Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long-Term Care Hospital Prospective Payment System and Fiscal Year 2015 Rates; Quality Reporting Requirements for Specific Providers; Reasonable Compensation Equivalents for Physician Services in Excluded Hospitals and Certain Teaching Hospitals; Provider Administrative Appeals and Judicial Review; Enforcement Provisions for Organ Transplant Centers; and Electronic Health Record (EHR) Incentive Program; Correction, 59675-59692 [2014-23630]

Download as PDF Federal Register / Vol. 79, No. 192 / Friday, October 3, 2014 / Rules and Regulations Authority: 42 U.S.C. 7401 et seq. PART 81—DESIGNATION OF AREAS FOR AIR QUALITY PLANNING PURPOSES 2. Section 81.350 is amended by revising the entry for MilwaukeeRacine, WI in the table entitled ■ 1. The authority citation for part 81 continues to read as follows: ■ 59675 ‘‘Wisconsin—PM2.5 (24-Hour NAAQS)’’ to read as follows: § 81.350 * * Wisconsin. * * * WISCONSIN–2006—24-HOUR PM2.5 NAAQS [Primary and Secondary] Designationa Classification Designated area Date1 Milwaukee-Racine, WI: Milwaukee County .................................. Racine County ........................................ Waukesha County .................................. * * Type Date 2 Type April 22, 2014 ............................. April 22, 2014 ............................. April 22, 2014 ............................. Attainment .................................. Attainment .................................. Attainment .................................. .................... .................... .................... .................... .................... .................... * * * * * a Includes Indian Country located in each county or area, except as otherwise specified. date is 30 days after November 13, 2009, unless otherwise noted. 2 This date is July 2, 2014, unless otherwise noted. 1 This [FR Doc. 2014–23634 Filed 10–2–14; 8:45 am] BILLING CODE 6560–50–P DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Medicare & Medicaid Services 42 CFR Parts 405, 412, 413, 415, 422, 424, 485, and 488 [CMS–1607–CN] RINs 0938–AS11; 0938–AR12; and 0938– AR53 Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the LongTerm Care Hospital Prospective Payment System and Fiscal Year 2015 Rates; Quality Reporting Requirements for Specific Providers; Reasonable Compensation Equivalents for Physician Services in Excluded Hospitals and Certain Teaching Hospitals; Provider Administrative Appeals and Judicial Review; Enforcement Provisions for Organ Transplant Centers; and Electronic Health Record (EHR) Incentive Program; Correction Centers for Medicare & Medicaid Services (CMS), HHS. ACTION: Final rule; correction. rmajette on DSK2TPTVN1PROD with RULES AGENCY: This document corrects technical and typographical errors in the final rule that appeared in the August 22, 2014 Federal Register titled ‘‘Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long-Term Care SUMMARY: VerDate Sep<11>2014 14:48 Oct 02, 2014 Jkt 235001 Hospital Prospective Payment System and Fiscal Year 2015 Rates; Quality Reporting Requirements for Specific Providers; Reasonable Compensation Equivalents for Physician Services in Excluded Hospitals and Certain Teaching Hospitals; Provider Administrative Appeals and Judicial Review; Enforcement Provisions for Organ Transplant Centers; and Electronic Health Record (EHR) Incentive Program.’’ DATES: Effective date: This document is effective October 1, 2014. FOR FURTHER INFORMATION CONTACT: Ing Jye Cheng, (410) 786–4487, Operating Prospective Payment, Capital Prospective Payment, and New Medical Service and Technology Add-On Payment Corrections. Donald Thompson, (410) 786–6504, Operating Prospective Payment, Wage Index, and Capital Prospective Payment Corrections. James Poyer, (410) 786–2261, PPSExempt Cancer Hospital Quality Reporting and Hospital Inpatient Quality Reporting Corrections. Mary Pratt, (410) 786–2261, Longterm Care Hospital Quality Data Reporting Corrections. Kellie Shannon, (410) 786–0416, Administrative Appeals by Providers and Judicial Review Corrections. Thomas Hamilton, (410) 786–6763, Organ Transplant Center Corrections. SUPPLEMENTARY INFORMATION: I. Background In FR Doc. 2014–18545 which appeared in the August 22, 2014 Federal Register (79 FR 49853), titled ‘‘Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute PO 00000 Frm 00053 Fmt 4700 Sfmt 4700 Care Hospitals and the Long-Term Care Hospital Prospective Payment System and Fiscal Year 2015 Rates; Quality Reporting Requirements for Specific Providers; Reasonable Compensation Equivalents for Physician Services in Excluded Hospitals and Certain Teaching Hospitals; Provider Administrative Appeals and Judicial Review; Enforcement Provisions for Organ Transplant Centers; and Electronic Health Record (EHR) Incentive Program’’ (hereinafter referred to as the FY 2015 IPPS/LTCH PPS final rule), there were a number of technical errors that are identified and corrected in section IV. of this correcting document. The provisions in this correction document are effective as if they had been included in the FY 2015 IPPS/LTCH PPS final rule that appeared in the August 22, 2014 Federal Register. Accordingly, the corrections are effective October 1, 2014. II. Summary of Errors and Corrections to Tables Posted on the CMS Web Site A. Summary of Errors in the Preamble On page 49865, in our discussion of the summary of costs and benefits of the payment adjustment of the HospitalAcquired Condition (HAC) Reduction Program for FY 2015, we made a technical error in the amount by which overall payments would decrease. On page 49918, in our discussion of new technology add-on payments, we made an error in the amount of the maximum add-on payment for Voraxaze®. On page 49940, we made an error in our discussion of the FY 2015 new technology add-on payment for the E:\FR\FM\03OCR1.SGM 03OCR1 59676 Federal Register / Vol. 79, No. 192 / Friday, October 3, 2014 / Rules and Regulations CardioMEMSTM HF (Heart Failure) Monitoring System. On pages 50246 through 50249, in the table titled ‘‘Previously Adopted Hospital IQR Program Measures And Measures Newly Finalized in this Final Rule for the FY 2017 Payment Determination and Subsequent Years,’’ we inadvertently listed VTE–3 as a ‘‘voluntary electronic clinical quality measure’’ only and inadvertently omitted PN–6 from the table, which should have been listed as a voluntary electronic clinical quality measure. On pages 50279 and 52084, in our discussion of the PPS-exempt Cancer Hospital Quality Reporting Program (PCHQR), we provided a Web site link that is not functional due to a typographical error, and made other typographical and technical errors. On pages 50298, 50302, and 50306, we made typographical and technical errors in our discussion of the LongTerm Care Hospital Quality Reporting (LTCHQR) Program. On page 50335, we made typographical and technical errors in our discussion of organ transplant centers. rmajette on DSK2TPTVN1PROD with RULES B. Summary of Errors in the Regulations Text On page 50350, in the regulations text at § 405.1811(c) and § 405.1835(c), we made technical errors in specifying the requirements regarding a provider’s right to contractor or Board hearings resulting from untimely contractor determinations. C. Summary of Errors in the Addendum In calculating the final FY 2015 IPPS operating and capital rates and impacts, we made two technical errors. First, there was a technical error in our determination of payments under the postacute care transfer policy for certain MS–DRGs within the ratesetting process. Specifically, we inadvertently did not treat those MS–DRGs that qualified for a special payment under the postacute care transfer policy (see § 412.4(f)(6)) in FY 2015 as MS–DRGs subject to the postacute care transfer policy. Consequently, the FY 2015 transfer-adjusted case-mix indexes and cases used to model IPPS payments in the ratesetting process were incorrect, and resulted in a miscalculation of the operating and capital IPPS budget neutrality factors, outlier threshold, operating standardized amounts, capital Federal rates, and impacts for the FY 2015 IPPS/LTCH PPS final rule. To conform with our established methodology, we are recalculating the FY 2015 transfer-adjusted case-mix indexes and cases used to model IPPS VerDate Sep<11>2014 14:48 Oct 02, 2014 Jkt 235001 payments in the ratesetting process after properly treating those MS–DRGs that qualified for a special payment under the postacute care transfer policy in FY 2015 as MS–DRGs subject to the postacute care transfer policy. Therefore, we are recalculating the operating and capital IPPS budget neutrality factors, outlier threshold, operating standardized amounts, capital Federal rates, and impacts for FY 2015 using our established methodology. The second error was the inadvertent error in identifying claims for indirect medical education (IME) payments for Medicare Advantage (MA) beneficiaries (MA IME claims) in the ratesetting process for the FY 2015 IPPS/LTCH PPS final rule. Per the methodology established in the FY 2011 IPPS/LTCH PPS final rule (75 FR 50422 through 50433), in order to identify IME MA claims, we first search the MedPAR file for all claims with an IME payment greater than zero. Then, we filter these claims for a subset of claims with a group health organization (GHO) paid indicator with a value of ‘‘1’’ or with the IME payment field equal to the DRG payment field. For the reasons described later in this section, in applying this methodology for the FY 2015 IPPS/ LTCH PPS final rule, we did not identify certain MA IME claims using the filter for claims where the IME payment field is equal to the DRG payment field. The Budget Control Act of 2011 requires mandatory across-the-board reductions in Federal spending, also known as sequestration. The American Taxpayer Relief Act of 2012 postponed sequestration for 2 months. As required by law, President Obama issued a sequestration order on March 1, 2013. For FY 2015, we used claims from the FY 2013 MedPAR in our ratesetting process to determine the operating and capital IPPS budget neutrality factors, outlier threshold, operating standardized amounts, capital Federal rates, and the IPPS impact analyses presented in the FY 2015 IPPS/LTCH PPS final rule. Claims for discharges occurring on or after April 1, 2013 had the 2-percent reduction for sequestration applied to the DRG payment field. As a result, in applying the methodology described previously for the FY 2015 IPPS/LTCH PPS final rule, we inadvertently did not properly identify certain claims for IME MA payments because the DRG payment field reflected the 2-percent reduction for sequestration (and therefore, the IME payment field did not equal the DRG payment field for those claims). As discussed in the FY 2015 IPPS/LTCH PPS final rule (79 FR 50364 and 50365), PO 00000 Frm 00054 Fmt 4700 Sfmt 4700 under our established methodology, payments for MA IME claims are used in our operating IPPS budget neutrality calculations. Therefore, the inadvertent omission of these MA IME claims resulted in a miscalculation of the operating budget neutrality calculations. (We note this error did not affect the calculation of the outlier threshold or the MS–DRG relative weights because, under our established methodology for the respective calculations of these IPPS payment factors, we only include claims with a ‘‘Claim Type’’ of 60, and the claims that were not properly identified as MA IME claims did not have a ‘‘Claim Type’’ of 60.) We are recalculating the operating budget neutrality factors that are used to determine the standardized amounts for FY 2015 to conform with our established methodology as stated in the FY 2015 IPPS/LTCH PPS final rule. Specifically, for this correcting document, we are restoring the 2percent reduction for sequestration to the DRG payment field in order to ensure that we properly identify all claims where the IME payment field is equal to the DRG payment field consistent with our established methodology. As described previously, one or both of these two technical errors resulted in errors to our calculation of the operating and capital IPPS budget neutrality factors, outlier threshold, operating standardized amounts, capital Federal rates, and impacts. As a result of these technical errors we are correcting the following errors: • In the operating and capital budget neutrality factors, outlier threshold, operating standardized amounts, capital Federal rates, and capital IPPS payment estimates that appear on the following pages of the Addendum of the FY 2015 IPPS/LTCH PPS final rule: 50367 through 50370, 50373 and 50374, 50380 through 50383, 50385 and 50386, 50388 through 50390, and 50404 (Tables 1A through 1D). • In the data presented in the tables referred to in the FY 2015 IPPS/LTCH PPS final rule and available via the Internet on the CMS Web site (see section II.D. of this correcting document). • In the operating and capital impacts that appear in the following pages of the Appendices of the FY 2015 IPPS/LTCH PPS final rule: 50405, 50407, 50409 through 50418, 50420 through 50429, 50435 and 50436, and 50446. The errors described previously also affect the calculation of the Hospital Readmissions Reduction Program payment adjustment factors and the Hospital Value-Based Purchasing (VBP) E:\FR\FM\03OCR1.SGM 03OCR1 rmajette on DSK2TPTVN1PROD with RULES Federal Register / Vol. 79, No. 192 / Friday, October 3, 2014 / Rules and Regulations Program payment adjustment factors for FY 2015. The readmissions payment adjustment factor is based in part on a ratio of a hospital’s ‘‘aggregate payment for excess readmissions’’ and its ‘‘aggregate payments for all discharges.’’ We use Medicare Part A inpatient claims from the MedPAR file as our data source for determining aggregate payments for excess readmissions and aggregate payments for all discharges. For FY 2015, we use MedPAR claims with discharge dates on or after July 1, 2010 and no later than June 30, 2013 to calculate the ratio used in determining the readmissions payment adjustment factors. Under the Hospital VBP Program, the Secretary reduces the base operating DRG payment amount for an eligible hospital for each discharge in a fiscal year by an applicable percent. The sum total of these reductions in a fiscal year must equal the total amount available for value-based incentive payments for all eligible hospitals for the fiscal year, as estimated by the Secretary. We use a linear exchange function to translate this estimated amount available into a value-based incentive payment percentage for each hospital, based on its total performance score (TPS). We then calculate the value-based incentive payment adjustment factor for each hospital and apply that factor to the base-operating DRG payment amount for each discharge occurring at that hospital in FY 2015 on a per claim basis. We finalized the methodology for using base operating DRG payment amounts derived from the MedPAR file in the calculation of the value-based incentive payment adjustment factors in the FY 2013 IPPS/LTCH PPS final rule (77 FR 53574 and 53575). In the FY 2015 IPPS/ LTCH PPS final rule (79 FR 50049), based on the March 2014 update of the FY 2013 MedPAR file (that is, MedPAR Part A claims with discharge dates on or after October 1, 2012 and on or before September 30, 2013), we estimated that the amount available for value-based incentive payments for FY 2015 is $1.4 billion (the applicable percent for the FY 2015 Hospital VBP Program is 1.50 percent). We use the same methodology described previously to identify only Medicare Part A claims in the MedPAR file and to remove IME MA claims when calculating the Hospital Readmissions Reduction Program and the Hospital VBP Program payment adjustment factors. In addition, we use the claims in the MedPAR file to determine the base operating DRG payment amounts used in the calculation of these payment adjustment factors. Consequently, in VerDate Sep<11>2014 14:48 Oct 02, 2014 Jkt 235001 determining the base-operating DRG payment amounts used in our calculation of the proxy readmissions adjustment factors (Table 15A) and the updated proxy Hospital VBP payment adjustment factors (Table 16A) for the FY 2015 IPPS/LTCH PPS final rule, we inadvertently failed to properly exclude all of the IME MA claims, and also inadvertently included the 2-percent sequestration reduction for claims in the FY 2013 MedPAR with a discharge date after April 1, 2013. Therefore, to properly account for how sequestration is reflected in the FY 2013 MedPAR data in the calculation of these payment adjustment factors, we restored the 2percent sequestration reduction to the DRG payment field on the MedPAR claim (as described previously). This correction ensures that we identify and remove all IME MA claims when the IME payment field is equal to the DRG payment field and correctly determine the base-operating DRG payment amount used in the calculation of the readmission and Hospital VBP payment adjustment factors for FY 2015. At the time of the issuance of the FY 2015 IPPS/LTCH PPS final rule, under the Hospital Readmissions Reduction Program, applicable hospitals had not yet had the opportunity to review and correct data from the FY 2015 applicable period before they were made public under our policy regarding the reporting of hospital-specific information. Therefore, in Table 15A listed in the Addendum of the FY 2015 IPPS/LTCH PPS final rule, we provided proxy FY 2015 readmission payment adjustment factors, and stated that we expected to publish the final FY 2015 readmissions payment adjustment factors in Table 15B on the CMS IPPS Web site by October 2014, and would use those final factors for determining payments for discharges occurring on or after October 1, 2014 (79 FR 50048). Similarly, in the final rule, we provided updated proxy value-based incentive payment adjustment factors for FY 2015 in Table 16A listed in the Addendum of that final rule to reflect changes based on the March 2014 update to the FY 2013 MedPAR file. These updated proxy value-based incentive payment adjustment factors for FY 2015 were based on historic FY 2014 Program TPSs because hospitals had not been given the opportunity to review and correct their actual TPSs for the FY 2015 Hospital VBP Program at the time we issued that final rule. We stated that after hospitals had been given an opportunity to review and correct their actual TPSs for FY 2015, we would publish Table 16B to display the actual PO 00000 Frm 00055 Fmt 4700 Sfmt 4700 59677 value-based incentive payment adjustment factors, and that we expected Table 16B to be posted on the CMS Web site in October 2014 (79 FR 50049). The review and corrections period for the data from the FY 2015 applicable period under the Hospital Readmissions Reduction Program resulted in no changes to the proxy adjustment factors shown in Table 15A. However, the calculation of the FY 2015 readmissions payment adjustment factors was affected by the inadvertent errors resulting from our use of claims in the FY 2013 MedPAR with a discharge date after April 1, 2013 without properly accounting for how sequestration was reflected in those data. Because we use claims data from July 1, 2010 to June 30, 2013 to calculate the FY 2015 readmissions payment adjustment factors, only a portion of that data (that is, the claims between April 1, 2013 and June 30, 2013) was impacted by the errors described previously. As a result of the correction of those errors, the FY 2015 readmissions payment adjustment factors have changed for 60 hospitals. The final FY 2015 readmissions payment adjustment factors, which were calculated after correcting the errors discussed previously, are posted in Table 15B on the CMS Web site at: https://www.cms.gov/Medicare/ Medicare-Fee-for-Service-Payment/ AcuteInpatientPPS/. (Click on the link on the left side of the screen titled, ’’FY 2015 IPPS Final Rule Home Page’’ or ’’Acute Inpatient—Files for Download’’.) As noted previously, the final FY 2015 readmissions payment adjustment factors in Table 15B will be used for determining payments for discharges occurring on or after October 1, 2014. After accounting for these corrections in determination of the FY 2015 readmissions payment adjustment factors, we are revising the estimated savings under the Hospital Readmissions Reduction Program to $428 million, from $424 million in the FY 2015 IPPS/LTCH PPS final rule (79 FR 50425). We note that we are not correcting the proxy FY 2015 readmissions payment adjustment factors for FY 2015 shown in Table 15A or the updated proxy valuebased incentive payment adjustment factors for FY 2015 shown in Table 16A. However, consistent with the methodology for calculating the operating budget neutrality factors for the FY 2015 IPPS/LTCH PPS final rule (79 FR 50366), we used corrected proxy payment adjustment factors in the recalculation of the IPPS rates for this correcting document. These factors can be found in the IPPS Impact File that E:\FR\FM\03OCR1.SGM 03OCR1 rmajette on DSK2TPTVN1PROD with RULES 59678 Federal Register / Vol. 79, No. 192 / Friday, October 3, 2014 / Rules and Regulations corresponds to this correcting document which is available on the CMS Web site. (We note that the description of the methodology for calculating the operating budget neutrality factors contained errors that are summarized later in the section and corrected in section IV.C.1. of this correcting document). The proxy factors in Table 15A were provided for informational purposes and they are not used for payment adjustment purposes and the final FY 2015 readmissions payment adjustment factors in Table 15B will be used for determining payments for discharges occurring on or after October 1, 2014 (79 FR 50048). Similarly, the proxy factors in Table 16A were provided for informational purposes, according to the methodology finalized in the FY 2013 IPPS/LTCH final rule (77 FR 53576), and they are not used for payment adjustment purposes. As stated in the FY 2015 IPPS/LTCH PPS final rule, we intend to post the actual Hospital VBP Program payment adjustment factors, as Table 16B, in October of 2014, after hospitals have had an opportunity to review and correct their TPSs. On page 50366, we made an error in the description of our budget neutrality methodology with respect to the readmissions payment adjustment factors that we used for the purpose of modeling aggregate payments when determining all budget neutrality factors. As we discussed in the FY 2015 IPPS/LTCH PPS final rule (79 FR 50048), for that final rule we determined proxy FY 2015 readmission payment adjustment factors (shown in Table 15A), which were calculated based on data from the FY 2015 applicable period of July 1, 2010 to June 30, 2013. In addition, we made a typographical error in the March 2013 and 2014 operating national average case weighted cost-to charge ratios (CCRs) set forth in the FY 2015 IPPS/LTCH PPS final rule. Also, we made a technical error in the calculation of the capital CCR adjustment factor that is applied to determine the capital CCRs used in our ratesetting process. This inadvertent technical error caused a miscalculation of the capital CCRs used in the determination of the operating and capital budget neutrality factors and the calculation of the outlier threshold for the FY 2015 IPPS/LTCH PPS final rule. Therefore, we are correcting the capital CCR adjustment factor and the capital CCRs used in our determination of the operating and capital budget neutrality factors as well as our calculation of the outlier threshold. Lastly, we made technical and typographical errors in the table heading VerDate Sep<11>2014 14:48 Oct 02, 2014 Jkt 235001 for Table 2–2 which is listed in the Addendum of the FY 2015 IPPS/LTCH PPS final rule as one of the tables that are only available through the Internet on the CMS Web site (page 50403). D. Corrections to Tables Posted on the CMS Web Site The following corrections are being made to the tables listed on pages 50402 and 50403 of the FY 2015 IPPS/LTCH PPS final rule that are only available through the Internet on the CMS Web site at https://www.cms.gov/Medicare/ Medicare-Fee-for-Service-Payment/ AcuteInpatientPPS/. In Table 2–2.—Acute Care Hospitals Case-Mix Indexes for Discharges Occurring in Federal Fiscal Year 2012; Hospital Wage Indexes for Federal Fiscal Year 2015; Hospital Average Hourly Wages for Federal Fiscal Years 2013 (2009 Wage Data), 2014 (2010 Wage Data), and 2015 (2011 Wage Data; Based on FY 2015 CBSA Delineations); and 3-Year Average of Hospital Average Hourly Wages, we are correcting the table heading as noted in section II.C. of this correcting document. We are also correcting the entries in column ‘‘FY 2015 Wage Index’’ as a result of the technical errors discussed in section II.C. of this correcting document. We are correcting the following tables in the entirety as a result of the technical errors discussed in section II.C. of this correcting document: • Table 4A–1.—Wage Index and Capital Geographic Adjustment Factor (GAF) for Acute Care Hospitals in Urban Areas by CBSA and by State—FY 2015; Based on CBSA Delineations Used in FY 2014. • Table 4A–2.—Wage Index and Capital Geographic Adjustment Factor (GAF) for Acute Care Hospitals in Urban Areas by CBSA and by State—FY 2015; Based on CBSA Delineations Used in FY 2015. • Table 4B–1.—Wage Index and Capital Geographic Adjustment Factor (GAF) for Acute Care Hospitals in Rural Areas by CBSA and by State—FY 2015; Based on CBSA Delineations Used in FY 2014. • Table 4B–2.—Wage Index and Capital Geographic Adjustment Factor (GAF) for Acute Care Hospitals in Rural Areas by CBSA and by State—FY 2015; Based on FY 2015 CBSA Delineations. • Table 4C–1.—Wage Index and Capital Geographic Adjustment Factor (GAF) for Acute Care Hospitals That Are Reclassified by CBSA and by State—FY 2015; Based on CBSA Delineations Used in FY 2014. • Table 4C–2.—Wage Index and Capital Geographic Adjustment Factor (GAF) for Acute Care Hospitals That Are PO 00000 Frm 00056 Fmt 4700 Sfmt 4700 Reclassified by CBSA and by State—FY 2015; Based on CBSA Delineations Used in FY 2015. • Table 4D–1.—States Designated as Frontier, with Acute Care Hospitals Receiving at a Minimum the Frontier State Floor Wage Index; Urban Areas with Acute Care Hospitals Receiving the Statewide Rural Floor or Imputed Floor Wage Index—FY 2015; Based on CBSA Delineations Used in FY 2014. • Table 4D–2.—States Designated as Frontier, with Acute Care Hospitals Receiving at a Minimum the Frontier State Floor Wage Index; Urban Areas with Acute Care Hospitals Receiving the Statewide Rural Floor or Imputed Floor Wage Index—FY 2015; Based on CBSA Delineations Used in FY 2015. • Table 4J.—Out-Migration Adjustment for Acute Care Hospitals— FY 2015 • Table 10.—New Technology AddOn Payment Thresholds 1,2 for Applications for FY 2016. Table 5.—List of Medicare Severity Diagnosis-Related Groups (MS–DRGs), Relative Weighting Factors, and Geometric and Arithmetic Mean Length of Stay—FY 2015. We are correcting this table by correcting typographical and technical errors in the columns titled ‘‘Geometric Mean LOS’’ and ‘‘Arithmetic Mean LOS’’. Table 8B.—FY 2015 Statewide Average Capital Cost-to-Charge Ratios (CCRs) for Acute Care Hospitals. We are correcting typographical and technical errors in this table. Table 18.—FY 2015 Medicare DSH Uncompensated Care Payment Factor 3 and Supplemental Medicare DSH File— FY 2015 Uncompensated Care Payment Factors. For the FY 2015 IPPS/LTCH PPS final rule, we published a list of hospitals that we identified to be subsection (d) hospitals and subsection (d) Puerto Rico hospitals eligible to receive empirically justified Medicare DSH payment adjustments and uncompensated care payments for FY 2015. As stated in the FY 2015 IPPS/ LTCH PPS final rule (79 FR 50022), we allowed the public an additional period after the issuance of the final rule to review and submit comments on the accuracy of the list of mergers that we identified in the final rule. Based on the comments received during this additional period, we are updating Table 18 and the Supplemental Medicare DSH File to reflect the merger information received in response to the final rule and are also making one other correction to Table 18 and the Supplemental Medicare DSH File. We have discovered that in calculating Factor 3 of the uncompensated care payment methodology, we inadvertently E:\FR\FM\03OCR1.SGM 03OCR1 Federal Register / Vol. 79, No. 192 / Friday, October 3, 2014 / Rules and Regulations excluded the Medicaid days from the most recently available 2012 or 2011 cost report for a certain provider that was projected to receive Medicare DSH in FY 2015. This provider submitted its Medicare hospital cost reports to its Medicare contractor prior to the March 2014 update of HCRIS but due to technical errors the Medicare hospital cost reports were not included in the March 2014 update of HCRIS. As a result, this provider had no Medicaid days included in the calculation of Factor 3. In order to correct this error, we have revised Factor 3 for all hospitals to incorporate the changes to the data for this provider whose Medicare hospital cost report data were inadvertently excluded from the March 2014 update of HCRIS. E. Summary of Errors in the Appendices On page 50428, in our discussion of the effects of the new technology addon payment policy, we made an error in the costs of the add-on payments for Voraxaze® for FY 2015. On pages 50405, 50407, and 50409 through 50429; we made errors in the operating impacts as described in section II.C. of this correcting document. On pages 50435 through 50437, we made errors in the capital impacts as described in section II.C. of this correcting document. On page 50446, we made an error in the estimated expenditures under the IPPS as a result of the errors described in section II.C. of this correcting document. III. Waiver of Proposed Rulemaking and Delay in 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 rule take effect in accordance with section 553(b) of the Administrative Procedure Act (APA) (5 U.S.C. 553(b)). However, we can waive this notice and comment procedure if the Secretary finds, for good cause, that the 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. Section 553(d) of the APA ordinarily requires a 30-day delay in effective date of final rules after the date of their publication in the Federal Register. This 30-day delay in effective date can be waived, however, if an agency finds for good cause that the delay is impracticable, unnecessary, or contrary to the public interest, and the agency incorporates a statement of the findings and its reasons in the rule issued. In our view, this correcting document does not constitute a rule that would be subject to the APA notice and comment or delayed effective date requirements. This correcting document corrects technical and typographic errors in the preamble, regulation text, addendum, payment rates, tables, and appendices included or referenced in the FY 2015 IPPS/LTCH PPS final rule but does not make substantive changes to the policies or payment methodologies that were adopted in the final rule. As a result, this correcting document is intended to ensure that the information in the FY 2015 IPPS/LTCH PPS final rule accurately reflects the policies adopted in that final rule. In addition, even if this were a rule to which the notice and comment procedures and delayed effective date requirements applied, we find that there is good cause to waive such requirements. Undertaking further notice and comment procedures to incorporate the corrections in this document into the final rule or delaying the effective date would be contrary to the public interest because it is in the public’s interest for providers to receive appropriate payments in as timely a manner as possible, and to ensure that the FY 2015 IPPS/LTCH PPS final rule accurately reflects our policies. Furthermore, such procedures would be unnecessary, as we are not altering our payment methodologies or policies, but rather, we are simply implementing correctly the policies that we previously proposed, received comment on, and subsequently finalized. This correcting document is intended solely to ensure that the FY 2015 IPPS/LTCH PPS final rule accurately reflects these payment methodologies and policies. Therefore, we believe we have good cause to waive the notice and comment and effective date requirements. IV. Correction of Errors In FR Doc. 2014–18545 of August 22, 2014 (79 FR 49853), make the following corrections: A. Corrections of Errors in the Preamble 1. On page 49865, third column, third bulleted paragraph, line 12, the figure ‘‘$369’’ is corrected to read ‘‘$373’’. 2. On page 49918, second column, first partial paragraph: a. Lines 7 through 12, the sentences ‘‘The cost of Voraxaze® is $22,500 per vial. The applicant stated that an average of four vials is used per Medicare beneficiary. Therefore, the average cost per case for Voraxaze® is $90,000 ($22,500 × 4).’’ are corrected to read ‘‘Based on the latest data from the manufacturer, the cost of Voraxaze® is $23,625 per vial. The applicant stated that an average of four vials is used per Medicare beneficiary. Therefore, the average cost per case for Voraxaze® is $94,500 ($23,625 × 4).’’ b. Lines 18 through 20, the sentence ‘‘As a result, the maximum new technology add-on payment for Voraxaze® is $45,000 per case.’’ is corrected to read ‘‘As a result, based on the latest data from the manufacturer, the maximum new technology add-on payment for Voraxaze® for FY 2015 is $47,250 per case.’’ 3. On page 49940, third column, last paragraph, fourth line from the bottom, the phrase ‘‘the maximum payment’’ is corrected to read ‘‘the maximum add-on payment’’. 4. On pages 50246 through 50249, the table titled ‘‘Previously Adopted Hospital IQR Program Measures and Measures Newly Finalized in this Final Rule for the FY 2017 Payment Determination and Subsequent Years’’ is corrected as follows: a. Adding the following entry (short name VTE–3) immediately preceding the entry VTE–5: Measure name NQF No. Submission methods for FY 2017 VTE–3 rmajette on DSK2TPTVN1PROD with RULES Short name Venous thromboembolism patients with anticoagulation overlap therapy. NQF #0373 Electronic clinical quality measure or chart-abstracted REQUIRED. b. Removing the entry for VTE–3 that follows the entry for Stroke-10. VerDate Sep<11>2014 14:48 Oct 02, 2014 Jkt 235001 c. Adding the following entry for PN– 6 immediately preceding the entry for VTE–4: PO 00000 Frm 00057 Fmt 4700 Sfmt 4700 59679 E:\FR\FM\03OCR1.SGM 03OCR1 New for FY 2017 59680 Federal Register / Vol. 79, No. 192 / Friday, October 3, 2014 / Rules and Regulations Short name Measure name NQF No. PN–6 ... Initial Antibiotic Selection for community-acquired pneumonia (CAP) in Immunocompetent Patients. NQF #0147 5. On 50279, second column, second full paragraph, lines 10 through 13, the hyperlink, ‘‘https://www.Fqualityforum. Forg/WorkArea/linkit.aspx ?LinkIdentifier=id&ItemID=70374’’ is corrected to read ‘‘https://www.quality forum.org/WorkArea/linkit.aspx ?LinkIdentifier=id&ItemID=70374.’’ 6. On page 50284: a. Second column, first partial paragraph: (1) Line 7, the phrase ‘‘However the six’’ is corrected to read ‘‘However for the six’’. (2) Line 12, the phrase ‘‘four quarters data’’ is corrected to read ‘‘four quarters of data’’. b. Third column, third full paragraph, lines 14 and 15, the parenthetical phase ‘‘(and not limited to orthopedic surgeries)’’ is corrected to read ‘‘(and are not limited to orthopedic surgeries)’’. 7. On page 50298, second column, first partial paragraph, line 6, the phrase ‘‘the CAM® Instrument’’ is corrected to read ‘‘the short CAM® instrument’’. 8. On page 50302, third column, second full paragraph, lines 3 and 4, the phrase ‘‘of long-term mechanical ventilation’’ is corrected to read ‘‘with patients on prolonged mechanical ventilation’’. 9. On page 50306, lower two-thirds of the page, third column, partial paragraph, lines 18 and 19, the phrase ‘‘tobacco performance measure set’’ is corrected to read ‘‘tobacco treatment performance measure set’’. 10. On page 50335, first column, first full paragraph: a. Line 34, the phrase ‘‘that because available’’ is corrected to read ‘‘that became available’’. b. Lines 38 and 39, the phrase ‘‘not enter into an SIA’’ is corrected to read ‘‘not entered into an SIA’’. rmajette on DSK2TPTVN1PROD with RULES B. Corrections of Errors in the Regulation Text § 405.1811 [Corrected] 1. On page 50350, in the first column, in § 405.1811(c) introductory text, lines 7 and 8, the phrase ‘‘for a cost reporting period if—’’ is corrected to read ‘‘for specific items for a cost reporting period if—’’. § 405.1835 [Corrected] 2. On page 50350, in the third column, in § 405.1835(c), in lines 7 VerDate Sep<11>2014 14:48 Oct 02, 2014 Jkt 235001 Submission methods for FY 2017 Electronic clinical quality measure. through 9, the phrase ‘‘for specific items claimed for a cost reporting period if—’’ is corrected to read ‘‘for specific items for a cost reporting period if—’’. C. Corrections of Errors in the Addendum 1. On page 50366, first column, first full paragraph the paragraph beginning with the phrase ‘‘For the purpose of calculating the FY’’ and ending with the phrase ‘‘to the FY 2013 IPPS/LTCH PPS final rule (77 FR 53399 through 53400).)’’ is corrected to read as follows: ‘‘For the purpose of calculating the proposed FY 2015 readmissions payment adjustment factors in the proposed rule, we used excess readmission ratios and aggregate payments for excess readmissions based on admissions from the prior fiscal year’s applicable period because hospitals have had the opportunity to review and correct these data before the data were made public under the policy we adopted regarding the reporting of hospital-specific readmission rates, consistent with section 1886(q)(6) of the Act. As discussed in section IV.H.11. of this preamble, because the review and corrections period will still be ongoing through August 19, 2014, which extends beyond the issuance of this FY 2015 IPPS/LTCH PPS final rule, we are calculating proxy FY 2015 readmissions payment adjustment factors using excess readmission ratios and aggregate payments for excess readmissions based on admissions from the finalized applicable period for FY 2015. We will determine the final readmissions payment adjustment factors that will be used for payments in FY 2015 after the completion of the review and correct process. (For additional information on our general policy for the reporting of hospital-specific readmission rates, consistent with section 1886(q)(6) of the Act, we refer readers to the FY 2013 IPPS/LTCH PPS final rule (77 FR 53399 through 53400).)’’ 2. On page 50367, third column, first full paragraph: a. Line 3, the figure ‘‘0.997543’’ is corrected to read ‘‘0.998761’’. b. Line 8, the figure ‘‘0.997543’’ is corrected to read ‘‘0.998761’’. 3. On page 50368: a. First column, first partial paragraph, line 19, the figure PO 00000 Frm 00058 Fmt 4700 Sfmt 4700 New for FY 2017 Voluntary electronic clinical quality measure. ‘‘0.997543’’ is corrected to read ‘‘0.998761’’. b. Third column: (1) First partial paragraph, line 11, the figure ‘‘0.997543’’ is corrected to read ‘‘0.998761’’. (2) Last paragraph: (a) Line 9, the figure ‘‘1.001443’’ is corrected to read ‘‘1.001421’’. (b) Line 13, the figure ‘‘0.997543’’ is corrected to read ‘‘0.998761’’. (c) Line 15, the figure ‘‘1.001443’’ is corrected to read ‘‘1.001421’’. (d) Line 21, the figure ‘‘0.998982’’ is corrected to read ‘‘1.000180’’. 4. On page 50369, first column, last partial paragraph, line 13, the figure ‘‘0.990406’’ is corrected to read ‘‘0.990429’’. 5. On page 50370, first column, second full paragraph: a. Line 3, the figure ‘‘0.989507’’ is corrected to read ‘‘0.989525’’. b. Line 5, the figure ‘‘0.991291’’ is corrected to read ‘‘0.991293’’. 6. On page 50373: a. First column, last paragraph, line 3, the figure ‘‘0.998859’’ is corrected to read ‘‘0.998854’’. b. Second column, first partial paragraph, line 1, the figure ‘‘0.998859’’ is corrected to read ‘‘0.998854’’. 7. On page 50374, second column, second full paragraph, line 5, the figure ‘‘0.99931’’ is corrected to read ‘‘0.999313’’. 8. On page 50380: a. First column: (1) First paragraph: (a) Line 4, the figure ‘‘0.292377’’ is corrected to read ‘‘0.292376’’. (b) Line 6, the figure ‘‘0.28714’’ is corrected to read ‘‘0.287139’’. (2) Second paragraph: (a) Line 7, the figure ‘‘0.024849’’ is corrected to read ‘‘0.024649’’. (b) Line 18, the figure ‘‘0.988307’’ is corrected to read ‘‘0.980352’’. c. Third column, second full paragraph, line 9, the figure ‘‘$24,758’’ is corrected to read ‘‘$24,626’’. 9. On page 50381: a. First column: (1) First full paragraph, line 15, the figure ‘‘6.27’’ is corrected to read ‘‘6.18’’. (2) Third full paragraph, the table is corrected to read as follows: E:\FR\FM\03OCR1.SGM 03OCR1 59681 Federal Register / Vol. 79, No. 192 / Friday, October 3, 2014 / Rules and Regulations Operating standardized amounts National ............................................................................................................................................................ Puerto Rico ...................................................................................................................................................... b. Third column, third full paragraph: (1) Line 4, the figure ‘‘5.71’’ is corrected to read ‘‘5.68’’. (2) Line 6, the figure ‘‘0.61’’ is corrected to read ‘‘0.58’’. (3) Line 10, the figure ‘‘5.71’’ is corrected to read ‘‘5.68’’. 10. On pages 50382 and 50383, the table titled, ‘‘Comparison of FY 2014 Capital federal rate 0.948999 0.926334 0.938237 0.916334 Standardized Amounts to the FY 2015 Standardized Amounts’’ is corrected to read as follows: COMPARISON OF FY 2014 STANDARDIZED AMOUNTS TO THE FY 2015 STANDARDIZED AMOUNTS Hospital submitted quality data and is a meaningful EHR user rmajette on DSK2TPTVN1PROD with RULES FY 2014 Base Rate after removing: 1. FY 2014 Geographic Reclassification Budget Neutrality (0.990718). 2. FY 2014 Rural Community Hospital Demonstration Program Budget Neutrality (0.999415). 3. Cumulative Factor: FY 2008, FY 2009, FY 2012, FY 2013, and FY 2014 Documentation and Coding Adjustment as Required under Sections 7(b)(1)(A) and 7(b)(1)(B) of Pub. L. 110–90 and Documentation and Coding Recoupment Adjustment as required under Section 631 of the American Taxpayer Relief Act of 2012 (0.9403). 4. FY 2014 Operating Outlier Offset (0.948995). FY 2015 Update Factor ................................. FY 2015 MS-DRG Recalibration and Wage Index Budget Neutrality Factor. FY 2015 Reclassification Budget Neutrality Factor. FY 2015 Rural Community Demonstration Program Budget Neutrality Factor. FY 2015 Operating Outlier Factor ................. Cumulative Factor: FY 2008, FY 2009, FY 2012, FY 2013, FY 2014 and FY 2015 Documentation and Coding Adjustment as Required under Sections 7(b)(1)(A) and 7(b)(1)(B) of Pub. L. 110–90 and Documentation and Coding Recoupment Adjustment as required under Section 631 of the American Taxpayer Relief Act of 2012. FY 2015 New Labor Market Delineation Wage Index Transition Budget Neutrality Factor. National Standardized Amount for FY 2015 if Wage Index is Greater Than 1.0000; Labor/Non-Labor Share Percentage (69.6/ 30.4). National Standardized Amount for FY 2015 if Wage Index is less Than or Equal to 1.0000; Labor/Non-Labor Share Percentage (62/38). 11. On page 50383, the table titled, ‘‘Comparison of FY 2014 Puerto RicoSpecific Payment Rate to the FY 2015 VerDate Sep<11>2014 14:48 Oct 02, 2014 Jkt 235001 Hospital submitted quality data and is NOT a meaningful EHR user Hospital did NOT submit quality data and is a meaningful EHR user Hospital did NOT submit quality data and is NOT a meaningful EHR user If Wage Index is Greater Than 1.0000: Labor (69.6%): $4,230.38 Nonlabor (30.4%): $1,847.75. If Wage Index is less Than or Equal to 1.0000: Labor (62%): $3,768.45 Nonlabor (38%): $2,309.70. If Wage Index is Greater Than 1.0000: Labor (69.6%): $4,230.38 Nonlabor (30.4%): $1,847.75. If Wage Index is less Than or Equal to 1.0000: Labor (62%): $3,768.45 Nonlabor (38%): $2,309.70. If Wage Index is Greater Than 1.0000: Labor (69.6%): $4,230.38 Nonlabor (30.4%): $1,847.75. If Wage Index is less Than or Equal to 1.0000: Labor (62%): $3,768.45 Nonlabor (38%): $2,309.70. If Wage Index is Greater Than 1.0000: Labor (69.6%): $4,230.38 Nonlabor (30.4%): $1,847.75. If Wage Index is less Than or Equal to 1.0000: Labor (62%): $3,768.45 Nonlabor (38%): $2,309.70. 1.022 .......................... 1.000180 .................... 1.01475 ...................... 1.000180 .................... 1.01475 ...................... 1.000180 .................... 1.0075. 1.000180. 0.990429 .................... 0.990429 .................... 0.990429 .................... 0.990429. 0.999313 .................... 0.999313 .................... 0.999313 .................... 0.999313. 0.948999 .................... 0.9329 ........................ 0.948999 .................... 0.9329 ........................ 0.948999 .................... 0.9329 ........................ 0.948999. 0.9329. 0.998854 .................... 0.998854 .................... 0.998854 .................... 0.998854. Labor: $3,784.75 Labor: $3,757.90 Labor: $3,757.90 Labor: $3,731.05 Nonlabor: $1,653.10. Nonlabor: $1,641.37. Nonlabor: $1,641.37. Nonlabor: $1,629.65. Labor: $3,371.47 Labor: $3,347.55 Labor: $3,347.55 Labor: $3,323.63 Nonlabor: $2,066.38. Nonlabor: $2,051.72. Nonlabor: $2,051.72. Nonlabor: $2,037.07. Puerto Rico-Specific Payment Rate’’ is corrected to read as follows: PO 00000 Frm 00059 Fmt 4700 Sfmt 4700 E:\FR\FM\03OCR1.SGM 03OCR1 59682 Federal Register / Vol. 79, No. 192 / Friday, October 3, 2014 / Rules and Regulations COMPARISON OF FY 2014 PUERTO RICO-SPECIFIC PAYMENT RATE TO THE FY 2015 PUERTO RICO-SPECIFIC PAYMENT RATE Update (2.2 percent); wage index is greater than 1.0000; labor/non-labor share percentage (63.2/36.8) FY 2014 Puerto Rico Base Rate, after removing: 1. FY 2014 Geographic Reclassification Budget Neutrality (0.990718). 2. FY 2014 Rural Community Hospital Demonstration Program Budget Neutrality (0.999415). 3. FY 2014 Puerto Rico Operating Outlier Offset (0.943455). FY 2015 Update Factor ...................................... FY 2015 MS-DRG Recalibration Budget Neutrality Factor. FY 2015 Reclassification Budget Neutrality Factor. FY 2015 Rural Community Hospital Demonstration Program Budget Neutrality Factor. FY 2015 New Labor Market Delineation Wage Index Transition Budget Neutrality Factor. FY 2015 Puerto Rico Operating Outlier Factor .. Puerto Rico-Specific Payment Rate for FY 2015 12. On page 50385, lower half of the page, first column, second paragraph, line 15, the figure ‘‘0.997543’’ is corrected to read ‘‘0.998761’’. 13. On page 50386, second column, last partial paragraph, line 6, the figure ‘‘1.2’’ is corrected to read ‘‘1.3’’. 14. On page 50388: a. First column: (1) Second full paragraph: (a) Line 9, the figure ‘‘6.27’’ is corrected to read ‘‘6.18’’. (b) Line 13, the figure ‘‘0.9373’’ is corrected to read ‘‘0.9382’’ (2) Third full paragraph: (a) Line 6, the phrase ‘‘0.9373 is a ¥0.21 percent’’ is corrected to read ‘‘0.9382 is a ¥0.12 percent’’. (b) Line 11, the mathematical expression ‘‘0.9979 (0.9373/0.9393)’’ is Update (2.2 percent); Wage index is less than or equal to 1.0000; labor/non-labor share percentage (62/38) Labor: $1,722.31 Nonlabor: $1,002.86 ............ Labor: $1,689.61 Nonlabor: $1,035.56. 1.022 ................................................................ 0.998761 .......................................................... 1.022. 0.998761. 0.990429 .......................................................... 0.990429. 0.999313 .......................................................... 0.999313. 0.998854 .......................................................... 0.998854. 0.926334 .......................................................... Labor: $1,609.97 Nonlabor: $937.45 ............... 0.926334. Labor: $1,579.40 Nonlabor: $968.02. corrected to read ‘‘0.9988 (0.9382/ 0.9393)’’. (c) Line 13, the figure ‘‘0.21 percent’’ is corrected to read ‘‘0.12 percent’’ b. Second column, second full paragraph: (1) Line 12, the figure ‘‘0.9987’’ is corrected to read’’0.9994’’. (2) Line 17, the figure ‘‘0.9877’’ is corrected to read ‘‘0.9884’’. (3) Line 18, the figure ‘‘1.0075’’ is corrected to read ‘‘1.0082’’. c. Third column: (1) Third full paragraph, line 9, the figure ‘‘$434.26’’ is corrected to read ‘‘$434.97’’. (2) Fifth full paragraph (second bulleted paragraph), last line, the figure ‘‘0.9986’’ is corrected to read ‘‘0.9993’’. (3) Sixth full paragraph (third bulleted paragraph), last line, the figure ‘‘0.9373’’ is corrected to read ‘‘0.9382’’. 15. On page 50389: a. Top of page, third column, partial paragraph: (1) Line 1, the figure ‘‘0.14’’ is corrected to read ‘‘0.07’’. (2) Line 4, the figure ‘‘0.21’’is corrected to read ‘‘0.11’’. (3) Line 7, the figure ‘‘1.15’’ is corrected to read ‘‘1.32’’. b. Top half of the page, first table titled, ‘‘Comparison of Factors and Adjustments: FY 2014 Capital Federal Rate and FY 2015 Capital Federal Rate’’ the table and table footnotes are corrected to read as follows: COMPARISON OF FACTORS AND ADJUSTMENTS: FY 2014 CAPITAL FEDERAL RATE AND FY 2015 CAPITAL FEDERAL RATE FY 2014 Update Factor 1 ............................................................................................ GAF/DRG Adjustment Factor 1 .................................................................... Outlier Adjustment Factor 2 .......................................................................... Capital Federal Rate .................................................................................... 1.0090 0.9987 0.9393 429.31 FY 2015 1.0150 0.9993 0.9382 434.97 Change 1.0150 0.9993 0.9989 1.0132 Percent change 1.50 ¥0.07 ¥0.11 1.32 rmajette on DSK2TPTVN1PROD with RULES 1 The update factor and the GAF/DRG budget neutrality adjustment factors are built permanently into the capital Federal rates. Thus, for example, the incremental change from FY 2014 to FY 2015 resulting from the application of the 0.9993 GAF/DRG budget neutrality adjustment factor for FY 2015 is a net change of 0.9993 (or ¥0.07 percent). 2 The outlier reduction factor is not built permanently into the capital Federal rate; that is, the factor is not applied cumulatively in determining the capital Federal rate. Thus, for example, the net change resulting from the application of the FY 2015 outlier adjustment factor is 0.9382/ 0.9393, or 0.9989 (or ¥0.11 percent). c. Middle of the page, second table titled, ‘‘Comparison of Factors and VerDate Sep<11>2014 14:48 Oct 02, 2014 Jkt 235001 Adjustments: Proposed FY 2015 Capital Federal Rate and Final FY 2015 Capital PO 00000 Frm 00060 Fmt 4700 Sfmt 4700 Federal Rate’’ is corrected to read as follows: E:\FR\FM\03OCR1.SGM 03OCR1 Federal Register / Vol. 79, No. 192 / Friday, October 3, 2014 / Rules and Regulations 59683 COMPARISON OF FACTORS AND ADJUSTMENTS: PROPOSED FY 2015 CAPITAL FEDERAL RATE AND FINAL FY 2015 CAPITAL FEDERAL RATE Proposed Update Factor .............................................................................................. GAF/DRG Adjustment Factor ...................................................................... Outlier Adjustment Factor ............................................................................ Capital Federal Rate .................................................................................... d. Bottom half of the page, third column, second full paragraph, last line, the figure ‘‘$209.10.’’ is corrected to read ‘‘$209.45.’’ 16. On page 50390, second column, first partial paragraph, last line, the figure ‘‘$24,758’’ is corrected to read ‘‘$24,626’’. 17. On page 50403, first column, first paragraph (table heading for Table 2–2), the heading, ‘‘Table 2–2.—Acute Care Hospitals Case-Mix Indexes for Discharges Occurring in Federal Fiscal Year 2012; Hospital Wage Indexes for Federal Fiscal Year 2015; Hospital 1.0150 0.9957 0.9374 433.01 Average Hourly Wages for Federal Fiscal Years 2013 (2009 Wage Data), 2014 (2010 Wage Data), and 2015 (2011 Wage Data; Based on FY 2015 CBSA Delineations); and 3-Year Average of Hospital Average Hourly Wages’’ is corrected to read ‘‘Table 2–2.—Acute Care Hospitals Case-Mix Indexes for Discharges Occurring in Federal Fiscal Year 2013; Hospital Wage Indexes for Federal Fiscal Year 2015; Hospital Average Hourly Wages for Federal Fiscal Years 2013 (2009 Wage Data; Based on FY 2014 CBSA Delineations), 2014 (2010 Wage Data; Based on FY Final Change 1.0150 0.9993 0.9382 434.97 Percent change 1.0000 1.0037 1.0009 1.0045 0.00 0.37 0.09 0.45 2014 CBSA Delineations), and 2015 (2011 Wage Data; Based on FY 2015 CBSA Delineations); and 3-Year Average of Hospital Average Hourly Wages (Based on FY 2014 and FY 2015 CBSA Delineations)’’. 18. On page 50404: a. Top one-sixth of the page, the first table titled ‘‘Table 1A.—National Adjusted Operating Standardized Amounts, Labor/Nonlabor (69.6 Percent Labor Share/30.4 Percent Nonlabor Share If Wage Index Is Greater Than 1)—FY 2015’’ is corrected to read as follows: TABLE 1A—NATIONAL ADJUSTED OPERATING STANDARDIZED AMOUNTS, LABOR/NONLABOR (69.6 PERCENT LABOR SHARE/30.4 PERCENT NONLABOR SHARE IF WAGE INDEX IS GREATER THAN 1)—FY 2015 Hospital submitted quality data and is a meaningful EHR user (update = 2.2 percent) Hospital did NOT submit quality data and is a meaningful EHR user (update = 1.475 percent) Hospital submitted quality data and is NOT a meaningful EHR user (update = 1.475 percent) Hospital did NOT submit quality data and is NOT a meaningful EHR user (Update = 0.75 percent) Labor Nonlabor Labor Nonlabor Labor Nonlabor Labor Nonlabor $3,784.75 $1,653.10 $3,757.90 $1,641.37 $3,757.90 $1,641.37 $3,731.05 $1,629.65 b. Top third of the page, the second table titled ‘‘Table 1B.—National Adjusted Operating Standardized Amounts, Labor/Nonlabor (62 Percent Labor Share/38 Percent Nonlabor Share If Wage Index Is Less Than Or Equal To 1)—FY 2015’’ is corrected to read as follows: TABLE 1B—NATIONAL ADJUSTED OPERATING STANDARDIZED AMOUNTS, LABOR/NONLABOR (62 PERCENT LABOR SHARE/ 38 PERCENT NONLABOR SHARE IF WAGE INDEX IS LESS THAN OR EQUAL TO 1)—FY 2015 Hospital submitted quality data and is a meaningful EHR user (update = 2.2 percent) Hospital did NOT submit quality data and is a meaningful EHR user (update = 1.475 percent) Hospital submitted quality data and is NOT a meaningful EHR user (update = 1.475 percent) Hospital did NOT submit quality data and is NOT a meaningful EHR user (update = 0.75 percent) Labor Nonlabor Labor Nonlabor Labor Nonlabor Labor Nonlabor $3,371.47 $2,066.38 $3,347.55 $2,051.72 $3,347.55 $2,051.72 $3,323.63 $2,037.07 rmajette on DSK2TPTVN1PROD with RULES c. Middle of the page, the third table titled ‘‘Table 1C.—Adjusted Operating Standardized Amounts For Puerto Rico, Labor/Nonlabor (National: 62 Percent Labor Share/38 Percent Nonlabor Share VerDate Sep<11>2014 14:48 Oct 02, 2014 Jkt 235001 Because Wage Index Is Less Than Or Equal To 1; Puerto Rico: 63.2 Percent Labor Share/36.8 Percent Nonlabor Share If Wage Index Is Greater Than 1 Or 62 Percent Labor Share/38 Percent PO 00000 Frm 00061 Fmt 4700 Sfmt 4700 Nonlabor Share If Wage Index Is Less Than Or Equal To 1—FY 2015’’ is corrected to read as follows: E:\FR\FM\03OCR1.SGM 03OCR1 59684 Federal Register / Vol. 79, No. 192 / Friday, October 3, 2014 / Rules and Regulations TABLE 1C—ADJUSTED OPERATING STANDARDIZED AMOUNTS FOR PUERTO RICO, LABOR/NONLABOR (NATIONAL: 62 PERCENT LABOR SHARE/38 PERCENT NONLABOR SHARE BECAUSE WAGE INDEX IS LESS THAN OR EQUAL TO 1; PUERTO RICO: 63.2 PERCENT LABOR SHARE/36.8 PERCENT NONLABOR SHARE IF WAGE INDEX IS GREATER THAN 1 OR 62 PERCENT LABOR SHARE/38 PERCENT NONLABOR SHARE IF WAGE INDEX IS LESS THAN OR EQUAL TO 1—FY 2015 Rates if wage index is greater than 1 Standardized amount Rates if wage index is less than or equal to 1 Labor . National 1 ........................................ Puerto Rico ..................................... 1 For Nonlabor Not Applicable ................................ $1,609.97 ....................................... Not Applicable ................................ $937.45 .......................................... $3,371.47 1,579.40 Nonlabor $2,066.38 968.02 FY 2015, there are no CBSAs in Puerto Rico with a national wage index greater than 1. d. Lower third of the page, the fourth table titled ‘‘Table 1D.—Capital Standard Federal Payment Rate—FY 2015’’ is corrected to read as follows: D. Corrections of Errors in the Appendices 1. On page 50405, first column, first paragraph: TABLE 1D—CAPITAL STANDARD a. Line 10, the figure ‘‘$654’’ is FEDERAL PAYMENT RATE—FY 2015 corrected to read ‘‘$623’’. b. Line 12, the figure ‘‘$132’’ is Rate corrected to read ‘‘$128’’. National ................................. $434.97 c. Line 14, the figure ‘‘1.6’’ is Puerto Rico ........................... 209.45 corrected to read ‘‘1.5’’. rmajette on DSK2TPTVN1PROD with RULES Labor VerDate Sep<11>2014 14:48 Oct 02, 2014 Jkt 235001 PO 00000 Frm 00062 Fmt 4700 Sfmt 4700 2. On page 50407, second column, last partial paragraph, line 3, the figure ‘‘5.71’’ is corrected to read ‘‘5.68’’. 3. On pages 50409 through 50419, table titled ‘‘Table I.—Impact Analysis of Changes to the IPPS For Operating Costs for FY 2015’’ the table and table footnotes are corrected as follows: BILLING CODE 4120–01–P E:\FR\FM\03OCR1.SGM 03OCR1 59685 Federal Register / Vol. 79, No. 192 / Friday, October 3, 2014 / Rules and Regulations TABLE I.-IMPACT ANALYSIS OF CHANGES TO THE IPPS FOR OPERATING COSTS FOR FY 2015 Appli . No. of Hospi· tals 1 (1) VerDate Sep<11>2014 14:48 Oct 02, 2014 2 (2) FY2015 Wage Data with Application of Wage Budget Neutrality4 (4) FY 2015 DRG, Rei. wts., Wage Index Change swith Wage and Recallbration Budget Neutrali ty5 (5) FY201 5 MGCR B Reclas sificatio ns6 Rural Floor and Imputed Floor with Application of National Rural Floor Budget Neutrality7 (6) (7) Impact of the New OMB CBSA Design a-tions 8 (8) Applic a-tion of the CBSA Transition Wage Index with Budge t Neutra -lity 9 X and OutMigr ation Adju stment Hos pitaI Rea dmis sion s Red UC· (10) (9) tion Progra m" (11) 10 Cha nge s to Med lear e DSH (12) All FY 201 5 Cha nqe s 3 (13) 12 3,396 1.5 0 0 0 0 0 0 0 0.1 -0.2 -1.3 -0.6 2,549 1,401 1,148 847 1.4 1.4 1.5 1.8 0 0.1 0 -0.2 0 0.1 -0.2 0.1 0 0.2 -0.2 -0.2 -0.1 -0.3 0.1 1.6 0 0 0 -0.3 0 0 0 0 0 0 0 0 0.1 0 0.2 0.1 -0.2 -0.2 -0.2 0 -1.4 -1.4 -1.3 -0.9 -0.6 -0.6 -0.6 -0.6 666 787 455 429 212 1.5 1.4 1.5 1.4 1.4 -0.2 -0.1 -0.1 0 0.2 0.1 -0.1 0 0 0 -0.1 -0.1 0 0.1 0.2 -0.4 0 0.1 -0.3 -0.2 0.1 0.3 0 0.1 -0.2 0.1 0 0.1 0.1 -0.1 0 0 0 0 0 0.4 0.2 0.1 0.2 0 -0.2 -0.3 -0.2 -0.1 -0.1 -0.7 -1.4 -1.1 -1.5 -1.4 -0.3 -0.7 -0.2 -0.6 -0.8 328 305 125 50 39 1.8 1.9 1.8 1.7 1.7 -0.2 -0.3 -0.2 -0.1 -0.1 -0.1 0.1 0.1 0.1 0.1 -0.3 -0.3 -0.2 0 0 0.4 0.9 1.8 1.8 2.8 -0.2 -0.2 -0.3 -0.3 -0.4 -0.1 0 0 0 0.1 0.1 0 0 0 -0.1 0.2 0.1 0.2 0.2 0 0 0 -0.1 -0.1 0.1 -0.7 -0.9 -0.9 -1.2 -0.7 -1.1 -1.4 0 -0.4 0.4 120 324 407 397 153 162 387 162 385 52 1.4 1.4 1.4 1.4 1.4 1.4 1.4 1.5 1.4 1.5 0 0.1 0 0 0 0 0 -0.1 0 0.2 0.8 0.1 -0.3 0 -0.5 -0.1 -0.6 0 0.6 0.1 0.8 0.2 -0.2 0 -0.4 0 -0.5 0 0.5 0.3 1.3 0.1 -0.3 -0.2 -0.4 -0.7 -0.5 -0.1 -0.2 -0.8 2.8 -0.4 -0.4 -0.6 -0.4 -0.5 -0.5 0 1.4 0 -0.5 0 0.1 0.1 0 0.1 0.1 0.1 0.1 -0.1 0.2 0.3 -0.1 -0.1 -0.1 -0.1 -0.1 -0.1 -0.1 0 0.1 0.2 0 0 0 0.8 0 0.2 0 0 -0.2 -0.2 -0.2 -0.3 -0.2 -0.1 -0.2 -0.2 -0.1 0 -1 -1.2 -1.3 -1.1 -1.6 -1 -2 -1.6 -1.5 -7.6 0 -0.1 -0.9 -0.5 -1.3 -0.4 -1.7 -0.8 0.1 -7.3 22 57 132 116 165 102 168 61 24 1.7 1.9 1.8 1.9 1.6 2.1 1.7 2 2.3 -0.1 -0.3 -0.2 -0.2 -0.1 -0.3 -0.1 -0.3 -0.6 0.6 0.7 -0.1 0 -0.3 0 0 -0.1 0.8 0.4 0.3 -0.3 -0.2 -0.3 -0.3 0 -0.4 -0.4 2.2 1.1 2.2 1.1 2.6 0.4 1.6 0.2 0.9 -0.3 -0.2 -0.4 -0.2 -0.5 -0.1 -0.4 -0.1 -0.1 0 -0.2 0 0.1 0 0.1 -0.1 0 -0.2 0 0.2 0 0 -0.1 0 0 0 0 0 0.2 0.1 0 0.1 0.3 0.1 0.6 0 0 -0.1 0.1 -0.1 -0.1 0 -0.2 0 0.2 -0.5 -0.7 -1 -0.5 -1.5 -0.3 -1.6 -0.4 -0.3 -0.9 -0.7 -0.8 0.2 -1.4 0.3 -1.8 0.6 1.3 2,563 1,413 1,150 833 1.4 1.4 1.5 1.8 0 0.1 0 -0.2 0 0.1 -0.2 0 0.1 0.2 -0.1 -0.2 -0.1 -0.3 0.1 1.2 0 0 0 -0.3 0 0 0 -0.1 0 0 0 0 0.1 0 0.2 0.3 -0.2 -0.2 -0.2 0 -1.4 -1.4 -1.3 -0.8 -0.6 -0.6 -0.6 -0.5 Jkt 235001 PO 00000 Frm 00063 Fmt 4700 Sfmt 4725 E:\FR\FM\03OCR1.SGM 03OCR1 ER03OC14.006</GPH> rmajette on DSK2TPTVN1PROD with RULES All Hospitals By Geographic Location: Urban hospitals Large urban areas Other urban areas Rural hospitals Bed Size (Urban): 0-99 beds 100-199 beds 200-299 beds 300-499 beds 500 or more beds Bed Size (Rural): 0-49 beds 50-99 beds 100-149 beds 150-199 beds 200 or more beds Urban by Region: New England Middle Atlantic South Atlantic East North Central East South Central West North Central West South Central Mountain Pacific Puerto Rico Rural by Re!lion: New En!lland Middle Atlantic South Atlantic East North Central East South Central West North Central West South Central Mountain Pacific By Payment Classification: Urban areas Large urban areas Other urban areas Rural areas Hospit al Rate Updat e and Documentation and Cod in g Adjust -ment FY 2015 Weight sand DRG Chang es with Application of Recallbratio n Budge t Neutralityl (3) catio n of the Front ier Wag e lnde 59686 Federal Register / Vol. 79, No. 192 / Friday, October 3, 2014 / Rules and Regulations Appli - No. of Hospitals 1 (1) VerDate Sep<11>2014 14:48 Oct 02, 2014 (2) FY2015 Wage Data with Application of Wage Budget Neutrality" (4). FY 2015 DRG, Rei. wts., Wage Index Change swith Wage and Recalibration Budget Neutrali ~~ FY201 5 MGCR B Reclas sificatio ns6 (6) Rural Floor and Imputed Floor with Application of National Rural Floor Budget Neutrality7 m· Impact of the New OMB CBSA Design a-lions 8 (8) Applic a-tion of the CBSA Transilion Wage Index with Budge t Neutra -lily 9 X and OutMigr alion Adju stment 10 (10) (9) Hos pital Rea dmis sion s Red uction Progra m11 (11) Cha nge s to Med icar e DSH 12 All FY 201 5 Cha (12) (13) n~e 53 2,357 795 244 1.5 1.5 1.4 -0.1 0 0.2 -0.1 0 0.1 -0.1 0 0.3 0.2 -0.1 -0.1 0.2 -0.1 -0.2 0.1 0.1 -0.1 0 0 0.1 0.1 0.2 0 -0.2 -0.2 -0.1 -1.1 -1.4 -1.6 -0.5 -0.5 -0.8 679 1,588 383 1.5 1.4 1.5 -0.1 0 -0.2 -0.1 0 0.2 -0.1 0.1 0 0 -0.1 0 0 0 0 0.2 0 0.1 0 0 0 0.2 0.1 0.3 -0.2 -0.2 -0.2 -0.3 -1.5 -1 0.6 -0.8 -0.7 373 212 24 137 2.1 1.8 1.4 1.4 -0.3 -0.2 -0.1 -0.1 0 0 -0.2 -0.1 -0.4 -0.1 -0.3 -0.2 0.3 1.8 2.4 1 -0.1 -0.3 -0.6 -0.6 0 0 0.1 -0.3 0 0 0 0.2 0 0.5 0.2 0.6 0 0 -0.2 -0.2 -0.6 -0.9 -1.7 -1.8 -0.5 -0.2 -1.2 -1.2 842 133 1,129 459 1.4 1.4 1.5 1.4 0.1 0 -0.1 -0.1 0 0 -0.1 -0.2 0.2 0 -0.1 -0.2 -0.2 0.3 0 -0.2 -0.1 0.1 0.3 0 0 0.1 0.1 0.2 0 0 0 0 0.1 0.1 0.1 0.2 -0.1 -0.3 -0.2 -0.2 -1.6 -0.3 -1.4 -0.3 -0.8 0.9 -0.7 0.7 193 325 162 124 15 1.4 2 2 2.1 2 0 -0.2 -0.3 -0.3 -0.3 0 -0.1 0 0 -0.1 -0.1 -0.3 -0.3 -0.2 -0.3 2.5 0 0.3 0.3 0.5 -0.5 -0.1 -0.2 0 -0.1 0 0 0 0 -0.1 0 0 0 0 0 0.6 0 0.1 0.1 0 -0.2 0 -0.1 0.1 0 -1.2 -0.4 -0.8 -0.3 -0.3 -0.6 0.8 -5.2 1.1 -8 1,935 892 542 1.5 1.4 1.5 0 0 0 0.1 -0.2 -0.1 0.1 -0.1 0 0 0.2 -0.1 0 0.1 0 0 0.1 0 0 -0.1 0 0.1 0.1 0 -0.2 -0.2 -0.1 -1.2 -1.5 -2 -0.4 -0.8 -1.4 501 2,081 601 93 1.4 1.4 1.6 1.6 0 0 -0.1 -0.2 0.1 0 -0.1 -0.2 0.2 0 -0.1 -0.3 -0.3 -0.1 0.8 0.2 0 0 0.1 0.5 0 0 0.2 -0.1 0 0 0 0 0 0.1 0.1 0.2 -0.1 -0.2 -0.2 -0.2 -3 -1.2 -0.6 -0.6 -2.3 -0.4 0 -0.6 719 2,677 450 1.5 1.4 1.4 0 0 0 0 0 0 0 0 0.1 2.4 -0.7 2.4 0.1 0 0.2 0 0 0 -0.1 0 -0.1 0 0.1 0 -0.2 -0.2 -0.2 -1.1 -1.4 -1.2 -0.1 -0.7 -0.1 2,054 1.4 0 0 0 -0.8 0 0 0 0.1 -0.2 -1.4 -0.7 269 1.8 -0.2 0 -0.1 2.5 -0.3 0.1 0 0 -0.1 -0.9 -0.2 514 1.9 -0.3 0 -0.3 -0.1 -0.2 -0.1 0 0.3 0.1 -0.9 -0.8 50 1.9 -0.2 -0.1 -0.4 -0.4 -0.1 -0.4 0.2 2 0 -0.6 -1.1 Jkt 235001 PO 00000 Frm 00064 Fmt 4700 Sfmt 4725 E:\FR\FM\03OCR1.SGM 03OCR1 ER03OC14.007</GPH> rmajette on DSK2TPTVN1PROD with RULES Teaching Status: Nonteaching Fewer than 100 residents 1DO or more residents Urban DSH: Non-DSH 100 or more beds Less than 100 beds Rural DSH: SCH RRC 100 or more beds Less than 1DO beds Urban teaching and DSH: Both teaching and DSH Teaching and no DSH No teaching and DSH No teaching and no DSH Special Hospital Types: RRC SCH MDH SCH and RRC MDH and RRC Type of Ownership: Voluntary Proprietary Government Medicare Utilization as a Percent of Inpatient Days: 0-25 25-50 50-65 Over65 FY 2015 Reclassifications by the Medicare Geographic Classification Review Board: All Reclassified Hospitals Non-Reclassified Hospitals Urban Hospitals Reclassified Urban Nonreclassified Hospitals, FY 2015 All Rural Hospitals Reclassified FY 2015 Rural Nonreclassified Hospitals FY 2015 All Section 401 Reclassified Hospitals Hospit al Rate Updat e and Documentalion and Cod in g Adjust -ment 2 FY 2015 Weight sand DRG Chang es with Application of Recalibratio n Budge t Neutralityl (3). catio n of the Front ier Wag e lnde 59687 Federal Register / Vol. 79, No. 192 / Friday, October 3, 2014 / Rules and Regulations Appll . No. of Hospi· tals 1 {1) 2 {2) FY2015 Wage Data with Application of Wage Budget Neutrallty' {4) FY 2015 DRG, Rei. Wts., Wage Index Change swith Wage and Recallbrat ion Budget Neutrali t/ FY201 5 MGCR B Reel as sificatio ns6 Rural Floor and Imputed Floor with Application of National Rural Floor Budget Neu· trallty7 {6) {lj} m 8 Applic a-tion of the CBSA Transltion Wage Index with Budge t Neutra -llty9 {8) nil Impact of the New OMB CBSA Design a-tions X and OutMigr ation Adju stment Hos pitaI Rea dmls sion s Red UC• tion Prog~ Cha nge sto Med icar e DSH All FY 201 5 Cha 12 n~e s 3 {10) m {11) {12) {13) 10 64 1.6 -0.2 0.3 0 3.1 -0.5 0.2 0.1 0.1 -0.1 -1.2 -1.9 15 1.4 0.9 0.1 1.1 -0.9 -0.1 0.1 -0.1 0.7 0 -0.1 1.9 1 Because data necessary to classify some hospitals by category were missing, the total number of hospitals in each category may not equal the national total. Discharge data are from FY 2013, and hospital cost report data are from reporting periods beginning in FY 2012 and FY 2011. 2 This column displays the payment impact of the hospital rate update and the documentation and coding adjustment including the 2.2 percent adjustment to the national standardized amount and hospital-specific rate (the estimated 2.9 percent market basket update reduced by the 0.5 percentage point for the multifactor productivity adjustment and the 0.2 percentage point reduction under the Affordable Care Act) and the 0.8 percent documentation and coding adjustment to the national standardized amount. This column displays the payment impact of the changes to the Version 32.0 GROUPER, the changes to the relative weights and the recalibration of the MS-DRG weights based on the corrected FY 2013 MedPAR data in accordance with section 1886(d)(4)(C)(iii) of the Act. This column displays the application of the recalibration budget neutrality factor of 0.998761 in accordance with section 1886(d)(4)(C)(iii) of the Act. 4 This column displays the payment impact of the update to wage index data using FY 2011 cost report data and the new OMB labor market area delineations. This column displays the payment impact of the application of the wage budget neutrality factor, which is calculated separately from the recalibration budget neutrality factor, and is calculated in accordance with section 1886(d)(3)(E)(i) of the Act. The wage budget neutrality factor is 1.001421. 5 This column displays the combined payment impact of the changes in Columns 3 through 4 and the cumulative budget neutrality factor for MS-DRG and wage changes in accordance with section 1886(d)(4)(C)(iii) of the Act and section 1886(d)(3)(E) of the Act. The cumulative wage and recalibration budget neutrality factor of 1.000180 is the product of the wage budget neutrality factor and the recalibration budget neutrality factor. 6 Shown here are the effects of geographic reclassifications by the Medicare Geographic Classification Review Board (MGCRB) along with the effects of the adoption of the new OMB labor market area delineations on these reclassifications. The effects demonstrate the FY 2015 payment impact of going from no reclassifications to the reclassifications scheduled to be in effect for FY 2015. Reclassification for prior years has no bearing on the payment impacts shown here. This column reflects the geographic budget neutrality factor of 0.990429. 7 This column displays the effects of the rural floor and imputed floor based on the adoption of new OMB labor market area delineations. The Affordable Care Act requires the rural floor budget neutrality adjustment to be 100 percent national level adjustment. The rural floor budget neutrality factor (which includes the imputed floor) applied to the wage index is 0.989525. 8 This column displays the effects of the adoption of the new OMB labor market area delineations. It does not reflect the 3-year transition for hospitals that are currently located in urban counties that would become rural under the new OMB delineations and the 1-year transition to the new OMB delineations where the wage indexes are blended such that hospitals receive 50 percent of their wage index based on the new OMB delineations, and 50 percent of their wage index based on their current labor market area. Rather, it shows the impact of the new OMB delineations fully implemented in FY 2015. ~his column shows the effects of both the 3-year transition for hospitals that are currently located in urban counties that become rural under the new OMB delineations, and the 50150 blended wage index adjustments in a budget neutral manner. For FY 2015, we are applying both the 3-year transition and 50150 blended wage index adjustments in a budget neutral manner, with a budget neutrality factor of 0.998854 applied to the standardized amount. 1 This column shows the combined impact of the policy required under section 10324 of the Affordable Care Act that hospitals located in frontier States have a wage index no less than 1.0 and of section 1886(d)(13) of the Act, as added by section 505 of Pub. L. 108-173, which provides for an increase in a hospital's wage index if a threshold percentage of residents of the county where the hospital Is located commute to work at hospitals in counties with higher wage indexes. These are non budget neutral policies. 11 This column displays the impact of the implementation of the Hospital Readmissions Reduction Program, section 3025 of the Affordable Care Act, a nonbudget neutral provision that adjusts a hospital's payment for excess readmissions. 12 This column displays the impact of the implementation of section 3133 of the Affordable Care Act that reduces Medicare DSH payments by 75 percent and establishes an additional uncompensated care payment. 13 This column shows the changes in payments from FY 2014 to FY 2015. It reflects the impact of the FY 2015 hospital update and the adjustment for documentation and coding. It also reflects changes in hospitals' reclassification status in FY 2015 compared to FY 2014, and the extension of MDH payment status for the first half of FY 2015, under Pub. L. 113-93 enacted on April1, 2014. It incorporates all of the changes displayed in Columns 2, 5, 6, 7, 8, 9, 10, 11, and 12 (the changes displayed in Columns 3 and 4 are included in Column 5). The sum of these impacts may be different from the percentage changes shown here due to rounding and interactive effects. BILLING CODE 4120–01–C 4. On page 50420: a. First column, last partial paragraph, last line, the figure ‘‘0.997543’’ is corrected to read ‘‘0.998761’’. VerDate Sep<11>2014 14:48 Oct 02, 2014 Jkt 235001 b. Second column, first partial paragraph, line 6, the figure ‘‘0.3’’ is corrected to read ‘‘0.2’’. c. Third column: PO 00000 Frm 00065 Fmt 4700 Sfmt 4700 (1) First full paragraph, line 26, the figure ‘‘1.001443’’ is corrected to read ‘‘1.001421’’. E:\FR\FM\03OCR1.SGM 03OCR1 ER03OC14.008</GPH> rmajette on DSK2TPTVN1PROD with RULES Other Reclassified Hospitals (Section 1886(d){8)(B)l. Specialty Hospitals Cardiac specialty Hospitals Hospit al Rate Updat eand Documentation and Codin g Adjust -ment FY 2015 Weight sand DRG Chang es with Appllcation of Recallbratio n Budge tNeutrallty'l {3) catlo n of the Front ier Wag e lnde 59688 Federal Register / Vol. 79, No. 192 / Friday, October 3, 2014 / Rules and Regulations (2) Last partial paragraph, line 6, the phrase ‘‘2 urban hospital’’ is corrected to read ‘‘2 urban hospitals’’. 5. On page 50421, bottom half of the page: a. First column, first full paragraph: (1) Line 9, the figure ‘‘1.001443’’ is corrected to read ‘‘1.001421’’. (2) Line 11, the figure ‘‘0.997543’’ is corrected to read ‘‘0.998761’’. (3) Line 18, the figures ‘‘0.998982’’ and ‘‘0.10’’ are corrected to read ‘‘1.000180’’ and ‘‘0.018’’, respectively. b. Second column, second full paragraph: (1) Line 6, the figure ‘‘0.990406’’ is corrected to read ‘‘0.990429’’. (2) Line 13, the figure ‘‘1.5’’ is corrected to read ‘‘1.6’’. c. Third column, first full paragraph, line 8, the figure ‘‘0.989507’’ is corrected to read ‘‘0.989525’’. 6. On page 50422: a. First column, second partial paragraph: (1) Line 1, the figure ‘‘422’’ is corrected to read ‘‘423’’. (2) Line 3, the figure ‘‘2,974’’ is corrected to read ‘‘2,973’’. (3) Line 6, the figure ‘‘0.989507’’ is corrected to read ‘‘0.989525’’. b. Second column: (1) First paragraph, line 23, the phrase, ‘‘this final rule for a complere’’ is corrected to read ‘‘this final rule for a complete’’. (2) Second paragraph, line 8, the figure ‘‘0.991291’’ is corrected to read ‘‘0.991293’’. (3) Last paragraph, line 7, the figure ‘‘1.121’’ is corrected to read ‘‘1.1093’’. (4) Last paragraph, last line, the figure ‘‘$1.9’’ is corrected to read ‘‘$1.8’’. 7. On page 50423, the table titled ‘‘FY 2015 IPPS Estimated Payments Due to Rural Floor and Imputed Floor with National Budget Neutrality’’ is corrected to read as follows: FY 2015 IPPS ESTIMATED PAYMENTS DUE TO RURAL FLOOR AND IMPUTED FLOOR WITH NATIONAL BUDGET NEUTRALITY Number of hospitals rmajette on DSK2TPTVN1PROD with RULES Percent change in payments due to application of rural floor and imputed floor with budget neutrality Difference (in millions) (1) State Number of hospitals that will receive the rural floor or imputed floor (2) (3) (4) Alabama ........................................................................................................... Alaska .............................................................................................................. Arizona ............................................................................................................. Arkansas .......................................................................................................... California .......................................................................................................... Colorado .......................................................................................................... Connecticut ...................................................................................................... Delaware .......................................................................................................... Washington, D.C .............................................................................................. Florida .............................................................................................................. Georgia ............................................................................................................ Hawaii .............................................................................................................. Idaho ................................................................................................................ Illinois ............................................................................................................... Indiana ............................................................................................................. Iowa ................................................................................................................. Kansas ............................................................................................................. Kentucky .......................................................................................................... Louisiana .......................................................................................................... Maine ............................................................................................................... Massachusetts ................................................................................................. Michigan ........................................................................................................... Minnesota ........................................................................................................ Mississippi ........................................................................................................ Missouri ............................................................................................................ Montana ........................................................................................................... Nebraska .......................................................................................................... Nevada ............................................................................................................. New Hampshire ............................................................................................... New Jersey ...................................................................................................... New Mexico ..................................................................................................... New York ......................................................................................................... North Carolina .................................................................................................. North Dakota .................................................................................................... Ohio ................................................................................................................. Oklahoma ......................................................................................................... Oregon ............................................................................................................. Pennsylvania .................................................................................................... Puerto Rico ...................................................................................................... Rhode Island .................................................................................................... South Carolina ................................................................................................. South Dakota ................................................................................................... Tennessee ....................................................................................................... Texas ............................................................................................................... Utah ................................................................................................................. VerDate Sep<11>2014 14:48 Oct 02, 2014 Jkt 235001 PO 00000 Frm 00066 Fmt 4700 Sfmt 4700 91 6 57 45 309 47 31 6 7 169 106 12 14 127 91 34 53 65 100 20 61 95 51 64 78 12 23 24 13 64 25 163 87 6 135 86 33 154 52 11 55 19 98 324 33 E:\FR\FM\03OCR1.SGM 2 4 9 0 200 6 8 0 0 25 0 0 0 0 0 0 0 1 0 0 51 0 0 0 0 4 0 6 9 15 2 0 0 1 10 2 0 10 11 4 7 0 16 6 2 03OCR1 ¥0.5 1.5 ¥0.1 ¥0.5 1.9 0.2 ¥0.4 ¥0.6 ¥0.6 ¥0.3 ¥0.5 ¥0.4 ¥0.4 ¥0.6 ¥0.6 ¥0.5 ¥0.4 ¥0.5 ¥0.5 ¥0.5 4.9 ¥0.5 ¥0.5 ¥0.5 ¥0.5 ¥0.3 ¥0.4 0.7 2.2 0.1 ¥0.3 ¥0.6 ¥0.5 ¥0.3 ¥0.4 ¥0.5 ¥0.5 ¥0.5 0 0.5 ¥0.3 ¥0.3 ¥0.2 ¥0.5 ¥0.4 ¥8.4 2.2 ¥1.9 ¥5.3 190.2 2.3 ¥6.6 ¥2.4 ¥2.6 ¥18.7 ¥13.2 ¥1.3 ¥1.2 ¥28.0 ¥13.2 ¥4.5 ¥3.8 ¥7.9 ¥7.0 ¥2.5 156.4 ¥23.2 ¥10.1 ¥5.3 ¥11.2 ¥0.8 ¥2.6 4.7 10.5 2.7 ¥1.1 ¥48.9 ¥15.9 ¥0.8 ¥16.9 ¥5.7 ¥4.8 ¥23.3 ¥0.1 1.8 ¥5.1 ¥1.1 ¥5.6 ¥30.1 ¥2.2 Federal Register / Vol. 79, No. 192 / Friday, October 3, 2014 / Rules and Regulations 59689 FY 2015 IPPS ESTIMATED PAYMENTS DUE TO RURAL FLOOR AND IMPUTED FLOOR WITH NATIONAL BUDGET NEUTRALITY—Continued Number of hospitals Percent change in payments due to application of rural floor and imputed floor with budget neutrality Difference (in millions) (1) State Number of hospitals that will receive the rural floor or imputed floor (2) (3) (4) Vermont ........................................................................................................... Virginia ............................................................................................................. Washington ...................................................................................................... West Virginia .................................................................................................... Wisconsin ......................................................................................................... Wyoming .......................................................................................................... 8. On page 50424: a. Second column, first partial paragraph, line 9, the figure ‘‘0.998859’’ is corrected to read ‘‘0.998854’’. b. Third column, first full paragraph, line 18, the figure ‘‘273’’ is corrected to read ‘‘279’’. 9. On page 50425: 6 79 49 30 65 11 ¥0.3 ¥0.5 ¥0.2 ¥0.4 ¥0.5 ¥0.2 0 1 8 0 2 1 a. First column, first partial paragraph, last line, the figure ‘‘$424’’ is corrected to read ‘‘$428’’. b. Second column, first full paragraph, line 1, the phrase ‘‘Rural West South’’ is corrected to read ‘‘Rural West North’’. c. Third column: (1) First partial paragraph, line 6, the figure ‘‘5.71’’ is corrected to read ‘‘5.68’’. ¥0.7 ¥12.0 ¥3.1 ¥3.2 ¥8.6 ¥0.3 (2) First full paragraph, line 14, the figure ‘‘0.7’’ is corrected to read ‘‘0.6’’. 10. On pages 50426 and 50427, the table titled ‘‘Table II.—Impact Analysis of Changes for FY 2015 Acute Care Hospital Operating Prospective Payment System (Payments Per Discharge)’’ is corrected to read as follows: TABLE II—IMPACT ANALYSIS OF CHANGES FOR FY 2015 ACUTE CARE HOSPITAL OPERATING PROSPECTIVE PAYMENT SYSTEM [Payments per discharge] Estimated average FY 2014 payment per discharge Estimated average FY 2015 payment per discharge All FY 2015 changes (1) rmajette on DSK2TPTVN1PROD with RULES Number of hospitals (2) (3) (4) All Hospitals ..................................................................................................... By Geographic Location: Urban hospitals ......................................................................................... Large urban areas .................................................................................... Other urban areas .................................................................................... Rural hospitals .......................................................................................... Bed Size (Urban): 0–99 beds ................................................................................................. 100–199 beds ........................................................................................... 200–299 beds ........................................................................................... 300–499 beds ........................................................................................... 500 or more beds ..................................................................................... Bed Size (Rural): 0–49 beds ................................................................................................. 50–99 beds ............................................................................................... 100–149 beds ........................................................................................... 150–199 beds ........................................................................................... 200 or more beds ..................................................................................... Urban by Region: New England ............................................................................................ Middle Atlantic .......................................................................................... South Atlantic ........................................................................................... East North Central .................................................................................... East South Central ................................................................................... West North Central ................................................................................... West South Central .................................................................................. Mountain ................................................................................................... Pacific ....................................................................................................... Puerto Rico ............................................................................................... Rural by Region: New England ............................................................................................ VerDate Sep<11>2014 14:48 Oct 02, 2014 Jkt 235001 PO 00000 Frm 00067 Fmt 4700 Sfmt 4700 3,396 11,249 11,184 ¥0.6 2,549 1,401 1,148 847 11,625 12,377 10,709 8,240 11,557 12,308 10,643 8,194 ¥0.6 ¥0.6 ¥0.6 ¥0.6 666 787 455 429 212 9,088 9,747 10,507 11,951 14,309 9,061 9,682 10,489 11,875 14,198 ¥0.3 ¥0.7 ¥0.2 ¥0.6 ¥0.8 328 305 125 50 39 6,778 7,803 8,113 8,857 9,988 6,701 7,692 8,109 8,819 10,027 ¥1.1 ¥1.4 0 ¥0.4 0.4 120 324 407 397 153 162 387 162 385 52 12,806 12,914 10,453 10,849 10,052 11,355 10,677 11,935 14,691 8,218 12,802 12,905 10,359 10,790 9,922 11,314 10,500 11,835 14,708 7,620 0 ¥0.1 ¥0.9 ¥0.5 ¥1.3 ¥0.4 ¥1.7 ¥0.8 0.1 ¥7.3 22 11,207 11,110 ¥0.9 E:\FR\FM\03OCR1.SGM 03OCR1 59690 Federal Register / Vol. 79, No. 192 / Friday, October 3, 2014 / Rules and Regulations TABLE II—IMPACT ANALYSIS OF CHANGES FOR FY 2015 ACUTE CARE HOSPITAL OPERATING PROSPECTIVE PAYMENT SYSTEM—Continued [Payments per discharge] Estimated average FY 2014 payment per discharge Estimated average FY 2015 payment per discharge All FY 2015 changes (1) rmajette on DSK2TPTVN1PROD with RULES Number of hospitals (2) (3) (4) Middle Atlantic .......................................................................................... South Atlantic ........................................................................................... East North Central .................................................................................... East South Central ................................................................................... West North Central ................................................................................... West South Central .................................................................................. Mountain ................................................................................................... Pacific ....................................................................................................... By Payment Classification: Urban hospitals ......................................................................................... Large urban areas .................................................................................... Other urban areas .................................................................................... Rural areas ............................................................................................... Teaching Status: Nonteaching .............................................................................................. Fewer than 100 residents ......................................................................... 100 or more residents .............................................................................. Urban DSH: Non-DSH .................................................................................................. 100 or more beds ..................................................................................... Less than 100 beds .................................................................................. Rural DSH: SCH .......................................................................................................... RRC .......................................................................................................... 100 or more beds ..................................................................................... Less than 100 beds .................................................................................. Urban teaching and DSH: Both teaching and DSH ............................................................................ Teaching and no DSH .............................................................................. No teaching and DSH .............................................................................. No teaching and no DSH ......................................................................... Special Hospital Types: RRC .......................................................................................................... SCH .......................................................................................................... MDH .......................................................................................................... SCH and RRC .......................................................................................... MDH and RRC .......................................................................................... Type of Ownership: Voluntary ................................................................................................... Proprietary ................................................................................................ Government .............................................................................................. Medicare Utilization as a Percent of Inpatient Days: 0–25 .......................................................................................................... 25–50 ........................................................................................................ 50–65 ........................................................................................................ Over 65 ..................................................................................................... FY 2015 Reclassifications by the Medicare Geographic Classification Review Board: All Reclassified Hospitals ......................................................................... Non-Reclassified Hospitals ....................................................................... Urban Hospitals Reclassified .................................................................... Urban Nonreclassified Hospitals, FY 2015: ............................................. All Rural Hospitals Reclassified FY 2015: ................................................ Rural Nonreclassified Hospitals FY 2015: ................................................ All Section 401 Reclassified Hospitals: .................................................... Other Reclassified Hospitals (Section 1886(d)(8)(B)) .............................. Specialty Hospitals: Cardiac specialty Hospitals ...................................................................... 11. On page 50428, first column, first paragraph, lines 31 through 35, the sentence ‘‘Based on the applicant’s VerDate Sep<11>2014 14:48 Oct 02, 2014 Jkt 235001 57 132 116 165 102 168 61 24 8,292 7,836 8,475 7,513 8,914 7,108 9,454 11,083 8,231 7,772 8,496 7,409 8,941 6,978 9,509 11,221 ¥0.7 ¥0.8 0.2 ¥1.4 0.3 ¥1.8 0.6 1.3 2,563 1,413 1,150 833 11,609 12,366 10,677 8,457 11,541 12,296 10,611 8,411 ¥0.6 ¥0.6 ¥0.6 ¥0.5 2,357 795 244 9,343 10,978 16,533 9,300 10,920 16,399 ¥0.5 ¥0.5 ¥0.8 679 1,588 383 9,836 12,055 8,434 9,899 11,960 8,375 0.6 ¥0.8 ¥0.7 373 212 24 137 7,907 9,194 7,395 6,329 7,867 9,175 7,305 6,253 ¥0.5 ¥0.2 ¥1.2 ¥1.2 842 133 1,129 459 13,277 11,130 9,781 9,223 13,167 11,230 9,713 9,289 ¥0.8 0.9 ¥0.7 0.7 193 325 162 124 15 9,403 9,577 7,072 10,293 9,195 9,350 9,654 6,706 10,410 8,458 ¥0.6 0.8 ¥5.2 1.1 ¥8 1,935 892 542 11,377 10,001 12,283 11,334 9,919 12,113 ¥0.4 ¥0.8 ¥1.4 501 2,081 601 93 14,885 11,359 9,146 8,408 14,544 11,311 9,145 8,353 ¥2.3 ¥0.4 0 ¥0.6 719 2,677 450 2,054 269 514 50 64 10,843 11,379 11,514 11,675 8,734 7,667 10,137 7,814 10,829 11,298 11,502 11,593 8,713 7,606 10,025 7,665 ¥0.1 ¥0.7 ¥0.1 ¥0.7 ¥0.2 ¥0.8 ¥1.1 ¥1.9 15 12,303 12,538 1.9 estimate from FY 2013, we currently estimate that new technology add-on payments for Voraxaze® will increase PO 00000 Frm 00068 Fmt 4700 Sfmt 4700 overall FY 2015 payments by $6,300,000.’’ is corrected to read ‘‘Based on the latest data from the E:\FR\FM\03OCR1.SGM 03OCR1 Federal Register / Vol. 79, No. 192 / Friday, October 3, 2014 / Rules and Regulations manufacturer, we currently estimate that new technology add-on payments for Voraxaze® will increase overall FY 2015 payments by $6,615,000.’’ 12. On page 50429: a. First column, second paragraph, line 6, the figure ‘‘$5.3’’ is corrected to read ‘‘$8.8’’. b. First column, third paragraph, line 16, the figure ‘‘166’’ is corrected to read ‘‘116’’. c. Second column, first partial paragraph, line 4, the figure ‘‘$70.7’’ is corrected to read ‘‘$71’’. 13. On page 50435, upper threefourths of the page: a. First column, fourth bulleted paragraph: (1) Line 4, the figure ‘‘0.9986’’ is corrected to read ‘‘0.9993’’. (2) Line 5, the figure ‘‘0.9373’’ is corrected to read ‘‘0.9382’’. b. Second column, first partial paragraph, line 2, the figure’’1.2’’ is corrected to read ‘‘1.3’’. c. Third column: (1) Second full paragraph, second sentence, is corrected to read, ‘‘The 59691 increase in capital payments for voluntary and proprietary hospitals is estimated at 1.5 percent, and for government hospitals the increase is estimated to be 1.3 percent.’’ (2) Third full paragraph: (a) Line 20, the figure ‘‘0.7’’ is corrected to read ‘‘0.8’’. (b) Line 24, the figure ‘‘(2.2 percent)’’ is corrected to read ‘‘(2.3 percent)’’. 14. On pages 50435 through 50437, the table titled, ‘‘Table III. Comparison of Total Payments Per Case’’ is corrected to read as follows: TABLE III—COMPARISON OF TOTAL PAYMENTS PER CASE [FY 2014 payments compared to FY 2015 payments] rmajette on DSK2TPTVN1PROD with RULES Number of hospitals By Geographic Location: All hospitals .............................................................................................. Large urban areas (populations over 1 million) ....................................... Other urban areas (populations of 1 million or fewer) ............................. Rural areas ............................................................................................... Urban hospitals ......................................................................................... 0–99 beds .......................................................................................... 100–199 beds .................................................................................... 200–299 beds .................................................................................... 300–499 beds .................................................................................... 500 or more beds .............................................................................. Rural hospitals .......................................................................................... 0–49 beds .......................................................................................... 50–99 beds ........................................................................................ 100–149 beds .................................................................................... 150–199 beds .................................................................................... 200 or more beds .............................................................................. By Region: Urban by Region ...................................................................................... New England ..................................................................................... Middle Atlantic ................................................................................... South Atlantic .................................................................................... East North Central ............................................................................. East South Central ............................................................................ West North Central ............................................................................ West South Central ........................................................................... Mountain ............................................................................................ Pacific ................................................................................................ Puerto Rico ........................................................................................ Rural by Region ........................................................................................ New England ..................................................................................... Middle Atlantic ................................................................................... South Atlantic .................................................................................... East North Central ............................................................................. East South Central ............................................................................ West North Central ............................................................................ West South Central ........................................................................... Mountain ............................................................................................ Pacific ................................................................................................ Puerto Rico ........................................................................................ By Payment Classification: All hospitals .............................................................................................. Large urban areas (populations over 1 million) ....................................... Other urban areas (populations of 1 million or fewer) ............................. Rural areas ............................................................................................... Teaching Status: Non-teaching ..................................................................................... Fewer than 100 Residents ................................................................ 100 or more Residents ...................................................................... Urban DSH: 100 or more beds ....................................................................... Less than 100 beds ................................................................... VerDate Sep<11>2014 14:48 Oct 02, 2014 Jkt 235001 PO 00000 Frm 00069 Fmt 4700 Sfmt 4700 Average FY 2014 payments/ case Average FY 2015 payments/ case Change 3,396 1,401 1,148 847 2,549 666 787 455 429 212 847 328 305 125 50 39 856 944 824 583 890 733 772 812 907 1,066 583 474 542 582 636 709 869 959 835 589 903 740 783 826 922 1,081 589 480 546 588 643 717 1.5 1.7 1.4 1.0 1.5 0.9 1.5 1.8 1.6 1.5 1.0 1.2 0.8 1.1 1.1 1.1 2,549 120 324 407 397 153 162 387 162 385 52 847 22 57 132 116 165 102 168 61 24 0 890 984 958 802 856 764 880 823 907 1,120 408 583 812 566 555 607 534 619 515 653 749 0 903 1,001 977 812 867 772 892 831 918 1,148 412 589 823 575 559 613 539 624 519 657 767 0 1.5 1.7 1.9 1.3 1.3 1.0 1.4 0.9 1.2 2.4 1.2 1.0 1.4 1.7 0.7 1.1 0.9 0.9 0.8 0.5 2.4 0.0 3,396 1,413 1,150 833 856 943 823 594 869 959 835 599 1.5 1.7 1.4 0.8 2,357 795 244 728 837 1,210 738 850 1,229 1.5 1.5 1.6 1,588 383 911 649 925 657 1.6 1.1 E:\FR\FM\03OCR1.SGM 03OCR1 59692 Federal Register / Vol. 79, No. 192 / Friday, October 3, 2014 / Rules and Regulations TABLE III—COMPARISON OF TOTAL PAYMENTS PER CASE—Continued [FY 2014 payments compared to FY 2015 payments] Number of hospitals rmajette on DSK2TPTVN1PROD with RULES Rural DSH: Sole Community (SCH/EACH) ................................................... Referral Center (RRC/EACH) .................................................... Other Rural: 100 or more beds ................................................................ Less than 100 beds ............................................................ Urban teaching and DSH: Both teaching and DSH .................................................................... Teaching and no DSH ....................................................................... No teaching and DSH ....................................................................... No teaching and no DSH .................................................................. Rural Hospital Types: Non special status hospitals .............................................................. RRC/EACH ........................................................................................ SCH/EACH ........................................................................................ SCH, RRC and EACH ....................................................................... Hospitals Reclassified by the Medicare Geographic Classification Review Board: FY2015 Reclassifications: All Urban Reclassified ....................................................................... All Urban Non-Reclassified ............................................................... All Rural Reclassified ........................................................................ All Rural Non-Reclassified ................................................................. Other Reclassified Hospitals (Section 1886(d)(8)(B)) ....................... Type of Ownership: Voluntary ........................................................................................... Proprietary ......................................................................................... Government ....................................................................................... Medicare Utilization as a Percent of Inpatient Days: 0–25 ................................................................................................... 25–50 ................................................................................................. 50–65 ................................................................................................. Over 65 .............................................................................................. a. Upper three-fourths of the page: (1) Second column, first paragraph: (a) Line 2, the figure ‘‘$654’’ is corrected to read ‘‘$623’’. (b) Line 14, the figure ‘‘$457’’ is corrected to read ‘‘$428’’. (c) Line 22, the figure ‘‘$369’’ is corrected to read ‘‘$373’’. (d) Line 44, the figure ‘‘$457’’ is corrected to read ‘‘$428’’. (e) Line 45, the figure ‘‘$888’’ is corrected to read ‘‘$862’’. (f) Line 51, the figure ‘‘$132’’ is corrected to read ‘‘$128’’. (g) Line 55, the figure ‘‘$756’’ is corrected to read ‘‘$734’’. (2) Third column, last paragraph, last line, the figure ‘‘$756’’ is corrected to read ‘‘$734’’. b. Lower quarter of the page, the table titled ‘‘Table V.—Accounting Statement: Classification of Estimated Expenditures VerDate Sep<11>2014 17:33 Oct 02, 2014 Jkt 235001 Average FY 2014 payments/ case 530 656 535 661 1.1 0.8 24 137 552 465 552 469 0.0 1.0 842 133 1,129 459 990 891 762 788 1,005 907 774 799 1.5 1.8 1.6 1.4 2,575 193 325 124 890 717 652 711 903 730 659 720 1.5 1.8 1.1 1.3 450 2,054 269 514 59 886 893 621 533 581 904 906 628 537 595 2.1 1.4 1.0 0.8 2.3 1,935 892 542 868 776 895 882 787 907 1.5 1.5 1.3 501 2,081 601 93 1,022 871 717 648 1,037 884 728 654 1.4 1.5 1.6 1.0 TABLE V—ACCOUNTING STATEMENT: CLASSIFICATION OF ESTIMATED EXPENDITURES UNDER THE IPPS FROM FY 2014 TO FY 2015 Annualized Monetized Transfers. From Whom to Whom Transfers ¥$734 million. Federal Government to IPPS Medicare Providers. Dated: September 30, 2014. Oliver Potts, Deputy Executive Secretary to the Department, Department of Health and Human Services. [FR Doc. 2014–23630 Filed 10–1–14; 11:15 am] BILLING CODE 4120–01–P PO 00000 Frm 00070 Fmt 4700 Change 373 212 under the IPPS from FY 2014 to FY 2015’’ is corrected to read as follows: Category Average FY 2015 payments/ case Sfmt 9990 E:\FR\FM\03OCR1.SGM 03OCR1

Agencies

[Federal Register Volume 79, Number 192 (Friday, October 3, 2014)]
[Rules and Regulations]
[Pages 59675-59692]
From the Federal Register Online via the Government Printing Office [www.gpo.gov]
[FR Doc No: 2014-23630]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare & Medicaid Services

42 CFR Parts 405, 412, 413, 415, 422, 424, 485, and 488

[CMS-1607-CN]
RINs 0938-AS11; 0938-AR12; and 0938-AR53


Medicare Program; Hospital Inpatient Prospective Payment Systems 
for Acute Care Hospitals and the Long-Term Care Hospital Prospective 
Payment System and Fiscal Year 2015 Rates; Quality Reporting 
Requirements for Specific Providers; Reasonable Compensation 
Equivalents for Physician Services in Excluded Hospitals and Certain 
Teaching Hospitals; Provider Administrative Appeals and Judicial 
Review; Enforcement Provisions for Organ Transplant Centers; and 
Electronic Health Record (EHR) Incentive Program; Correction

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

ACTION: Final rule; correction.

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SUMMARY: This document corrects technical and typographical errors in 
the final rule that appeared in the August 22, 2014 Federal Register 
titled ``Medicare Program; Hospital Inpatient Prospective Payment 
Systems for Acute Care Hospitals and the Long-Term Care Hospital 
Prospective Payment System and Fiscal Year 2015 Rates; Quality 
Reporting Requirements for Specific Providers; Reasonable Compensation 
Equivalents for Physician Services in Excluded Hospitals and Certain 
Teaching Hospitals; Provider Administrative Appeals and Judicial 
Review; Enforcement Provisions for Organ Transplant Centers; and 
Electronic Health Record (EHR) Incentive Program.''

DATES: Effective date: This document is effective October 1, 2014.

FOR FURTHER INFORMATION CONTACT: Ing Jye Cheng, (410) 786-4487, 
Operating Prospective Payment, Capital Prospective Payment, and New 
Medical Service and Technology Add-On Payment Corrections.
    Donald Thompson, (410) 786-6504, Operating Prospective Payment, 
Wage Index, and Capital Prospective Payment Corrections.
    James Poyer, (410) 786-2261, PPS-Exempt Cancer Hospital Quality 
Reporting and Hospital Inpatient Quality Reporting Corrections.
    Mary Pratt, (410) 786-2261, Long-term Care Hospital Quality Data 
Reporting Corrections.
    Kellie Shannon, (410) 786-0416, Administrative Appeals by Providers 
and Judicial Review Corrections.
    Thomas Hamilton, (410) 786-6763, Organ Transplant Center 
Corrections.

SUPPLEMENTARY INFORMATION:

I. Background

    In FR Doc. 2014-18545 which appeared in the August 22, 2014 Federal 
Register (79 FR 49853), titled ``Medicare Program; Hospital Inpatient 
Prospective Payment Systems for Acute Care Hospitals and the Long-Term 
Care Hospital Prospective Payment System and Fiscal Year 2015 Rates; 
Quality Reporting Requirements for Specific Providers; Reasonable 
Compensation Equivalents for Physician Services in Excluded Hospitals 
and Certain Teaching Hospitals; Provider Administrative Appeals and 
Judicial Review; Enforcement Provisions for Organ Transplant Centers; 
and Electronic Health Record (EHR) Incentive Program'' (hereinafter 
referred to as the FY 2015 IPPS/LTCH PPS final rule), there were a 
number of technical errors that are identified and corrected in section 
IV. of this correcting document. The provisions in this correction 
document are effective as if they had been included in the FY 2015 
IPPS/LTCH PPS final rule that appeared in the August 22, 2014 Federal 
Register. Accordingly, the corrections are effective October 1, 2014.

II. Summary of Errors and Corrections to Tables Posted on the CMS Web 
Site

A. Summary of Errors in the Preamble

    On page 49865, in our discussion of the summary of costs and 
benefits of the payment adjustment of the Hospital-Acquired Condition 
(HAC) Reduction Program for FY 2015, we made a technical error in the 
amount by which overall payments would decrease.
    On page 49918, in our discussion of new technology add-on payments, 
we made an error in the amount of the maximum add-on payment for 
Voraxaze[supreg].
    On page 49940, we made an error in our discussion of the FY 2015 
new technology add-on payment for the

[[Page 59676]]

CardioMEMSTM HF (Heart Failure) Monitoring System.
    On pages 50246 through 50249, in the table titled ``Previously 
Adopted Hospital IQR Program Measures And Measures Newly Finalized in 
this Final Rule for the FY 2017 Payment Determination and Subsequent 
Years,'' we inadvertently listed VTE-3 as a ``voluntary electronic 
clinical quality measure'' only and inadvertently omitted PN-6 from the 
table, which should have been listed as a voluntary electronic clinical 
quality measure.
    On pages 50279 and 52084, in our discussion of the PPS-exempt 
Cancer Hospital Quality Reporting Program (PCHQR), we provided a Web 
site link that is not functional due to a typographical error, and made 
other typographical and technical errors.
    On pages 50298, 50302, and 50306, we made typographical and 
technical errors in our discussion of the Long-Term Care Hospital 
Quality Reporting (LTCHQR) Program.
    On page 50335, we made typographical and technical errors in our 
discussion of organ transplant centers.

B. Summary of Errors in the Regulations Text

    On page 50350, in the regulations text at Sec.  405.1811(c) and 
Sec.  405.1835(c), we made technical errors in specifying the 
requirements regarding a provider's right to contractor or Board 
hearings resulting from untimely contractor determinations.

C. Summary of Errors in the Addendum

    In calculating the final FY 2015 IPPS operating and capital rates 
and impacts, we made two technical errors.
    First, there was a technical error in our determination of payments 
under the postacute care transfer policy for certain MS-DRGs within the 
ratesetting process. Specifically, we inadvertently did not treat those 
MS-DRGs that qualified for a special payment under the postacute care 
transfer policy (see Sec.  412.4(f)(6)) in FY 2015 as MS-DRGs subject 
to the postacute care transfer policy. Consequently, the FY 2015 
transfer-adjusted case-mix indexes and cases used to model IPPS 
payments in the ratesetting process were incorrect, and resulted in a 
miscalculation of the operating and capital IPPS budget neutrality 
factors, outlier threshold, operating standardized amounts, capital 
Federal rates, and impacts for the FY 2015 IPPS/LTCH PPS final rule. To 
conform with our established methodology, we are recalculating the FY 
2015 transfer-adjusted case-mix indexes and cases used to model IPPS 
payments in the ratesetting process after properly treating those MS-
DRGs that qualified for a special payment under the postacute care 
transfer policy in FY 2015 as MS-DRGs subject to the postacute care 
transfer policy. Therefore, we are recalculating the operating and 
capital IPPS budget neutrality factors, outlier threshold, operating 
standardized amounts, capital Federal rates, and impacts for FY 2015 
using our established methodology.
    The second error was the inadvertent error in identifying claims 
for indirect medical education (IME) payments for Medicare Advantage 
(MA) beneficiaries (MA IME claims) in the ratesetting process for the 
FY 2015 IPPS/LTCH PPS final rule. Per the methodology established in 
the FY 2011 IPPS/LTCH PPS final rule (75 FR 50422 through 50433), in 
order to identify IME MA claims, we first search the MedPAR file for 
all claims with an IME payment greater than zero. Then, we filter these 
claims for a subset of claims with a group health organization (GHO) 
paid indicator with a value of ``1'' or with the IME payment field 
equal to the DRG payment field. For the reasons described later in this 
section, in applying this methodology for the FY 2015 IPPS/LTCH PPS 
final rule, we did not identify certain MA IME claims using the filter 
for claims where the IME payment field is equal to the DRG payment 
field.
    The Budget Control Act of 2011 requires mandatory across-the-board 
reductions in Federal spending, also known as sequestration. The 
American Taxpayer Relief Act of 2012 postponed sequestration for 2 
months. As required by law, President Obama issued a sequestration 
order on March 1, 2013.
    For FY 2015, we used claims from the FY 2013 MedPAR in our 
ratesetting process to determine the operating and capital IPPS budget 
neutrality factors, outlier threshold, operating standardized amounts, 
capital Federal rates, and the IPPS impact analyses presented in the FY 
2015 IPPS/LTCH PPS final rule. Claims for discharges occurring on or 
after April 1, 2013 had the 2-percent reduction for sequestration 
applied to the DRG payment field. As a result, in applying the 
methodology described previously for the FY 2015 IPPS/LTCH PPS final 
rule, we inadvertently did not properly identify certain claims for IME 
MA payments because the DRG payment field reflected the 2-percent 
reduction for sequestration (and therefore, the IME payment field did 
not equal the DRG payment field for those claims). As discussed in the 
FY 2015 IPPS/LTCH PPS final rule (79 FR 50364 and 50365), under our 
established methodology, payments for MA IME claims are used in our 
operating IPPS budget neutrality calculations. Therefore, the 
inadvertent omission of these MA IME claims resulted in a 
miscalculation of the operating budget neutrality calculations. (We 
note this error did not affect the calculation of the outlier threshold 
or the MS-DRG relative weights because, under our established 
methodology for the respective calculations of these IPPS payment 
factors, we only include claims with a ``Claim Type'' of 60, and the 
claims that were not properly identified as MA IME claims did not have 
a ``Claim Type'' of 60.) We are recalculating the operating budget 
neutrality factors that are used to determine the standardized amounts 
for FY 2015 to conform with our established methodology as stated in 
the FY 2015 IPPS/LTCH PPS final rule. Specifically, for this correcting 
document, we are restoring the 2-percent reduction for sequestration to 
the DRG payment field in order to ensure that we properly identify all 
claims where the IME payment field is equal to the DRG payment field 
consistent with our established methodology.
    As described previously, one or both of these two technical errors 
resulted in errors to our calculation of the operating and capital IPPS 
budget neutrality factors, outlier threshold, operating standardized 
amounts, capital Federal rates, and impacts. As a result of these 
technical errors we are correcting the following errors:
     In the operating and capital budget neutrality factors, 
outlier threshold, operating standardized amounts, capital Federal 
rates, and capital IPPS payment estimates that appear on the following 
pages of the Addendum of the FY 2015 IPPS/LTCH PPS final rule: 50367 
through 50370, 50373 and 50374, 50380 through 50383, 50385 and 50386, 
50388 through 50390, and 50404 (Tables 1A through 1D).
     In the data presented in the tables referred to in the FY 
2015 IPPS/LTCH PPS final rule and available via the Internet on the CMS 
Web site (see section II.D. of this correcting document).
     In the operating and capital impacts that appear in the 
following pages of the Appendices of the FY 2015 IPPS/LTCH PPS final 
rule: 50405, 50407, 50409 through 50418, 50420 through 50429, 50435 and 
50436, and 50446.
    The errors described previously also affect the calculation of the 
Hospital Readmissions Reduction Program payment adjustment factors and 
the Hospital Value-Based Purchasing (VBP)

[[Page 59677]]

Program payment adjustment factors for FY 2015. The readmissions 
payment adjustment factor is based in part on a ratio of a hospital's 
``aggregate payment for excess readmissions'' and its ``aggregate 
payments for all discharges.'' We use Medicare Part A inpatient claims 
from the MedPAR file as our data source for determining aggregate 
payments for excess readmissions and aggregate payments for all 
discharges. For FY 2015, we use MedPAR claims with discharge dates on 
or after July 1, 2010 and no later than June 30, 2013 to calculate the 
ratio used in determining the readmissions payment adjustment factors. 
Under the Hospital VBP Program, the Secretary reduces the base 
operating DRG payment amount for an eligible hospital for each 
discharge in a fiscal year by an applicable percent. The sum total of 
these reductions in a fiscal year must equal the total amount available 
for value-based incentive payments for all eligible hospitals for the 
fiscal year, as estimated by the Secretary. We use a linear exchange 
function to translate this estimated amount available into a value-
based incentive payment percentage for each hospital, based on its 
total performance score (TPS). We then calculate the value-based 
incentive payment adjustment factor for each hospital and apply that 
factor to the base-operating DRG payment amount for each discharge 
occurring at that hospital in FY 2015 on a per claim basis. We 
finalized the methodology for using base operating DRG payment amounts 
derived from the MedPAR file in the calculation of the value-based 
incentive payment adjustment factors in the FY 2013 IPPS/LTCH PPS final 
rule (77 FR 53574 and 53575). In the FY 2015 IPPS/LTCH PPS final rule 
(79 FR 50049), based on the March 2014 update of the FY 2013 MedPAR 
file (that is, MedPAR Part A claims with discharge dates on or after 
October 1, 2012 and on or before September 30, 2013), we estimated that 
the amount available for value-based incentive payments for FY 2015 is 
$1.4 billion (the applicable percent for the FY 2015 Hospital VBP 
Program is 1.50 percent).
    We use the same methodology described previously to identify only 
Medicare Part A claims in the MedPAR file and to remove IME MA claims 
when calculating the Hospital Readmissions Reduction Program and the 
Hospital VBP Program payment adjustment factors. In addition, we use 
the claims in the MedPAR file to determine the base operating DRG 
payment amounts used in the calculation of these payment adjustment 
factors. Consequently, in determining the base-operating DRG payment 
amounts used in our calculation of the proxy readmissions adjustment 
factors (Table 15A) and the updated proxy Hospital VBP payment 
adjustment factors (Table 16A) for the FY 2015 IPPS/LTCH PPS final 
rule, we inadvertently failed to properly exclude all of the IME MA 
claims, and also inadvertently included the 2-percent sequestration 
reduction for claims in the FY 2013 MedPAR with a discharge date after 
April 1, 2013. Therefore, to properly account for how sequestration is 
reflected in the FY 2013 MedPAR data in the calculation of these 
payment adjustment factors, we restored the 2-percent sequestration 
reduction to the DRG payment field on the MedPAR claim (as described 
previously). This correction ensures that we identify and remove all 
IME MA claims when the IME payment field is equal to the DRG payment 
field and correctly determine the base-operating DRG payment amount 
used in the calculation of the readmission and Hospital VBP payment 
adjustment factors for FY 2015.
    At the time of the issuance of the FY 2015 IPPS/LTCH PPS final 
rule, under the Hospital Readmissions Reduction Program, applicable 
hospitals had not yet had the opportunity to review and correct data 
from the FY 2015 applicable period before they were made public under 
our policy regarding the reporting of hospital-specific information. 
Therefore, in Table 15A listed in the Addendum of the FY 2015 IPPS/LTCH 
PPS final rule, we provided proxy FY 2015 readmission payment 
adjustment factors, and stated that we expected to publish the final FY 
2015 readmissions payment adjustment factors in Table 15B on the CMS 
IPPS Web site by October 2014, and would use those final factors for 
determining payments for discharges occurring on or after October 1, 
2014 (79 FR 50048). Similarly, in the final rule, we provided updated 
proxy value-based incentive payment adjustment factors for FY 2015 in 
Table 16A listed in the Addendum of that final rule to reflect changes 
based on the March 2014 update to the FY 2013 MedPAR file. These 
updated proxy value-based incentive payment adjustment factors for FY 
2015 were based on historic FY 2014 Program TPSs because hospitals had 
not been given the opportunity to review and correct their actual TPSs 
for the FY 2015 Hospital VBP Program at the time we issued that final 
rule. We stated that after hospitals had been given an opportunity to 
review and correct their actual TPSs for FY 2015, we would publish 
Table 16B to display the actual value-based incentive payment 
adjustment factors, and that we expected Table 16B to be posted on the 
CMS Web site in October 2014 (79 FR 50049).
    The review and corrections period for the data from the FY 2015 
applicable period under the Hospital Readmissions Reduction Program 
resulted in no changes to the proxy adjustment factors shown in Table 
15A. However, the calculation of the FY 2015 readmissions payment 
adjustment factors was affected by the inadvertent errors resulting 
from our use of claims in the FY 2013 MedPAR with a discharge date 
after April 1, 2013 without properly accounting for how sequestration 
was reflected in those data. Because we use claims data from July 1, 
2010 to June 30, 2013 to calculate the FY 2015 readmissions payment 
adjustment factors, only a portion of that data (that is, the claims 
between April 1, 2013 and June 30, 2013) was impacted by the errors 
described previously. As a result of the correction of those errors, 
the FY 2015 readmissions payment adjustment factors have changed for 60 
hospitals. The final FY 2015 readmissions payment adjustment factors, 
which were calculated after correcting the errors discussed previously, 
are posted in Table 15B on the CMS Web site at: https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/AcuteInpatientPPS/. 
(Click on the link on the left side of the screen titled, ''FY 2015 
IPPS Final Rule Home Page'' or ''Acute Inpatient--Files for 
Download''.) As noted previously, the final FY 2015 readmissions 
payment adjustment factors in Table 15B will be used for determining 
payments for discharges occurring on or after October 1, 2014. After 
accounting for these corrections in determination of the FY 2015 
readmissions payment adjustment factors, we are revising the estimated 
savings under the Hospital Readmissions Reduction Program to $428 
million, from $424 million in the FY 2015 IPPS/LTCH PPS final rule (79 
FR 50425).
    We note that we are not correcting the proxy FY 2015 readmissions 
payment adjustment factors for FY 2015 shown in Table 15A or the 
updated proxy value-based incentive payment adjustment factors for FY 
2015 shown in Table 16A. However, consistent with the methodology for 
calculating the operating budget neutrality factors for the FY 2015 
IPPS/LTCH PPS final rule (79 FR 50366), we used corrected proxy payment 
adjustment factors in the recalculation of the IPPS rates for this 
correcting document. These factors can be found in the IPPS Impact File 
that

[[Page 59678]]

corresponds to this correcting document which is available on the CMS 
Web site. (We note that the description of the methodology for 
calculating the operating budget neutrality factors contained errors 
that are summarized later in the section and corrected in section 
IV.C.1. of this correcting document). The proxy factors in Table 15A 
were provided for informational purposes and they are not used for 
payment adjustment purposes and the final FY 2015 readmissions payment 
adjustment factors in Table 15B will be used for determining payments 
for discharges occurring on or after October 1, 2014 (79 FR 50048). 
Similarly, the proxy factors in Table 16A were provided for 
informational purposes, according to the methodology finalized in the 
FY 2013 IPPS/LTCH final rule (77 FR 53576), and they are not used for 
payment adjustment purposes. As stated in the FY 2015 IPPS/LTCH PPS 
final rule, we intend to post the actual Hospital VBP Program payment 
adjustment factors, as Table 16B, in October of 2014, after hospitals 
have had an opportunity to review and correct their TPSs.
    On page 50366, we made an error in the description of our budget 
neutrality methodology with respect to the readmissions payment 
adjustment factors that we used for the purpose of modeling aggregate 
payments when determining all budget neutrality factors. As we 
discussed in the FY 2015 IPPS/LTCH PPS final rule (79 FR 50048), for 
that final rule we determined proxy FY 2015 readmission payment 
adjustment factors (shown in Table 15A), which were calculated based on 
data from the FY 2015 applicable period of July 1, 2010 to June 30, 
2013.
    In addition, we made a typographical error in the March 2013 and 
2014 operating national average case weighted cost-to charge ratios 
(CCRs) set forth in the FY 2015 IPPS/LTCH PPS final rule. Also, we made 
a technical error in the calculation of the capital CCR adjustment 
factor that is applied to determine the capital CCRs used in our 
ratesetting process. This inadvertent technical error caused a 
miscalculation of the capital CCRs used in the determination of the 
operating and capital budget neutrality factors and the calculation of 
the outlier threshold for the FY 2015 IPPS/LTCH PPS final rule. 
Therefore, we are correcting the capital CCR adjustment factor and the 
capital CCRs used in our determination of the operating and capital 
budget neutrality factors as well as our calculation of the outlier 
threshold.
    Lastly, we made technical and typographical errors in the table 
heading for Table 2-2 which is listed in the Addendum of the FY 2015 
IPPS/LTCH PPS final rule as one of the tables that are only available 
through the Internet on the CMS Web site (page 50403).

D. Corrections to Tables Posted on the CMS Web Site

    The following corrections are being made to the tables listed on 
pages 50402 and 50403 of the FY 2015 IPPS/LTCH PPS final rule that are 
only available through the Internet on the CMS Web site at https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/AcuteInpatientPPS/.
    In Table 2-2.--Acute Care Hospitals Case-Mix Indexes for Discharges 
Occurring in Federal Fiscal Year 2012; Hospital Wage Indexes for 
Federal Fiscal Year 2015; Hospital Average Hourly Wages for Federal 
Fiscal Years 2013 (2009 Wage Data), 2014 (2010 Wage Data), and 2015 
(2011 Wage Data; Based on FY 2015 CBSA Delineations); and 3-Year 
Average of Hospital Average Hourly Wages, we are correcting the table 
heading as noted in section II.C. of this correcting document. We are 
also correcting the entries in column ``FY 2015 Wage Index'' as a 
result of the technical errors discussed in section II.C. of this 
correcting document.
    We are correcting the following tables in the entirety as a result 
of the technical errors discussed in section II.C. of this correcting 
document:
     Table 4A-1.--Wage Index and Capital Geographic Adjustment 
Factor (GAF) for Acute Care Hospitals in Urban Areas by CBSA and by 
State--FY 2015; Based on CBSA Delineations Used in FY 2014.
     Table 4A-2.--Wage Index and Capital Geographic Adjustment 
Factor (GAF) for Acute Care Hospitals in Urban Areas by CBSA and by 
State--FY 2015; Based on CBSA Delineations Used in FY 2015.
     Table 4B-1.--Wage Index and Capital Geographic Adjustment 
Factor (GAF) for Acute Care Hospitals in Rural Areas by CBSA and by 
State--FY 2015; Based on CBSA Delineations Used in FY 2014.
     Table 4B-2.--Wage Index and Capital Geographic Adjustment 
Factor (GAF) for Acute Care Hospitals in Rural Areas by CBSA and by 
State--FY 2015; Based on FY 2015 CBSA Delineations.
     Table 4C-1.--Wage Index and Capital Geographic Adjustment 
Factor (GAF) for Acute Care Hospitals That Are Reclassified by CBSA and 
by State--FY 2015; Based on CBSA Delineations Used in FY 2014.
     Table 4C-2.--Wage Index and Capital Geographic Adjustment 
Factor (GAF) for Acute Care Hospitals That Are Reclassified by CBSA and 
by State--FY 2015; Based on CBSA Delineations Used in FY 2015.
     Table 4D-1.--States Designated as Frontier, with Acute 
Care Hospitals Receiving at a Minimum the Frontier State Floor Wage 
Index; Urban Areas with Acute Care Hospitals Receiving the Statewide 
Rural Floor or Imputed Floor Wage Index--FY 2015; Based on CBSA 
Delineations Used in FY 2014.
     Table 4D-2.--States Designated as Frontier, with Acute 
Care Hospitals Receiving at a Minimum the Frontier State Floor Wage 
Index; Urban Areas with Acute Care Hospitals Receiving the Statewide 
Rural Floor or Imputed Floor Wage Index--FY 2015; Based on CBSA 
Delineations Used in FY 2015.
     Table 4J.--Out-Migration Adjustment for Acute Care 
Hospitals--FY 2015
     Table 10.--New Technology Add-On Payment Thresholds \1,2\ 
for Applications for FY 2016.
    Table 5.--List of Medicare Severity Diagnosis-Related Groups (MS-
DRGs), Relative Weighting Factors, and Geometric and Arithmetic Mean 
Length of Stay--FY 2015. We are correcting this table by correcting 
typographical and technical errors in the columns titled ``Geometric 
Mean LOS'' and ``Arithmetic Mean LOS''.
    Table 8B.--FY 2015 Statewide Average Capital Cost-to-Charge Ratios 
(CCRs) for Acute Care Hospitals. We are correcting typographical and 
technical errors in this table.
    Table 18.--FY 2015 Medicare DSH Uncompensated Care Payment Factor 3 
and Supplemental Medicare DSH File--FY 2015 Uncompensated Care Payment 
Factors. For the FY 2015 IPPS/LTCH PPS final rule, we published a list 
of hospitals that we identified to be subsection (d) hospitals and 
subsection (d) Puerto Rico hospitals eligible to receive empirically 
justified Medicare DSH payment adjustments and uncompensated care 
payments for FY 2015. As stated in the FY 2015 IPPS/LTCH PPS final rule 
(79 FR 50022), we allowed the public an additional period after the 
issuance of the final rule to review and submit comments on the 
accuracy of the list of mergers that we identified in the final rule. 
Based on the comments received during this additional period, we are 
updating Table 18 and the Supplemental Medicare DSH File to reflect the 
merger information received in response to the final rule and are also 
making one other correction to Table 18 and the Supplemental Medicare 
DSH File. We have discovered that in calculating Factor 3 of the 
uncompensated care payment methodology, we inadvertently

[[Page 59679]]

excluded the Medicaid days from the most recently available 2012 or 
2011 cost report for a certain provider that was projected to receive 
Medicare DSH in FY 2015. This provider submitted its Medicare hospital 
cost reports to its Medicare contractor prior to the March 2014 update 
of HCRIS but due to technical errors the Medicare hospital cost reports 
were not included in the March 2014 update of HCRIS. As a result, this 
provider had no Medicaid days included in the calculation of Factor 3. 
In order to correct this error, we have revised Factor 3 for all 
hospitals to incorporate the changes to the data for this provider 
whose Medicare hospital cost report data were inadvertently excluded 
from the March 2014 update of HCRIS.

E. Summary of Errors in the Appendices

    On page 50428, in our discussion of the effects of the new 
technology add-on payment policy, we made an error in the costs of the 
add-on payments for Voraxaze[supreg] for FY 2015.
    On pages 50405, 50407, and 50409 through 50429; we made errors in 
the operating impacts as described in section II.C. of this correcting 
document.
    On pages 50435 through 50437, we made errors in the capital impacts 
as described in section II.C. of this correcting document.
    On page 50446, we made an error in the estimated expenditures under 
the IPPS as a result of the errors described in section II.C. of this 
correcting document.

III. Waiver of Proposed Rulemaking and Delay in 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 rule take effect in accordance with section 553(b) of 
the Administrative Procedure Act (APA) (5 U.S.C. 553(b)). However, we 
can waive this notice and comment procedure if the Secretary finds, for 
good cause, that the 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.
    Section 553(d) of the APA ordinarily requires a 30-day delay in 
effective date of final rules after the date of their publication in 
the Federal Register. This 30-day delay in effective date can be 
waived, however, if an agency finds for good cause that the delay is 
impracticable, unnecessary, or contrary to the public interest, and the 
agency incorporates a statement of the findings and its reasons in the 
rule issued.
    In our view, this correcting document does not constitute a rule 
that would be subject to the APA notice and comment or delayed 
effective date requirements. This correcting document corrects 
technical and typographic errors in the preamble, regulation text, 
addendum, payment rates, tables, and appendices included or referenced 
in the FY 2015 IPPS/LTCH PPS final rule but does not make substantive 
changes to the policies or payment methodologies that were adopted in 
the final rule. As a result, this correcting document is intended to 
ensure that the information in the FY 2015 IPPS/LTCH PPS final rule 
accurately reflects the policies adopted in that final rule.
    In addition, even if this were a rule to which the notice and 
comment procedures and delayed effective date requirements applied, we 
find that there is good cause to waive such requirements. Undertaking 
further notice and comment procedures to incorporate the corrections in 
this document into the final rule or delaying the effective date would 
be contrary to the public interest because it is in the public's 
interest for providers to receive appropriate payments in as timely a 
manner as possible, and to ensure that the FY 2015 IPPS/LTCH PPS final 
rule accurately reflects our policies. Furthermore, such procedures 
would be unnecessary, as we are not altering our payment methodologies 
or policies, but rather, we are simply implementing correctly the 
policies that we previously proposed, received comment on, and 
subsequently finalized. This correcting document is intended solely to 
ensure that the FY 2015 IPPS/LTCH PPS final rule accurately reflects 
these payment methodologies and policies. Therefore, we believe we have 
good cause to waive the notice and comment and effective date 
requirements.

IV. Correction of Errors

    In FR Doc. 2014-18545 of August 22, 2014 (79 FR 49853), make the 
following corrections:

A. Corrections of Errors in the Preamble

    1. On page 49865, third column, third bulleted paragraph, line 12, 
the figure ``$369'' is corrected to read ``$373''.
    2. On page 49918, second column, first partial paragraph:
    a. Lines 7 through 12, the sentences ``The cost of Voraxaze[supreg] 
is $22,500 per vial. The applicant stated that an average of four vials 
is used per Medicare beneficiary. Therefore, the average cost per case 
for Voraxaze[supreg] is $90,000 ($22,500 x 4).'' are corrected to read 
``Based on the latest data from the manufacturer, the cost of 
Voraxaze[supreg] is $23,625 per vial. The applicant stated that an 
average of four vials is used per Medicare beneficiary. Therefore, the 
average cost per case for Voraxaze[supreg] is $94,500 ($23,625 x 4).''
    b. Lines 18 through 20, the sentence ``As a result, the maximum new 
technology add-on payment for Voraxaze[supreg] is $45,000 per case.'' 
is corrected to read ``As a result, based on the latest data from the 
manufacturer, the maximum new technology add-on payment for 
Voraxaze[supreg] for FY 2015 is $47,250 per case.''
    3. On page 49940, third column, last paragraph, fourth line from 
the bottom, the phrase ``the maximum payment'' is corrected to read 
``the maximum add-on payment''.
    4. On pages 50246 through 50249, the table titled ``Previously 
Adopted Hospital IQR Program Measures and Measures Newly Finalized in 
this Final Rule for the FY 2017 Payment Determination and Subsequent 
Years'' is corrected as follows:
    a. Adding the following entry (short name VTE-3) immediately 
preceding the entry VTE-5:

----------------------------------------------------------------------------------------------------------------
                                                                      Submission methods
   Short name            Measure name                NQF No.             for FY 2017          New for FY 2017
----------------------------------------------------------------------------------------------------------------
VTE-3...........  Venous thromboembolism      NQF 0373...  Electronic clinical    .....................
                   patients with                                     quality measure or
                   anticoagulation overlap                           chart-abstracted
                   therapy.                                          REQUIRED.
----------------------------------------------------------------------------------------------------------------

    b. Removing the entry for VTE-3 that follows the entry for Stroke-
10.
    c. Adding the following entry for PN-6 immediately preceding the 
entry for VTE-4:

[[Page 59680]]



----------------------------------------------------------------------------------------------------------------
                                                                      Submission methods
   Short name            Measure name                NQF No.             for FY 2017          New for FY 2017
----------------------------------------------------------------------------------------------------------------
PN-6............  Initial Antibiotic          NQF 0147...  Electronic clinical    Voluntary electronic
                   Selection for community-                          quality measure.       clinical quality
                   acquired pneumonia (CAP)                                                 measure.
                   in Immunocompetent
                   Patients.
----------------------------------------------------------------------------------------------------------------

    5. On 50279, second column, second full paragraph, lines 10 through 
13, the hyperlink, ``https://www.Fqualityforum.Forg/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=70374'' is corrected to read 
``https://www.qualityforum.org/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=70374.''
    6. On page 50284:
    a. Second column, first partial paragraph:
    (1) Line 7, the phrase ``However the six'' is corrected to read 
``However for the six''.
    (2) Line 12, the phrase ``four quarters data'' is corrected to read 
``four quarters of data''.
    b. Third column, third full paragraph, lines 14 and 15, the 
parenthetical phase ``(and not limited to orthopedic surgeries)'' is 
corrected to read ``(and are not limited to orthopedic surgeries)''.
    7. On page 50298, second column, first partial paragraph, line 6, 
the phrase ``the CAM[supreg] Instrument'' is corrected to read ``the 
short CAM[supreg] instrument''.
    8. On page 50302, third column, second full paragraph, lines 3 and 
4, the phrase ``of long-term mechanical ventilation'' is corrected to 
read ``with patients on prolonged mechanical ventilation''.
    9. On page 50306, lower two-thirds of the page, third column, 
partial paragraph, lines 18 and 19, the phrase ``tobacco performance 
measure set'' is corrected to read ``tobacco treatment performance 
measure set''.
    10. On page 50335, first column, first full paragraph:
    a. Line 34, the phrase ``that because available'' is corrected to 
read ``that became available''.
    b. Lines 38 and 39, the phrase ``not enter into an SIA'' is 
corrected to read ``not entered into an SIA''.

B. Corrections of Errors in the Regulation Text

Sec.  405.1811 [Corrected]
    1. On page 50350, in the first column, in Sec.  405.1811(c) 
introductory text, lines 7 and 8, the phrase ``for a cost reporting 
period if--'' is corrected to read ``for specific items for a cost 
reporting period if--''.
Sec.  405.1835 [Corrected]
    2. On page 50350, in the third column, in Sec.  405.1835(c), in 
lines 7 through 9, the phrase ``for specific items claimed for a cost 
reporting period if--'' is corrected to read ``for specific items for a 
cost reporting period if--''.

C. Corrections of Errors in the Addendum

    1. On page 50366, first column, first full paragraph the paragraph 
beginning with the phrase ``For the purpose of calculating the FY'' and 
ending with the phrase ``to the FY 2013 IPPS/LTCH PPS final rule (77 FR 
53399 through 53400).)'' is corrected to read as follows:
    ``For the purpose of calculating the proposed FY 2015 readmissions 
payment adjustment factors in the proposed rule, we used excess 
readmission ratios and aggregate payments for excess readmissions based 
on admissions from the prior fiscal year's applicable period because 
hospitals have had the opportunity to review and correct these data 
before the data were made public under the policy we adopted regarding 
the reporting of hospital-specific readmission rates, consistent with 
section 1886(q)(6) of the Act. As discussed in section IV.H.11. of this 
preamble, because the review and corrections period will still be 
ongoing through August 19, 2014, which extends beyond the issuance of 
this FY 2015 IPPS/LTCH PPS final rule, we are calculating proxy FY 2015 
readmissions payment adjustment factors using excess readmission ratios 
and aggregate payments for excess readmissions based on admissions from 
the finalized applicable period for FY 2015. We will determine the 
final readmissions payment adjustment factors that will be used for 
payments in FY 2015 after the completion of the review and correct 
process. (For additional information on our general policy for the 
reporting of hospital-specific readmission rates, consistent with 
section 1886(q)(6) of the Act, we refer readers to the FY 2013 IPPS/
LTCH PPS final rule (77 FR 53399 through 53400).)''
    2. On page 50367, third column, first full paragraph:
    a. Line 3, the figure ``0.997543'' is corrected to read 
``0.998761''.
    b. Line 8, the figure ``0.997543'' is corrected to read 
``0.998761''.
    3. On page 50368:
    a. First column, first partial paragraph, line 19, the figure 
``0.997543'' is corrected to read ``0.998761''.
    b. Third column:
    (1) First partial paragraph, line 11, the figure ``0.997543'' is 
corrected to read ``0.998761''.
    (2) Last paragraph:
    (a) Line 9, the figure ``1.001443'' is corrected to read 
``1.001421''.
    (b) Line 13, the figure ``0.997543'' is corrected to read 
``0.998761''.
    (c) Line 15, the figure ``1.001443'' is corrected to read 
``1.001421''.
    (d) Line 21, the figure ``0.998982'' is corrected to read 
``1.000180''.
    4. On page 50369, first column, last partial paragraph, line 13, 
the figure ``0.990406'' is corrected to read ``0.990429''.
    5. On page 50370, first column, second full paragraph:
    a. Line 3, the figure ``0.989507'' is corrected to read 
``0.989525''.
    b. Line 5, the figure ``0.991291'' is corrected to read 
``0.991293''.
    6. On page 50373:
    a. First column, last paragraph, line 3, the figure ``0.998859'' is 
corrected to read ``0.998854''.
    b. Second column, first partial paragraph, line 1, the figure 
``0.998859'' is corrected to read ``0.998854''.
    7. On page 50374, second column, second full paragraph, line 5, the 
figure ``0.99931'' is corrected to read ``0.999313''.
    8. On page 50380:
    a. First column:
    (1) First paragraph:
    (a) Line 4, the figure ``0.292377'' is corrected to read 
``0.292376''.
    (b) Line 6, the figure ``0.28714'' is corrected to read 
``0.287139''.
    (2) Second paragraph:
    (a) Line 7, the figure ``0.024849'' is corrected to read 
``0.024649''.
    (b) Line 18, the figure ``0.988307'' is corrected to read 
``0.980352''.
    c. Third column, second full paragraph, line 9, the figure 
``$24,758'' is corrected to read ``$24,626''.
    9. On page 50381:
    a. First column:
    (1) First full paragraph, line 15, the figure ``6.27'' is corrected 
to read ``6.18''.
    (2) Third full paragraph, the table is corrected to read as 
follows:

[[Page 59681]]



------------------------------------------------------------------------
                                          Operating
                                        standardized     Capital federal
                                           amounts            rate
------------------------------------------------------------------------
National............................          0.948999          0.938237
Puerto Rico.........................          0.926334          0.916334
------------------------------------------------------------------------

    b. Third column, third full paragraph:
    (1) Line 4, the figure ``5.71'' is corrected to read ``5.68''.
    (2) Line 6, the figure ``0.61'' is corrected to read ``0.58''.
    (3) Line 10, the figure ``5.71'' is corrected to read ``5.68''.
    10. On pages 50382 and 50383, the table titled, ``Comparison of FY 
2014 Standardized Amounts to the FY 2015 Standardized Amounts'' is 
corrected to read as follows:

                 Comparison of FY 2014 Standardized Amounts to the FY 2015 Standardized Amounts
----------------------------------------------------------------------------------------------------------------
                                                      Hospital submitted   Hospital did NOT    Hospital did NOT
                                  Hospital submitted   quality data  and    submit quality      submit quality
                                   quality data  and       is NOT a         data  and is a    data  and is NOT a
                                    is a meaningful     meaningful EHR      meaningful EHR      meaningful EHR
                                       EHR user              user                user                user
----------------------------------------------------------------------------------------------------------------
FY 2014 Base Rate after
 removing:
    1. FY 2014 Geographic         If Wage Index is    If Wage Index is    If Wage Index is    If Wage Index is
     Reclassification Budget       Greater Than        Greater Than        Greater Than        Greater Than
     Neutrality (0.990718).        1.0000: Labor       1.0000: Labor       1.0000: Labor       1.0000: Labor
    2. FY 2014 Rural Community     (69.6%):            (69.6%):            (69.6%):            (69.6%):
     Hospital Demonstration        $4,230.38           $4,230.38           $4,230.38           $4,230.38
     Program Budget Neutrality     Nonlabor (30.4%):   Nonlabor (30.4%):   Nonlabor (30.4%):   Nonlabor (30.4%):
     (0.999415).                   $1,847.75.          $1,847.75.          $1,847.75.          $1,847.75.
    3. Cumulative Factor: FY      If Wage Index is    If Wage Index is    If Wage Index is    If Wage Index is
     2008, FY 2009, FY 2012, FY    less Than or        less Than or        less Than or        less Than or
     2013, and FY 2014             Equal to 1.0000:    Equal to 1.0000:    Equal to 1.0000:    Equal to 1.0000:
     Documentation and Coding      Labor (62%):        Labor (62%):        Labor (62%):        Labor (62%):
     Adjustment as Required        $3,768.45           $3,768.45           $3,768.45           $3,768.45
     under Sections 7(b)(1)(A)     Nonlabor (38%):     Nonlabor (38%):     Nonlabor (38%):     Nonlabor (38%):
     and 7(b)(1)(B) of Pub. L.     $2,309.70.          $2,309.70.          $2,309.70.          $2,309.70.
     110-90 and Documentation
     and Coding Recoupment
     Adjustment as required
     under Section 631 of the
     American Taxpayer Relief
     Act of 2012 (0.9403).
    4. FY 2014 Operating Outlier
     Offset (0.948995).
FY 2015 Update Factor...........  1.022.............  1.01475...........  1.01475...........  1.0075.
FY 2015 MS[dash]DRG               1.000180..........  1.000180..........  1.000180..........  1.000180.
 Recalibration and Wage Index
 Budget Neutrality Factor.
FY 2015 Reclassification Budget   0.990429..........  0.990429..........  0.990429..........  0.990429.
 Neutrality Factor.
FY 2015 Rural Community           0.999313..........  0.999313..........  0.999313..........  0.999313.
 Demonstration Program Budget
 Neutrality Factor.
FY 2015 Operating Outlier Factor  0.948999..........  0.948999..........  0.948999..........  0.948999.
Cumulative Factor: FY 2008, FY    0.9329............  0.9329............  0.9329............  0.9329.
 2009, FY 2012, FY 2013, FY 2014
 and FY 2015 Documentation and
 Coding Adjustment as Required
 under Sections 7(b)(1)(A) and
 7(b)(1)(B) of Pub. L. 110-90
 and Documentation and Coding
 Recoupment Adjustment as
 required under Section 631 of
 the American Taxpayer Relief
 Act of 2012.
FY 2015 New Labor Market          0.998854..........  0.998854..........  0.998854..........  0.998854.
 Delineation Wage Index
 Transition Budget Neutrality
 Factor.
National Standardized Amount for  Labor: $3,784.75    Labor: $3,757.90    Labor: $3,757.90    Labor: $3,731.05
 FY 2015 if Wage Index is          Nonlabor:           Nonlabor:           Nonlabor:           Nonlabor:
 Greater Than 1.0000; Labor/Non-   $1,653.10.          $1,641.37.          $1,641.37.          $1,629.65.
 Labor Share Percentage (69.6/
 30.4).
National Standardized Amount for  Labor: $3,371.47    Labor: $3,347.55    Labor: $3,347.55    Labor: $3,323.63
 FY 2015 if Wage Index is less     Nonlabor:           Nonlabor:           Nonlabor:           Nonlabor:
 Than or Equal to 1.0000; Labor/   $2,066.38.          $2,051.72.          $2,051.72.          $2,037.07.
 Non-Labor Share Percentage (62/
 38).
----------------------------------------------------------------------------------------------------------------

    11. On page 50383, the table titled, ``Comparison of FY 2014 Puerto 
Rico-Specific Payment Rate to the FY 2015 Puerto Rico-Specific Payment 
Rate'' is corrected to read as follows:

[[Page 59682]]



 Comparison of FY 2014 Puerto Rico-Specific Payment Rate to the FY 2015
                    Puerto Rico-Specific Payment Rate
------------------------------------------------------------------------
                                   Update (2.2           Update (2.2
                              percent); wage index  percent); Wage index
                                 is greater than       is less than or
                               1.0000; labor/non-     equal to 1.0000;
                                   labor share      labor/non[dash]labor
                                percentage (63.2/   share percentage (62/
                                      36.8)                  38)
------------------------------------------------------------------------
FY 2014 Puerto Rico Base
 Rate, after removing:
    1. FY 2014 Geographic     Labor: $1,722.31      Labor: $1,689.61
     Reclassification Budget   Nonlabor: $1,002.86.  Nonlabor:
     Neutrality (0.990718).                          $1,035.56.
    2. FY 2014 Rural
     Community Hospital
     Demonstration Program
     Budget Neutrality
     (0.999415).
    3. FY 2014 Puerto Rico
     Operating Outlier
     Offset (0.943455).
FY 2015 Update Factor.......  1.022...............  1.022.
FY 2015 MS[dash]DRG           0.998761............  0.998761.
 Recalibration Budget
 Neutrality Factor.
FY 2015 Reclassification      0.990429............  0.990429.
 Budget Neutrality Factor.
FY 2015 Rural Community       0.999313............  0.999313.
 Hospital Demonstration
 Program Budget Neutrality
 Factor.
FY 2015 New Labor Market      0.998854............  0.998854.
 Delineation Wage Index
 Transition Budget
 Neutrality Factor.
FY 2015 Puerto Rico           0.926334............  0.926334.
 Operating Outlier Factor.
Puerto Rico[dash]Specific     Labor: $1,609.97      Labor: $1,579.40
 Payment Rate for FY 2015.     Nonlabor: $937.45.    Nonlabor: $968.02.
------------------------------------------------------------------------

    12. On page 50385, lower half of the page, first column, second 
paragraph, line 15, the figure ``0.997543'' is corrected to read 
``0.998761''.
    13. On page 50386, second column, last partial paragraph, line 6, 
the figure ``1.2'' is corrected to read ``1.3''.
    14. On page 50388:
    a. First column:
    (1) Second full paragraph:
    (a) Line 9, the figure ``6.27'' is corrected to read ``6.18''.
    (b) Line 13, the figure ``0.9373'' is corrected to read ``0.9382''
    (2) Third full paragraph:
    (a) Line 6, the phrase ``0.9373 is a -0.21 percent'' is corrected 
to read ``0.9382 is a -0.12 percent''.
    (b) Line 11, the mathematical expression ``0.9979 (0.9373/0.9393)'' 
is corrected to read ``0.9988 (0.9382/0.9393)''.
    (c) Line 13, the figure ``0.21 percent'' is corrected to read 
``0.12 percent''
    b. Second column, second full paragraph:
    (1) Line 12, the figure ``0.9987'' is corrected to read''0.9994''.
    (2) Line 17, the figure ``0.9877'' is corrected to read ``0.9884''.
    (3) Line 18, the figure ``1.0075'' is corrected to read ``1.0082''.
    c. Third column:
    (1) Third full paragraph, line 9, the figure ``$434.26'' is 
corrected to read ``$434.97''.
    (2) Fifth full paragraph (second bulleted paragraph), last line, 
the figure ``0.9986'' is corrected to read ``0.9993''.
    (3) Sixth full paragraph (third bulleted paragraph), last line, the 
figure ``0.9373'' is corrected to read ``0.9382''.
    15. On page 50389:
    a. Top of page, third column, partial paragraph:
    (1) Line 1, the figure ``0.14'' is corrected to read ``0.07''.
    (2) Line 4, the figure ``0.21''is corrected to read ``0.11''.
    (3) Line 7, the figure ``1.15'' is corrected to read ``1.32''.
    b. Top half of the page, first table titled, ``Comparison of 
Factors and Adjustments: FY 2014 Capital Federal Rate and FY 2015 
Capital Federal Rate'' the table and table footnotes are corrected to 
read as follows:

      Comparison of Factors and Adjustments: FY 2014 Capital Federal Rate and FY 2015 Capital Federal Rate
----------------------------------------------------------------------------------------------------------------
                                                      FY 2014         FY 2015         Change      Percent change
----------------------------------------------------------------------------------------------------------------
Update Factor \1\...............................          1.0090          1.0150          1.0150            1.50
GAF/DRG Adjustment Factor \1\...................          0.9987          0.9993          0.9993           -0.07
Outlier Adjustment Factor \2\...................          0.9393          0.9382          0.9989           -0.11
Capital Federal Rate............................        429.31          434.97            1.0132            1.32
----------------------------------------------------------------------------------------------------------------
\1\ The update factor and the GAF/DRG budget neutrality adjustment factors are built permanently into the
  capital Federal rates. Thus, for example, the incremental change from FY 2014 to FY 2015 resulting from the
  application of the 0.9993 GAF/DRG budget neutrality adjustment factor for FY 2015 is a net change of 0.9993
  (or -0.07 percent).
\2\ The outlier reduction factor is not built permanently into the capital Federal rate; that is, the factor is
  not applied cumulatively in determining the capital Federal rate. Thus, for example, the net change resulting
  from the application of the FY 2015 outlier adjustment factor is 0.9382/0.9393, or 0.9989 (or -0.11 percent).

    ----c. Middle of the page, second table titled, ``Comparison of 
Factors and Adjustments: Proposed FY 2015 Capital Federal Rate and 
Final FY 2015 Capital Federal Rate'' is corrected to read as follows:

[[Page 59683]]



 Comparison of Factors and Adjustments: Proposed FY 2015 Capital Federal Rate and Final FY 2015 Capital Federal
                                                      Rate
----------------------------------------------------------------------------------------------------------------
                                                     Proposed          Final          Change      Percent change
----------------------------------------------------------------------------------------------------------------
Update Factor...................................          1.0150          1.0150          1.0000            0.00
GAF/DRG Adjustment Factor.......................          0.9957          0.9993          1.0037            0.37
Outlier Adjustment Factor.......................          0.9374          0.9382          1.0009            0.09
Capital Federal Rate............................        433.01          434.97            1.0045            0.45
----------------------------------------------------------------------------------------------------------------

    d. Bottom half of the page, third column, second full paragraph, 
last line, the figure ``$209.10.'' is corrected to read ``$209.45.''
    16. On page 50390, second column, first partial paragraph, last 
line, the figure ``$24,758'' is corrected to read ``$24,626''.
    17. On page 50403, first column, first paragraph (table heading for 
Table 2-2), the heading, ``Table 2-2.--Acute Care Hospitals Case-Mix 
Indexes for Discharges Occurring in Federal Fiscal Year 2012; Hospital 
Wage Indexes for Federal Fiscal Year 2015; Hospital Average Hourly 
Wages for Federal Fiscal Years 2013 (2009 Wage Data), 2014 (2010 Wage 
Data), and 2015 (2011 Wage Data; Based on FY 2015 CBSA Delineations); 
and 3-Year Average of Hospital Average Hourly Wages'' is corrected to 
read ``Table 2-2.--Acute Care Hospitals Case-Mix Indexes for Discharges 
Occurring in Federal Fiscal Year 2013; Hospital Wage Indexes for 
Federal Fiscal Year 2015; Hospital Average Hourly Wages for Federal 
Fiscal Years 2013 (2009 Wage Data; Based on FY 2014 CBSA Delineations), 
2014 (2010 Wage Data; Based on FY 2014 CBSA Delineations), and 2015 
(2011 Wage Data; Based on FY 2015 CBSA Delineations); and 3-Year 
Average of Hospital Average Hourly Wages (Based on FY 2014 and FY 2015 
CBSA Delineations)''.
    18. On page 50404:
    a. Top one-sixth of the page, the first table titled ``Table 1A.--
National Adjusted Operating Standardized Amounts, Labor/Nonlabor (69.6 
Percent Labor Share/30.4 Percent Nonlabor Share If Wage Index Is 
Greater Than 1)--FY 2015'' is corrected to read as follows:

    Table 1A--National Adjusted Operating Standardized Amounts, Labor/Nonlabor (69.6 Percent Labor Share/30.4
                        Percent Nonlabor Share if Wage Index Is Greater Than 1)--FY 2015
----------------------------------------------------------------------------------------------------------------
 Hospital submitted quality     Hospital did NOT submit   Hospital submitted quality    Hospital did NOT submit
  data and is a meaningful       quality data and is a         data and is NOT a       quality data and is NOT a
   EHR user  (update = 2.2       meaningful  EHR user        meaningful  EHR user        meaningful  EHR user
          percent)             (update = 1.475 percent)    (update = 1.475 percent)     (Update = 0.75 percent)
----------------------------------------------------------------------------------------------------------------
    Labor         Nonlabor        Labor       Nonlabor        Labor       Nonlabor        Labor       Nonlabor
----------------------------------------------------------------------------------------------------------------
   $3,784.75      $1,653.10     $3,757.90     $1,641.37     $3,757.90     $1,641.37     $3,731.05     $1,629.65
----------------------------------------------------------------------------------------------------------------

    b. Top third of the page, the second table titled ``Table 1B.--
National Adjusted Operating Standardized Amounts, Labor/Nonlabor (62 
Percent Labor Share/38 Percent Nonlabor Share If Wage Index Is Less 
Than Or Equal To 1)--FY 2015'' is corrected to read as follows:

  Table 1B--National Adjusted Operating Standardized Amounts, Labor/Nonlabor (62 Percent Labor Share/38 Percent
                        Nonlabor Share if Wage Index Is Less Than or Equal to 1)--FY 2015
----------------------------------------------------------------------------------------------------------------
 Hospital submitted quality      Hospital did NOT submit     Hospital submitted quality      Hospital did NOT
  data and is a meaningful        quality data and is a     data and is NOT a meaningful    submit quality data
   EHR user  (update = 2.2        meaningful  EHR user        EHR user  (update = 1.475        and is NOT a
          percent)              (update = 1.475 percent)              percent)             meaningful  EHR user
-----------------------------------------------------------------------------------------     (update = 0.75
                                                                                                 percent)
    Labor         Nonlabor        Labor         Nonlabor        Labor         Nonlabor   -----------------------
                                                                                              Labor     Nonlabor
----------------------------------------------------------------------------------------------------------------
   $3,371.47      $2,066.38      $3,347.55      $2,051.72      $3,347.55      $2,051.72     $3,323.63   $2,037.0
                                                                                                           7
----------------------------------------------------------------------------------------------------------------

    c. Middle of the page, the third table titled ``Table 1C.--Adjusted 
Operating Standardized Amounts For Puerto Rico, Labor/Nonlabor 
(National: 62 Percent Labor Share/38 Percent Nonlabor Share Because 
Wage Index Is Less Than Or Equal To 1; Puerto Rico: 63.2 Percent Labor 
Share/36.8 Percent Nonlabor Share If Wage Index Is Greater Than 1 Or 62 
Percent Labor Share/38 Percent Nonlabor Share If Wage Index Is Less 
Than Or Equal To 1--FY 2015'' is corrected to read as follows:

[[Page 59684]]



  Table 1C--Adjusted Operating Standardized Amounts for Puerto Rico, Labor/NOnlabor (National: 62 Percent Labor
 Share/38 Percent Nonlabor Share Because Wage Index Is Less Than or Equal to 1; Puerto Rico: 63.2 Percent Labor
 Share/36.8 Percent Nonlabor Share if Wage Index Is Greater Than 1 or 62 Percent Labor Share/38 Percent Nonlabor
                             Share if Wage Index Is Less Than or Equal to 1--FY 2015
----------------------------------------------------------------------------------------------------------------
                                       Rates if wage index is  greater than 1      Rates if wage index is  less
                                   ----------------------------------------------       than or equal to 1
        Standardized amount                                                      -------------------------------
                                            Labor                 Nonlabor             Labor         Nonlabor
----------------------------------------------------------------------------------------------------------------
 
National \1\......................  Not Applicable.......  Not Applicable.......       $3,371.47       $2,066.38
Puerto Rico.......................  $1,609.97............  $937.45..............        1,579.40          968.02
----------------------------------------------------------------------------------------------------------------
\1\ For FY 2015, there are no CBSAs in Puerto Rico with a national wage index greater than 1.

    d. Lower third of the page, the fourth table titled ``Table 1D.--
Capital Standard Federal Payment Rate--FY 2015'' is corrected to read 
as follows:

        Table 1D--Capital Standard Federal Payment Rate--FY 2015
------------------------------------------------------------------------
                                                               Rate
------------------------------------------------------------------------
National................................................         $434.97
Puerto Rico.............................................          209.45
------------------------------------------------------------------------

D. Corrections of Errors in the Appendices

    1. On page 50405, first column, first paragraph:
    a. Line 10, the figure ``$654'' is corrected to read ``$623''.
    b. Line 12, the figure ``$132'' is corrected to read ``$128''.
    c. Line 14, the figure ``1.6'' is corrected to read ``1.5''.
    2. On page 50407, second column, last partial paragraph, line 3, 
the figure ``5.71'' is corrected to read ``5.68''.
    3. On pages 50409 through 50419, table titled ``Table I.--Impact 
Analysis of Changes to the IPPS For Operating Costs for FY 2015'' the 
table and table footnotes are corrected as follows:
BILLING CODE 4120-01-P

[[Page 59685]]

[GRAPHIC] [TIFF OMITTED] TR03OC14.006


[[Page 59686]]


[GRAPHIC] [TIFF OMITTED] TR03OC14.007


[[Page 59687]]


[GRAPHIC] [TIFF OMITTED] TR03OC14.008

BILLING CODE 4120-01-C
    4. On page 50420:
    a. First column, last partial paragraph, last line, the figure 
``0.997543'' is corrected to read ``0.998761''.
    b. Second column, first partial paragraph, line 6, the figure 
``0.3'' is corrected to read ``0.2''.
    c. Third column:
    (1) First full paragraph, line 26, the figure ``1.001443'' is 
corrected to read ``1.001421''.

[[Page 59688]]

    (2) Last partial paragraph, line 6, the phrase ``2 urban hospital'' 
is corrected to read ``2 urban hospitals''.
    5. On page 50421, bottom half of the page:
    a. First column, first full paragraph:
    (1) Line 9, the figure ``1.001443'' is corrected to read 
``1.001421''.
    (2) Line 11, the figure ``0.997543'' is corrected to read 
``0.998761''.
    (3) Line 18, the figures ``0.998982'' and ``0.10'' are corrected to 
read ``1.000180'' and ``0.018'', respectively.
    b. Second column, second full paragraph:
    (1) Line 6, the figure ``0.990406'' is corrected to read 
``0.990429''.
    (2) Line 13, the figure ``1.5'' is corrected to read ``1.6''.
    c. Third column, first full paragraph, line 8, the figure 
``0.989507'' is corrected to read ``0.989525''.
    6. On page 50422:
    a. First column, second partial paragraph:
    (1) Line 1, the figure ``422'' is corrected to read ``423''.
    (2) Line 3, the figure ``2,974'' is corrected to read ``2,973''.
    (3) Line 6, the figure ``0.989507'' is corrected to read 
``0.989525''.
    b. Second column:
    (1) First paragraph, line 23, the phrase, ``this final rule for a 
complere'' is corrected to read ``this final rule for a complete''.
    (2) Second paragraph, line 8, the figure ``0.991291'' is corrected 
to read ``0.991293''.
    (3) Last paragraph, line 7, the figure ``1.121'' is corrected to 
read ``1.1093''.
    (4) Last paragraph, last line, the figure ``$1.9'' is corrected to 
read ``$1.8''.
    7. On page 50423, the table titled ``FY 2015 IPPS Estimated 
Payments Due to Rural Floor and Imputed Floor with National Budget 
Neutrality'' is corrected to read as follows:

      FY 2015 IPPS Estimated Payments Due to Rural Floor and Imputed Floor With National Budget Neutrality
----------------------------------------------------------------------------------------------------------------
                                                                                  Percent change
                                                                                    in payments
                                                                     Number of        due to
                                                                  hospitals that  application of
                      State                          Number of     will receive     rural floor   Difference (in
                                                     hospitals       the rural      and imputed      millions)
                                                                     floor or       floor with
                                                                   imputed floor      budget
                                                                                    neutrality
                                                             (1)             (2)             (3)             (4)
----------------------------------------------------------------------------------------------------------------
Alabama.........................................              91               2            -0.5            -8.4
Alaska..........................................               6               4             1.5             2.2
Arizona.........................................              57               9            -0.1            -1.9
Arkansas........................................              45               0            -0.5            -5.3
California......................................             309             200             1.9           190.2
Colorado........................................              47               6             0.2             2.3
Connecticut.....................................              31               8            -0.4            -6.6
Delaware........................................               6               0            -0.6            -2.4
Washington, D.C.................................               7               0            -0.6            -2.6
Florida.........................................             169              25            -0.3           -18.7
Georgia.........................................             106               0            -0.5           -13.2
Hawaii..........................................              12               0            -0.4            -1.3
Idaho...........................................              14               0            -0.4            -1.2
Illinois........................................             127               0            -0.6           -28.0
Indiana.........................................              91               0            -0.6           -13.2
Iowa............................................              34               0            -0.5            -4.5
Kansas..........................................              53               0            -0.4            -3.8
Kentucky........................................              65               1            -0.5            -7.9
Louisiana.......................................             100               0            -0.5            -7.0
Maine...........................................              20               0            -0.5            -2.5
Massachusetts...................................              61              51             4.9           156.4
Michigan........................................              95               0            -0.5           -23.2
Minnesota.......................................              51               0            -0.5           -10.1
Mississippi.....................................              64               0            -0.5            -5.3
Missouri........................................              78               0            -0.5           -11.2
Montana.........................................              12               4            -0.3            -0.8
Nebraska........................................              23               0            -0.4            -2.6
Nevada..........................................              24               6             0.7             4.7
New Hampshire...................................              13               9             2.2            10.5
New Jersey......................................              64              15             0.1             2.7
New Mexico......................................              25               2            -0.3            -1.1
New York........................................             163               0            -0.6           -48.9
North Carolina..................................              87               0            -0.5           -15.9
North Dakota....................................               6               1            -0.3            -0.8
Ohio............................................             135              10            -0.4           -16.9
Oklahoma........................................              86               2            -0.5            -5.7
Oregon..........................................              33               0            -0.5            -4.8
Pennsylvania....................................             154              10            -0.5           -23.3
Puerto Rico.....................................              52              11               0            -0.1
Rhode Island....................................              11               4             0.5             1.8
South Carolina..................................              55               7            -0.3            -5.1
South Dakota....................................              19               0            -0.3            -1.1
Tennessee.......................................              98              16            -0.2            -5.6
Texas...........................................             324               6            -0.5           -30.1
Utah............................................              33               2            -0.4            -2.2

[[Page 59689]]

 
Vermont.........................................               6               0            -0.3            -0.7
Virginia........................................              79               1            -0.5           -12.0
Washington......................................              49               8            -0.2            -3.1
West Virginia...................................              30               0            -0.4            -3.2
Wisconsin.......................................              65               2            -0.5            -8.6
Wyoming.........................................              11               1            -0.2            -0.3
----------------------------------------------------------------------------------------------------------------

    8. On page 50424:
    a. Second column, first partial paragraph, line 9, the figure 
``0.998859'' is corrected to read ``0.998854''.
    b. Third column, first full paragraph, line 18, the figure ``273'' 
is corrected to read ``279''.
    9. On page 50425:
    a. First column, first partial paragraph, last line, the figure 
``$424'' is corrected to read ``$428''.
    b. Second column, first full paragraph, line 1, the phrase ``Rural 
West South'' is corrected to read ``Rural West North''.
    c. Third column:
    (1) First partial paragraph, line 6, the figure ``5.71'' is 
corrected to read ``5.68''.
    (2) First full paragraph, line 14, the figure ``0.7'' is corrected 
to read ``0.6''.
    10. On pages 50426 and 50427, the table titled ``Table II.--Impact 
Analysis of Changes for FY 2015 Acute Care Hospital Operating 
Prospective Payment System (Payments Per Discharge)'' is corrected to 
read as follows:

    Table II--Impact Analysis of Changes for FY 2015 Acute Care Hospital Operating Prospective Payment System
                                            [Payments per discharge]
----------------------------------------------------------------------------------------------------------------
                                                                     Estimated       Estimated
                                                     Number of      average FY      average FY      All FY 2015
                                                     hospitals     2014 payment    2015 payment       changes
                                                                   per discharge   per discharge
                                                             (1)             (2)             (3)             (4)
----------------------------------------------------------------------------------------------------------------
All Hospitals...................................           3,396          11,249          11,184            -0.6
By Geographic Location:
    Urban hospitals.............................           2,549          11,625          11,557            -0.6
    Large urban areas...........................           1,401          12,377          12,308            -0.6
    Other urban areas...........................           1,148          10,709          10,643            -0.6
    Rural hospitals.............................             847           8,240           8,194            -0.6
Bed Size (Urban):
    0-99 beds...................................             666           9,088           9,061            -0.3
    100-199 beds................................             787           9,747           9,682            -0.7
    200-299 beds................................             455          10,507          10,489            -0.2
    300-499 beds................................             429          11,951          11,875            -0.6
    500 or more beds............................             212          14,309          14,198            -0.8
Bed Size (Rural):
    0-49 beds...................................             328           6,778           6,701            -1.1
    50-99 beds..................................             305           7,803           7,692            -1.4
    100-149 beds................................             125           8,113           8,109               0
    150-199 beds................................              50           8,857           8,819            -0.4
    200 or more beds............................              39           9,988          10,027             0.4
Urban by Region:
    New England.................................             120          12,806          12,802               0
    Middle Atlantic.............................             324          12,914          12,905            -0.1
    South Atlantic..............................             407          10,453          10,359            -0.9
    East North Central..........................             397          10,849          10,790            -0.5
    East South Central..........................             153          10,052           9,922            -1.3
    West North Central..........................             162          11,355          11,314            -0.4
    West South Central..........................             387          10,677          10,500            -1.7
    Mountain....................................             162          11,935          11,835            -0.8
    Pacific.....................................             385          14,691          14,708             0.1
    Puerto Rico.................................              52           8,218           7,620            -7.3
Rural by Region:
    New England.................................              22          11,207          11,110            -0.9

[[Page 59690]]

 
    Middle Atlantic.............................              57           8,292           8,231            -0.7
    South Atlantic..............................             132           7,836           7,772            -0.8
    East North Central..........................             116           8,475           8,496             0.2
    East South Central..........................             165           7,513           7,409            -1.4
    West North Central..........................             102           8,914           8,941             0.3
    West South Central..........................             168           7,108           6,978            -1.8
    Mountain....................................              61           9,454           9,509             0.6
    Pacific.....................................              24          11,083          11,221             1.3
By Payment Classification:
    Urban hospitals.............................           2,563          11,609          11,541            -0.6
    Large urban areas...........................           1,413          12,366          12,296            -0.6
    Other urban areas...........................           1,150          10,677          10,611            -0.6
    Rural areas.................................             833           8,457           8,411            -0.5
Teaching Status:
    Nonteaching.................................           2,357           9,343           9,300            -0.5
    Fewer than 100 residents....................             795          10,978          10,920            -0.5
    100 or more residents.......................             244          16,533          16,399            -0.8
Urban DSH:
    Non-DSH.....................................             679           9,836           9,899             0.6
    100 or more beds............................           1,588          12,055          11,960            -0.8
    Less than 100 beds..........................             383           8,434           8,375            -0.7
Rural DSH:
    SCH.........................................             373           7,907           7,867            -0.5
    RRC.........................................             212           9,194           9,175            -0.2
    100 or more beds............................              24           7,395           7,305            -1.2
    Less than 100 beds..........................             137           6,329           6,253            -1.2
Urban teaching and DSH:
    Both teaching and DSH.......................             842          13,277          13,167            -0.8
    Teaching and no DSH.........................             133          11,130          11,230             0.9
    No teaching and DSH.........................           1,129           9,781           9,713            -0.7
    No teaching and no DSH......................             459           9,223           9,289             0.7
Special Hospital Types:
    RRC.........................................             193           9,403           9,350            -0.6
    SCH.........................................             325           9,577           9,654             0.8
    MDH.........................................             162           7,072           6,706            -5.2
    SCH and RRC.................................             124          10,293          10,410             1.1
    MDH and RRC.................................              15           9,195           8,458              -8
Type of Ownership:
    Voluntary...................................           1,935          11,377          11,334            -0.4
    Proprietary.................................             892          10,001           9,919            -0.8
    Government..................................             542          12,283          12,113            -1.4
Medicare Utilization as a Percent of Inpatient
 Days:
    0-25........................................             501          14,885          14,544            -2.3
    25-50.......................................           2,081          11,359          11,311            -0.4
    50-65.......................................             601           9,146           9,145               0
    Over 65.....................................              93           8,408           8,353            -0.6
FY 2015 Reclassifications by the Medicare
 Geographic Classification Review Board:
    All Reclassified Hospitals..................             719          10,843          10,829            -0.1
    Non-Reclassified Hospitals..................           2,677          11,379          11,298            -0.7
    Urban Hospitals Reclassified................             450          11,514          11,502            -0.1
    Urban Nonreclassified Hospitals, FY 2015:...           2,054          11,675          11,593            -0.7
    All Rural Hospitals Reclassified FY 2015:...             269           8,734           8,713            -0.2
    Rural Nonreclassified Hospitals FY 2015:....             514           7,667           7,606            -0.8
    All Section 401 Reclassified Hospitals:.....              50          10,137          10,025            -1.1
    Other Reclassified Hospitals (Section                     64           7,814           7,665            -1.9
     1886(d)(8)(B)).............................
Specialty Hospitals:
    Cardiac specialty Hospitals.................              15          12,303          12,538             1.9
----------------------------------------------------------------------------------------------------------------

    11. On page 50428, first column, first paragraph, lines 31 through 
35, the sentence ``Based on the applicant's estimate from FY 2013, we 
currently estimate that new technology add-on payments for 
Voraxaze[supreg] will increase overall FY 2015 payments by 
$6,300,000.'' is corrected to read ``Based on the latest data from the

[[Page 59691]]

manufacturer, we currently estimate that new technology add-on payments 
for Voraxaze[supreg] will increase overall FY 2015 payments by 
$6,615,000.''
    12. On page 50429:
    a. First column, second paragraph, line 6, the figure ``$5.3'' is 
corrected to read ``$8.8''.
    b. First column, third paragraph, line 16, the figure ``166'' is 
corrected to read ``116''.
    c. Second column, first partial paragraph, line 4, the figure 
``$70.7'' is corrected to read ``$71''.
    13. On page 50435, upper three-fourths of the page:
    a. First column, fourth bulleted paragraph:
    (1) Line 4, the figure ``0.9986'' is corrected to read ``0.9993''.
    (2) Line 5, the figure ``0.9373'' is corrected to read ``0.9382''.
    b. Second column, first partial paragraph, line 2, the 
figure''1.2'' is corrected to read ``1.3''.
    c. Third column:
    (1) Second full paragraph, second sentence, is corrected to read, 
``The increase in capital payments for voluntary and proprietary 
hospitals is estimated at 1.5 percent, and for government hospitals the 
increase is estimated to be 1.3 percent.''
    (2) Third full paragraph:
    (a) Line 20, the figure ``0.7'' is corrected to read ``0.8''.
    (b) Line 24, the figure ``(2.2 percent)'' is corrected to read 
``(2.3 percent)''.
    14. On pages 50435 through 50437, the table titled, ``Table III. 
Comparison of Total Payments Per Case'' is corrected to read as 
follows:

                                Table III--Comparison of Total Payments per Case
                                 [FY 2014 payments compared to FY 2015 payments]
----------------------------------------------------------------------------------------------------------------
                                                                    Average FY      Average FY
                                                     Number of    2014 payments/  2015 payments/      Change
                                                     hospitals         case            case
----------------------------------------------------------------------------------------------------------------
By Geographic Location:
    All hospitals...............................           3,396             856             869             1.5
    Large urban areas (populations over 1                  1,401             944             959             1.7
     million)...................................
    Other urban areas (populations of 1 million            1,148             824             835             1.4
     or fewer)..................................
    Rural areas.................................             847             583             589             1.0
    Urban hospitals.............................           2,549             890             903             1.5
        0-99 beds...............................             666             733             740             0.9
        100-199 beds............................             787             772             783             1.5
        200-299 beds............................             455             812             826             1.8
        300-499 beds............................             429             907             922             1.6
        500 or more beds........................             212           1,066           1,081             1.5
    Rural hospitals.............................             847             583             589             1.0
        0-49 beds...............................             328             474             480             1.2
        50-99 beds..............................             305             542             546             0.8
        100-149 beds............................             125             582             588             1.1
        150-199 beds............................              50             636             643             1.1
        200 or more beds........................              39             709             717             1.1
By Region:
    Urban by Region.............................           2,549             890             903             1.5
        New England.............................             120             984           1,001             1.7
        Middle Atlantic.........................             324             958             977             1.9
        South Atlantic..........................             407             802             812             1.3
        East North Central......................             397             856             867             1.3
        East South Central......................             153             764             772             1.0
        West North Central......................             162             880             892             1.4
        West South Central......................             387             823             831             0.9
        Mountain................................             162             907             918             1.2
        Pacific.................................             385           1,120           1,148             2.4
        Puerto Rico.............................              52             408             412             1.2
    Rural by Region.............................             847             583             589             1.0
        New England.............................              22             812             823             1.4
        Middle Atlantic.........................              57             566             575             1.7
        South Atlantic..........................             132             555             559             0.7
        East North Central......................             116             607             613             1.1
        East South Central......................             165             534             539             0.9
        West North Central......................             102             619             624             0.9
        West South Central......................             168             515             519             0.8
        Mountain................................              61             653             657             0.5
        Pacific.................................              24             749             767             2.4
        Puerto Rico.............................               0               0               0             0.0
By Payment Classification:
    All hospitals...............................           3,396             856             869             1.5
    Large urban areas (populations over 1                  1,413             943             959             1.7
     million)...................................
    Other urban areas (populations of 1 million            1,150             823             835             1.4
     or fewer)..................................
    Rural areas.................................             833             594             599             0.8
    Teaching Status:
        Non-teaching............................           2,357             728             738             1.5
        Fewer than 100 Residents................             795             837             850             1.5
        100 or more Residents...................             244           1,210           1,229             1.6
        Urban DSH:
            100 or more beds....................           1,588             911             925             1.6
            Less than 100 beds..................             383             649             657             1.1

[[Page 59692]]

 
        Rural DSH:
            Sole Community (SCH/EACH)...........             373             530             535             1.1
            Referral Center (RRC/EACH)..........             212             656             661             0.8
            Other Rural:
                100 or more beds................              24             552             552             0.0
                Less than 100 beds..............             137             465             469             1.0
    Urban teaching and DSH:
        Both teaching and DSH...................             842             990           1,005             1.5
        Teaching and no DSH.....................             133             891             907             1.8
        No teaching and DSH.....................           1,129             762             774             1.6
        No teaching and no DSH..................             459             788             799             1.4
    Rural Hospital Types:
        Non special status hospitals............           2,575             890             903             1.5
        RRC/EACH................................             193             717             730             1.8
        SCH/EACH................................             325             652             659             1.1
        SCH, RRC and EACH.......................             124             711             720             1.3
Hospitals Reclassified by the Medicare
 Geographic Classification Review Board:
    FY2015 Reclassifications:
        All Urban Reclassified..................             450             886             904             2.1
        All Urban Non-Reclassified..............           2,054             893             906             1.4
        All Rural Reclassified..................             269             621             628             1.0
        All Rural Non-Reclassified..............             514             533             537             0.8
        Other Reclassified Hospitals (Section                 59             581             595             2.3
         1886(d)(8)(B)).........................
    Type of Ownership:
        Voluntary...............................           1,935             868             882             1.5
        Proprietary.............................             892             776             787             1.5
        Government..............................             542             895             907             1.3
    Medicare Utilization as a Percent of
     Inpatient Days:
        0-25....................................             501           1,022           1,037             1.4
        25-50...................................           2,081             871             884             1.5
        50-65...................................             601             717             728             1.6
        Over 65.................................              93             648             654             1.0
----------------------------------------------------------------------------------------------------------------

    a. Upper three-fourths of the page:
    (1) Second column, first paragraph:
    (a) Line 2, the figure ``$654'' is corrected to read ``$623''.
    (b) Line 14, the figure ``$457'' is corrected to read ``$428''.
    (c) Line 22, the figure ``$369'' is corrected to read ``$373''.
    (d) Line 44, the figure ``$457'' is corrected to read ``$428''.
    (e) Line 45, the figure ``$888'' is corrected to read ``$862''.
    (f) Line 51, the figure ``$132'' is corrected to read ``$128''.
    (g) Line 55, the figure ``$756'' is corrected to read ``$734''.
    (2) Third column, last paragraph, last line, the figure ``$756'' is 
corrected to read ``$734''.
    b. Lower quarter of the page, the table titled ``Table V.--
Accounting Statement: Classification of Estimated Expenditures under 
the IPPS from FY 2014 to FY 2015'' is corrected to read as follows:

 Table V--Accounting Statement: Classification of Estimated Expenditures
                 Under the IPPS From FY 2014 to FY 2015
------------------------------------------------------------------------
                 Category                             Transfers
------------------------------------------------------------------------
Annualized Monetized Transfers............  -$734 million.
From Whom to Whom.........................  Federal Government to IPPS
                                             Medicare Providers.
------------------------------------------------------------------------


    Dated: September 30, 2014.
Oliver Potts,
Deputy Executive Secretary to the Department, Department of Health and 
Human Services.
[FR Doc. 2014-23630 Filed 10-1-14; 11:15 am]
BILLING CODE 4120-01-P
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