgery....... 25 -3
43235...................................... Uppr gi endoscopy diagnosis.... 23 13
45384...................................... Lesion remove colonoscopy...... 22 7
52000...................................... Cystoscopy..................... 21 5
62310...................................... Inject spine c/t............... 20 14
29823...................................... Shoulder arthroscopy/surgery... 19 5
67042...................................... Vit for macular hole........... 19 0
28285...................................... Repair of hammertoe............ 18 5
50590...................................... Fragmenting of kidney stone.... 18 2
----------------------------------------------------------------------------------------------------------------
* Note that HCPCS codes we are proposing to delete for CY 2014 are not displayed in this table.
** The 100 decrease in estimated payment reflects our CY 2014 proposal to package the payment for CPT code
64636.

(Catalog of Federal Domestic Assistance Program No. 93.778, Medical
Assistance Program); (Catalog of Federal Domestic Assistance Program
No. 93.773, Medicare--Hospital Insurance; and Program No. 93.774,
Medicare--Supplementary Medical Insurance Program)

Dated: September 4, 2013.
Jennifer M. Cannistra,
Executive Secretary to the Department, Department of Health and Human
Services.
[FR Doc. 2013-21849 Filed 9-5-13; 8:45 am]
BILLING CODE 4120-01-P

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