Medicare and Medicaid Programs: Hospital Outpatient Prospective Payment and Ambulatory Surgical Center Payment Systems and Quality Reporting Programs; Physician-Owned Hospitals: Data Sources for Expansion Exception; Physician Certification of Inpatient Hospital Services; Medicare Advantage Organizations and Part D Sponsors: CMS-Identified Overpayments Associated With Submitted Payment Data; Corrections, 9629-9636 [2015-03760]
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Federal Register / Vol. 80, No. 36 / Tuesday, February 24, 2015 / Rules and Regulations
DEPARTMENT OF HEALTH AND
HUMAN SERVICES
Centers for Medicare & Medicaid
Services
42 CFR Parts 411, 412, 416, 419, 422,
423, and 424
[CMS–1613–CN]
RIN 0938–AS15
Medicare and Medicaid Programs:
Hospital Outpatient Prospective
Payment and Ambulatory Surgical
Center Payment Systems and Quality
Reporting Programs; Physician-Owned
Hospitals: Data Sources for Expansion
Exception; Physician Certification of
Inpatient Hospital Services; Medicare
Advantage Organizations and Part D
Sponsors: CMS-Identified
Overpayments Associated With
Submitted Payment Data; Corrections
Centers for Medicare &
Medicaid Services (CMS), HHS.
ACTION: Correction of final rule.
AGENCY:
This document corrects
technical errors that appeared in the
final rule with comment period
published in the Federal Register on
November 10, 2014, entitled ‘‘Medicare
and Medicaid Programs: Hospital
Outpatient Prospective Payment and
Ambulatory Surgical Center Payment
Systems and Quality Reporting
Programs; Physician-Owned Hospitals:
Data Sources for Expansion Exception;
Physician Certification of Inpatient
Hospital Services; Medicare Advantage
Organizations and Part D Sponsors:
CMS-Identified Overpayments
Associated with Submitted Payment
Data.’’
DATES: Effective Date: This document is
effective February 24, 2015.
Applicability Date: The corrections
noted in this document and posted on
the CMS Web site are applicable to
payments for services furnished on or
after January 1, 2015.
FOR FURTHER INFORMATION CONTACT:
David Rice, (410) 786–6004, hospital
outpatient prospective payment system
(OPPS) issues.
Esther Markowitz, (410) 786–4595,
ambulatory surgical center (ASC)
payment issues.
Marjorie Baldo, (410) 786–4617, OPPS
issues related to status indicators (SI)
and ambulatory payment classification
(APC) changes.
SUPPLEMENTARY INFORMATION:
tkelley on DSK3SPTVN1PROD with RULES
SUMMARY:
I. Background
In FR Doc. 2014–26146 of November
10, 2014 (79 FR 66770) (hereinafter
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referred to as the CY 2015 OPPS/ASC
final rule with comment period), there
were a number of technical errors that
are discussed in the Summary of Errors,
and further identified and corrected in
the Correction of Errors section below.
The provisions in this correction notice
are applicable to payments for services
furnished on or after January 1, 2015,
and, therefore, are treated as if they had
been included in the CY 2015 OPPS/
ASC final rule with comment period (79
FR 66770) appearing in the November
10, 2014 Federal Register.
II. Summary of Errors and Corrections
Posted on the CMS Web site
A. Hospital Outpatient Prospective
Payment System (OPPS) Corrections
In the CY 2015 OPPS/ASC final rule
with comment period, for the OPPS
cancer hospital payment adjustment (79
FR 66831 through 66832), we finalized
a target payment-to-cost ratio (PCR) of
0.89. This target PCR is equal to the
weighted average PCR for the other
OPPS hospitals included in this dataset
(see 79 FR 66832 for more details on the
hospitals included in this dataset).
Under our longstanding policy, outlier
payments are included in the
calculation of the weighted average PCR
(or ‘‘target PCR’’) for these hospitals. We
have since determined that some outlier
payments were not included in the cost
report data we used to calculate the
target PCR. We have corrected this error
and included these outlier payments in
the target PCR calculation, which results
in a target PCR equal to 0.90 for each
cancer hospital.
In addition to identifying the error in
calculating the target PCR because of
missing outlier payments, we
determined that certain outlier
payments were similarly not included
in our calculations for estimated cancer
hospital PCRs. We have now corrected
this error and included these outlier
payments in determining the estimated
cancer hospital PCRs. As a result of
correcting these two technical errors,
the estimated total cancer hospital
payment adjustments, which are based
on the difference between estimated
cancer hospital PCRs and the target PCR
is also being corrected in this notice.
The revisions to the target PCR and
estimated cancer hospital PCRs have
decreased our estimate of total cancer
hospital payment adjustments by $18.6
million.
OPPS cancer hospital payment
adjustment payments are budget
neutral; therefore, we are updating the
budget neutrality adjustment to the
OPPS conversion factor for the
differential in estimated total cancer
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9629
hospital payment adjustments of $18.6
million. This additional $18.6 million
increases the conversion factor from
$74.144 to $74.173, which will slightly
increase payment rates for most
ambulatory payment classifications
(APCs). These revised APC payment
rates are reflected in the attached
Addenda.
We are also making technical
corrections to certain healthcare
common procedure coding system
(HCPCS) codes that appeared in Table
36—HCPCS Codes to Which the CY
2015 Drug-Specific Packaging
Determination Methodology Applies (79
FR 66889). Specifically, we are
correcting the CY 2015 OPPS status
indicators (SI) for HCPCS codes J1070,
J1080, J2271, J3120, and J3130 from ‘‘N’’
to ‘‘D’’ to accurately indicate that these
codes were deleted on December 31,
2014, and should not have appeared in
Table 36. These codes were correctly
assigned to OPPS SI ‘‘D’’ in the OPPS
Addendum B that was released with the
CY 2015 OPPS/ASC final rule. In
addition, HCPCS codes J1440 and J1441
were deleted on December 31, 2013, and
should not have appeared in Table 36.
HCPCS codes J1440 and J1441 were not
listed in the OPPS Addendum B that
was released with the CY 2015 OPPS/
ASC final rule.
Also, in Addendum B of the CY 2015
OPPS/ASC final rule with comment
period, HCPCS code J7180 (Factor xiii
anti-hem factor) was incorrectly
assigned a status indicator ‘‘N’’. Because
HCPCS code J7180 is a separately
payable drug, we have corrected this
error and assigned status indicator ‘‘K’’
and APC 1416. This correction is
included in the revised OPPS
Addendum B which is posted to the
CMS Web site at https://www.cms.gov/
Medicare/Medicare-Fee-for-ServicePayment/HospitalOutpatientPPS/
Hospital-Outpatient-Regulations-andNotices.html.
B. Ambulatory Surgical Center (ASC)
Payment System Corrections
ASC payment rates are based on the
OPPS relative payment weights for the
majority of covered surgical procedures
and covered ancillary services. For some
items, such as device-intensive
procedures, the ASC payment rates also
take into account the OPPS conversion
factor and payment rates. Therefore,
corrections to the CY 2015 OPPS
conversion factor and payment rates
affect the CY 2015 ASC payment rates.
To account for geographic wage
variation, individual ASC payments are
adjusted by applying the pre-floor and
pre-reclassified inpatient prospective
payment system (IPPS) hospital wage
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indexes to the labor-related share,
which is 50 percent of the ASC payment
amount. In other words, the wage index
for an ASC is the pre-floor and prereclassified IPPS hospital wage index of
the CBSA that maps to the CBSA where
the ASC is located. The FY 2015 IPPS
hospital wage indexes reflect new Office
of Management and Budget (OMB) labor
market area delineations; therefore, the
CY 2015 final ASC wage indexes reflect
the new OMB delineations. However, as
described in the CY 2015 OPPS/ASC
final rule (79 FR 66935 through 66937),
we finalized a policy to apply a one-year
blended wage index for all ASCs that
will experience any decrease in their
actual wage index exclusively due to the
implementation of the new OMB
delineations. Specifically, for ASCs
where the CY 2015 ASC wage index
with the CY 2015 Core-Based Statistical
Areas (CBSAs) is lower than with the
CY 2014 CBSAs, the CY 2015 ASC wage
index is 50 percent of the ASC wage
index based on the CY 2014 CBSA and
50 percent of the ASC wage index based
on the new CY 2015 CBSA. We have
since determined that the transitional
wage index for CY 2015 was calculated
incorrectly. We have now recalculated
the CY 2015 ASC wage index per the
policy finalized in the CY 2015 OPPS/
ASC final rule with comment period.
Due to these corrections, the final CY
2015 ASC wage index budget neutrality
adjustment changes from 0.9998, as
originally published (79 FR 66939 and
67023), to 0.9995. Using the final
corrected wage index budget neutrality
adjustment, the final CY 2015 ASC
conversion factor changes from $44.071,
as originally published (79 FR 66939,
66940, and 67023), to $44.058. The final
CY 2015 ASC conversion factor for
ASCs that do not meet the requirements
of the ASC Quality Reporting Program
changes from $43.202, as originally
published (79 FR 66939), to $43.189.
The final CY 2015 ASC rates and
indicators for certain office-based
covered surgical procedures and certain
covered ancillary services were
impacted due to corrections to the final
CY 2015 Medicare Physician Fee
Schedule (MPFS) rates. We note that we
expect to issue the CY 2015 MPFS
corrections in a separate Federal
Register document in the near future.
For covered office-based surgical
procedures, covered ancillary radiology
services (except certain nuclear
medicine procedures and radiology
procedures that use contrast agents),
and certain covered ancillary diagnostic
tests, the payment rate is the lower of
the amount calculated using the ASC
standard ratesetting methodology and
the MPFS nonfacility practice expense
relative value unit-based amount
effective January 1, 2015. The
corrections discussed in the MPFS
correcting document affected some of
the final payment indicators and rates
for these covered surgical procedures
and covered ancillary services. As such,
we have corrected these payment
indicators and rates based upon the
MPFS corrections discussed in the
MPFS correcting document. As stated in
the preamble and addenda to the CY
2015 OPPS/ASC final rule with
comment period (79 FR 66922, 66923,
66931, 66934, and 66939), the ASC
payment indicators and rates do not
include the effect of the negative update
to the MPFS payment rates effective
April 1, 2015 under current law.
Updates to the ASC rates and payment
indicators effective April 1, 2015 will be
included in the April 2015 quarterly
ASC addenda posted on the CMS Web
site.
C. Summary of Errors and Corrections to
the OPPS and ASC Addenda Posted on
the CMS Web site
1. OPPS Addenda Posted on the CMS
Web site
We are making several minor
technical corrections to the OPPS
addenda. First, as a result of the cancer
hospital payment adjustment correction
and subsequent budget neutrality
adjustment corrections, we have
updated Addenda A, B, and C to reflect
corrected APC payment rates.
Secondly, CPT codes 88342, 88344,
and 88366, were incorrectly assigned to
OPPS SI ‘‘E’’ and ‘‘N’’. Because these
services may be separately payable in
certain instances, we have corrected this
error. Specifically, we are correcting the
OPPS SI and APC assignments for CPT
code 88342 to ‘‘Q1’’ and APC 0433; for
CPT code 88344 to ‘‘Q1’’ and APC 0433;
and for CPT code 88366 to ‘‘Q1’’ and
APC 0342. We have updated OPPS
Addendum B to reflect these corrected
SIs.
Further, the 24 codes listed below
were assigned to incorrect OPPS SIs.
The correct OPPS SIs are listed in the
table below. Because these changes were
too late to include in the January 2015
Integrated Outpatient Code Editor
(IOCE), they will be included in the
April 2015 IOCE update retroactive to
January 1, 2015.
tkelley on DSK3SPTVN1PROD with RULES
HCPCS code
Short descriptor
CY 2015
OPPS SI
CY 2015
OPPS APC
0356T ..........
86592 ..........
86593 ..........
86631 ..........
86632 ..........
86780 ..........
87110 ..........
87270 ..........
87320 ..........
87341 ..........
87490 ..........
87491 ..........
87590 ..........
87591 ..........
87800 ..........
87810 ..........
87850 ..........
88380 ..........
88381 ..........
88387 ..........
93895 ..........
G0461 .........
G0462 .........
V2760 ..........
Insrt drug device for iop .................................................................................................................
Syphilis test non-trep qual .............................................................................................................
Syphilis test non-trep quant ...........................................................................................................
Chlamydia antibody ........................................................................................................................
Chlamydia igm antibody .................................................................................................................
Treponema pallidum ......................................................................................................................
Chlamydia culture ..........................................................................................................................
Chlamydia trachomatis ag if ..........................................................................................................
Chylmd trach ag eia .......................................................................................................................
Hepatitis b surface ag eia ..............................................................................................................
Chylmd trach dna dir probe ...........................................................................................................
Chylmd trach dna amp probe ........................................................................................................
N.gonorrhoeae dna dir prob ...........................................................................................................
N.gonorrhoeae dna amp prob ........................................................................................................
Detect agnt mult dna direc .............................................................................................................
Chylmd trach assay w/optic ...........................................................................................................
N. gonorrhoeae assay w/optic .......................................................................................................
Microdissection laser ......................................................................................................................
Microdissection manual ..................................................................................................................
Tiss exam molecular study ............................................................................................................
Carotid intima atheroma eval .........................................................................................................
Immunohisto/cyto chem 1st st .......................................................................................................
Immunohisto/cyto chem add ..........................................................................................................
Scratch resistant coating ................................................................................................................
Q1
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
N
N
N
E
D
D
E
0698
........................
........................
........................
........................
........................
........................
........................
........................
........................
........................
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9631
HCPCS code
Short descriptor
CY 2015
OPPS SI
CY 2015
OPPS APC
V2762 ..........
V2786 ..........
V2797 ..........
Polarization, any lens .....................................................................................................................
Occupational multifocal lens ..........................................................................................................
Vis item/svc in other code ..............................................................................................................
E
E
E
........................
........................
........................
tkelley on DSK3SPTVN1PROD with RULES
We are correcting the OPPS SI for CPT
code 0356T to ‘‘Q1’’ since this is the SI
assigned to APC 0698. In addition, we
are correcting the OPPS SI for CPT
codes 86592 through 87850 to ‘‘A’’ to
indicate that these preventive services
are paid separately in another Medicare
payment system other than the OPPS.
Further, we are correcting the OPPS SI
for CPT codes 88380, 88381, and 88387
to ‘‘N’’ to indicate that these services are
packaged. We are also correcting the
OPPS SI for CPT code 93895 to ‘‘E’’ to
indicate that this service is non-covered.
We are correcting the OPPS SI for
HCPCS codes G0461 and G0462 to ‘‘D’’
to indicate that these codes were deleted
on December 31, 2014. Also, we are
correcting the OPPS SI for HCPCS codes
V2760, V2762, V2786, and V2797 to ‘‘E’’
to indicate that these items are noncovered under the OPPS.
To view the corrected CY 2015 OPPS
payment rates that result from these
technical corrections, we refer readers to
the Addenda and supporting files that
are posted on the CMS Web site at:
https://www.cms.gov/Medicare/
Medicare-Fee-for-Service-Payment/
HospitalOutpatientPPS/.
Select ‘‘CMS–1613–CN’’ from the list of
regulations. All corrected Addenda for
this correcting document are contained
in the zipped folder titled ‘‘2015 OPPS
Final Rule Addenda’’ at the bottom of
the page for CMS–1613–CN.
2. Ambulatory Surgical Center (ASC)
Payment System Addenda Posted on the
CMS Web site
As a result of the technical corrections
described in Section II.B. and IV. of this
correction notice, we have updated
Addenda AA and BB to reflect the final
corrected payment rates and indicators
for CY 2015 for ASC covered surgical
procedures and covered ancillary
services. To view the corrected final CY
2015 ASC payment rates and indicators
that result from these technical
corrections, we refer readers to the
Addenda and supporting files that are
posted on the CMS Web site at: https://
www.cms.gov/Medicare/Medicare-Feefor-Service-Payment/ASCPayment/ASCRegulations-and-Notices.html. Select
‘‘CMS–1613–CN’’ from the list of
regulations. All corrected ASC addenda
for this correcting document are
contained in the zipped folder entitled
‘‘Addendum AA, BB, DD1, DD2, and
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EE’’ at the bottom of the page for CMS–
1613–CN. The corrected final CY 2015
ASC wage index file and updated public
use files are also posted on this Web
page.
III. Waiver of Proposed Rulemaking,
60-Day Comment Period, and Delay of
Effective Date
Under 5 U.S.C. 553(b) of the
Administrative Procedure Act (APA),
the agency is required to publish a
notice of the proposed rule in the
Federal Register before the provisions
of a rule take effect. Similarly, section
1871(b)(1) of the Act requires the
Secretary to provide for notice of the
proposed rule in the Federal Register
and provide a period of not less than 60
days for public comment. In addition,
section 553(d) of the APA, and section
1871(e)(1)(B)(i) of the Act mandate a 30day delay in effective date after issuance
or publication of a rule. Sections
553(b)(B) and 553(d)(3) of the APA
provide for exceptions from the notice
and comment and delay in effective date
APA requirements; in cases in which
these exceptions apply, sections
1871(b)(2)(C) and 1871(e)(1)(B)(ii) of the
Act provide exceptions from the notice
and 60-day comment period and delay
in effective date requirements of the Act
as well. Section 553(b)(B) of the APA
and section 1871(b)(2)(C) of the Act
authorize an agency to dispense with
normal rulemaking requirements for
good cause if the agency makes a
finding that the notice and comment
process are impracticable, unnecessary,
or contrary to the public interest. In
addition, both section 553(d)(3) of the
APA and section 1871(e)(1)(B)(ii) of the
Act allow the agency to avoid the 30day delay in effective date where such
delay is contrary to the public interest
and an agency includes a statement of
support.
In our view, this correcting document
does not constitute a rulemaking that
would be subject to these requirements.
This correcting document corrects
technical errors in the preamble,
addenda, payment rates, and tables
included or referenced in the CY 2015
OPPS/ASC final rule with comment
period. The corrections contained in
this document are consistent with, and
do not make substantive changes to, the
policies and payment methodologies
that were adopted subjected to notice
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and comment procedures in the CY
2015 OPPS/ASC final rule with
comment period. As a result, the
corrections made through this correcting
document are intended to ensure that
the CY 2015 OPPS/ASC final rule with
comment period accurately reflects the
policies adopted in that rule.
Even if this were a rulemaking to
which the notice and comment 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
CY 2015 OPPS/ASC final rule with
comment period or delaying the
effective date would be contrary to the
public interest because it is in the
public’s interest for providers and
suppliers to receive appropriate
payments in as timely a manner as
possible, and to ensure that the CY 2015
OPPS/ASC final rule with comment
period accurately reflects our policies as
of the date they take effect and are
applicable. Further, such procedures
would be unnecessary, because we are
not altering the payment methodologies
or policies, but rather, we are simply
correctly implementing the policies that
we previously proposed, received
comment on, and subsequently
finalized. This correcting document is
intended solely to ensure that the CY
2015 OPPS/ASC final rule with
comment period accurately reflects
these payment methodologies and
policies. For these reasons, we believe
we have good cause to waive the notice
and comment and effective date
requirements.
IV. Correction of Errors
In FR Doc. 2014–26146 of November
10, 2014 (79 FR 66770), make the
following corrections:
Correction of Errors in the Preamble
1. On page 66776, second column,
second bullet, lines 11 and 17, the figure
‘‘0.89’’ is corrected to read ‘‘0.90’’.
2. On page 66777, third column, first
paragraph under column heading (4),
line 11, the figure ‘‘2.3’’ is corrected to
read ‘‘2.4’’.
3. On page 66825,
a. Second column,
(1) First partial paragraph, lines 6
through 14, remove the last two
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sentences of the paragraph and add the
following sentence in its place: ‘‘The CY
2015 estimated cancer hospital payment
adjustments result in a budget neutral
adjustment factor of 1.0004 to the
conversion factor for the cancer hospital
payment adjustment.’’
(2) Second full paragraph,
(a) Line 17, the figure ‘‘$72.692’’ is
corrected to read ‘‘$72.690’’.
(b) Line 19, the figure ‘‘¥$1.484’’ is
corrected to read ‘‘¥$1.483’’.
b. Third column,
(1) First full paragraph, line 13, the
figure ‘‘$72.661’’ is corrected to read
‘‘$72.690’’.
(2) Last paragraph, line 10, the figure
‘‘$74.144’’ is corrected to read
‘‘$74.173’’.
4. On page 66826, first column, first
partial paragraph,
(a) Line 2, the figure ‘‘1.0000’’ is
corrected to read ‘‘1.0004’’.
(b) Line 7, the figure ‘‘$74.144’’ is
corrected to read ‘‘$74.173’’.
5. On page 66832,
a. First column, first partial
paragraph,
(1) Line 3, the figure ‘‘89’’ is corrected
to read ‘‘90’’.
(2) Lines 5 and 11, the figure ‘‘0.89’’
is corrected to read ‘‘0.90’’.
b. Second column,
(1) First partial paragraph, line 4, the
figure ‘‘0.89’’ is corrected to read ‘‘0.90’’.
(2) First full paragraph, lines 4 and 9,
the figure ‘‘0.89 is corrected to read
‘‘0.90’’.
c. Third column, first partial
paragraph,
(1) Line 3, the figure ‘‘89’’ is corrected
to read ‘‘90’’.
(2) Lines 5 and 11, the figure ‘‘0.89’’
is corrected to read ‘‘0.90’’.
d. Table 14—Estimated CY 2015
Hospital-Specific Payment Adjustment
For Cancer Hospitals To Be Provided At
Cost Report Settlement, the table is
corrected to read as follows:
TABLE 14—ESTIMATED CY 2015 HOSPITAL-SPECIFIC PAYMENT ADJUSTMENT FOR CANCER HOSPITALS TO BE PROVIDED
AT COST REPORT SETTLEMENT
Provider No.
050146
050660
100079
100271
220162
330154
330354
360242
390196
450076
500138
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
Estimated
percentage
increase in
OPPS Payments
for CY 2015
Hospital name
City of Hope Comprehensive Cancer Center .......................................................................................................
USC Norris Cancer Hospital .................................................................................................................................
Sylvester Comprehensive Cancer Center .............................................................................................................
H. Lee Moffitt Cancer Center & Research Institute ..............................................................................................
Dana-Farber Cancer Institute ................................................................................................................................
Memorial Sloan-Kettering Cancer Center .............................................................................................................
Roswell Park Cancer Institute ...............................................................................................................................
James Cancer Hospital & Solove Research Institute ...........................................................................................
Fox Chase Cancer Center ....................................................................................................................................
M.D. Anderson Cancer Center ..............................................................................................................................
Seattle Cancer Care Alliance ................................................................................................................................
6. On page 66889, Table 36—HCPCS
Codes To Which The CY 2015 DrugSpecific Packaging Determination
16.1
23.2
12.7
20.5
47.3
42.4
19.2
32.7
19.7
49.4
43.6
Methodology Applies, the table is
corrected to read as follows:
TABLE 36—HCPCS CODES TO WHICH THE CY 2015 DRUG-SPECIFIC PACKAGING DETERMINATION METHODOLOGY
APPLIES
tkelley on DSK3SPTVN1PROD with RULES
CY 2015
HCPCS code
C9257
J9035
J1020
J1030
J1040
J1460
J1560
J1642
J1644
J1840
J1850
J2270
J2788
J2790
J2920
J2930
J3471
J3472
J7030
J7040
J7050
J7502
J7515
J8520
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VerDate Sep<11>2014
CY 2015 long descriptor
CY 2015 SI
Injection, bevacizumab, 0.25 mg ..............................................................................................................................
Injection, bevacizumab, 10 mg .................................................................................................................................
Injection, methylprednisolone acetate, 20 mg ..........................................................................................................
Injection, methylprednisolone acetate, 40 mg ..........................................................................................................
Injection, methylprednisolone acetate, 80 mg ..........................................................................................................
Injection, gamma globulin, intramuscular, 1 cc ........................................................................................................
Injection, gamma globulin, intramuscular over 10 cc ...............................................................................................
Injection, heparin sodium, (heparin lock flush), per 10 units ....................................................................................
Injection, heparin sodium, per 1000 units .................................................................................................................
Injection, kanamycin sulfate, up to 500 mg ..............................................................................................................
Injection, kanamycin sulfate, up to 75 mg ................................................................................................................
Injection, morphine sulfate, up to 10 mg ..................................................................................................................
Injection, rho d immune globulin, human, minidose, 50 micrograms (250 i.u.) .......................................................
Injection, rho d immune globulin, human, full dose, 300 micrograms (1500 i.u.) ....................................................
Injection, methylprednisolone sodium succinate, up to 40 mg .................................................................................
Injection, methylprednisolone sodium succinate, up to 125 mg ...............................................................................
Injection, hyaluronidase, ovine, preservative free, per 1 usp unit (up to 999 usp units) .........................................
Injection, hyaluronidase, ovine, preservative free, per 1000 usp units ....................................................................
Infusion, normal saline solution , 1000 cc ................................................................................................................
Infusion, normal saline solution, sterile (500 ml = 1 unit) .........................................................................................
Infusion, normal saline solution , 250 cc ..................................................................................................................
Cyclosporine, oral, 100 mg .......................................................................................................................................
Cyclosporine, oral, 25 mg .........................................................................................................................................
Capecitabine, oral, 150 mg .......................................................................................................................................
K
K
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
K
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Federal Register / Vol. 80, No. 36 / Tuesday, February 24, 2015 / Rules and Regulations
9633
TABLE 36—HCPCS CODES TO WHICH THE CY 2015 DRUG-SPECIFIC PACKAGING DETERMINATION METHODOLOGY
APPLIES—Continued
CY 2015
HCPCS code
CY 2015 long descriptor
CY 2015 SI
J8521 ...........
J9250 ...........
J9260 ...........
Capecitabine, oral, 500 mg .......................................................................................................................................
Methotrexate sodium, 5 mg ......................................................................................................................................
Methotrexate sodium, 50 mg ....................................................................................................................................
K
N
N
7. On page 66917, third column,
remove the first full paragraph and add
the following paragraph in its place:
‘‘For the new Category III CPT codes
implemented in July 2014 through the
quarterly update CR, as shown below in
Table 43, we are not finalizing the ‘‘Z2’’
payment indicator that we proposed for
CPT codes 0348T, 0349T, and 0350T or
the ‘‘R2’’ payment indicator that we
proposed for CPT code 0356T. For CY
2015, these codes will be conditionally
packaged under the OPPS when
provided with a significant procedure
(status indicator ‘‘Q1’’). With the
exception of device removal procedures
(as discussed in section XII.D.1.b. of this
final rule with comment period), HCPCS
codes that are conditionally packaged
under the OPPS are always packaged
(payment indicator ‘‘N1’’) under the
ASC payment system. Therefore, the
final CY 2015 ASC payment indicator
for CPT codes 0348T, 0349T, 0350T,
and 0356T is ‘‘N1’’ for CY 2015.
8. On page 66918, Table 43—New
Category III CPT Codes for Covered
Surgical Procedures or Covered
Ancillary Services Implemented in July
2014, the table is corrected to read as
follows:
TABLE 43—NEW CATEGORY III CPT CODES FOR COVERED SURGICAL PROCEDURES OR COVERED ANCILLARY SERVICES
IMPLEMENTED IN JULY 2014
Final CY 2015
ASC payment
indicator
CY 2014
CPT code
CY 2015
CPT code
CY 2015 long descriptor
0348T
0348T
0349T
0349T
0350T
0350T
0356T
0356T
Radiologic examination, radiostereometric analysis (RSA); spine, (includes, cervical, thoracic and
lumbosacral, when performed) ........................................................................................................
Radiologic examination, radiostereometric analysis (RSA); upper extremity(ies), (includes shoulder, elbow and wrist, when performed) ...........................................................................................
Radiologic examination, radiostereometric analysis (RSA); lower extremity(ies), (includes hip,
proximal femur, knee and ankle, when performed) .........................................................................
Insertion of drug-eluting implant (including punctal dilation and implant removal when performed)
into lacrimal canaliculus, each .........................................................................................................
N1
N1
N1
N1
tkelley on DSK3SPTVN1PROD with RULES
N1 = Packaged service/item; no separate payment made.
9. On page 66939,
a. Second column, last paragraph, line
10, the figure ‘‘0.9998’’ is corrected to
read ‘‘0.9995’’.
b. Third column, first partial
paragraph,
(1) Line 6, the figure ‘‘$44.071’’ is
corrected to read ‘‘$44.058’’.
(2) Line 11, the figure ‘‘0.9998’’ is
corrected to read ‘‘0.9995’’.
(3) Line 21, the figure ‘‘$43.202’’ is
corrected to read ‘‘$43.189’’.
(4) Line 26, the figure ‘‘0.9998’’ is
corrected to read ‘‘0.9995’’.
10. On page 66940, first column,
second full paragraph, line 6, the figure
‘‘$44.071’’ is corrected to read
‘‘$44.058’’.
11. On page 66962, second column,
first full paragraph,
a. Line 12, the figure ‘‘$72.661’’ is
corrected to read ‘‘$72.690’’.
b. Line 14, the figure ‘‘$74.144’’ is
corrected to read ‘‘$74.173’’.
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12. On page 67019,
a. Second column, first paragraph,
(1) Line 3, the figure ‘‘(4,006)’’ is
corrected to read ‘‘(4,007)’’.
(2) Line 31, the figure ‘‘(3,871)’’ is
corrected to read ‘‘(3,782)’’.
b. Third column, remove the entire
fourth paragraph, which begins with
‘‘There is no difference in impact’’ and
add the following paragraph in its place:
‘‘The impacts reflect slightly smaller
total cancer hospital payment
adjustments as a result of the updated
target PCR and updated estimated
cancer hospital PCRs for 2015.’’
13. On page 67020,
a. First column, first full paragraph
under column 5 heading,
(1) Line 10, the figures ‘‘3.4 and 4.2’’
are corrected to read ‘‘3.5 and 4.3’’
respectively. (2) Line 14, the figure
‘‘3.2’’ is corrected to read ‘‘3.3’’.
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b. Second column, first partial
paragraph, line 9, the figure ‘‘$74.144’’
is corrected to read ‘‘$74.173’’.
c. Third column,
(1) First partial paragraph, last line,
the figure ‘‘2.3’’ is corrected to read
‘‘2.4’’.
(2) First full paragraph, line 11, the
figures ‘‘0.9 to 2.1’’ are corrected to read
‘‘1.0 to 2.2’’ respectively.
(3) Second full paragraph, line 4, the
figure ‘‘3.1’’ is corrected to read ‘‘3.2’’.
(4) Last paragraph,
(a) Line 7, the figure ‘‘1.7’’ is corrected
to read ‘‘1.8’’.
(b) Line 9, the figure ‘‘2.1’’ is
corrected to read ‘‘2.2’’.
14. On pages 67020 through 67022,
Table 49—Estimated Impact of the CY
2015 Changes for the Hospital
Outpatient Prospective Payment
System, the table is corrected to read as
follows:
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9634
Federal Register / Vol. 80, No. 36 / Tuesday, February 24, 2015 / Rules and Regulations
TABLE 49—ESTIMATED IMPACT OF THE PROPOSED CY 2015 CHANGES FOR THE HOSPITAL OUTPATIENT PROSPECTIVE
PAYMENT SYSTEM
New wage
index and
provider
adjustments
(1)
tkelley on DSK3SPTVN1PROD with RULES
APC
recalibration
(all changes)
(2)
(3)
(4)
ALL FACILITIES * ....................................
ALL HOSPITALS .....................................
(excludes hospitals permanently held
harmless and CMHCs).
URBAN HOSPITALS ...............................
LARGE URBAN (GT 1 MILL.) ..........
OTHER URBAN (LE 1 MILL.) ..........
RURAL HOSPITALS ................................
SOLE COMMUNITY .........................
OTHER RURAL ................................
BEDS (URBAN):
0–99 BEDS .......................................
100–199 BEDS .................................
200–299 BEDS .................................
300–499 BEDS .................................
500 + BEDS ......................................
BEDS (RURAL):
0–49 BEDS .......................................
50–100 BEDS ...................................
101–149 BEDS .................................
150–199 BEDS .................................
200 + BEDS ......................................
VOLUME (URBAN):
LT 5,000 Lines ..................................
5,000–10,999 Lines ..........................
11,000–20,999 Lines ........................
21,000–42,999 Lines ........................
42,999–89,999 Lines ........................
GT 89,999 Lines ...............................
VOLUME (RURAL):
LT 5,000 Lines ..................................
5,000–10,999 Lines ..........................
11,000–20,999 Lines ........................
21,000–42,999 Lines ........................
GT 42,999 Lines ...............................
REGION (URBAN):
NEW ENGLAND ...............................
MIDDLE ATLANTIC ..........................
SOUTH ATLANTIC ...........................
EAST NORTH CENT. .......................
EAST SOUTH CENT. .......................
WEST NORTH CENT. ......................
WEST SOUTH CENT. ......................
MOUNTAIN .......................................
PACIFIC ............................................
PUERTO RICO .................................
REGION (RURAL):
NEW ENGLAND ...............................
MIDDLE ATLANTIC ..........................
SOUTH ATLANTIC ...........................
EAST NORTH CENT ........................
EAST SOUTH CENT ........................
WEST NORTH CENT .......................
WEST SOUTH CENT .......................
MOUNTAIN .......................................
PACIFIC ............................................
TEACHING STATUS:
NON-TEACHING ..............................
MINOR ..............................................
MAJOR .............................................
DSH PATIENT PERCENT:
0 ........................................................
GT 0–0.10 .........................................
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All budget
neutral
changes and
update
(column 4)
with frontier
wage index
adjustment
All changes
(5)
Number of
hospitals
All budget
neutral
changes
(combined
cols 2, 3) with
market basket
update
(6)
4,007
3,872
0.0
0.0
2.2
2.3
2.3
2.4
2.3
2.3
3,008
1,646
1,362
863
376
487
0.0
0.1
0.0
0.0
0.1
¥0.2
0.0
0.2
¥0.1
¥0.3
¥0.2
¥0.3
2.3
2.5
2.1
1.9
2.2
1.7
2.4
2.5
2.3
2.2
2.6
1.7
2.4
2.6
2.1
1.9
2.2
1.6
1,067
856
458
410
217
0.0
0.0
¥0.1
¥0.1
0.3
0.0
0.0
0.1
0.1
¥0.1
2.3
2.2
2.3
2.3
2.5
2.5
2.3
2.4
2.4
2.4
2.3
2.3
2.3
2.3
2.5
345
315
116
46
41
0.1
0.3
¥0.3
¥0.4
¥0.3
¥0.2
¥0.3
¥0.1
¥0.4
¥0.4
2.2
2.3
1.9
1.4
1.6
2.4
2.5
2.1
2.2
1.5
2.2
2.2
1.8
1.5
1.5
544
135
117
228
526
1,458
¥1.7
¥0.8
¥1.5
¥0.7
¥0.3
0.1
¥0.3
¥0.2
0.0
0.0
0.0
0.0
0.3
1.3
0.7
1.6
1.9
2.4
0.5
1.4
1.2
1.5
2.0
2.5
0.5
1.4
0.9
1.6
2.0
2.4
34
27
42
161
599
¥3.8
¥1.8
¥1.1
0.2
0.0
¥0.3
¥0.5
¥0.3
¥0.3
¥0.3
¥1.8
¥0.1
0.9
2.2
2.0
1.1
1.1
0.9
2.8
2.2
¥2.0
0.0
1.0
2.2
1.9
152
361
482
473
179
194
527
203
389
48
1.1
0.5
¥0.2
0.1
¥0.9
0.0
¥0.7
0.0
0.3
¥0.4
0.2
0.5
¥0.3
¥0.1
¥0.5
¥0.2
¥0.5
¥0.1
1.1
0.3
3.5
3.2
1.8
2.2
0.9
2.0
1.1
2.2
3.7
2.1
3.5
3.2
1.7
2.2
0.9
3.3
1.0
2.5
3.6
2.1
3.5
3.3
1.8
2.2
0.9
2.1
1.1
2.2
3.7
2.0
23
58
130
120
165
101
181
61
24
1.6
0.8
¥0.6
0.0
¥0.8
0.2
¥0.7
0.7
0.8
¥0.1
0.2
¥0.5
0.0
¥0.5
¥0.2
¥0.8
¥0.4
0.9
3.7
3.3
1.1
2.2
1.0
2.2
0.8
2.5
4.0
3.6
3.3
1.1
2.2
1.0
3.5
0.7
4.3
4.0
3.7
3.2
1.0
2.2
0.9
2.2
0.7
2.7
3.9
2,839
706
326
¥0.2
¥0.2
0.7
0.0
¥0.1
0.1
2.0
2.0
3.1
2.1
2.2
3.1
2.0
2.0
3.2
21
328
PO 00000
0.0
0.0
0.0
0.3
0.3
0.2
2.6
2.7
2.6
2.8
2.6
2.7
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24FER1
Federal Register / Vol. 80, No. 36 / Tuesday, February 24, 2015 / Rules and Regulations
9635
TABLE 49—ESTIMATED IMPACT OF THE PROPOSED CY 2015 CHANGES FOR THE HOSPITAL OUTPATIENT PROSPECTIVE
PAYMENT SYSTEM—Continued
APC
recalibration
(all changes)
New wage
index and
provider
adjustments
(1)
(2)
(3)
(4)
0.10–0.16 ..........................................
0.16–0.23 ..........................................
0.23–0.35 ..........................................
GE 0.35 .............................................
DSH NOT AVAILABLE ** ..................
URBAN TEACHING/DSH:
TEACHING & DSH ...........................
NO TEACHING/DSH ........................
NO TEACHING/NO DSH ..................
DSH NOT AVAILABLE ** ..................
TYPE OF OWNERSHIP:
VOLUNTARY ....................................
PROPRIETARY ................................
GOVERNMENT ................................
CMHCs .....................................................
All budget
neutral
changes and
update
(column 4)
with frontier
wage index
adjustment
All changes
(5)
Number of
hospitals
All budget
neutral
changes
(combined
cols 2, 3) with
market basket
update
(6)
334
680
1,076
824
608
0.1
0.1
0.0
0.1
¥3.6
0.0
0.0
0.0
0.1
0.0
2.4
2.3
2.2
2.3
¥1.4
2.5
2.4
2.4
2.3
¥1.3
2.4
2.3
2.2
2.5
¥1.4
938
1,477
18
575
0.2
¥0.2
¥0.1
¥3.3
0.0
0.1
0.4
0.1
2.5
2.1
2.5
¥0.9
2.6
2.2
2.5
¥0.9
2.5
2.1
2.5
¥1.0
2,006
1,322
543
72
0.1
¥0.4
¥0.1
0.0
0.0
¥0.1
¥0.1
¥0.5
2.4
1.7
2.1
1.8
2.5
1.9
2.1
1.8
2.4
1.8
2.2
1.3
Column (1) shows the total number of hospitals and/or CMHCs.
Column (2) shows the impact of all final CY 2015 OPPS APC policies and compares those to the CY 2014 OPPS.
Column (3) shows the budget neutral impact of updating the wage index by applying the final FY 2015 hospital inpatient wage index, including
all hold harmless policies and transitional wages. The final rural adjustment continues our current policy of 7.1 percent so the budget neutrality
factor is 1. The budget neutrality adjustment for the cancer hospital adjustment is 1.004.
Column (4) shows the impact of all budget neutrality adjustments and the addition of the proposed 2.2 percent OPD fee schedule update factor (2.9 percent reduced by 0.5 percentage points for the final productivity adjustment and further reduced by 0.2 percentage point in order to
satisfy statutory requirements set forth in the Affordable Care Act).
Column (5) shows the impact of all budget neutral changes and the non-budget neutral impact of applying the frontier State wage adjustment
in CY 2015.
Column (6) shows the additional adjustments to the conversion factor resulting from a change in the pass-through estimate, adding estimated
outlier payments, and applying payment wage indexes.
* These 4,007 providers include children and cancer hospitals, which are held harmless to pre-BBA amounts, and CMHCs.
** Complete DSH numbers are not available for providers that are not paid under IPPS, including rehabilitation, psychiatric, and long-term care
hospitals.
15. On page 67022, second column,
first full paragraph,
a. Line 13, the figure ‘‘1.7’’ is
corrected to read ‘‘1.8’’.
b. Line 16, the figure ‘‘1.7’’ is
corrected to read ‘‘1.8’’.
c. Line 19, the figure ‘‘¥0.4’’ is
corrected to read ‘‘¥0.5’’.
16. On page 67023, second column,
first partial paragraph,
a. Line 12, the figure ‘‘0.9998’’ is
corrected to read ‘‘0.9995’’.
b. Last line, the figure ‘‘$44.071’’ is
corrected to read ‘‘$44.058’’.
17. On page 67024, third column (top
third of the page above Table 50), first
partial paragraph, line 1, replace ‘‘9’’
with ‘‘11’’.
18. On pages 67024 through 67025,
Table 51—Estimated Impact of the CY
2015 Update to the ASC Payment
System on Aggregate Payments for
Selected Procedures, the table is
corrected to read as follows:
TABLE 51—ESTIMATED IMPACT OF THE CY 2015 UPDATE TO THE ASC PAYMENT SYSTEM ON AGGREGATE PAYMENTS
FOR SELECTED PROCEDURES
Short descriptor
Estimated CY
2014 ASC
payments (in
millions)
Estimated CY
2015 percent
change
(1)
tkelley on DSK3SPTVN1PROD with RULES
CPT/HCPCS code
(2)
(3)
(4)
66984 .........................
43239 .........................
45380 .........................
45385 .........................
66982 .........................
64483 .........................
62311 .........................
45378 .........................
66821 .........................
64493 .........................
G0105 ........................
Cataract surg w/iol, 1 stage .............................................................................................
Upper GI endoscopy, biopsy ...........................................................................................
Colonoscopy and biopsy .................................................................................................
Lesion removal colonoscopy ...........................................................................................
Cataract surgery, complex ...............................................................................................
Inj foramen epidural l/s ....................................................................................................
Inject spine l/s (cd) ..........................................................................................................
Diagnostic colonoscopy ...................................................................................................
After cataract laser surgery .............................................................................................
Inj paravert f jnt l/s 1 lev ..................................................................................................
Colorectal scrn; hi risk ind ...............................................................................................
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24FER1
$1,131
170
167
107
93
90
79
72
63
47
45
¥1
11
7
7
¥1
0
0
7
3
0
1
9636
Federal Register / Vol. 80, No. 36 / Tuesday, February 24, 2015 / Rules and Regulations
TABLE 51—ESTIMATED IMPACT OF THE CY 2015 UPDATE TO THE ASC PAYMENT SYSTEM ON AGGREGATE PAYMENTS
FOR SELECTED PROCEDURES—Continued
CPT/HCPCS code
Short descriptor
Estimated CY
2014 ASC
payments (in
millions)
Estimated CY
2015 percent
change
(1)
(2)
(3)
(4)
64635 .........................
63650 .........................
G0121 ........................
64590 .........................
15823 .........................
63685 .........................
29827 .........................
64721 .........................
29881 .........................
29824 .........................
29880 .........................
43235 .........................
62310 .........................
29823 .........................
52000 .........................
G0260 ........................
45384 .........................
67042 .........................
26055 .........................
Destroy lumb/sac facet jnt ...............................................................................................
Implant neuroelectrodes ..................................................................................................
Colon ca scrn not hi rsk ind ............................................................................................
Insrt/redo pn/gastr stimul .................................................................................................
Revision of upper eyelid ..................................................................................................
Insrt/redo spine n generator ............................................................................................
Arthroscop rotator cuff repr .............................................................................................
Carpal tunnel surgery ......................................................................................................
Knee arthroscopy/surgery ................................................................................................
Shoulder arthroscopy/surgery ..........................................................................................
Knee arthroscopy/surgery ................................................................................................
Uppr gi endoscopy diagnosis ..........................................................................................
Inject spine c/t ..................................................................................................................
Shoulder arthroscopy/surgery ..........................................................................................
Cystoscopy ......................................................................................................................
Inj for sacroiliac jt anesth .................................................................................................
Lesion remove colonoscopy ............................................................................................
Vit for macular hole .........................................................................................................
Incise finger tendon sheath .............................................................................................
Dated: February 18, 2015.
C’Reda Weeden,
Executive Secretary to the Department,
Department of Health and Human Services.
FOR FURTHER INFORMATION CONTACT:
[FR Doc. 2015–03760 Filed 2–23–15; 8:45 am]
Table of Contents
BILLING CODE 4120–01–P
DEPARTMENT OF HEALTH AND
HUMAN SERVICES
Centers for Medicare & Medicaid
Services
42 CFR Part 600
[CMS–2391–FN]
RIN 0938–ZB18
Basic Health Program; Federal
Funding Methodology for Program
Year 2016
Centers for Medicare &
Medicaid Services (CMS), HHS.
ACTION: Final methodology.
AGENCY:
This document provides the
methodology and data sources necessary
to determine federal payment amounts
made in program year 2016 to states that
elect to establish a Basic Health Program
under the Affordable Care Act to offer
health benefits coverage to low-income
individuals otherwise eligible to
purchase coverage through Affordable
Insurance Exchanges.
DATES: These regulations are effective
on January 1, 2016.
tkelley on DSK3SPTVN1PROD with RULES
SUMMARY:
VerDate Sep<11>2014
16:15 Feb 23, 2015
Jkt 235001
Christopher Truffer, (410) 786–1264;
Stephanie Kaminsky (410) 786–4653.
SUPPLEMENTARY INFORMATION:
I. Background
II. Summary of Proposed Provisions and
Analysis of and Responses to Public
Comments on the Proposed Methodology
A. Background
B. Overview of the Funding Methodology
and Calculation of the Payment Amount
C. Required Rate Cells
D. Sources and State Data Considerations
E. Discussion of Specific Variables Used in
Payment Equations
F. Adjustments for American Indians and
Alaska Natives
G. State Option to Use 2015 QHP
Premiums for BHP Payments
H. State Option To Include Retrospective
State-Specific Health Risk Adjustment in
Certified Methodology
III. Provisions of the Final Methodology
A. Overview of the Funding Methodology
and Calculation of the Payment Amount
B. Federal BHP Payment Rate Cells
C. Sources and State Data Considerations
D. Discussion of Specific Variables Used in
Payment Equations
E. Adjustments for American Indians and
Alaska Natives
F. State Option To Use 2015 QHP
Premiums for BHP Payments
G. State Option To Include Retrospective
State-Specific Health Risk Adjustment in
Certified Methodology
IV. Collection of Information Requirements
V. Regulatory Impact Statement
A. Overall Impact
B. Unfunded Mandates Reform Act
C. Regulatory Flexibility Act
D. Federalism
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45
41
41
38
35
34
34
32
30
27
25
23
23
22
22
21
21
21
19
¥5
4
1
¥1
2
29
1
¥1
¥1
1
¥1
10
0
1
1
0
7
1
¥2
Acronyms
To assist the reader, the following
acronyms are used in this document.
DAV Change in Actuarial Value
APTC Advance payment of the premium
tax credit
ARP Adjusted reference premium
AV Actuarial value
BHP Basic Health Program
CCIIO CMS’ Center for Consumer
Information and Insurance Oversight
CDC Centers for Disease Control and
Prevention
CHIP Children’s Health Insurance Program
CPI–U Consumer price index for all urban
consumers
CSR Cost-sharing reduction
EHB Essential Health Benefit
FPL Federal poverty line
FRAC Factor for removing administrative
costs
IRF Income reconciliation factor
IRS Internal Revenue Service
IUF Induced utilization factor
QHP Qualified health plan
OTA Office of Tax Analysis [of the U.S.
Department of Treasury]
PHF Population health factor
PTC Premium tax credit
PTCF Premium tax credit formula
PTF Premium trend factor
RP Reference premium
SBM State Based Marketplace
TRAF Tobacco rating adjustment factor
I. Background
The Patient Protection and Affordable
Care Act (Pub. L. 111–148, enacted on
March 23, 2010), together with the
Health Care and Education
Reconciliation Act of 2010 (Pub. L. 111–
152, enacted on March 30, 2010)
(collectively referred as the Affordable
E:\FR\FM\24FER1.SGM
24FER1
]]>Agencies
[Federal Register Volume 80, Number 36 (Tuesday, February 24, 2015)]
[Rules and Regulations]
[Pages 9629-9636]
From the Federal Register Online via the Government Printing Office [www.gpo.gov]
[FR Doc No: 2015-03760]
[[Page 9629]]
=======================================================================
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DEPARTMENT OF HEALTH AND HUMAN SERVICES
Centers for Medicare & Medicaid Services
42 CFR Parts 411, 412, 416, 419, 422, 423, and 424
[CMS-1613-CN]
RIN 0938-AS15
Medicare and Medicaid Programs: Hospital Outpatient Prospective
Payment and Ambulatory Surgical Center Payment Systems and Quality
Reporting Programs; Physician-Owned Hospitals: Data Sources for
Expansion Exception; Physician Certification of Inpatient Hospital
Services; Medicare Advantage Organizations and Part D Sponsors: CMS-
Identified Overpayments Associated With Submitted Payment Data;
Corrections
AGENCY: Centers for Medicare & Medicaid Services (CMS), HHS.
ACTION: Correction of final rule.
-----------------------------------------------------------------------
SUMMARY: This document corrects technical errors that appeared in the
final rule with comment period published in the Federal Register on
November 10, 2014, entitled ``Medicare and Medicaid Programs: Hospital
Outpatient Prospective Payment and Ambulatory Surgical Center Payment
Systems and Quality Reporting Programs; Physician-Owned Hospitals: Data
Sources for Expansion Exception; Physician Certification of Inpatient
Hospital Services; Medicare Advantage Organizations and Part D
Sponsors: CMS-Identified Overpayments Associated with Submitted Payment
Data.''
DATES: Effective Date: This document is effective February 24, 2015.
Applicability Date: The corrections noted in this document and
posted on the CMS Web site are applicable to payments for services
furnished on or after January 1, 2015.
FOR FURTHER INFORMATION CONTACT: David Rice, (410) 786-6004, hospital
outpatient prospective payment system (OPPS) issues.
Esther Markowitz, (410) 786-4595, ambulatory surgical center (ASC)
payment issues.
Marjorie Baldo, (410) 786-4617, OPPS issues related to status
indicators (SI) and ambulatory payment classification (APC) changes.
SUPPLEMENTARY INFORMATION:
I. Background
In FR Doc. 2014-26146 of November 10, 2014 (79 FR 66770)
(hereinafter referred to as the CY 2015 OPPS/ASC final rule with
comment period), there were a number of technical errors that are
discussed in the Summary of Errors, and further identified and
corrected in the Correction of Errors section below. The provisions in
this correction notice are applicable to payments for services
furnished on or after January 1, 2015, and, therefore, are treated as
if they had been included in the CY 2015 OPPS/ASC final rule with
comment period (79 FR 66770) appearing in the November 10, 2014 Federal
Register.
II. Summary of Errors and Corrections Posted on the CMS Web site
A. Hospital Outpatient Prospective Payment System (OPPS) Corrections
In the CY 2015 OPPS/ASC final rule with comment period, for the
OPPS cancer hospital payment adjustment (79 FR 66831 through 66832), we
finalized a target payment-to-cost ratio (PCR) of 0.89. This target PCR
is equal to the weighted average PCR for the other OPPS hospitals
included in this dataset (see 79 FR 66832 for more details on the
hospitals included in this dataset). Under our longstanding policy,
outlier payments are included in the calculation of the weighted
average PCR (or ``target PCR'') for these hospitals. We have since
determined that some outlier payments were not included in the cost
report data we used to calculate the target PCR. We have corrected this
error and included these outlier payments in the target PCR
calculation, which results in a target PCR equal to 0.90 for each
cancer hospital.
In addition to identifying the error in calculating the target PCR
because of missing outlier payments, we determined that certain outlier
payments were similarly not included in our calculations for estimated
cancer hospital PCRs. We have now corrected this error and included
these outlier payments in determining the estimated cancer hospital
PCRs. As a result of correcting these two technical errors, the
estimated total cancer hospital payment adjustments, which are based on
the difference between estimated cancer hospital PCRs and the target
PCR is also being corrected in this notice. The revisions to the target
PCR and estimated cancer hospital PCRs have decreased our estimate of
total cancer hospital payment adjustments by $18.6 million.
OPPS cancer hospital payment adjustment payments are budget
neutral; therefore, we are updating the budget neutrality adjustment to
the OPPS conversion factor for the differential in estimated total
cancer hospital payment adjustments of $18.6 million. This additional
$18.6 million increases the conversion factor from $74.144 to $74.173,
which will slightly increase payment rates for most ambulatory payment
classifications (APCs). These revised APC payment rates are reflected
in the attached Addenda.
We are also making technical corrections to certain healthcare
common procedure coding system (HCPCS) codes that appeared in Table
36--HCPCS Codes to Which the CY 2015 Drug-Specific Packaging
Determination Methodology Applies (79 FR 66889). Specifically, we are
correcting the CY 2015 OPPS status indicators (SI) for HCPCS codes
J1070, J1080, J2271, J3120, and J3130 from ``N'' to ``D'' to accurately
indicate that these codes were deleted on December 31, 2014, and should
not have appeared in Table 36. These codes were correctly assigned to
OPPS SI ``D'' in the OPPS Addendum B that was released with the CY 2015
OPPS/ASC final rule. In addition, HCPCS codes J1440 and J1441 were
deleted on December 31, 2013, and should not have appeared in Table 36.
HCPCS codes J1440 and J1441 were not listed in the OPPS Addendum B that
was released with the CY 2015 OPPS/ASC final rule.
Also, in Addendum B of the CY 2015 OPPS/ASC final rule with comment
period, HCPCS code J7180 (Factor xiii anti-hem factor) was incorrectly
assigned a status indicator ``N''. Because HCPCS code J7180 is a
separately payable drug, we have corrected this error and assigned
status indicator ``K'' and APC 1416. This correction is included in the
revised OPPS Addendum B which is posted to the CMS Web site at https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/HospitalOutpatientPPS/Hospital-Outpatient-Regulations-and-Notices.html.
B. Ambulatory Surgical Center (ASC) Payment System Corrections
ASC payment rates are based on the OPPS relative payment weights
for the majority of covered surgical procedures and covered ancillary
services. For some items, such as device-intensive procedures, the ASC
payment rates also take into account the OPPS conversion factor and
payment rates. Therefore, corrections to the CY 2015 OPPS conversion
factor and payment rates affect the CY 2015 ASC payment rates.
To account for geographic wage variation, individual ASC payments
are adjusted by applying the pre-floor and pre-reclassified inpatient
prospective payment system (IPPS) hospital wage
[[Page 9630]]
indexes to the labor-related share, which is 50 percent of the ASC
payment amount. In other words, the wage index for an ASC is the pre-
floor and pre-reclassified IPPS hospital wage index of the CBSA that
maps to the CBSA where the ASC is located. The FY 2015 IPPS hospital
wage indexes reflect new Office of Management and Budget (OMB) labor
market area delineations; therefore, the CY 2015 final ASC wage indexes
reflect the new OMB delineations. However, as described in the CY 2015
OPPS/ASC final rule (79 FR 66935 through 66937), we finalized a policy
to apply a one-year blended wage index for all ASCs that will
experience any decrease in their actual wage index exclusively due to
the implementation of the new OMB delineations. Specifically, for ASCs
where the CY 2015 ASC wage index with the CY 2015 Core-Based
Statistical Areas (CBSAs) is lower than with the CY 2014 CBSAs, the CY
2015 ASC wage index is 50 percent of the ASC wage index based on the CY
2014 CBSA and 50 percent of the ASC wage index based on the new CY 2015
CBSA. We have since determined that the transitional wage index for CY
2015 was calculated incorrectly. We have now recalculated the CY 2015
ASC wage index per the policy finalized in the CY 2015 OPPS/ASC final
rule with comment period.
Due to these corrections, the final CY 2015 ASC wage index budget
neutrality adjustment changes from 0.9998, as originally published (79
FR 66939 and 67023), to 0.9995. Using the final corrected wage index
budget neutrality adjustment, the final CY 2015 ASC conversion factor
changes from $44.071, as originally published (79 FR 66939, 66940, and
67023), to $44.058. The final CY 2015 ASC conversion factor for ASCs
that do not meet the requirements of the ASC Quality Reporting Program
changes from $43.202, as originally published (79 FR 66939), to
$43.189.
The final CY 2015 ASC rates and indicators for certain office-based
covered surgical procedures and certain covered ancillary services were
impacted due to corrections to the final CY 2015 Medicare Physician Fee
Schedule (MPFS) rates. We note that we expect to issue the CY 2015 MPFS
corrections in a separate Federal Register document in the near future.
For covered office-based surgical procedures, covered ancillary
radiology services (except certain nuclear medicine procedures and
radiology procedures that use contrast agents), and certain covered
ancillary diagnostic tests, the payment rate is the lower of the amount
calculated using the ASC standard ratesetting methodology and the MPFS
nonfacility practice expense relative value unit-based amount effective
January 1, 2015. The corrections discussed in the MPFS correcting
document affected some of the final payment indicators and rates for
these covered surgical procedures and covered ancillary services. As
such, we have corrected these payment indicators and rates based upon
the MPFS corrections discussed in the MPFS correcting document. As
stated in the preamble and addenda to the CY 2015 OPPS/ASC final rule
with comment period (79 FR 66922, 66923, 66931, 66934, and 66939), the
ASC payment indicators and rates do not include the effect of the
negative update to the MPFS payment rates effective April 1, 2015 under
current law. Updates to the ASC rates and payment indicators effective
April 1, 2015 will be included in the April 2015 quarterly ASC addenda
posted on the CMS Web site.
C. Summary of Errors and Corrections to the OPPS and ASC Addenda Posted
on the CMS Web site
1. OPPS Addenda Posted on the CMS Web site
We are making several minor technical corrections to the OPPS
addenda. First, as a result of the cancer hospital payment adjustment
correction and subsequent budget neutrality adjustment corrections, we
have updated Addenda A, B, and C to reflect corrected APC payment
rates.
Secondly, CPT codes 88342, 88344, and 88366, were incorrectly
assigned to OPPS SI ``E'' and ``N''. Because these services may be
separately payable in certain instances, we have corrected this error.
Specifically, we are correcting the OPPS SI and APC assignments for CPT
code 88342 to ``Q1'' and APC 0433; for CPT code 88344 to ``Q1'' and APC
0433; and for CPT code 88366 to ``Q1'' and APC 0342. We have updated
OPPS Addendum B to reflect these corrected SIs.
Further, the 24 codes listed below were assigned to incorrect OPPS
SIs. The correct OPPS SIs are listed in the table below. Because these
changes were too late to include in the January 2015 Integrated
Outpatient Code Editor (IOCE), they will be included in the April 2015
IOCE update retroactive to January 1, 2015.
----------------------------------------------------------------------------------------------------------------
CY 2015 OPPS CY 2015 OPPS
HCPCS code Short descriptor SI APC
----------------------------------------------------------------------------------------------------------------
0356T..................... Insrt drug device for iop......................... Q1 0698
86592..................... Syphilis test non-trep qual....................... A ...............
86593..................... Syphilis test non-trep quant...................... A ...............
86631..................... Chlamydia antibody................................ A ...............
86632..................... Chlamydia igm antibody............................ A ...............
86780..................... Treponema pallidum................................ A ...............
87110..................... Chlamydia culture................................. A ...............
87270..................... Chlamydia trachomatis ag if....................... A ...............
87320..................... Chylmd trach ag eia............................... A ...............
87341..................... Hepatitis b surface ag eia........................ A ...............
87490..................... Chylmd trach dna dir probe........................ A ...............
87491..................... Chylmd trach dna amp probe........................ A ...............
87590..................... N.gonorrhoeae dna dir prob........................ A ...............
87591..................... N.gonorrhoeae dna amp prob........................ A ...............
87800..................... Detect agnt mult dna direc........................ A ...............
87810..................... Chylmd trach assay w/optic........................ A ...............
87850..................... N. gonorrhoeae assay w/optic...................... A ...............
88380..................... Microdissection laser............................. N ...............
88381..................... Microdissection manual............................ N ...............
88387..................... Tiss exam molecular study......................... N ...............
93895..................... Carotid intima atheroma eval...................... E ...............
G0461..................... Immunohisto/cyto chem 1st st...................... D ...............
G0462..................... Immunohisto/cyto chem add......................... D ...............
V2760..................... Scratch resistant coating......................... E ...............
[[Page 9631]]
V2762..................... Polarization, any lens............................ E ...............
V2786..................... Occupational multifocal lens...................... E ...............
V2797..................... Vis item/svc in other code........................ E ...............
----------------------------------------------------------------------------------------------------------------
We are correcting the OPPS SI for CPT code 0356T to ``Q1'' since
this is the SI assigned to APC 0698. In addition, we are correcting the
OPPS SI for CPT codes 86592 through 87850 to ``A'' to indicate that
these preventive services are paid separately in another Medicare
payment system other than the OPPS. Further, we are correcting the OPPS
SI for CPT codes 88380, 88381, and 88387 to ``N'' to indicate that
these services are packaged. We are also correcting the OPPS SI for CPT
code 93895 to ``E'' to indicate that this service is non-covered. We
are correcting the OPPS SI for HCPCS codes G0461 and G0462 to ``D'' to
indicate that these codes were deleted on December 31, 2014. Also, we
are correcting the OPPS SI for HCPCS codes V2760, V2762, V2786, and
V2797 to ``E'' to indicate that these items are non-covered under the
OPPS.
To view the corrected CY 2015 OPPS payment rates that result from
these technical corrections, we refer readers to the Addenda and
supporting files that are posted on the CMS Web site at: https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/HospitalOutpatientPPS/. Select ``CMS-1613-CN'' from the list
of regulations. All corrected Addenda for this correcting document are
contained in the zipped folder titled ``2015 OPPS Final Rule Addenda''
at the bottom of the page for CMS-1613-CN.
2. Ambulatory Surgical Center (ASC) Payment System Addenda Posted on
the CMS Web site
As a result of the technical corrections described in Section II.B.
and IV. of this correction notice, we have updated Addenda AA and BB to
reflect the final corrected payment rates and indicators for CY 2015
for ASC covered surgical procedures and covered ancillary services. To
view the corrected final CY 2015 ASC payment rates and indicators that
result from these technical corrections, we refer readers to the
Addenda and supporting files that are posted on the CMS Web site at:
https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/ASCPayment/ASC-Regulations-and-Notices.html. Select ``CMS-1613-CN''
from the list of regulations. All corrected ASC addenda for this
correcting document are contained in the zipped folder entitled
``Addendum AA, BB, DD1, DD2, and EE'' at the bottom of the page for
CMS-1613-CN. The corrected final CY 2015 ASC wage index file and
updated public use files are also posted on this Web page.
III. Waiver of Proposed Rulemaking, 60-Day Comment Period, and Delay of
Effective Date
Under 5 U.S.C. 553(b) of the Administrative Procedure Act (APA),
the agency is required to publish a notice of the proposed rule in the
Federal Register before the provisions of a rule take effect.
Similarly, section 1871(b)(1) of the Act requires the Secretary to
provide for notice of the proposed rule in the Federal Register and
provide a period of not less than 60 days for public comment. In
addition, section 553(d) of the APA, and section 1871(e)(1)(B)(i) of
the Act mandate a 30-day delay in effective date after issuance or
publication of a rule. Sections 553(b)(B) and 553(d)(3) of the APA
provide for exceptions from the notice and comment and delay in
effective date APA requirements; in cases in which these exceptions
apply, sections 1871(b)(2)(C) and 1871(e)(1)(B)(ii) of the Act provide
exceptions from the notice and 60-day comment period and delay in
effective date requirements of the Act as well. Section 553(b)(B) of
the APA and section 1871(b)(2)(C) of the Act authorize an agency to
dispense with normal rulemaking requirements for good cause if the
agency makes a finding that the notice and comment process are
impracticable, unnecessary, or contrary to the public interest. In
addition, both section 553(d)(3) of the APA and section
1871(e)(1)(B)(ii) of the Act allow the agency to avoid the 30-day delay
in effective date where such delay is contrary to the public interest
and an agency includes a statement of support.
In our view, this correcting document does not constitute a
rulemaking that would be subject to these requirements. This correcting
document corrects technical errors in the preamble, addenda, payment
rates, and tables included or referenced in the CY 2015 OPPS/ASC final
rule with comment period. The corrections contained in this document
are consistent with, and do not make substantive changes to, the
policies and payment methodologies that were adopted subjected to
notice and comment procedures in the CY 2015 OPPS/ASC final rule with
comment period. As a result, the corrections made through this
correcting document are intended to ensure that the CY 2015 OPPS/ASC
final rule with comment period accurately reflects the policies adopted
in that rule.
Even if this were a rulemaking to which the notice and comment 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 CY 2015 OPPS/ASC final rule with comment period or delaying the
effective date would be contrary to the public interest because it is
in the public's interest for providers and suppliers to receive
appropriate payments in as timely a manner as possible, and to ensure
that the CY 2015 OPPS/ASC final rule with comment period accurately
reflects our policies as of the date they take effect and are
applicable. Further, such procedures would be unnecessary, because we
are not altering the payment methodologies or policies, but rather, we
are simply correctly implementing the policies that we previously
proposed, received comment on, and subsequently finalized. This
correcting document is intended solely to ensure that the CY 2015 OPPS/
ASC final rule with comment period accurately reflects these payment
methodologies and policies. For these reasons, we believe we have good
cause to waive the notice and comment and effective date requirements.
IV. Correction of Errors
In FR Doc. 2014-26146 of November 10, 2014 (79 FR 66770), make the
following corrections:
Correction of Errors in the Preamble
1. On page 66776, second column, second bullet, lines 11 and 17,
the figure ``0.89'' is corrected to read ``0.90''.
2. On page 66777, third column, first paragraph under column
heading (4), line 11, the figure ``2.3'' is corrected to read ``2.4''.
3. On page 66825,
a. Second column,
(1) First partial paragraph, lines 6 through 14, remove the last
two
[[Page 9632]]
sentences of the paragraph and add the following sentence in its place:
``The CY 2015 estimated cancer hospital payment adjustments result in a
budget neutral adjustment factor of 1.0004 to the conversion factor for
the cancer hospital payment adjustment.''
(2) Second full paragraph,
(a) Line 17, the figure ``$72.692'' is corrected to read
``$72.690''.
(b) Line 19, the figure ``-$1.484'' is corrected to read ``-
$1.483''.
b. Third column,
(1) First full paragraph, line 13, the figure ``$72.661'' is
corrected to read ``$72.690''.
(2) Last paragraph, line 10, the figure ``$74.144'' is corrected to
read ``$74.173''.
4. On page 66826, first column, first partial paragraph,
(a) Line 2, the figure ``1.0000'' is corrected to read ``1.0004''.
(b) Line 7, the figure ``$74.144'' is corrected to read
``$74.173''.
5. On page 66832,
a. First column, first partial paragraph,
(1) Line 3, the figure ``89'' is corrected to read ``90''.
(2) Lines 5 and 11, the figure ``0.89'' is corrected to read
``0.90''.
b. Second column,
(1) First partial paragraph, line 4, the figure ``0.89'' is
corrected to read ``0.90''.
(2) First full paragraph, lines 4 and 9, the figure ``0.89 is
corrected to read ``0.90''.
c. Third column, first partial paragraph,
(1) Line 3, the figure ``89'' is corrected to read ``90''.
(2) Lines 5 and 11, the figure ``0.89'' is corrected to read
``0.90''.
d. Table 14--Estimated CY 2015 Hospital-Specific Payment Adjustment
For Cancer Hospitals To Be Provided At Cost Report Settlement, the
table is corrected to read as follows:
Table 14--Estimated CY 2015 Hospital-Specific Payment Adjustment for Cancer Hospitals To Be Provided at Cost
Report Settlement
----------------------------------------------------------------------------------------------------------------
Estimated
percentage
Provider No. Hospital name increase in
OPPS Payments
for CY 2015
----------------------------------------------------------------------------------------------------------------
050146............................ City of Hope Comprehensive Cancer Center.................. 16.1
050660............................ USC Norris Cancer Hospital................................ 23.2
100079............................ Sylvester Comprehensive Cancer Center..................... 12.7
100271............................ H. Lee Moffitt Cancer Center & Research Institute......... 20.5
220162............................ Dana-Farber Cancer Institute.............................. 47.3
330154............................ Memorial Sloan-Kettering Cancer Center.................... 42.4
330354............................ Roswell Park Cancer Institute............................. 19.2
360242............................ James Cancer Hospital & Solove Research Institute......... 32.7
390196............................ Fox Chase Cancer Center................................... 19.7
450076............................ M.D. Anderson Cancer Center............................... 49.4
500138............................ Seattle Cancer Care Alliance.............................. 43.6
----------------------------------------------------------------------------------------------------------------
6. On page 66889, Table 36--HCPCS Codes To Which The CY 2015 Drug-
Specific Packaging Determination Methodology Applies, the table is
corrected to read as follows:
Table 36--HCPCS Codes to Which the CY 2015 Drug-Specific Packaging Determination Methodology Applies
----------------------------------------------------------------------------------------------------------------
CY 2015 HCPCS code CY 2015 long descriptor CY 2015 SI
----------------------------------------------------------------------------------------------------------------
C9257.............................. Injection, bevacizumab, 0.25 mg........................... K
J9035.............................. Injection, bevacizumab, 10 mg............................. K
J1020.............................. Injection, methylprednisolone acetate, 20 mg.............. N
J1030.............................. Injection, methylprednisolone acetate, 40 mg.............. N
J1040.............................. Injection, methylprednisolone acetate, 80 mg.............. N
J1460.............................. Injection, gamma globulin, intramuscular, 1 cc............ N
J1560.............................. Injection, gamma globulin, intramuscular over 10 cc....... N
J1642.............................. Injection, heparin sodium, (heparin lock flush), per 10 N
units.
J1644.............................. Injection, heparin sodium, per 1000 units................. N
J1840.............................. Injection, kanamycin sulfate, up to 500 mg................ N
J1850.............................. Injection, kanamycin sulfate, up to 75 mg................. N
J2270.............................. Injection, morphine sulfate, up to 10 mg.................. N
J2788.............................. Injection, rho d immune globulin, human, minidose, 50 N
micrograms (250 i.u.).
J2790.............................. Injection, rho d immune globulin, human, full dose, 300 N
micrograms (1500 i.u.).
J2920.............................. Injection, methylprednisolone sodium succinate, up to 40 N
mg.
J2930.............................. Injection, methylprednisolone sodium succinate, up to 125 N
mg.
J3471.............................. Injection, hyaluronidase, ovine, preservative free, per 1 N
usp unit (up to 999 usp units).
J3472.............................. Injection, hyaluronidase, ovine, preservative free, per N
1000 usp units.
J7030.............................. Infusion, normal saline solution , 1000 cc................ N
J7040.............................. Infusion, normal saline solution, sterile (500 ml = 1 N
unit).
J7050.............................. Infusion, normal saline solution , 250 cc................. N
J7502.............................. Cyclosporine, oral, 100 mg................................ N
J7515.............................. Cyclosporine, oral, 25 mg................................. N
J8520.............................. Capecitabine, oral, 150 mg................................ K
[[Page 9633]]
J8521.............................. Capecitabine, oral, 500 mg................................ K
J9250.............................. Methotrexate sodium, 5 mg................................. N
J9260.............................. Methotrexate sodium, 50 mg................................ N
----------------------------------------------------------------------------------------------------------------
7. On page 66917, third column, remove the first full paragraph and
add the following paragraph in its place: ``For the new Category III
CPT codes implemented in July 2014 through the quarterly update CR, as
shown below in Table 43, we are not finalizing the ``Z2'' payment
indicator that we proposed for CPT codes 0348T, 0349T, and 0350T or the
``R2'' payment indicator that we proposed for CPT code 0356T. For CY
2015, these codes will be conditionally packaged under the OPPS when
provided with a significant procedure (status indicator ``Q1''). With
the exception of device removal procedures (as discussed in section
XII.D.1.b. of this final rule with comment period), HCPCS codes that
are conditionally packaged under the OPPS are always packaged (payment
indicator ``N1'') under the ASC payment system. Therefore, the final CY
2015 ASC payment indicator for CPT codes 0348T, 0349T, 0350T, and 0356T
is ``N1'' for CY 2015.
8. On page 66918, Table 43--New Category III CPT Codes for Covered
Surgical Procedures or Covered Ancillary Services Implemented in July
2014, the table is corrected to read as follows:
Table 43--New Category III CPT Codes for Covered Surgical Procedures or Covered Ancillary Services Implemented
in July 2014
----------------------------------------------------------------------------------------------------------------
Final CY 2015
CY 2014 CPT CY 2015 CPT CY 2015 long descriptor ASC payment
code code indicator
----------------------------------------------------------------------------------------------------------------
0348T 0348T Radiologic examination, radiostereometric analysis (RSA); spine, N1
(includes, cervical, thoracic and lumbosacral, when performed)....
0349T 0349T Radiologic examination, radiostereometric analysis (RSA); upper N1
extremity(ies), (includes shoulder, elbow and wrist, when
performed)........................................................
0350T 0350T Radiologic examination, radiostereometric analysis (RSA); lower N1
extremity(ies), (includes hip, proximal femur, knee and ankle,
when performed)...................................................
0356T 0356T Insertion of drug-eluting implant (including punctal dilation and N1
implant removal when performed) into lacrimal canaliculus, each...
----------------------------------------------------------------------------------------------------------------
N1 = Packaged service/item; no separate payment made.
9. On page 66939,
a. Second column, last paragraph, line 10, the figure ``0.9998'' is
corrected to read ``0.9995''.
b. Third column, first partial paragraph,
(1) Line 6, the figure ``$44.071'' is corrected to read
``$44.058''.
(2) Line 11, the figure ``0.9998'' is corrected to read ``0.9995''.
(3) Line 21, the figure ``$43.202'' is corrected to read
``$43.189''.
(4) Line 26, the figure ``0.9998'' is corrected to read ``0.9995''.
10. On page 66940, first column, second full paragraph, line 6, the
figure ``$44.071'' is corrected to read ``$44.058''.
11. On page 66962, second column, first full paragraph,
a. Line 12, the figure ``$72.661'' is corrected to read
``$72.690''.
b. Line 14, the figure ``$74.144'' is corrected to read
``$74.173''.
12. On page 67019,
a. Second column, first paragraph,
(1) Line 3, the figure ``(4,006)'' is corrected to read
``(4,007)''.
(2) Line 31, the figure ``(3,871)'' is corrected to read
``(3,782)''.
b. Third column, remove the entire fourth paragraph, which begins
with ``There is no difference in impact'' and add the following
paragraph in its place: ``The impacts reflect slightly smaller total
cancer hospital payment adjustments as a result of the updated target
PCR and updated estimated cancer hospital PCRs for 2015.''
13. On page 67020,
a. First column, first full paragraph under column 5 heading,
(1) Line 10, the figures ``3.4 and 4.2'' are corrected to read
``3.5 and 4.3'' respectively. (2) Line 14, the figure ``3.2'' is
corrected to read ``3.3''.
b. Second column, first partial paragraph, line 9, the figure
``$74.144'' is corrected to read ``$74.173''.
c. Third column,
(1) First partial paragraph, last line, the figure ``2.3'' is
corrected to read ``2.4''.
(2) First full paragraph, line 11, the figures ``0.9 to 2.1'' are
corrected to read ``1.0 to 2.2'' respectively.
(3) Second full paragraph, line 4, the figure ``3.1'' is corrected
to read ``3.2''.
(4) Last paragraph,
(a) Line 7, the figure ``1.7'' is corrected to read ``1.8''.
(b) Line 9, the figure ``2.1'' is corrected to read ``2.2''.
14. On pages 67020 through 67022, Table 49--Estimated Impact of the
CY 2015 Changes for the Hospital Outpatient Prospective Payment System,
the table is corrected to read as follows:
[[Page 9634]]
Table 49--Estimated Impact of the Proposed CY 2015 Changes for the Hospital Outpatient Prospective Payment System
--------------------------------------------------------------------------------------------------------------------------------------------------------
All budget
All budget neutral
neutral changes and
Number of APC New wage index changes update (column
hospitals recalibration and provider (combined cols 4) with All changes
(all changes) adjustments 2, 3) with frontier wage
market basket index
update adjustment
(1) (2) (3) (4) (5) (6)
--------------------------------------------------------------------------------------------------------------------------------------------------------
ALL FACILITIES *........................................ 4,007 0.0 0.0 2.2 2.3 2.3
ALL HOSPITALS........................................... 3,872 0.0 0.0 2.3 2.4 2.3
(excludes hospitals permanently held harmless and CMHCs)
URBAN HOSPITALS......................................... 3,008 0.0 0.0 2.3 2.4 2.4
LARGE URBAN (GT 1 MILL.)............................ 1,646 0.1 0.2 2.5 2.5 2.6
OTHER URBAN (LE 1 MILL.)............................ 1,362 0.0 -0.1 2.1 2.3 2.1
RURAL HOSPITALS......................................... 863 0.0 -0.3 1.9 2.2 1.9
SOLE COMMUNITY...................................... 376 0.1 -0.2 2.2 2.6 2.2
OTHER RURAL......................................... 487 -0.2 -0.3 1.7 1.7 1.6
BEDS (URBAN):
0-99 BEDS........................................... 1,067 0.0 0.0 2.3 2.5 2.3
100-199 BEDS........................................ 856 0.0 0.0 2.2 2.3 2.3
200-299 BEDS........................................ 458 -0.1 0.1 2.3 2.4 2.3
300-499 BEDS........................................ 410 -0.1 0.1 2.3 2.4 2.3
500 + BEDS.......................................... 217 0.3 -0.1 2.5 2.4 2.5
BEDS (RURAL):
0-49 BEDS........................................... 345 0.1 -0.2 2.2 2.4 2.2
50-100 BEDS......................................... 315 0.3 -0.3 2.3 2.5 2.2
101-149 BEDS........................................ 116 -0.3 -0.1 1.9 2.1 1.8
150-199 BEDS........................................ 46 -0.4 -0.4 1.4 2.2 1.5
200 + BEDS.......................................... 41 -0.3 -0.4 1.6 1.5 1.5
VOLUME (URBAN):
LT 5,000 Lines...................................... 544 -1.7 -0.3 0.3 0.5 0.5
5,000-10,999 Lines.................................. 135 -0.8 -0.2 1.3 1.4 1.4
11,000-20,999 Lines................................. 117 -1.5 0.0 0.7 1.2 0.9
21,000-42,999 Lines................................. 228 -0.7 0.0 1.6 1.5 1.6
42,999-89,999 Lines................................. 526 -0.3 0.0 1.9 2.0 2.0
GT 89,999 Lines..................................... 1,458 0.1 0.0 2.4 2.5 2.4
VOLUME (RURAL):
LT 5,000 Lines...................................... 34 -3.8 -0.3 -1.8 1.1 -2.0
5,000-10,999 Lines.................................. 27 -1.8 -0.5 -0.1 1.1 0.0
11,000-20,999 Lines................................. 42 -1.1 -0.3 0.9 0.9 1.0
21,000-42,999 Lines................................. 161 0.2 -0.3 2.2 2.8 2.2
GT 42,999 Lines..................................... 599 0.0 -0.3 2.0 2.2 1.9
REGION (URBAN):
NEW ENGLAND......................................... 152 1.1 0.2 3.5 3.5 3.5
MIDDLE ATLANTIC..................................... 361 0.5 0.5 3.2 3.2 3.3
SOUTH ATLANTIC...................................... 482 -0.2 -0.3 1.8 1.7 1.8
EAST NORTH CENT..................................... 473 0.1 -0.1 2.2 2.2 2.2
EAST SOUTH CENT..................................... 179 -0.9 -0.5 0.9 0.9 0.9
WEST NORTH CENT..................................... 194 0.0 -0.2 2.0 3.3 2.1
WEST SOUTH CENT..................................... 527 -0.7 -0.5 1.1 1.0 1.1
MOUNTAIN............................................ 203 0.0 -0.1 2.2 2.5 2.2
PACIFIC............................................. 389 0.3 1.1 3.7 3.6 3.7
PUERTO RICO......................................... 48 -0.4 0.3 2.1 2.1 2.0
REGION (RURAL):
NEW ENGLAND......................................... 23 1.6 -0.1 3.7 3.6 3.7
MIDDLE ATLANTIC..................................... 58 0.8 0.2 3.3 3.3 3.2
SOUTH ATLANTIC...................................... 130 -0.6 -0.5 1.1 1.1 1.0
EAST NORTH CENT..................................... 120 0.0 0.0 2.2 2.2 2.2
EAST SOUTH CENT..................................... 165 -0.8 -0.5 1.0 1.0 0.9
WEST NORTH CENT..................................... 101 0.2 -0.2 2.2 3.5 2.2
WEST SOUTH CENT..................................... 181 -0.7 -0.8 0.8 0.7 0.7
MOUNTAIN............................................ 61 0.7 -0.4 2.5 4.3 2.7
PACIFIC............................................. 24 0.8 0.9 4.0 4.0 3.9
TEACHING STATUS:
NON-TEACHING........................................ 2,839 -0.2 0.0 2.0 2.1 2.0
MINOR............................................... 706 -0.2 -0.1 2.0 2.2 2.0
MAJOR............................................... 326 0.7 0.1 3.1 3.1 3.2
DSH PATIENT PERCENT:
0................................................... 21 0.0 0.3 2.6 2.6 2.6
GT 0-0.10........................................... 328 0.3 0.2 2.7 2.8 2.7
[[Page 9635]]
0.10-0.16........................................... 334 0.1 0.0 2.4 2.5 2.4
0.16-0.23........................................... 680 0.1 0.0 2.3 2.4 2.3
0.23-0.35........................................... 1,076 0.0 0.0 2.2 2.4 2.2
GE 0.35............................................. 824 0.1 0.1 2.3 2.3 2.5
DSH NOT AVAILABLE **................................ 608 -3.6 0.0 -1.4 -1.3 -1.4
URBAN TEACHING/DSH:
TEACHING & DSH...................................... 938 0.2 0.0 2.5 2.6 2.5
NO TEACHING/DSH..................................... 1,477 -0.2 0.1 2.1 2.2 2.1
NO TEACHING/NO DSH.................................. 18 -0.1 0.4 2.5 2.5 2.5
DSH NOT AVAILABLE **................................ 575 -3.3 0.1 -0.9 -0.9 -1.0
TYPE OF OWNERSHIP:
VOLUNTARY........................................... 2,006 0.1 0.0 2.4 2.5 2.4
PROPRIETARY......................................... 1,322 -0.4 -0.1 1.7 1.9 1.8
GOVERNMENT.......................................... 543 -0.1 -0.1 2.1 2.1 2.2
CMHCs................................................... 72 0.0 -0.5 1.8 1.8 1.3
--------------------------------------------------------------------------------------------------------------------------------------------------------
Column (1) shows the total number of hospitals and/or CMHCs.
Column (2) shows the impact of all final CY 2015 OPPS APC policies and compares those to the CY 2014 OPPS.
Column (3) shows the budget neutral impact of updating the wage index by applying the final FY 2015 hospital inpatient wage index, including all hold
harmless policies and transitional wages. The final rural adjustment continues our current policy of 7.1 percent so the budget neutrality factor is 1.
The budget neutrality adjustment for the cancer hospital adjustment is 1.004.
Column (4) shows the impact of all budget neutrality adjustments and the addition of the proposed 2.2 percent OPD fee schedule update factor (2.9
percent reduced by 0.5 percentage points for the final productivity adjustment and further reduced by 0.2 percentage point in order to satisfy
statutory requirements set forth in the Affordable Care Act).
Column (5) shows the impact of all budget neutral changes and the non-budget neutral impact of applying the frontier State wage adjustment in CY 2015.
Column (6) shows the additional adjustments to the conversion factor resulting from a change in the pass-through estimate, adding estimated outlier
payments, and applying payment wage indexes.
* These 4,007 providers include children and cancer hospitals, which are held harmless to pre-BBA amounts, and CMHCs.
** Complete DSH numbers are not available for providers that are not paid under IPPS, including rehabilitation, psychiatric, and long-term care
hospitals.
15. On page 67022, second column, first full paragraph,
a. Line 13, the figure ``1.7'' is corrected to read ``1.8''.
b. Line 16, the figure ``1.7'' is corrected to read ``1.8''.
c. Line 19, the figure ``-0.4'' is corrected to read ``-0.5''.
16. On page 67023, second column, first partial paragraph,
a. Line 12, the figure ``0.9998'' is corrected to read ``0.9995''.
b. Last line, the figure ``$44.071'' is corrected to read
``$44.058''.
17. On page 67024, third column (top third of the page above Table
50), first partial paragraph, line 1, replace ``9'' with ``11''.
18. On pages 67024 through 67025, Table 51--Estimated Impact of the
CY 2015 Update to the ASC Payment System on Aggregate Payments for
Selected Procedures, the table is corrected to read as follows:
Table 51--Estimated Impact of the CY 2015 Update to the ASC Payment System on Aggregate Payments for Selected
Procedures
----------------------------------------------------------------------------------------------------------------
Estimated CY
2014 ASC Estimated CY
CPT/HCPCS code Short descriptor payments (in 2015 percent
millions) change
(1) (2).......................................... (3) (4)
----------------------------------------------------------------------------------------------------------------
66984............................ Cataract surg w/iol, 1 stage................. $1,131 -1
43239............................ Upper GI endoscopy, biopsy................... 170 11
45380............................ Colonoscopy and biopsy....................... 167 7
45385............................ Lesion removal colonoscopy................... 107 7
66982............................ Cataract surgery, complex.................... 93 -1
64483............................ Inj foramen epidural l/s..................... 90 0
62311............................ Inject spine l/s (cd)........................ 79 0
45378............................ Diagnostic colonoscopy....................... 72 7
66821............................ After cataract laser surgery................. 63 3
64493............................ Inj paravert f jnt l/s 1 lev................. 47 0
G0105............................ Colorectal scrn; hi risk ind................. 45 1
[[Page 9636]]
64635............................ Destroy lumb/sac facet jnt................... 45 -5
63650............................ Implant neuroelectrodes...................... 41 4
G0121............................ Colon ca scrn not hi rsk ind................. 41 1
64590............................ Insrt/redo pn/gastr stimul................... 38 -1
15823............................ Revision of upper eyelid..................... 35 2
63685............................ Insrt/redo spine n generator................. 34 29
29827............................ Arthroscop rotator cuff repr................. 34 1
64721............................ Carpal tunnel surgery........................ 32 -1
29881............................ Knee arthroscopy/surgery..................... 30 -1
29824............................ Shoulder arthroscopy/surgery................. 27 1
29880............................ Knee arthroscopy/surgery..................... 25 -1
43235............................ Uppr gi endoscopy diagnosis.................. 23 10
62310............................ Inject spine c/t............................. 23 0
29823............................ Shoulder arthroscopy/surgery................. 22 1
52000............................ Cystoscopy................................... 22 1
G0260............................ Inj for sacroiliac jt anesth................. 21 0
45384............................ Lesion remove colonoscopy.................... 21 7
67042............................ Vit for macular hole......................... 21 1
26055............................ Incise finger tendon sheath.................. 19 -2
----------------------------------------------------------------------------------------------------------------
Dated: February 18, 2015.
C'Reda Weeden,
Executive Secretary to the Department, Department of Health and Human
Services.
[FR Doc. 2015-03760 Filed 2-23-15; 8:45 am]
BILLING CODE 4120-01-P
