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]
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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 ..................................
....................
....................
....................
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*
*
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*
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.
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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:
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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
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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
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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.
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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
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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),
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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)
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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
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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
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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
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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
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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
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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
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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.
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c. Adding the following entry for PN–
6 immediately preceding the entry for
VTE–4:
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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
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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
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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:
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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
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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:
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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
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Federal Rate’’ is corrected to read as
follows:
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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
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14:48 Oct 02, 2014
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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
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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
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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
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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
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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
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E:\FR\FM\03OCR1.SGM
03OCR1
ER03OC14.006
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
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03OCR1
ER03OC14.007
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’’.
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b. Second column, first partial
paragraph, line 6, the figure ‘‘0.3’’ is
corrected to read ‘‘0.2’’.
c. Third column:
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(1) First full paragraph, line 26, the
figure ‘‘1.001443’’ is corrected to read
‘‘1.001421’’.
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ER03OC14.008
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 .................................................................................................................
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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 ............................................................................................
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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
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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
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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
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overall FY 2015 payments by
$6,300,000.’’ is corrected to read ‘‘Based
on the latest data from the
E:\FR\FM\03OCR1.SGM
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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
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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]
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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]
=======================================================================
-----------------------------------------------------------------------
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.
-----------------------------------------------------------------------
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