Justia Department Of Health And Human Services Centers For Medicare & Medicaid Services Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long-Term Care Hospital Prospective Payment System and Policy Changes and Fiscal Year 2017 Rates; Quality Reporting Requirements for Specific Providers; Graduate Medical Education; Hospital Notification Procedures Applicable to Beneficiaries Receiving Observation Services; Technical Changes Relating to Costs to Organizations and Medicare Cost Reports; Finalization of Interim Final Rules With Comment Period on LTCH PPS Payments for Severe Wounds, Modifications of Limitations on Redesignation by the Medicare Geographic Classification Review Board, and Extensions of Payments to MDHs and Low-Volume Hospitals; Correction, 68947-68963 [2016-24042]

Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long-Term Care Hospital Prospective Payment System and Policy Changes and Fiscal Year 2017 Rates; Quality Reporting Requirements for Specific Providers; Graduate Medical Education; Hospital Notification Procedures Applicable to Beneficiaries Receiving Observation Services; Technical Changes Relating to Costs to Organizations and Medicare Cost Reports; Finalization of Interim Final Rules With Comment Period on LTCH PPS Payments for Severe Wounds, Modifications of Limitations on Redesignation by the Medicare Geographic Classification Review Board, and Extensions of Payments to MDHs and Low-Volume Hospitals; Correction, 68947-68963 [2016-24042]

Download as PDF Federal Register / Vol. 81, No. 193 / Wednesday, October 5, 2016 / Rules and Regulations I. Background DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Medicare & Medicaid Services 42 CFR Parts 405, 412, 413, and 489 [CMS–1655–F; CMS–1664–F; CMS–1632–F2] RIN 0938–AS77; 0938–AS88; 0938–AS41 Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the LongTerm Care Hospital Prospective Payment System and Policy Changes and Fiscal Year 2017 Rates; Quality Reporting Requirements for Specific Providers; Graduate Medical Education; Hospital Notification Procedures Applicable to Beneficiaries Receiving Observation Services; Technical Changes Relating to Costs to Organizations and Medicare Cost Reports; Finalization of Interim Final Rules With Comment Period on LTCH PPS Payments for Severe Wounds, Modifications of Limitations on Redesignation by the Medicare Geographic Classification Review Board, and Extensions of Payments to MDHs and Low-Volume Hospitals; Correction Centers for Medicare & Medicaid Services (CMS), HHS. ACTION: Final rule; correction. AGENCY: This document corrects technical and typographical errors in the final rule that appeared in the August 22, 2016 Federal Register titled ‘‘Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long-Term Care Hospital Prospective Payment System and Policy Changes and Fiscal Year 2017 Rates; Quality Reporting Requirements for Specific Providers; Graduate Medical Education; Hospital Notification Procedures Applicable to Beneficiaries Receiving Observation Services; Technical Changes Relating to Costs to Organizations and Medicare Cost Reports; Finalization of Interim Final Rules With Comment Period on LTCH PPS Payments for Severe Wounds, Modifications of Limitations on Redesignation by the Medicare Geographic Classification Review Board, and Extensions of Payments to MDHs and Low-Volume Hospitals.’’ DATES: This correction is effective October 1, 2016. FOR FURTHER INFORMATION CONTACT: Donald Thompson, (410) 786–4487. SUPPLEMENTARY INFORMATION: ehiers on DSK5VPTVN1PROD with RULES SUMMARY: VerDate Sep<11>2014 15:06 Oct 04, 2016 Jkt 241001 In FR Doc. 2016–18476 of August 22, 2016 (81 FR 56761) there were a number of technical and typographical errors identified and corrected in the Correction of Errors section of this correcting document. The provisions in this correcting document are effective as if they had been included in the document that appeared in the August 22, 2016 Federal Register. Accordingly, the corrections are effective October 1, 2016. II. Summary of Errors A. Summary of Errors in the Preamble On page 56775, we made a typographical error in stating the cost reduction. On page 56796, we are correcting errors and inadvertent omissions in the summary and response to a comment on the assignment of 18 additional diagnosis codes. On page 56797, we erroneously referred to the wrong table. On page 56801, we are correcting errors and inadvertent omissions in our response to comments on our proposal to redesignate four ICD–10–PCS procedure codes. On page 56803 and in the table on page 56804 describing ICD–10–PCS Endovascular Thrombectomy Procedure Codes Reassigned to MS–DRGs 270, 271, and 272 for FY 2017, we are correcting technical errors in our discussion in response to comments to remove 34 ICD–10–PCS procedure codes describing endovascular thrombectomy of non-lower limbs from the proposed list of codes to be reassigned to MS–DRGs 270, 271 and 272. In this response, we erroneously referred to 34 procedure codes describing non-lower limb procedures (as included in the list submitted by the commenter) rather than 32 non-lower limb procedure codes. Two of the 34 procedure codes identified by the commenter, ICD–10–PCS procedure codes 04CT3ZZ (Extirpation of matter from right peroneal artery, percutaneous approach) and 04CU3ZZ (Extirpation of matter from left peroneal artery, percutaneous approach), describe endovascular thrombectomy of lower limbs. These codes are assigned to MS– DRGs 270, 271 and 272, accurately replicating the logic of ICD–9–CM MS– DRGs Version 32 and supporting clinical and resource use homogeneity as originally proposed and in accordance with the finalized policy to add procedures describing endovascular thrombectomy of lower limbs to ICD–10 Version 34 MS–DRGS 270, 271 and 272. PO 00000 Frm 00015 Fmt 4700 Sfmt 4700 68947 On page 56804, as a result of our correction of the MS–DRG assignment in Table 6B—New Procedure Codes for 13 ICD–10–PCS procedure codes that describe endovascular thrombectomy procedures of the lower limb, as described in section II.D. of this correction document, we are making additional conforming corrections to the table describing ICD–10–PCS Endovascular Thrombectomy Procedure Codes Reassigned to MS–DRGs 270, 271, and 272 for FY 2017. On pages 56821 and 56823, we erroneously stated there were 58 additional combination codes for removal and replacement of knee joints. There were 57 additional combination codes. On pages 56822 and 56823, we erroneously listed the code number for (Replacement of Left Knee Joint, Femoral Surface with Synthetic Substitute, Cemented, Open Approach) as code 0SRU0JA three times within the table. The correct code number should be 0SRU0J9 (Replacement of Left Knee Joint, Femoral Surface with Synthetic Substitute, Cemented, Open Approach). As a result of the corrections to pages 56803, 56804, 56821, 56822, and 56823, we have made conforming changes to the ICD–10 MS–DRG Definitions Manual Version 34 and ICD–10 MS– DRG Grouper Software Version 34 for FY 2017. On page 56858, we erroneously omitted MS–DRG 265 from the table of MS–DRGs subject to the policy for replaced devices offered without cost or with a credit. On pages 56895 and 56897, we inadvertently made an error to the title of ICD–10–PCS procedure code XW03331 and omitted an additional procedure code that describes Idarucizumab. Cases involving Idarucizumab that are eligible for new technology add-on payments will be identified by ICD–10–PCS procedure codes XW03331 (Introduction of Idarucizumab, Dabigatran reversal agent into peripheral vein, percutaneous approach, New Technology Group 1) and XW04331 (Introduction of Idarucizumab, Dabigatran reversal agent into central vein, percutaneous approach, New Technology Group 1). On page 56927, as a result of the correction of the technical errors described in section II.B of this correction document, we have made conforming changes to the following: The number of hospitals approved for wage index reclassifications by the Medicare Geographic Classification Review Board (MGCRB) starting in FY 2017 and the number of hospitals in a E:\FR\FM\05OCR1.SGM 05OCR1 68948 Federal Register / Vol. 81, No. 193 / Wednesday, October 5, 2016 / Rules and Regulations MGCRB reclassification status for FY 2017. On page 57002 in the table titled, ‘‘Previously Adopted and Newly Finalized Baseline and Performance Periods for the FY 2021 Program Year’’ we erroneously repeated the same information three times, and in the first instance provided incorrect performance period years for the Mortality (MORT–30–AMI, MORT–30– HF, MORT–30–COPD) and THA/TKA measures. On page 57033, we made a typographical error and omitted a dash within the web link address creating a non-functional link. On pages 57195, 57196, 57199, 57211, 57213, 57218, and 57220 through 57223 we inadvertently made technical and typographical errors to the Long-Term Care Hospital Quality Reporting Program section and have corrected those errors for clarification. ehiers on DSK5VPTVN1PROD with RULES B. Summary of Errors in the Addendum As discussed in section II.D. of this correcting document, we made technical errors with regard to the calculation of Factor 3 of the uncompensated care payment methodology. The revisions made to address some of these errors directly affected and required the recalculation of all the budget neutrality factors and final outlier threshold. Factor 3 is used to determine the amount of total uncompensated care payment a hospital is eligible to receive as well as the amount of the uncompensated care payment a hospital receives per discharge. Per discharge uncompensated care payments are then included when determining total payments for purposes of all of the budget neutrality factors and the final outlier threshold. Therefore, we made conforming changes to pages 57278 through 57280, 57286, and 57291 to take into account the updated per-discharge uncompensated care payments determined using revised Factor 3 amounts. We made further conforming corrections to the national outlier adjustment factors on page 57286 and the table on page 57288 as a result of these changes. Finally, we made conforming corrections to the national operating standardized amounts. We made inadvertent errors related to the MGCRB reclassification status of one provider as well as the status of three providers reclassified as urban to rural under section 1886(d)(8)(E) of the Act (codified in the regulations under § 412.103 and hereinafter referred to as § 412.103). Specifically, the reclassification status in the FY 2017 IPPS/LTCH PPS final VerDate Sep<11>2014 15:06 Oct 04, 2016 Jkt 241001 rule did not properly reflect the following: • Withdrawal of a MGCRB reclassification for FY 2017 for one provider. • Application of urban to rural reclassification under § 412.103 for three providers. Therefore, on page 57279, we recalculated the reclassification hospital budget neutrality adjustment. The reclassification errors also required the recalculation of additional budget neutrality adjustment factors, the fixed-loss cost threshold, the final wage indexes, and the national operating standardized amounts. Therefore, we made conforming changes to the following: • On page 57280, the rural floor budget neutrality adjustment and the wage index transition budget neutrality adjustment. • On page 57286, the calculation of the outlier fixed-loss cost threshold and the national outlier adjustment factors. • On page 57288, the table titled ‘‘Change of FY 2016 Standardized Amounts to the FY 2017 Standardized Amounts’’. On pages 57291 and 57293 through 57295, in our discussion of the determination of the Federal hospital inpatient capital related prospective payment rate update, we have made conforming corrections to the increase in the capital Federal rate, the incremental and cumulative budget neutrality adjustment factors for changes in the GAFs and the MS–DRG relative weights, the GAF/MS–DRG budget neutrality adjustment factor (due to the errors in our calculation of the GAFs, which are computed from the wage index), the capital Federal rate, and the outlier threshold (as discussed previously). Also, as a result of these errors, on pages 57294 and 57295, we have made conforming corrections in the tables showing the comparison of factors and adjustments for the FY 2016 capital Federal rate and FY 2017 capital Federal rate and the proposed FY 2017 capital Federal rate and final FY 2017 capital Federal rate. On page 57307, we are making conforming corrections the fixed-loss amount for site neutral discharges due to corrections in the IPPS rates and factors discussed previously. On page 57312, we have made conforming corrections to the national operating standardized amounts and capital standard Federal payment rate (which also include the rates payable to hospitals located in Puerto Rico) in Tables 1A, 1B, 1C, and 1D as a result of the conforming corrections to certain PO 00000 Frm 00016 Fmt 4700 Sfmt 4700 budget neutrality factors and the outlier threshold (as described previously). C. Summary of Errors in the Appendices On pages 57312, 57315 through 57317, 57319 through 57323, 57330 through 57332 in our regulatory impact analyses, we made conforming corrections to the factors, values, and tables and accompanying discussion of the changes in operating and capital IPPS payments for FY 2017 and the effects of certain budget neutrality factors as a result of the technical errors that lead to conforming changes in our calculation of the operating and capital IPPS budget neutrality factors, outlier threshold, final wage indexes, operating standardized amounts, and capital Federal rate (as described in section II.B. of this correction document). On pages 57324 through 57326, in the table titled ‘‘Modeled Disproportionate Share Hospital Payments for Estimated FY 2017 DSHs by Hospital Type: Model DSH $ (In Millions) From FY 2016 To FY 2017’’ and the accompanying discussion, we made corrections to address technical and formatting errors in the estimated impacts resulting from inadvertent errors in the calculation of Factor 3 for certain hospitals. On pages 57331 through 57332, we made conforming corrections to Table III—Comparison of Total Payments Per Case [FY 2016 Payments Compared to FY 2017 Payments]. On page 57342, we made conforming corrections to the discussion of the estimated changes in operating and capital IPPS payments and the accounting statement and table for acute care hospitals that arose from the corrections of errors and conforming changes as described in sections II.B. and II.D. of this correcting document. D. Summary of Errors in and Corrections to Files and Tables Posted on the CMS Web Site We are correcting the errors in the following IPPS tables that are listed on page 57311 of the FY 2017 IPPS/LTCH PPS final rule and are available on the Internet on the CMS Web site at https:// www.cms.gov/Medicare/Medicare-Feefor-Service-Payment/ AcuteInpatientPPS/FY2017-IPPS-FinalRule-Home-Page.html. The tables that are available on the Internet have been updated to reflect the revisions discussed in this correcting document. Table 2—Case-Mix Index and Wage Index Table—FY 2017. Because the uncompensated care and reclassification errors discussed in section II.B. of this correction document required that we recalculate the rural and imputed floor budget neutrality factor, we are E:\FR\FM\05OCR1.SGM 05OCR1 ehiers on DSK5VPTVN1PROD with RULES Federal Register / Vol. 81, No. 193 / Wednesday, October 5, 2016 / Rules and Regulations correcting the values in the column titled FY 2017 Wage Index for all providers. For the three providers for which we are applying urban to rural reclassification under § 412.103, we are correcting the values in the column titled ‘‘FY 2017 Wage Index’’, inserting the rural reclassified CBSA in the column titled ‘‘Reclassified/ Redesignated CBSA’’, and inserting a ‘‘Y’’ in the column titled ‘‘Hospital Reclassified as Rural Under Section 1886(d)(8)(E) of the Act (§ 412.103)’’. For the provider that withdrew its MGCRB reclassification for FY 2017, we are revising the wage index in the column titled FY 2017 Wage Index, and we are removing the MGCRB flag in the column titled MGCRB Reclass. Table 3—Wage Index Table by CBSA—FY 2017. Because the uncompensated care and reclassification errors discussed in section II.B. of this correction document required that we recalculate the rural and imputed floor budget neutrality factor, we are making corresponding changes to the wage indexes and GAFs of all CBSAs listed in Table 3. Specifically, we are correcting the values and flags in the columns titled ‘‘Wage Index’’, ‘‘Reclassified Wage Index’’, ‘‘GAF’’, ‘‘Reclassified GAF’’, ‘‘Pre-Frontier and/or Pre-Rural Floor Wage Index’’ and ‘‘Eligible for Rural Floor Wage Index’’. Table 6B—New Procedure Codes for FY 2017. In Table 6B—New Procedure Codes, we inadvertently listed the incorrect MS–DRG assignment for 13 ICD–10–PCS procedure codes that describe endovascular thrombectomy procedures of the lower limb involving a bifurcation. We are correcting the MS– DRG assignment of these 13 ICD–10– PCS codes in Table 6B. Table 10—New Technology Add-On Payment Thresholds for Applications for FY 2018. We are correcting the thresholds in this table as a result of the corrections to the operating standardized amounts discussed in section II.B. of this correcting document. Table 18—FY 2017 Medicare DSH Uncompensated Care Payment Factor 3 and Projected DSH Eligibility. For the FY 2017 IPPS/LTCH PPS final rule, we published a list of hospitals that we identified to be subsection (d) hospitals and subsection (d) Puerto Rico hospitals eligible to receive empirically justified Medicare DSH payment adjustments and uncompensated care payments for FY 2017. We also published, in the Supplemental Medicare DSH File located in the FY 2017 IPPS/LTCH PPS final rule data files page at https:// www.cms.gov/Medicare/MedicareFeefor-Service-Payment/ AcuteInpatientPPS/FY2017-IPPS- VerDate Sep<11>2014 15:06 Oct 04, 2016 Jkt 241001 FinalRule-Home-Page-Items/FY2017IPPSFinal-Rule-Data-Files.html, the data used to calculate each hospital’s Factor 3, total uncompensated care payment, and estimated uncompensated care payment per discharge. Shortly after the publication of the FY2017 IPPS/LTCH PPS final rule, we discovered that, in calculating Factor 3 of the uncompensated care payment methodology, we had understated the low-income insured days of hospitals that merged after 2011 with one surviving provider number because we inadvertently excluded the low income insured days of acquired hospitals from the low income insured days used in the Factor 3 calculation of surviving hospitals that were projected to receive Medicare DSH in FY 2017. In addition, we discovered that we had calculated a Factor 3 for hospitals that have ceased operations and erroneously calculated Factor 3 using Medicaid days reported on Worksheet S–3 instead of Worksheet S–2 of certain hospitals’ FY 2013 cost reports. We are revising Factor 3 for all hospitals to correct these errors. These corrections to the uncompensated care payments impacted the calculation of all the budget neutrality factors as well as the outlier fixed-loss cost threshold for outlier payments. In addition, we discovered that we had inadvertently excluded the Medicaid days from the 2011 cost report for a provider as well as the Medicaid days from the 2012 cost report for another provider from the calculation of Factor 3. Due to technical errors by our Medicare Administrative Contractors the Medicaid days from these cost reports were not included in the March 2016 update of HCRIS. We projected that both providers would be eligible to receive Medicare DSH in FY 2017. Accordingly, we are revising Factor 3 for all hospitals to reflect these Medicaid days; however, the impact of these revisions is too small to affect other aspects of the IPPS ratesetting, such as the calculation of the fixed-loss threshold for outlier payments. We are also correcting the errors in the following LTCH PPS table that is listed on page 57311 of the FY 2017 IPPS/LTCH PPS final rule and is available on the Internet on the CMS Web site at https://www.cms.gov/ Medicare/Medicare-Fee-for-ServicePayment/LongTermCareHospitalPPS/ index.html under the list item for regulation number CMS–1655–F. The table that is available on the Internet has been updated to reflect the revisions discussed in this correcting document. Table 11—MS–LTC–DRGs, Relative Weights, Geometric Average Length of Stay, Short Stay Outlier (SSO) PO 00000 Frm 00017 Fmt 4700 Sfmt 4700 68949 Threshold, and ‘‘IPPS Comparable Threshold’’ for LTCH PPS Discharges Occurring from October 1, 2016 through September 30, 2017. We are correcting this table by correcting typographical errors for MS–LTC–DRGs 627 and 658 in the columns titled ‘‘Relative Weight,’’ ‘‘Geometric Average Length of Stay,’’ ‘‘Short-Stay Outlier (SSO) Threshold,’’ and ‘‘IPPS Comparable Threshold.’’ III. Waiver of Proposed Rulemaking and Delay in Effective Date We ordinarily publish a notice of proposed rulemaking in the Federal Register to provide a period for public comment before the provisions of a rule take effect in accordance with section 553(b) of the Administrative Procedure Act (APA) (5 U.S.C. 553(b)). However, we can waive this notice and comment procedure if the Secretary finds, for good cause, that the notice and comment process is impracticable, unnecessary, or contrary to the public interest, and incorporates a statement of the finding and the reasons therefore in the notice. Section 553(d) of the APA ordinarily requires a 30-day delay in the effective date of final rules after the date of their publication in the Federal Register. This 30-day delay in effective date can be waived, however, if an agency finds for good cause that the delay is impracticable, unnecessary, or contrary to the public interest, and the agency incorporates a statement of the findings and its reasons in the rule issued. We believe that this correcting document does not constitute a rule that would be subject to the APA notice and comment or delayed effective date requirements. This correcting document corrects technical and typographic errors in the preamble, addendum, payment rates, tables, and appendices included or referenced in the FY 2017 IPPS/LTCH PPS final rule but does not make substantive changes to the policies or payment methodologies that were adopted in the final rule. As a result, this correcting document is intended to ensure that the information in the FY 2017 IPPS/LTCH PPS final rule accurately reflects the policies adopted in that final rule. In addition, even if this were a rule to which the notice and comment procedures and delayed effective date requirements applied, we find that there is good cause to waive such requirements. Undertaking further notice and comment procedures to incorporate the corrections in this document into the final rule or delaying the effective date would be contrary to the public interest because it is in the public’s interest for providers to receive E:\FR\FM\05OCR1.SGM 05OCR1 68950 Federal Register / Vol. 81, No. 193 / Wednesday, October 5, 2016 / Rules and Regulations appropriate payments in as timely a manner as possible, and to ensure that the FY 2017 IPPS/LTCH PPS final rule accurately reflects our policies. Furthermore, such procedures would be unnecessary, as we are not altering our payment methodologies or policies, but rather, we are simply implementing correctly the policies that we previously proposed, received comment on, and subsequently finalized. This correcting document is intended solely to ensure that the FY 2017 IPPS/LTCH PPS final rule accurately reflects these payment methodologies and policies. Therefore, we believe we have good cause to waive the notice and comment and effective date requirements. IV. Correction of Errors In FR Doc. 2016–18476 of August 22, 2016 (81 FR 56761), we are making the following corrections: A. Corrections of Errors in the Preamble 1. On page 56775, third column, second bulleted paragraph, line 25, the figure ‘‘$50.4 million’’ is corrected to read ‘‘$56.4 million’’. 2. On page 56796— a. Top half of the page, third column, third full paragraph, (1) Lines 4 and 5, the phrase ‘‘describing similar conditions’’ is corrected to read ‘‘displayed in Table 6A—New Diagnosis Codes associated with the proposed rule (which is available via the Internet on the CMS Web site at: https://www.cms.gov/ Medicare/Medicare-Fee-for-ServicePayment/AcuteInpatientPPS/ index.html) that describe similar conditions’’. ehiers on DSK5VPTVN1PROD with RULES 04CK3Z6 ...................... 04CL3Z6 ....................... 04CM3Z6 ...................... 04CN3Z6 ...................... 04CP3Z6 ...................... 04CQ3Z6 ...................... 04CR3Z6 ...................... 04CS3Z6 ...................... 04CT3Z6 ...................... 04CT3ZZ ...................... 04CU3Z6 ...................... 04CU3ZZ ...................... 04CV3Z6 ...................... 04CW3Z6 ..................... 04CY3Z6 ...................... Extirpation Extirpation Extirpation Extirpation Extirpation Extirpation Extirpation Extirpation Extirpation Extirpation Extirpation Extirpation Extirpation Extirpation Extirpation of of of of of of of of of of of of of of of Matter Matter Matter Matter Matter Matter Matter Matter Matter Matter Matter Matter Matter Matter Matter 7. On page 56821, middle of the page— a. Second column, first partial paragraph, line 2, the phrase ‘‘identified 58’’ is corrected to read ‘‘identified 57’’. VerDate Sep<11>2014 15:06 Oct 04, 2016 Jkt 241001 (2) Lines 9 and 10, the phrase, ‘‘18 ICD–10–CN diagnosis codes in the following table be reassigned’’ is corrected to read ‘‘18 ICD–10–CM diagnosis codes in the following table also be reassigned’’. b. Lower half of the page, first column, last paragraph— (1) Lines 6 and 7, the phrase ‘‘describing procedures performed on’’ is corrected to read ‘‘describing conditions affecting’’. (2) Line 14, the phrase ‘‘MS DRGs 091, 092 and 093.’’ is corrected to read ‘‘MS–DRGs 091, 092, and 093 because they are also nervous system codes.’’ 3. On page 56797, first column, first paragraph, lines 15 and 16, the phrase ‘‘These 18 codes also are reflected in Table 6E’’ is corrected to read ‘‘These 18 codes are reflected in Table 6A’’. 4. On page 56801, second column, second full paragraph— a. Lines 11 and 12, the phrase ‘‘performing such procedures because loop’’ is corrected to read ‘‘performing such procedures because, as noted in the FY 2017 IPPS/LTCH PPS proposed rule, loop’’. b. Lines 25 and 26, the phrase ‘‘were not able to finalize that specific request.’’ is corrected to read ‘‘were not able to replicate that specific request in the ICD–9–CM based MS–DRGs.’’. c. Lines 26 through 29, the sentence ‘‘Rather, we finalized an alternative option, which was to change the designation for four of the six codes requested.’’ is corrected to read ‘‘Rather, we proposed an alternative option, which was to change the designation for four of the six codes requested, because we believed that if we limited the change in designation to these four from from from from from from from from from from from from from from from Right Femoral Artery, Bifurcation, Percutaneous Approach. Left Femoral Artery, Bifurcation, Percutaneous Approach. Right Popliteal Artery, Bifurcation, Percutaneous Approach. Left Popliteal Artery, Bifurcation, Percutaneous Approach. Right Anterior Tibial Artery, Bifurcation, Percutaneous Approach. Left Anterior Tibial Artery, Bifurcation, Percutaneous Approach. Right Posterior Tibial Artery, Bifurcation, Percutaneous Approach. Left Posterior Tibial Artery, Bifurcation, Percutaneous Approach. Right Peroneal Artery, Bifurcation, Percutaneous Approach. Right Peroneal Artery, Percutaneous Approach. Left Peroneal Artery, Bifurcation, Percutaneous Approach. Left Peroneal Artery, Percutaneous Approach. Right Foot Artery, Bifurcation, Percutaneous Approach. Left Foot Artery, Bifurcation, Percutaneous Approach. Lower Artery, Bifurcation, Percutaneous Approach. b. Third column, first partial paragraph, line 3, the phrase ‘‘following 58’’ is corrected to read ‘‘following 57’’. 8. On pages 56821 through 56823, in the table titled ‘‘ICD–10–PCS CODE PAIRS PROPOSED TO BE ADDED TO PO 00000 codes, the change would not have any impact.’’. d. Lines 40 through 41, the phrase ‘‘not finalizing the proposal to change the two’’ is corrected to read ‘‘not changing the designation of the two’’. 5. On page 56803, bottom of the page— a. First column, last paragraph, lines 7 and 8, the phrase ‘‘removing the 34 codes’’ is corrected to read ‘‘removing 32 of the 34 codes’’. b. Second column, first partial paragraph— (1) Lines 5 and 6, the phrase ‘‘34 nonlower’’ is corrected to read ‘‘32 nonlower’’. (2) Lines 8 and 9, the phrase ‘‘These 34 non-lower’’ is corrected to read ‘‘These 32 non-lower’’. (3) Line 13, after the phrase ‘‘for FY 2017.’’ the paragraph is corrected by adding sentences to read as follows: ‘‘Two of the procedure codes identified by the commenter, ICD–10– PCS procedure codes 04CT3ZZ (Extirpation of matter from right peroneal artery, percutaneous approach) and 04CU3ZZ (Extirpation of matter from left peroneal artery, percutaneous approach) describe endovascular thrombectomy of lower limbs and are not non-lower limb procedure codes.’’. c. Third column, first full paragraph, line 11, the phrase ‘‘34 procedure’’ is corrected to read ‘‘32 procedure’’. 6. On page 56804, top of page, the table titled ‘‘ICD–10–PCS ENDOVASCULAR THROMBECTOMY PROCEDURE CODES REASSIGNED TO MS–DRGs 270, 271, AND 272 FOR FY 2017’’ is corrected by adding the following entries: Frm 00018 Fmt 4700 Sfmt 4700 VERSION 34 ICD–10 MS–DRGs 466, 467, and 468: PROPOSED NEW KNEE REVISION ICD–10–PCS COMBINATIONS’’, the codes (in the 4th column) for the following entries are corrected to read as follows: E:\FR\FM\05OCR1.SGM 05OCR1 Federal Register / Vol. 81, No. 193 / Wednesday, October 5, 2016 / Rules and Regulations 68951 ICD–10–PCS CODE PAIRS PROPOSED TO BE ADDED TO VERSION 34 ICD–10 MS–DRGS 466, 467, AND 468: PROPOSED NEW KNEE REVISION ICD–10–PCS COMBINATIONS Code Code description 0SPD08Z ...... Removal of Spacer from Left Knee Joint, Open Approach. 0SPD38Z ...... Removal of Spacer from Percutaneous Approach. Knee 0SPD48Z ...... Removal of Spacer from Left Knee Percutaneous Endoscopic Approach. 9. On page 56823, lower half of the page— a. First column, second paragraph, line 10, the phrase ‘‘58 new’’ is corrected to read ‘‘57 new’’. b. Second column— (1) First partial paragraph, line 11, the phrase ‘‘58 new’’ is corrected to read ‘‘ new’’. (2) First full paragraph, lines 3 and 4, the phrase ‘‘58 new’’ is corrected to read ‘‘57 new’’. 10. On page 56858, top of the page, the untitled table is corrected by adding the following entry after line 34 (which is the entry for MDC 5, MS–DRG 262): MDC 5 MS–DRG 265 MS–DRG Title AICD Lead Procedures. Left Code Code description and 0SRU0J9 ...... Joint, and 0SRU0J9 ...... Joint, and 0SRU0J9 ...... Replacement of Left Knee Joint, Femoral Surface with Synthetic Substitute, Cemented, Open Approach. Replacement of Left Knee Joint, Femoral Surface with Synthetic Substitute, Cemented, Open Approach. Replacement of Left Knee Joint, Femoral Surface with Synthetic Substitute, Cemented, Open Approach. 11. On page 56895, third column, first partial paragraph— a. Lines 8 and 9, the phrase ‘‘a unique ICD–10–PCS procedure code’’ is corrected to read ‘‘two unique ICD–10– PCS procedure codes’’. b. Lines 10 through 15, the sentence ‘‘The approved procedure code is XW0331 (Introduction of Idarucizumab, Dabigatran reversal agent into central vein, percutaneous approach, New Technology Group 1).’’ is corrected to read ‘‘The approved procedure codes are XW0331 (Introduction of Idarucizumab, Dabigatran reversal agent into peripheral vein, percutaneous approach, New Technology Group 1) and XW04331 (Introduction of Idarucizumab, Dabigatran reversal agent into central vein, percutaneous approach, New Technology Group 1).’’. 12. On page 56897, third column, third full paragraph, line 11, the phrase ‘‘procedure code XW03331.’’ is corrected to read ‘‘procedure codes XW03331 and XW04331.’’. 13. On page 56927— a. Second column, last partial paragraph, line 5 the phrase ‘‘265 hospitals’’ is corrected to read ‘‘264 hospitals’’. b. Third column, first partial paragraph, line 12, the phrase ‘‘817 hospitals’’ is corrected to read ‘‘816 hospitals’’. 14. On page 57002, bottom of the page, the table titled ‘‘PREVIOUSLY ADOPTED AND NEWLY FINALIZED BASELINE AND PERFORMANCE PERIODS FOR THE FY 2021 PROGRAM YEAR’’ is corrected to read as follows: PREVIOUSLY ADOPTED AND NEWLY FINALIZED BASELINE AND PERFORMANCE PERIODS FOR THE FY 2021 PROGRAM YEAR Domain Baseline period Clinical Care • Mortality (MORT–30–AMI, MORT–30–HF, MORT–30–COPD) * • THA/TKA * ...................................................... • MORT–30–PN (updated cohort) .................... Efficiency and Cost Reduction • MSPB ............................................................. • Payment (AMI Payment and HF Payment) ... Performance period • July 1, 2011–June 30, 2014 ......................... • July 1, 2016–June 30, 2019 • April 1, 2011–March 31, 2014 ...................... • July 1, 2012–June 30, 2015 ......................... • April 1, 2016–March 31, 2019 • September 1, 2017–June 30, 2019 • January 1, 2017–December 31, 2017 .......... • July 1, 2012–June 30, 2015 ......................... • January 1, 2019–December 31, 2019 • July 1, 2017–June 30, 2019 ehiers on DSK5VPTVN1PROD with RULES * Previously adopted baseline and performance periods that remain unchanged (80 FR 49562 through 49563). 15. On page 57033, first column, last paragraph, lines 2 through 4, the web link ‘‘https://www.cms.gov/Medicare/ Medicare-Fee-for-ServicePayment/ AcuteInpatientPPS/dgme.html’’ is corrected to read ‘‘https://www.cms.gov/ Medicare/Medicare-Fee-for-ServicePayment/AcuteInpatientPPS/ dgme.html.’’ 16. On page 57195— a. First column, last partial paragraph, lines 4 and 5, the phrase ‘‘it recommended’’ is corrected to read ‘‘the commenters recommended’’. b. Third column, third full paragraph— VerDate Sep<11>2014 20:46 Oct 04, 2016 Jkt 241001 (1). Line 14, the phrase ‘‘This measure’’ is corrected to read ‘‘The Drug Regimen Review Conducted with Follow-Up for Identified Issues-PAC LTCH QRP quality measure’’. (2) Lines 23 through 25, the phrase ‘‘ and Potentially Preventable 30-Day Post-Discharge Readmission Measure for LTCH QRP,’’ is corrected to read ‘‘, Potentially Preventable 30-Day PostDischarge Readmission Measure for LTCH QRP and Medicare Spending Per Beneficiary-PAC LTCH QRP,’’. 17. On page 57196, third column, first full paragraph, lines 13 through 16, the phrase ‘‘with information more frequently, such as unadjusted counts of PO 00000 Frm 00019 Fmt 4700 Sfmt 4700 potentially preventable readmissions (PPRs) and discharge data.’’ is corrected to read ‘‘with information, such as unadjusted counts of potentially preventable readmissions (PPRs) and discharge data, more frequently.’’ 18. On page 57199, first column, second full paragraph, lines 3 and 4, the phrase ‘‘SES or SDS status.’’ is corrected to read ‘‘SES or SDS.’’ 19. On page 57211, third column, second full paragraph, line 16, the phrase ‘‘to discharge’’ is corrected to read ‘‘to be discharged’’. 20. On page 57213— a. Second column, last partial paragraph, lines 6 through 8, the phrase E:\FR\FM\05OCR1.SGM 05OCR1 68952 Federal Register / Vol. 81, No. 193 / Wednesday, October 5, 2016 / Rules and Regulations ‘‘and a SNF stay within a 30-day window, the SNF stay is a candidate to for’’ is corrected to read ‘‘and then a SNF stay within a 30-day window, the SNF stay is a candidate for’’. b. Third column, after the last paragraph, Footnote 280, lines 1 and 2, the measure name ‘‘Hospital-Wide AllCause Readmission Measure (HWR) (CMS/Yale).’’ is corrected to read ‘‘Hospital-Wide All-Cause Unplanned Readmission Measure (HWR) (CMS/ Yale).’’ 21. On page 57218, third column, first full paragraph, lines 4 and 5, the phrase ‘‘The commenter was correct in its interpretation of’’ is corrected to read ‘‘The commenter’s interpretation was correct regarding’’. 22. On page 57220, second column, second footnoted full paragraph (Footnote 311), lines 1 through 6, the footnote ‘‘311Greenwald, J.L., Halasyamani, L., Greene, J., LaCivita, C., et al. (2010). Making inpatient medication reconciliation patient centered, clinically relevant and implementable: A consensus statement on key principles and necessary first steps. Journal of Hospital Medicine, 5(8), 477–485.’’ is corrected to read ‘‘311Institute of Medicine. Preventing Medication Errors. Washington, DC: National Academies Press; 2006.’’ 23. On page 57221, second column, second full paragraph, lines 3 and 4, the phrase ‘‘cross-setting and quality measure’’ is corrected to read ‘‘crosssetting quality measure’’. 24. On page 57222— a. Second column, first full paragraph, lines 11 and 12, the phrase ‘‘however, the adoption of the measure’’ is corrected to read ‘‘however, the measure’’. b. Third column, first full paragraph— (1) Line 4, the word ‘‘facilities’’ is corrected to read ‘‘facility’s’’. (2) Line 22, the phrase ‘‘collected admission’’ is corrected to read ‘‘collected at admission’’. 25. On page 57223— a. First column, second paragraph— (1) Lines 1 through 4, the phrase ‘‘Since the time of the MAP consideration, with our measure contractor, we tested this measure in a pilot test involving twelve PAC facilities,’’ is corrected to read ‘‘Since the time of the NQF-convened MAP consideration we have further tested this measure in a pilot test involving twelve PAC facilities’’. (2) Lines 7 and 8, the phrase, ‘‘record collection system’’ is corrected to read ‘‘records system’’. b. Second column, third full paragraph, lines 9 and 10, the phrase ‘‘PAC facility.’’ is corrected to read ‘‘PAC facility. We appreciate MedPAC and other commenters’ recommendation for a quality measure that assesses postdischarge medication communication with primary care providers for patients discharged to home.’’ B. Correction of Errors in the Addendum 1. On page 57278, third column, fifth full paragraph, a. Line 3, the figure ‘‘0.999079’’ is corrected to read ‘‘0.999078’’. b. Line 9, the figure ‘‘0.999079’’ is corrected to read ‘‘0.999078’’. 2. On page 57279— a. Second column, first full paragraph, line 9, the figure ‘‘1.000209’’ is corrected to read ‘‘1.00021’’. b. Third column, third full paragraph, line 12, the figure ‘‘0.988224’’ is corrected to read ‘‘0.988136’’. 3. On page 57280— a. First column, fifth full paragraph, line 4, the figure ‘‘0.993200’’ is corrected to read ‘‘0.991987’’. b. Third column, second full paragraph, (1) Line 3, the figure ‘‘0.999994’’ is corrected to read ‘‘0.999997’’. (2) Line 6, the figure ‘‘0.999994’’ is corrected to read ‘‘0.999997’’. 4. On page 57286— a. Second column, last paragraph— (1) Line 6, the figure ‘‘$23,570’’ is corrected to read ‘‘$23,573’’. (2) Line 8, the figure ‘‘$83,347,416,971’’ is corrected to read ‘‘$83,364,479,923’’. (3) Line 9, the figure ‘‘$4,479,256,519’’ is corrected to read ‘‘$4,479,256,368’’. b. Third column— (1) First partial paragraph, line 11, the figure ‘‘$23,570’’ is corrected to read ‘‘$23,573’’. (2) Following the third full paragraph, the untitled table is corrected to read as follows: Operating standardized amounts National ......... Capital Federal rate 0.948998 0.938602 5. On page 57288, middle of the page, the table titled ‘‘CHANGE OF FY 2016 STANDARDIZED AMOUNTS TO THE FY 2017 STANDARDIZED AMOUNTS’’, is corrected to read as follows: CHANGE OF FY 2016 STANDARDIZED AMOUNTS TO THE FY 2017 STANDARDIZED AMOUNTS Hospital submitted quality data and is a meaningful EHR user ehiers on DSK5VPTVN1PROD with RULES FY 2016 Base Rate after removing: 1. FY 2016 Geographic Reclassification Budget Neutrality (0.988169). 2. FY 2016 Rural Community Hospital Demonstration Program Budget Neutrality (0.999837). VerDate Sep<11>2014 If Wage Index is Greater Than 1.0000: Labor (69.6 percent): $4,394.09. Nonlabor (30.4 percent): $1,919.26. 15:06 Oct 04, 2016 Jkt 241001 PO 00000 Hospital submitted quality data and is NOT a meaningful EHR user If Wage Index is Greater Than 1.0000: Labor (69.6 percent): $4,394.09. Nonlabor (30.4 percent): $1,919.26. Frm 00020 Fmt 4700 Sfmt 4700 Hospital did NOT submit quality data and is a meaningful EHR user If Wage Index is Greater Than 1.0000: Labor (69.6 percent): $4,394.09. Nonlabor (30.4 percent): $1,919.26. E:\FR\FM\05OCR1.SGM 05OCR1 Hospital did NOT submit quality data and is NOT a meaningful EHR user If Wage Index is Greater Than 1.0000: Labor (69.6 percent): $4,394.09. Nonlabor (30.4 percent): $1,919.26. Federal Register / Vol. 81, No. 193 / Wednesday, October 5, 2016 / Rules and Regulations 68953 CHANGE OF FY 2016 STANDARDIZED AMOUNTS TO THE FY 2017 STANDARDIZED AMOUNTS—Continued ehiers on DSK5VPTVN1PROD with RULES Hospital submitted quality data and is a meaningful EHR user 3. Cumulative FY 2008, FY 2009, FY 2012, FY 2013, FY 2014, FY 2015 and FY 2016 Documentation and Coding Adjustments as Required under Sections 7(b)(1)(A) and 7(b)(1)(B) of Public Law 110–90 and Documentation and Coding Recoupment Adjustment as required under Section 631 of the American Taxpayer Relief Act of 2012 (0.9255). 4. FY 2016 Operating Outlier Offset (0.948998). 5. FY 2016 New Labor Market Delineation Wage Index Transition Budget Neutrality Factor (0.999998). 6. FY 2017 2-Midnight Rule Permanent Adjustment (1/0.998). FY 2017 Update Factor ..... FY 2017 MS-DRG Recalibration Budget Neutrality Factor. FY 2017 Wage Index Budget Neutrality Factor. FY 2017 Reclassification Budget Neutrality Factor. FY 2017 Operating Outlier Factor. Cumulative Factor: FY 2008, FY 2009, FY 2012, FY 2013, FY 2014, FY 2015, FY 2016 and FY 2017 Documentation and Coding Adjustment as Required under Sections 7(b)(1)(A) and 7(b)(1)(B) of Public Law 110–90 and Documentation and Coding Recoupment Adjustment as required under Section 631 of the American Taxpayer Relief Act of 2012. FY 2017 New Labor Market Delineation Wage Index 3-Year Hold Harmless Transition Budget Neutrality Factor. FY 2017 2-Midnight Rule One-Time Prospective Increase. National Standardized Amount for FY 2017 if Wage Index is Greater Than 1.0000; Labor/NonLabor Share Percentage (69.6/30.4). VerDate Sep<11>2014 Hospital submitted quality data and is NOT a meaningful EHR user Hospital did NOT submit quality data and is a meaningful EHR user Hospital did NOT submit quality data and is NOT a meaningful EHR user If Wage Index is less Than or Equal to 1.0000: Labor (62 percent): $3,914.28. Nonlabor (38 percent): $2,399.07. If Wage Index is less Than or Equal to 1.0000: Labor (62 percent): $3,914.28. Nonlabor (38 percent): $2,399.07. If Wage Index is less Than or Equal to 1.0000: Labor (62 percent): $3,914.28. Nonlabor (38 percent): $2,399.07. If Wage Index is less Than or Equal to 1.0000: Labor (62 percent): $3,914.28. Nonlabor (38 percent): $2,399.07. 1.0165 ............................... 0.999078 ........................... 0.99625 ............................. 0.999078 ........................... 1.00975 ............................. 0.999078 ........................... 0.9895. 0.999078. 1.00021 ............................. 1.00021 ............................. 1.00021 ............................. 1.00021. 0.988136 ........................... 0.988136 ........................... 0.988136 ........................... 0.988136. 0.948998 ........................... 0.948998 ........................... 0.948998 ........................... 0.98998. 0.9118 ............................... 0.9118 ............................... 0.9118 ............................... 0.9118. 0.999997 ........................... 0.999997 ........................... 0.999997 ........................... 0.999997. 1.006 ................................. 1.006 ................................. 1.006 ................................. 1.006. Labor: $3,839.23 ............... Nonlabor: $1,676.91 ......... Labor: $3,762.75 ............... Nonlabor: $1,643.50 ......... Labor: $3,8143.74 ............. Nonlabor: $1,665.77 ......... Labor: $3,737.25. Nonlabor: $1,632.37. 15:06 Oct 04, 2016 Jkt 241001 PO 00000 Frm 00021 Fmt 4700 Sfmt 4700 E:\FR\FM\05OCR1.SGM 05OCR1 68954 Federal Register / Vol. 81, No. 193 / Wednesday, October 5, 2016 / Rules and Regulations CHANGE OF FY 2016 STANDARDIZED AMOUNTS TO THE FY 2017 STANDARDIZED AMOUNTS—Continued Hospital submitted quality data and is a meaningful EHR user National Standardized Amount for FY 2017 if Wage Index is less Than or Equal to 1.0000; Labor/Non-Labor Share Percentage (62/38). Hospital submitted quality data and is NOT a meaningful EHR user Hospital did NOT submit quality data and is a meaningful EHR user Labor: $3,420.01 ............... Nonlabor: $2,096.13 ......... Labor: $3,351.88 ............... Nonlabor: $2,054.37 ......... Labor: $3,397.30 ............... Nonlabor: $2,082.21 ......... 6. On page 57291— a. First column, second full paragraph, line 15, the figure ‘‘0.999079’’ is corrected to read ‘‘0.999078’’. b. Third column, first full paragraph line 6, the figure ‘‘1.84’’ is corrected to read ‘‘1.83’’. 7. On page 57293, third column— a. First partial paragraph— (1) Line 1, the figure ‘‘0.9995’’ is corrected to read ‘‘0.9994’’. (2) Line 4, ‘‘0.9855’’ is corrected to read ‘‘0.9854’’. b. First full paragraph, line 16, the figure ‘‘0.9851’’ is corrected to read ‘‘0.9850’’. c. Last paragraph— (1) Line 2, the figure ‘‘0.9991’’is corrected to read ‘‘0.9990’’. (2) Line 4, ‘‘0.9995’’ is corrected to read ‘‘0.9994’’. 8. On page 57294— a. Top of the page— (1) Second column— (a) First full paragraph, line 17, the figure ‘‘$446.81’’ is corrected to read ‘‘$446.79’’. Hospital did NOT submit quality data and is NOT a meaningful EHR user Labor: $3,329.16. Nonlabor: $2,040.46. (b) Second bulleted paragraph, line 6, the figure ‘‘0.9991’’ is corrected to read ‘‘0.9990’’. (2) Third column, second full paragraph— (a) Line 13, the figure, ‘‘0.09’’ is corrected to read ‘‘0.10’’. (b) Line 26, the figure, ‘‘1.84’’ is corrected to read ‘‘1.832’’. b. Bottom of the page, the table titled ‘‘COMPARISON OF FACTORS AND ADJUSTMENTS: FY 2016 CAPITAL FEDERAL RATE AND FY 2017 CAPITAL FEDERAL RATE’’ is corrected to read as follows: COMPARISON OF FACTORS AND ADJUSTMENTS: FY 2016 CAPITAL FEDERAL RATE AND FY 2017 CAPITAL FEDERAL RATE FY 2016 Update Factor 1 ................................................................................................ GAF/DRG Adjustment Factor 1 ........................................................................ Outlier Adjustment Factor 2 .............................................................................. Permanent 2-midnight Policy Adjustment Factor ............................................ One-Time 2-midnight Policy Adjustment Factor .............................................. Capital Federal Rate ........................................................................................ 1.0130 0.9976 0.9365 N/A N/A $438.75 FY 2017 1.009 0.9990 0.9386 1.002 1.006 $446.79 Change 1.009 0.9990 1.0022 1.002 1.006 1.0183 Percent change 3 0.9 ¥0.10 0.22 0.2 0.6 1.83 1 The update factor and the GAF/DRG budget neutrality adjustment factors are built permanently into the capital Federal rates. Thus, for example, the incremental change from FY 2016 to FY 2017 resulting from the application of the 0.9990 GAF/DRG budget neutrality adjustment factor for FY 2017 is a net change of 0.9990 (or ¥0.10 percent). 2 The outlier reduction factor is not built permanently into the capital Federal rate; that is, the factor is not applied cumulatively in determining the capital Federal rate. Thus, for example, the net change resulting from the application of the FY 2017 outlier adjustment factor is 0.9386/ 0.9365, or 1.0022 (or 0.22 percent). 3 Sum of individual changes may not match percent change in capital rate due to rounding. 9. On page 57295— a. The top of the page, the table titled ‘‘COMPARISON OF FACTORS AND ADJUSTMENTS: PROPOSED FY 2017 CAPITAL FEDERAL RATE AND FINAL FY 2017 CAPITAL FEDERAL RATE’’ is corrected to read as follows: COMPARISON OF FACTORS AND ADJUSTMENTS: PROPOSED FY 2017 CAPITAL FEDERAL RATE AND FINAL FY 2017 CAPITAL FEDERAL RATE Proposed FY 2017 ehiers on DSK5VPTVN1PROD with RULES Update Factor 1 ................................................................................................ GAF/DRG Adjustment Factor 1 ........................................................................ Outlier Adjustment Factor 2 .............................................................................. Permanent 2-midnight Policy Adjustment Factor ............................................ One-Time 2-midnight Policy Adjustment Factor .............................................. Capital Federal Rate ........................................................................................ b. Lower three-fourths of the page, first column, second paragraph, line 21, the figure, ‘‘$23,570.’’ is corrected to read ‘‘$23,573.’’ VerDate Sep<11>2014 15:06 Oct 04, 2016 Jkt 241001 1.0090 0.9993 0.9374 1.002 1.006 $446.35 10. On page 57307, second column, first full paragraph— a. Line 15, the figure ‘‘$23,570’’ is corrected to read ‘‘$23,573’’. PO 00000 Frm 00022 Fmt 4700 Sfmt 4700 Final FY 2017 1.0090 0.9990 0.9386 1.002 1.006 $446.79 Change 1.0000 0.9997 1.0013 1.000 1.000 1.0010 Percent change 0.00 ¥0.03 0.13 0.00 0.00 0.10 b. Line 35, the figure ‘‘$23,570’’ is corrected to read ‘‘$23,573’’. 11. On page 57312— a. Top of the page— E:\FR\FM\05OCR1.SGM 05OCR1 Federal Register / Vol. 81, No. 193 / Wednesday, October 5, 2016 / Rules and Regulations (1) Table 1A titled ‘‘NATIONAL ADJUSTED OPERATING STANDARDIZED AMOUNTS, LABOR/ NONLABOR (69.6 PERCENT LABOR SHARE/30.4 PERCENT NONLABOR SHARE IF WAGE INDEX IS GREATER 68955 THAN 1)—FY 2017’’ is corrected to read as follows: TABLE 1A—NATIONAL ADJUSTED OPERATING STANDARDIZED AMOUNTS, LABOR/NONLABOR (69.6 PERCENT LABOR SHARE/30.4 PERCENT NONLABOR SHARE IF WAGE INDEX IS GREATER THAN 1)—FY 2017 Hospital submitted quality data and is a meaningful EHR user (update = 1.65 percent) Hospital submitted quality data and is NOT a meaningful EHR user (update = ¥0.375 percent) Hospital did NOT submit quality data and is a meaningful EHR user (update = 0.975 percent) Hospital did NOT submit quality data and is NOT a meaningful EHR user (update = ¥1.05 percent) Labor Nonlabor Labor Nonlabor Labor Nonlabor Labor Nonlabor $3,839.23 $1,677.91 $3,762.75 $1,643.50 $3,813.74 $1,665.77 $3,737.25 $1,632.37 (2) Table 1B titled ‘‘NATIONAL ADJUSTED OPERATING STANDARDIZED AMOUNTS, LABOR/ NONLABOR (62 PERCENT LABOR SHARE/38 PERCENT NONLABOR SHARE IF WAGE INDEX IS LESS THAN OR EQUAL TO 1)—FY 2017’’ is corrected to read as follows: TABLE 1B—NATIONAL ADJUSTED OPERATING STANDARDIZED AMOUNTS, LABOR/NONLABOR (62 PERCENT LABOR SHARE/ 38 PERCENT NONLABOR SHARE IF WAGE INDEX IS LESS THAN OR EQUAL TO 1)—FY 2017 Hospital submitted quality data and is a meaningful EHR user (update = 1.65 percent) Hospital submitted quality data and is NOT a meaningful EHR user (update = ¥0.375 percent) Hospital did NOT submit quality data and is a meaningful EHR user (update = 0.975 percent) Hospital did NOT submit quality data and is NOT a meaningful EHR user (update = ¥1.05 percent) Labor Nonlabor Labor Nonlabor Labor Nonlabor Labor Nonlabor $3,420.01 $2,096.13 $3,351.88 $2,054.37 $3,397.30 $2,082.21 $3,329.16 $2,040.46 b. Middle of the page— (1) Table 1C titled ‘‘ADJUSTED OPERATING STANDARDIZED AMOUNTS FOR HOSPITALS IN PUERTO RICO, LABOR/NONLABOR (NATIONAL: 62 PERCENT LABOR SHARE/38 PERCENT NONLABOR SHARE BECAUSE WAGE INDEX IS LESS THAN OR EQUAL TO 1);—FY 2017’’ is corrected to read as follows: TABLE 1C—ADJUSTED OPERATING STANDARDIZED AMOUNTS FOR HOSPITALS IN PUERTO RICO, LABOR/NONLABOR (NATIONAL: 62 PERCENT LABOR SHARE/38 PERCENT NONLABOR SHARE BECAUSE WAGE INDEX IS LESS THAN OR EQUAL TO 1)—FY 2017 Rates if wage index is greater than 1 Rates if wage index is less than or equal to 1 Standardized amount Labor National 1 ........................................ 1 For Nonlabor Labor Nonlabor Not Applicable ................................ Not Applicable ................................ $3,420.01 $2,096.13 FY 2017, there are no CBSAs in Puerto Rico with a national wage index greater than 1. (2) Table 1D titled ‘‘CAPITAL STANDARD FEDERAL PAYMENT RATE—FY 2017’’ is corrected as follows: TABLE 1D—CAPITAL STANDARD FEDERAL PAYMENT RATE—FY 2017 Rate ehiers on DSK5VPTVN1PROD with RULES National ................................. VerDate Sep<11>2014 15:06 Oct 04, 2016 $446.79 Jkt 241001 C. Corrections of Errors in the Appendices 1. On page 57312, bottom of the page, third column, first partial paragraph, a. Line 8, the figure ‘‘$987’’ is corrected to read ‘‘$990’’. b. Line 10, the figure ‘‘$66’’ is corrected to read ‘‘$72’’. 2. On page 57315, upper three-fourths of the page— a. Second column, third full paragraph, (1) Line 7, the figure ‘‘1,380’’ is corrected to read ‘‘1,369’’. PO 00000 Frm 00023 Fmt 4700 Sfmt 4700 (2) Line 9, the figure ‘‘1,135’’ is corrected to read ‘‘1,146’’. b. Third column, first full paragraph, line 13— (1) The figure ‘‘1,372’’ is corrected to read ‘‘1,369’’. (2) The figure ‘‘1,150’’ is corrected to read ‘‘1,153’’. 3. On pages 57315 through 57317, the table titled ‘‘TABLE I—IMPACT ANALYSIS OF CHANGES TO THE IPPS FOR OPERATING COSTS FOR FY 2017’’ is corrected to read as follows: E:\FR\FM\05OCR1.SGM 05OCR1 68956 Federal Register / Vol. 81, No. 193 / Wednesday, October 5, 2016 / Rules and Regulations TABLE I—IMPACT ANALYSIS OF CHANGES TO THE IPPS FOR OPERATING COSTS FOR FY 2017 ehiers on DSK5VPTVN1PROD with RULES All Hospitals .................................. By Geographic Location: Urban hospitals ............................. Large urban areas ................. Other urban areas .................. Rural hospitals .............................. Bed Size (Urban): 0–99 beds .............................. 100–199 beds ........................ 200–299 beds ........................ 300–499 beds ........................ 500 or more beds .................. Bed Size (Rural): 0–49 beds .............................. 50–99 beds ............................ 100–149 beds ........................ 150–199 beds ........................ 200 or more beds .................. Urban by Region: New England .......................... Middle Atlantic ........................ South Atlantic ......................... East North Central ................. East South Central ................. West North Central ................ West South Central ................ Mountain ................................ Pacific ..................................... Puerto Rico ............................ Rural by Region: New England .......................... Middle Atlantic ........................ South Atlantic ......................... East North Central ................. East South Central ................. West North Central ................ West South Central ................ Mountain ................................ Pacific ..................................... By Payment Classification: Urban hospitals ...................... Large urban areas ................. Other urban areas .................. Rural areas ............................ Teaching Status: Nonteaching ........................... Fewer than 100 residents ...... 100 or more residents ............ Urban DSH: Non-DSH ................................ 100 or more beds .................. Less than 100 beds ............... Rural DSH: SCH ........................................ RRC ....................................... 100 or more beds .................. Less than 100 beds ............... Urban teaching and DSH: Both teaching and DSH ......... Teaching and no DSH ........... No teaching and DSH ............ No teaching and no DSH ....... Special Hospital Types: RRC ....................................... SCH ........................................ MDH ....................................... SCH and RRC ....................... MDH and RRC ....................... Type of Ownership: Voluntary ................................ Proprietary .............................. Government ........................... VerDate Sep<11>2014 15:06 Oct 04, 2016 FY 2017 Wage data under new CBSA designations with application of wage budget neutrality (2) 3 (3) 4 FY 2017 MGCRB reclassifications Rural and imputed floor with application of national rural and imputed floor budget neutrality Application of the frontier wage index and out-migration adjustment All FY 2017 changes (4) 5 FY 2017 weights and DRG changes with application of recalibration budget neutrality (1) 2 Number of hospitals 1 Hospital rate update and documentation and coding adjustment (5) 6 (6) 7 (7) 8 3,330 1.0 0.0 0.0 0.0 0.0 0.1 0.9 2,515 1,369 1,146 815 0.9 0.9 1.0 1.6 0.0 0.1 0.0 ¥0.4 0.0 0.0 0.0 0.1 ¥0.1 ¥0.3 0.1 1.3 0.0 ¥0.1 0.2 ¥0.2 0.1 0.0 0.2 0.1 0.9 0.9 1.0 1.2 659 767 446 431 212 0.9 1.0 1.0 1.0 0.9 ¥0.2 ¥0.1 ¥0.1 0.1 0.2 0.2 0.0 ¥0.1 0.0 0.0 ¥0.5 0.0 0.1 ¥0.2 ¥0.2 0.1 0.3 0.0 0.1 ¥0.2 0.2 0.2 0.1 0.2 0.0 0.9 0.7 0.8 0.9 1.1 317 292 120 46 40 1.5 1.8 1.6 1.7 1.6 ¥0.5 ¥0.6 ¥0.4 ¥0.2 ¥0.1 0.1 0.1 0.0 0.2 0.2 0.2 0.8 1.5 1.7 2.5 ¥0.2 ¥0.2 ¥0.2 ¥0.3 ¥0.3 0.3 0.1 0.2 0.0 0.0 1.0 1.2 1.0 1.3 1.5 116 315 407 390 147 163 385 163 378 51 0.8 0.9 1.0 0.9 1.0 1.1 0.9 1.1 0.9 0.9 0.0 0.1 0.0 0.0 0.0 0.1 0.0 0.0 0.0 0.1 ¥0.5 ¥0.1 ¥0.2 ¥0.1 ¥0.1 ¥0.1 0.2 0.1 0.4 ¥0.5 1.1 0.8 ¥0.5 ¥0.2 ¥0.4 ¥0.8 ¥0.5 ¥0.3 ¥0.4 ¥1.0 0.9 ¥0.2 ¥0.3 ¥0.4 ¥0.3 ¥0.4 ¥0.4 1.2 1.0 0.1 0.1 0.1 0.1 0.0 0.0 0.7 0.0 0.2 0.1 0.1 ¥0.4 0.9 0.9 1.0 1.2 1.0 1.2 2.2 0.5 0.3 21 54 128 115 155 98 160 60 24 0 2,522 1,369 1,153 808 1.3 1.7 1.7 1.7 1.1 2.2 1.5 1.7 1.9 0.0 0.9 0.9 1.0 1.6 ¥0.2 ¥0.4 ¥0.5 ¥0.4 ¥0.3 ¥0.4 ¥0.4 ¥0.4 ¥0.4 0.0 0.0 0.1 0.0 ¥0.4 0.3 0.1 ¥0.1 0.0 0.4 0.0 0.4 0.1 ¥0.3 0.0 0.0 0.0 0.0 0.1 1.4 0.8 2.3 1.0 2.2 0.2 1.3 0.2 1.3 0.0 ¥0.1 ¥0.3 0.1 1.4 ¥0.3 ¥0.2 ¥0.3 ¥0.2 ¥0.4 ¥0.1 ¥0.3 ¥0.1 ¥0.1 0.0 0.0 ¥0.1 0.2 ¥0.2 0.2 0.1 0.1 0.1 0.1 0.3 0.1 0.2 0.0 0.0 0.1 0.0 0.2 0.1 1.6 1.6 1.0 1.2 1.0 1.5 1.2 1.3 1.3 0.0 0.9 0.9 1.0 1.2 2,266 815 249 1.1 1.0 0.9 ¥0.2 0.0 0.2 0.0 0.0 0.0 0.1 ¥0.1 ¥0.1 0.2 0.0 ¥0.2 0.1 0.2 0.0 0.8 0.9 1.1 589 1,642 363 0.9 0.9 1.0 ¥0.1 0.1 ¥0.3 ¥0.2 0.0 0.0 0.2 ¥0.1 ¥0.5 0.0 0.0 0.1 0.2 0.1 0.1 0.8 0.9 0.7 240 325 29 142 2.0 1.7 0.9 0.8 ¥0.6 ¥0.3 ¥0.4 ¥0.4 0.1 0.1 0.1 0.2 0.1 1.8 2.9 1.3 ¥0.1 ¥0.2 ¥0.4 ¥0.4 0.0 0.0 0.1 0.7 1.4 1.3 0.5 0.2 898 109 1,107 408 0.9 0.9 1.0 0.9 0.1 0.0 ¥0.1 ¥0.1 0.0 ¥0.1 0.1 ¥0.2 ¥0.2 1.1 ¥0.1 ¥0.4 ¥0.1 0.0 0.3 0.0 0.1 0.0 0.1 0.2 1.0 0.7 0.8 0.9 189 324 148 126 12 0.8 2.1 1.7 2.2 2.1 ¥0.1 ¥0.3 ¥0.6 ¥0.3 ¥0.6 0.1 ¥0.1 0.0 0.1 ¥0.1 1.9 0.0 0.6 0.4 1.3 0.0 0.0 ¥0.1 ¥0.1 ¥0.2 0.5 0.0 0.1 0.0 0.0 1.2 1.7 1.3 1.8 2.2 1,927 881 522 1.0 1.0 1.0 0.0 0.0 0.0 0.0 0.1 ¥0.1 0.0 0.0 ¥0.2 0.0 0.0 0.0 0.1 0.1 0.1 0.9 0.9 0.9 Jkt 241001 PO 00000 Frm 00024 Fmt 4700 Sfmt 4700 E:\FR\FM\05OCR1.SGM 05OCR1 68957 Federal Register / Vol. 81, No. 193 / Wednesday, October 5, 2016 / Rules and Regulations TABLE I—IMPACT ANALYSIS OF CHANGES TO THE IPPS FOR OPERATING COSTS FOR FY 2017—Continued Medicare Utilization as a Percent of Inpatient Days: 0–25 ....................................... 25–50 ..................................... 50–65 ..................................... Over 65 .................................. FY 2017 Reclassifications by the Medicare Geographic Classification Review Board: All Reclassified Hospitals ....... Non¥Reclassified Hospitals .. Urban Hospitals Reclassified Urban Nonreclassified Hospitals ................................... Rural Hospitals Reclassified Full Year ............................. Rural Nonreclassified Hospitals Full Year ................... All Section 401 Reclassified Hospitals: ............................ Other Reclassified Hospitals (Section 1886(d)(8)(B)) ...... FY 2017 Wage data under new CBSA designations with application of wage budget neutrality (2) 3 (3) 4 FY 2017 MGCRB reclassifications Rural and imputed floor with application of national rural and imputed floor budget neutrality Application of the frontier wage index and out-migration adjustment All FY 2017 changes (4) 5 FY 2017 weights and DRG changes with application of recalibration budget neutrality (1) 2 Number of hospitals 1 Hospital rate update and documentation and coding adjustment (5) 6 (6) 7 (7) 8 523 2,122 545 89 0.8 1.0 1.2 1.2 0.1 0.0 ¥0.2 ¥0.3 0.1 0.0 ¥0.1 0.3 ¥0.3 0.0 0.6 ¥0.4 0.2 ¥0.1 0.0 0.2 0.0 0.1 0.1 0.2 1.1 0.9 0.9 1.0 791 2,539 532 1.1 1.0 1.0 ¥0.1 0.0 0.0 0.0 0.0 ¥0.1 2.3 ¥0.8 2.3 ¥0.2 0.1 ¥0.1 0.0 0.1 0.0 0.9 0.9 0.9 1,936 0.9 0.1 0.0 ¥0.9 0.1 0.1 0.9 277 1.7 ¥0.3 0.1 2.2 ¥0.2 0.0 1.3 489 1.6 ¥0.4 0.2 ¥0.2 ¥0.2 0.3 1.1 72 1.7 ¥0.2 0.0 0.3 ¥0.1 0.9 1.5 48 1.2 ¥0.4 0.1 3.1 ¥0.4 0.0 0.8 1 Because ehiers on DSK5VPTVN1PROD with RULES data necessary to classify some hospitals by category were missing, the total number of hospitals in each category may not equal the national total. Discharge data are from FY 2015, and hospital cost report data are from reporting periods beginning in FY 2012 and FY 2013. 2 This column displays the payment impact of the hospital rate update and other adjustments including the 1.65 percent adjustment to the national standardized amount and hospital-specific rate (the estimated 2.7 percent market basket update reduced by 0.3 percentage points for the multifactor productivity adjustment and the 0.75 percentage point reduction under the Affordable Care Act), the ¥1.5 percent documentation and coding adjustment to the national standardized amount and the adjustment of (1/0.998) to permanently remove the ¥0.2 percent reduction, and the 1.006 temporary adjustment to address the effects of the 0.2 percent reduction in effect for FYs 2014 through 2016 related to the 2-midnight policy. 3 This column displays the payment impact of the changes to the Version 34 GROUPER, the changes to the relative weights and the recalibration of the MS DRG weights based on FY 2015 MedPAR data in accordance with section 1886(d)(4)(C)(iii) of the Act. This column displays the application of the recalibration budget neutrality factor of 0.999078 in accordance with section 1886(d)(4)(C)(iii) of the Act. 4 This column displays the payment impact of the update to wage index data using FY 2013 cost report data and the OMB labor market area delineations based on 2010 Decennial Census data. This column displays the payment impact of the application of the wage budget neutrality factor, which is calculated separately from the recalibration budget neutrality factor, and is calculated in accordance with section 1886(d)(3)(E)(i) of the Act. The wage budget neutrality factor is 1.000210. 5 Shown here are the effects of geographic reclassifications by the Medicare Geographic Classification Review Board (MGCRB) along with the effects of the continued implementation of the new OMB labor market area delineations on these reclassifications. The effects demonstrate the FY 2017 payment impact of going from no reclassifications to the reclassifications scheduled to be in effect for FY 2017. Reclassification for prior years has no bearing on the payment impacts shown here. This column reflects the geographic budget neutrality factor of 0.988136. 6 This column displays the effects of the rural and imputed floor based on the continued implementation of the new OMB labor market area delineations. The Affordable Care Act requires the rural floor budget neutrality adjustment to be 100 percent national level adjustment. The rural floor budget neutrality factor (which includes the imputed floor) applied to the wage index is 0.991987. This column also shows the effect of the 3-year transition for hospitals that were located in urban counties that became rural under the new OMB delineations or hospitals deemed urban where the urban area became rural under the new OMB delineations, with a budget neutrality factor of 0.999997. 7 This column shows the combined impact of the policy required under section 10324 of the Affordable Care Act that hospitals located in frontier States have a wage index no less than 1.0 and of section 1886(d)(13) of the Act, as added by section 505 of Public Law 108–173, which provides for an increase in a hospital’s wage index if a threshold percentage of residents of the county where the hospital is located commute to work at hospitals in counties with higher wage indexes. These are not budget neutral policies. 8 This column shows the estimated change in payments from FY 2016 to FY 2017. 4. On page 57319, a. First column, second full paragraph, (1) Line 6, the figure ‘‘0.988224’’ is corrected to read ‘‘0.988136’’. (2) Line 13, the figure ‘‘1.4’’ is corrected to read ‘‘1.3’’. b. Second column— (1) First full paragraph— (a) Line 8, the figure ‘‘0.9930’’ is corrected to read ‘‘0.991987’’. (b) Line 9, the figure ‘‘0.7’’ is corrected to read ‘‘0.8’’. (2) Third full paragraph— VerDate Sep<11>2014 15:06 Oct 04, 2016 Jkt 241001 (a) Line 1, the figure ‘‘397’’ is corrected to read ‘‘436’’. (b) Line 5— (1) The figure ‘‘0.9930’’ is corrected to read ‘‘0.991987’’. (2) The figure ‘‘0.7’’ is corrected to read ‘‘0.8’’. (c) Line 23, the figure ‘‘1.0’’ is corrected to read ‘‘0.9’’. (d) Line 31, the figure ‘‘$24’’ is corrected to read ‘‘$22’’. (e) Line 33, the figure ‘‘0.7’’ is corrected to read ‘‘0.6’’. c. Third column— PO 00000 Frm 00025 Fmt 4700 Sfmt 4700 (1) First full paragraph, (a) Line 7, the figure ‘‘$10’’ is corrected to read ‘‘$6.4’’. (b) Line 18, the figure ‘‘$17’’ is corrected to read ‘‘$18’’. (2) Second full paragraph, line 28, the figure ‘‘0.999994’’ is corrected to read ‘‘0.999997’’. 5. On page 57320, the table titled ‘‘FY 2017 IPPS Estimated Payments Due to Rural Floor and Imputed Floor with National Budget Neutrality’’ is corrected to read as follows: E:\FR\FM\05OCR1.SGM 05OCR1 68958 Federal Register / Vol. 81, No. 193 / Wednesday, October 5, 2016 / Rules and Regulations FY 2017 IPPS ESTIMATED PAYMENTS DUE TO RURAL AND IMPUTED FLOOR WITH NATIONAL BUDGET NEUTRALITY Number of hospitals Percent change in payments due to application of rural floor and imputed floor with budget neutrality Difference (in $ millions) (1) State Number of hospitals that will receive the rural floor or imputed floor (2) (3) (4) ehiers on DSK5VPTVN1PROD with RULES Alabama ................................................................................... Alaska ...................................................................................... Arizona ..................................................................................... Arkansas .................................................................................. California .................................................................................. Colorado .................................................................................. Connecticut .............................................................................. Delaware .................................................................................. Washington, DC ....................................................................... Florida ...................................................................................... Georgia .................................................................................... Hawaii ...................................................................................... Idaho ........................................................................................ Illinois ....................................................................................... Indiana ..................................................................................... Iowa ......................................................................................... Kansas ..................................................................................... Kentucky .................................................................................. Louisiana .................................................................................. Maine ....................................................................................... Massachusetts ......................................................................... Michigan ................................................................................... Minnesota ................................................................................ Mississippi ................................................................................ Missouri .................................................................................... Montana ................................................................................... Nebraska .................................................................................. Nevada ..................................................................................... New Hampshire ....................................................................... New Jersey .............................................................................. New Mexico ............................................................................. New York ................................................................................. North Carolina .......................................................................... North Dakota ............................................................................ Ohio ......................................................................................... Oklahoma ................................................................................. Oregon ..................................................................................... Pennsylvania ............................................................................ Puerto Rico .............................................................................. Rhode Island ............................................................................ South Carolina ......................................................................... South Dakota ........................................................................... Tennessee ............................................................................... Texas ....................................................................................... Utah ......................................................................................... Vermont ................................................................................... Virginia ..................................................................................... Washington .............................................................................. West Virginia ............................................................................ Wisconsin ................................................................................. Wyoming .................................................................................. 6. On page 57321, second column, first partial paragraph — a Line 1, the figure ‘‘277’’ is corrected to read ‘‘278’’. VerDate Sep<11>2014 15:06 Oct 04, 2016 Jkt 241001 83 6 57 44 301 48 31 6 7 171 105 12 14 126 89 35 53 65 95 18 58 95 49 62 74 12 26 24 13 64 25 154 84 6 130 86 34 151 51 11 57 18 92 320 33 6 76 49 29 65 10 b Line 7, the figure ‘‘1.0’’ is corrected to read ‘‘0.9’’. 7. On pages 57321 through 57323, the table titled ‘‘TABLE II—IMPACT ANALYSIS OF CHANGES FOR FY 2017 PO 00000 Frm 00026 Fmt 4700 Sfmt 4700 ¥0.3 2.1 3.5 ¥0.4 1.3 0.2 0.2 0 ¥0.4 ¥0.3 ¥0.4 ¥0.3 ¥0.3 ¥0.4 ¥0.4 ¥0.4 ¥0.3 ¥0.4 ¥0.4 ¥0.4 0.6 ¥0.4 ¥0.3 ¥0.4 ¥0.3 0.3 ¥0.3 ¥0.2 2.2 0.2 ¥0.3 ¥0.3 ¥0.4 ¥0.3 ¥0.4 ¥0.3 ¥0.4 ¥0.4 0.1 4.7 ¥0.1 ¥0.2 ¥0.3 ¥0.4 ¥0.3 ¥0.2 ¥0.3 ¥0.1 ¥0.2 ¥0.3 ¥0.1 6 4 46 0 186 3 8 2 0 16 0 0 0 3 0 0 0 0 2 0 15 0 0 0 2 4 0 3 9 18 0 21 1 1 10 2 2 5 12 10 5 0 20 3 1 0 1 6 3 6 0 ¥6 4 63 ¥4 131 3 4 0 ¥1 ¥2 ¥18 ¥10 ¥1 ¥1 ¥19 ¥11 ¥4 ¥3 ¥6 ¥5 ¥2 22 ¥18 ¥6 ¥4 ¥8 1 ¥2 ¥2 11 6 ¥1 ¥20 ¥12 ¥1 ¥13 ¥4 ¥4 ¥20 0 18 ¥2 ¥1 ¥7 ¥26 ¥2 ¥1 ¥8 ¥1 ¥5 0 ACUTE CARE HOSPITAL OPERATING PROSPECTIVE PAYMENT SYSTEM [PAYMENTS PER DISCHARGE]’’ is corrected to read as follows: E:\FR\FM\05OCR1.SGM 05OCR1 Federal Register / Vol. 81, No. 193 / Wednesday, October 5, 2016 / Rules and Regulations 68959 TABLE II—IMPACT ANALYSIS OF CHANGES FOR FY 2017 ACUTE CARE HOSPITAL OPERATING PROSPECTIVE PAYMENT SYSTEM [Payments per discharge] Estimated average FY 2016 payment per discharge Estimated average FY 2017 payment per discharge FY 2017 changes (1) ehiers on DSK5VPTVN1PROD with RULES Number of hospitals (2) (3) (4) All Hospitals ..................................................................................................... By Geographic Location: Urban hospitals ......................................................................................... Large urban areas .................................................................................... Other urban areas .................................................................................... Rural hospitals .......................................................................................... Bed Size (Urban): 0–99 beds ................................................................................................. 100–199 beds ........................................................................................... 200–299 beds ........................................................................................... 300–499 beds ........................................................................................... 500 or more beds ..................................................................................... Bed Size (Rural): 0–49 beds ................................................................................................. 50–99 beds ............................................................................................... 100–149 beds ........................................................................................... 150–199 beds ........................................................................................... 200 or more beds ..................................................................................... Urban by Region: New England ............................................................................................ Middle Atlantic .......................................................................................... South Atlantic ........................................................................................... East North Central .................................................................................... East South Central ................................................................................... West North Central ................................................................................... West South Central .................................................................................. Mountain ................................................................................................... Pacific ....................................................................................................... Puerto Rico ............................................................................................... Rural by Region: New England ............................................................................................ Middle Atlantic .......................................................................................... South Atlantic ........................................................................................... East North Central .................................................................................... East South Central ................................................................................... West North Central ................................................................................... West South Central .................................................................................. Mountain ................................................................................................... Pacific ....................................................................................................... By Payment Classification: Urban hospitals ......................................................................................... Large urban areas .................................................................................... Other urban areas .................................................................................... Rural areas ............................................................................................... Teaching Status: Nonteaching .............................................................................................. Fewer than 100 residents ......................................................................... 100 or more residents .............................................................................. Urban DSH: Non-DSH .................................................................................................. 100 or more beds ..................................................................................... Less than 100 beds .................................................................................. Rural DSH: SCH .......................................................................................................... RRC .......................................................................................................... 100 or more beds ..................................................................................... Less than 100 beds .................................................................................. Urban teaching and DSH: Both teaching and DSH ............................................................................ Teaching and no DSH .............................................................................. No teaching and DSH .............................................................................. No teaching and no DSH ......................................................................... Special Hospital Types: RRC .......................................................................................................... VerDate Sep<11>2014 15:06 Oct 04, 2016 Jkt 241001 PO 00000 Frm 00027 Fmt 4700 Sfmt 4700 3,330 $11,542 $11,649 0.9 2,515 1,369 1,146 815 11,890 12,690 10,946 8,602 11,997 12,799 11,051 8,707 0.9 0.9 1.0 1.2 659 767 446 431 212 9,392 10,050 10,757 12,092 14,613 9,478 10,117 10,840 12,202 14,772 0.9 0.7 0.8 0.9 1.1 317 292 120 46 40 7,208 8,192 8,434 9,243 10,171 7,279 8,292 8,519 9,367 10,320 1.0 1.2 1.0 1.3 1.5 116 315 407 390 147 163 385 163 378 51 12,957 13,471 10,498 11,190 10,042 11,578 10,693 12,279 15,372 8,491 12,901 13,593 10,595 11,303 10,160 11,692 10,820 12,549 15,452 8,513 ¥0.4 0.9 0.9 1.0 1.2 1.0 1.2 2.2 0.5 0.3 21 54 128 115 155 98 160 60 24 11,818 8,655 8,043 8,918 7,639 9,420 7,243 10,100 12,045 12,009 8,791 8,122 9,023 7,716 9,560 7,328 10,228 12,197 1.6 1.6 1.0 1.2 1.0 1.5 1.2 1.3 1.3 2,522 1,369 1,153 808 11,886 12,690 10,940 8,602 11,993 12,799 11,046 8,706 0.9 0.9 1.0 1.2 2,266 815 249 9,600 11,133 16,764 9,680 11,231 16,949 0.8 0.9 1.1 589 1,642 363 10,055 12,247 8,853 10,140 12,359 8,914 0.8 0.9 0.7 240 325 29 142 8,584 9,006 7,018 6,823 8,702 9,123 7,054 6,838 1.4 1.3 0.5 0.2 898 109 1,107 408 13,344 11,361 10,047 9,455 13,474 11,442 10,124 9,539 1.0 0.7 0.8 0.9 189 9,709 9,824 1.2 E:\FR\FM\05OCR1.SGM 05OCR1 68960 Federal Register / Vol. 81, No. 193 / Wednesday, October 5, 2016 / Rules and Regulations TABLE II—IMPACT ANALYSIS OF CHANGES FOR FY 2017 ACUTE CARE HOSPITAL OPERATING PROSPECTIVE PAYMENT SYSTEM—Continued [Payments per discharge] Number of hospitals Estimated average FY 2016 payment per discharge Estimated average FY 2017 payment per discharge FY 2017 changes (1) (2) (3) (4) SCH .......................................................................................................... MDH .......................................................................................................... SCH and RRC .......................................................................................... MDH and RRC .......................................................................................... Type of Ownership: Voluntary ................................................................................................... Proprietary ................................................................................................ Government .............................................................................................. Medicare Utilization as a Percent of Inpatient Days: 0–25 .......................................................................................................... 25–50 ........................................................................................................ 50–65 ........................................................................................................ Over 65 ..................................................................................................... FY 2017 Reclassifications by the Medicare Geographic Classification Review Board: All Reclassified Hospitals ......................................................................... Non-Reclassified Hospitals ....................................................................... Urban Hospitals Reclassified .................................................................... Urban Nonreclassified Hospitals .............................................................. Rural Hospitals Reclassified Full Year ..................................................... Rural Nonreclassified Hospitals Full Year ................................................ All Section 401 Reclassified Hospitals ..................................................... Other Reclassified Hospitals (Section 1886(d)(8)(B)) .............................. 7. On page 57324, top of the page, third column, last paragraph, line 1, the figure ‘‘2,426’’ is corrected to read ‘‘2,419’’. 324 148 126 12 10,344 7,321 10,767 8,822 10,516 7,415 10,957 9,019 1.7 1.3 1.8 2.2 1,927 881 522 11,719 10,130 12,485 11,830 10,218 12,596 0.9 0.9 0.9 523 2,122 545 89 14,996 11,460 9,343 6,948 15,160 11,562 9,431 7,019 1.1 0.9 0.9 1.0 791 2,539 532 1,936 277 489 72 48 11,399 11,595 12,008 11,849 8,984 8,173 11,307 7,889 11,507 11,701 12,115 11,955 9,101 8,266 11,474 7,954 0.9 0.9 0.9 0.9 1.3 1.1 1.5 0.8 8. On pages 57324 and 57325, the table titled ‘‘Modeled Disproportionate Share Hospital Payments for Estimated FY 2017 DSHs by Hospital Type: Model DSH $ (In Millions) From FY 2016 to FY 2017’’ is corrected to read as follows: MODELED DISPROPORTIONATE SHARE HOSPITAL PAYMENTS FOR ESTIMATED FY 2017 DSHS BY HOSPITAL TYPE: MODEL DSH $ (IN MILLIONS) FROM FY 2016 TO FY 2017 Total ..................................................................................... By Geographic Location: Urban Hospitals ............................................................ Large Urban Areas ................................................ Other Urban Areas ................................................ Rural Hospitals ............................................................. Bed Size (Urban): 0 to 99 Beds ................................................................. 100 to 249 Beds ........................................................... 250+ Beds .................................................................... Bed Size (Rural): 0 to 99 Beds ................................................................. 100 to 249 Beds ........................................................... 250+ Beds .................................................................... Urban by Region: East North Central ........................................................ East South Central ....................................................... Middle Atlantic .............................................................. Mountain ....................................................................... New England ................................................................ Pacific ........................................................................... Puerto Rico ................................................................... VerDate Sep<11>2014 15:06 Oct 04, 2016 Jkt 241001 PO 00000 Frm 00028 FY 2016 final rule estimated DSH $ * (in millions) FY 2017 final rule estimated DSH $ * (in millions) Dollar difference: FY 2017– FY 2016 (in millions) Percent change ** (1) ehiers on DSK5VPTVN1PROD with RULES Number of DSHs (FY 2017) (2) (3) (4) (5) 2,419 $9,767 $9,551 ¥$216 ¥2.2 1,921 1,045 876 498 9,294 5,885 3,408 473 9,106 5,765 3,341 445 ¥188 ¥120 ¥68 ¥28 ¥2.0 ¥2.0 ¥2.0 ¥5.9 336 837 748 189 2,211 6,894 185 2,154 6,767 ¥4 ¥57 ¥127 ¥2.2 ¥2.6 ¥1.8 368 116 14 206 211 56 190 199 56 ¥16 ¥12 0 ¥7.8 ¥5.5 ¥0.2 322 129 232 125 90 312 41 1,273 574 1,614 448 394 1,459 104 1,252 566 1,570 448 385 1,448 116 ¥22 ¥8 ¥44 0 ¥9 ¥10 12 ¥1.7 ¥1.4 ¥2.7 ¥0.1 ¥2.4 ¥0.7 11.3 Fmt 4700 Sfmt 4700 E:\FR\FM\05OCR1.SGM 05OCR1 Federal Register / Vol. 81, No. 193 / Wednesday, October 5, 2016 / Rules and Regulations 68961 MODELED DISPROPORTIONATE SHARE HOSPITAL PAYMENTS FOR ESTIMATED FY 2017 DSHS BY HOSPITAL TYPE: MODEL DSH $ (IN MILLIONS) FROM FY 2016 TO FY 2017—Continued Number of DSHs (FY 2017) FY 2017 final rule estimated DSH $ * (in millions) Dollar difference: FY 2017– FY 2016 (in millions) Percent change ** (1) South Atlantic ................................................................ West North Central ....................................................... West South Central ...................................................... Rural by Region: East North Central ........................................................ East South Central ....................................................... Middle Atlantic .............................................................. Mountain ....................................................................... New England ................................................................ Pacific ........................................................................... South Atlantic ................................................................ West North Central ....................................................... West South Central ...................................................... By Payment Classification: Urban Hospitals ............................................................ Large Urban Areas ................................................ Other Urban Areas ................................................ Rural Hospitals ............................................................. Teaching Status: Nonteaching .................................................................. Fewer than 100 residents ............................................. 100 or more residents .................................................. Type of Ownership: Voluntary ....................................................................... Proprietary .................................................................... Government .................................................................. Unknown ....................................................................... Medicare Utilization Percent: Missing or Unknown ..................................................... 0 to 25 ........................................................................... 25 to 50 ......................................................................... 50 to 65 ......................................................................... Greater than 65 ............................................................ FY 2016 final rule estimated DSH $ * (in millions) (2) (3) (4) (5) 314 104 252 1,777 451 1,200 1,721 439 1,161 ¥56 ¥11 ¥39 ¥3.2 ¥2.5 ¥3.2 64 141 28 21 11 7 86 31 109 49 149 34 16 15 9 98 20 83 44 141 33 15 16 7 92 19 78 ¥4 ¥8 ¥1 0 1 ¥3 ¥6 ¥1 ¥6 ¥8.3 ¥5.3 ¥2.4 ¥0.2 7.2 ¥27.4 ¥6.4 ¥6.3 ¥7.0 1,886 1,043 843 533 9,243 5,884 3,359 523 9,055 5,764 3,292 496 ¥188 ¥120 ¥68 ¥28 ¥2.0 ¥2.0 ¥2.0 ¥5.3 1,544 637 238 3,117 3,213 3,437 3,053 3,132 3,366 ¥64 ¥81 ¥71 ¥2.1 ¥2.5 ¥2.1 1,405 541 471 2 6,044 1,672 2,023 27 5,913 1,629 1,983 25 ¥131 ¥43 ¥40 ¥2 ¥2.2 ¥2.6 ¥2.0 ¥6.1 4 428 1,617 319 51 1 3,013 6,356 385 12 1 2,974 6,189 375 11 0 ¥39 ¥166 ¥10 ¥1 0.9 ¥1.3 ¥2.6 ¥2.5 ¥8.2 ehiers on DSK5VPTVN1PROD with RULES Source: Dobson | DaVanzo analysis of 2011–2013 Hospital Cost Reports. * Dollar DSH calculated by [0.25 * estimated section 1886(d)(5)(F) payments] + [0.75 * estimated section 1886(d)(5)(F) payments * Factor 2 * Factor 3]. When summed across all hospitals projected to receive DSH payments, DSH payments are estimated to be $9,767 million in FY 2016 and $9,551 million in FY 2017. ** Percentage change is determined as the difference between Medicare DSH payments modeled for the FY 2017 IPPS/LTCH PPS final rule (column 3) and Medicare DSH payments modeled for the FY 2016 IPPS/LTCH PPS final rule (column 2) divided by Medicare DSH payments modeled for the FY 2016 final rule (column 2) times 100 percent. 9. On page 57325, bottom of the page, third column, last paragraph, line 8, the figure ‘‘6.4’’ is corrected to read ‘‘5.9’’. 10. On page 57326, first column— a. First partial paragraph— (1) Line 7 the figure ‘‘5.2’’ is corrected to read ‘‘5.5’’. (2) Line 8, the figure ‘‘5.9’’ is corrected to read ‘‘0.2’’. b. First full paragraph, line 12, the figure ‘‘11.4’’ is corrected to read ‘‘11.3’’. c. Third full paragraph (last paragraph)— (1) Line 12, the figure ‘‘11.4’’ is corrected to read ‘‘11.3’’. (2) Line 18, the figure ‘‘$9.5 million’’ is corrected to read ‘‘$9.4 million’’. 11. On page 57330, third column— a. Fourth bulleted paragraph, line 4, the figure ‘‘0.9991’’ is corrected to read ‘‘0.9990’’. VerDate Sep<11>2014 15:06 Oct 04, 2016 Jkt 241001 b. Last paragraph, line 6, the figure ‘‘1.84’’ is corrected to read ‘‘1.83’’. 12. On page 57331, top half of the page— a. First column— (1) First partial paragraph— (a) Line 1, the phrase ‘‘Less than half of the hospitals’’ is corrected to read ‘‘Most of the hospitals’’. (b) Lines 4 through 6, the phrase ‘‘the effects of changes to the GAFs, while the remainder of these urban area hospitals would experience no change or a decrease in’’ is corrected to read ‘‘the effects of changes to the GAFs, while hospitals in one urban area are expected to experience a decrease in’’. (c) Line 11, the phrase ‘‘except for two rural areas where changes in’’ is corrected to read, ‘‘except for one rural area where changes in’’. PO 00000 Frm 00029 Fmt 4700 Sfmt 4700 (2) Third paragraph, lines 8 and line 9, the phrase ‘‘0.7 percent, while hospitals in rural areas, on average, are expected to experience a 0.8’’ is corrected to read ‘‘0.7 percent, and hospitals in rural areas, on average, are also expected to experience a 0.7’’. b. Second column— (1) First partial paragraph, lines 2 through 6, the sentence ‘‘The primary factor contributing to the small difference in the projected increase in capital IPPS payments per case for urban hospitals as compared to rural hospitals is the changes to the GAFs.’’ is corrected by deleting the sentence. (2) First full paragraph— (a) Lines 4 through 8, ‘‘range from a 4.2 percent increase for the Puerto Rico urban hospitals, and a 1.4 percent E:\FR\FM\05OCR1.SGM 05OCR1 68962 Federal Register / Vol. 81, No. 193 / Wednesday, October 5, 2016 / Rules and Regulations increase for the West South Central urban region to a 0.7 percent increase for the Mountain urban region.’’ is corrected to read ‘‘range from a 4.1 percent increase for the Puerto Rico urban hospitals, and a 2.1 percent increase for the Mountain urban region to a 0.7 percent increase for several other urban regions.’’. (b) Line 13, the figure ‘‘4.2’’ is corrected to read ‘‘4.1’’. (c) Line 23, the figure ‘‘1.6’’ is corrected to read ‘‘2.1’’. (d) Line 26, the figure ‘‘0.4’’ should read ‘‘0.1’’. c. Third column— (1) First full paragraph, line 9, the figure ‘‘0.7’’ is corrected to read ‘‘0.6’’. (2) Second full paragraph— (a) Line 13, the figure ‘‘1.0’’ is corrected to read ‘‘0.9’’. (b) Line 17, the figure ‘‘1.0’’ is corrected to read ‘‘0.9’’. (c) Line 20, the figure ‘‘0.2’’ is corrected to read ‘‘0.3’’. 13. On pages 57331 and 57332, the table titled ‘‘Table III.—Comparison of Total Payments Per Case [FY 2016 Payments Compared To FY 2017 Payments]’’ is corrected to read as follows: TABLE III—COMPARISON OF TOTAL PAYMENTS PER CASE [FY 2016 payments compared to FY 2017 payments] Average FY 2016 payments/case Average FY 2017 payments/case 3,330 1,369 1,146 815 2,515 659 767 446 431 212 815 317 292 120 46 40 912 1,011 871 618 947 768 824 865 958 1,139 618 520 577 610 669 738 920 1,019 879 623 955 774 829 871 967 1,149 623 524 582 614 673 745 0.8 0.7 0.9 0.7 0.8 0.8 0.6 0.7 0.9 0.9 0.7 0.7 0.8 0.6 0.6 0.9 2,515 116 315 407 390 147 163 385 163 378 51 815 21 54 128 115 155 98 160 60 24 947 1,031 1,056 840 908 793 923 858 977 1,219 435 618 868 591 584 638 562 666 536 718 804 955 1,024 1,064 847 915 804 930 868 998 1,227 453 623 878 603 584 643 566 668 542 717 812 0.8 ¥0.6 0.7 0.8 0.8 1.3 0.7 1.1 2.1 0.7 4.1 0.7 1.1 2.1 0.0 0.9 0.9 0.4 1.2 ¥0.1 1.0 3,330 1,369 1,153 808 912 1,011 870 619 920 1,019 878 623 0.8 0.7 0.9 0.7 2,266 815 249 771 885 1,287 776 892 1,298 0.7 0.8 0.9 1,642 363 968 696 976 702 0.8 0.8 240 325 575 649 581 654 1.0 0.7 29 538 540 0.4 ehiers on DSK5VPTVN1PROD with RULES Number of hospitals By Geographic Location: All hospitals .............................................................................................. Large urban areas (populations over 1 million) ................................ Other urban areas (populations of 1 million of fewer) ...................... Rural areas ........................................................................................ Urban hospitals ......................................................................................... 0–99 beds .......................................................................................... 100–199 beds .................................................................................... 200–299 beds .................................................................................... 300–499 beds .................................................................................... 500 or more beds .............................................................................. Rural hospitals .......................................................................................... 0–49 beds .......................................................................................... 50–99 beds ........................................................................................ 100–149 beds .................................................................................... 150–199 beds .................................................................................... 200 or more beds .............................................................................. By Region: Urban by Region ...................................................................................... New England ..................................................................................... Middle Atlantic ................................................................................... South Atlantic .................................................................................... East North Central ............................................................................. East South Central ............................................................................ West North Central ............................................................................ West South Central ........................................................................... Mountain ............................................................................................ Pacific ................................................................................................ Puerto Rico ........................................................................................ Rural by Region ........................................................................................ New England ..................................................................................... Middle Atlantic ................................................................................... South Atlantic .................................................................................... East North Central ............................................................................. East South Central ............................................................................ West North Central ............................................................................ West South Central ........................................................................... Mountain ............................................................................................ Pacific ................................................................................................ By Payment Classification: All hospitals .............................................................................................. Large urban areas (populations over 1 million) ................................ Other urban areas (populations of 1 million of fewer) ...................... Rural areas ............................................................................................... Teaching Status: Non-teaching ..................................................................................... Fewer than 100 Residents ................................................................ 100 or more Residents ...................................................................... Urban DSH: 100 or more beds ....................................................................... Less than 100 beds ................................................................... Rural DSH: Sole Community (SCH/EACH) ................................................... Referral Center (RRC/EACH) .................................................... Other Rural: 100 or more beds ................................................................ VerDate Sep<11>2014 15:06 Oct 04, 2016 Jkt 241001 PO 00000 Frm 00030 Fmt 4700 Sfmt 4700 E:\FR\FM\05OCR1.SGM 05OCR1 Change Federal Register / Vol. 81, No. 193 / Wednesday, October 5, 2016 / Rules and Regulations 68963 TABLE III—COMPARISON OF TOTAL PAYMENTS PER CASE—Continued [FY 2016 payments compared to FY 2017 payments] Average FY 2016 payments/case Average FY 2017 payments/case 142 526 528 0.3 898 109 1,107 408 1,043 942 813 815 1,052 948 820 820 0.9 0.6 0.8 0.6 2,529 189 324 126 948 772 706 748 955 782 716 756 0.7 1.4 1.4 1.1 532 1,936 277 489 42 953 948 650 578 599 962 955 655 580 602 0.9 0.7 0.9 0.3 0.5 1,927 881 522 926 820 963 934 827 969 0.8 0.8 0.6 523 2,122 545 89 1,103 916 745 529 1,114 923 750 531 1.0 0.8 0.7 0.4 Number of hospitals Less than 100 beds ............................................................ Urban teaching and DSH: Both teaching and DSH .................................................................... Teaching and no DSH ....................................................................... No teaching and DSH ....................................................................... No teaching and no DSH .................................................................. Rural Hospital Types: Non special status hospitals .............................................................. RRC/EACH ........................................................................................ SCH/EACH ........................................................................................ SCH, RRC and EACH ....................................................................... Hospitals Reclassified by the Medicare Geographic Classification Review Board: FY2017 Reclassifications: All Urban Reclassified ....................................................................... All Urban Non-Reclassified ............................................................... All Rural Reclassified ........................................................................ All Rural Non-Reclassified ................................................................. Other Reclassified Hospitals (Section 1886(d)(8)(B)) ....................... Type of Ownership: Voluntary ........................................................................................... Proprietary ......................................................................................... Government ....................................................................................... Medicare Utilization as a Percent of Inpatient Days: 0–25 ................................................................................................... 25–50 ................................................................................................. 50–65 ................................................................................................. Over 65 .............................................................................................. 14. On page 57342— a. Top of the page— (1) First column, first full paragraph— (a) Line 11, the figure ‘‘987’’ is corrected to read ‘‘990’’. (b) Line 23, the figure ‘‘809’’ is corrected to read ‘‘811’’. (2) Second column, first partial paragraph— (a) Line 12, the figure ‘‘809’’ is corrected to read ‘‘811’’. (b) Line 14, the figure’’680’’ is corrected to read ‘‘683’’. (c) Line 19, the figure ‘‘66’’ is corrected to read ‘‘72’’. Change (d) Line 23, the figure ‘‘746’’ is corrected to read ‘‘755’’. b. Middle of the page, the table titled ‘‘TABLE V—ACCOUNTING STATEMENT: CLASSIFICATION OF ESTIMATED EXPENDITURES UNDER THE IPPS FROM FY 2016 TO FY 2017’’ is corrected to read as follows: TABLE V—ACCOUNTING STATEMENT: CLASSIFICATION OF ESTIMATED EXPENDITURES UNDER THE IPPS FROM FY 2016 TO FY 2017 Category Transfers Annualized Monetized Transfers .............................................................. From Whom to Whom .............................................................................. Dated: September 29, 2016. Madhura Valverde, Executive Secretary to the Department, Department of Health and Human Services. [FR Doc. 2016–24042 Filed 9–30–16; 11:15 am] $755 million. Federal Government to IPPS Medicare Providers. ACTION: Fish and Wildlife Service SUMMARY: 50 CFR Part 17 [Docket No. FWS–R4–ES–2015–0132; 4500030113] BILLING CODE 4120–01–P ehiers on DSK5VPTVN1PROD with RULES RIN 1018–AZ09 Endangered and Threatened Wildlife and Plants; Threatened Species Status for Kentucky Arrow Darter With 4(d) Rule AGENCY: Fish and Wildlife Service, Interior. VerDate Sep<11>2014 15:06 Oct 04, 2016 Jkt 241001 Final rule. DEPARTMENT OF THE INTERIOR PO 00000 Frm 00031 Fmt 4700 Sfmt 4700 We, the U.S. Fish and Wildlife Service (Service), determine threatened species status under the Endangered Species Act of 1973 (Act), as amended, for Kentucky arrow darter (Etheostoma spilotum), a fish species from the upper Kentucky River basin in Kentucky. The effect of this regulation will be to add this species to the List of Endangered and Threatened Wildlife. We are also adopting a rule under section 4(d) of the Act (a ‘‘4(d) rule’’) to further provide for the conservation of the Kentucky arrow darter. E:\FR\FM\05OCR1.SGM 05OCR1

Agencies

[Federal Register Volume 81, Number 193 (Wednesday, October 5, 2016)]
[Rules and Regulations]
[Pages 68947-68963]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2016-24042]



[[Page 68947]]

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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare & Medicaid Services

42 CFR Parts 405, 412, 413, and 489

[CMS-1655-F; CMS-1664-F; CMS-1632-F2]
RIN 0938-AS77; 0938-AS88; 0938-AS41


Medicare Program; Hospital Inpatient Prospective Payment Systems 
for Acute Care Hospitals and the Long-Term Care Hospital Prospective 
Payment System and Policy Changes and Fiscal Year 2017 Rates; Quality 
Reporting Requirements for Specific Providers; Graduate Medical 
Education; Hospital Notification Procedures Applicable to Beneficiaries 
Receiving Observation Services; Technical Changes Relating to Costs to 
Organizations and Medicare Cost Reports; Finalization of Interim Final 
Rules With Comment Period on LTCH PPS Payments for Severe Wounds, 
Modifications of Limitations on Redesignation by the Medicare 
Geographic Classification Review Board, and Extensions of Payments to 
MDHs and Low-Volume Hospitals; Correction

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

ACTION: Final rule; correction.

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

SUMMARY: This document corrects technical and typographical errors in 
the final rule that appeared in the August 22, 2016 Federal Register 
titled ``Medicare Program; Hospital Inpatient Prospective Payment 
Systems for Acute Care Hospitals and the Long-Term Care Hospital 
Prospective Payment System and Policy Changes and Fiscal Year 2017 
Rates; Quality Reporting Requirements for Specific Providers; Graduate 
Medical Education; Hospital Notification Procedures Applicable to 
Beneficiaries Receiving Observation Services; Technical Changes 
Relating to Costs to Organizations and Medicare Cost Reports; 
Finalization of Interim Final Rules With Comment Period on LTCH PPS 
Payments for Severe Wounds, Modifications of Limitations on 
Redesignation by the Medicare Geographic Classification Review Board, 
and Extensions of Payments to MDHs and Low-Volume Hospitals.''

DATES: This correction is effective October 1, 2016.

FOR FURTHER INFORMATION CONTACT: Donald Thompson, (410) 786-4487.

SUPPLEMENTARY INFORMATION: 

I. Background

    In FR Doc. 2016-18476 of August 22, 2016 (81 FR 56761) there were a 
number of technical and typographical errors identified and corrected 
in the Correction of Errors section of this correcting document. The 
provisions in this correcting document are effective as if they had 
been included in the document that appeared in the August 22, 2016 
Federal Register. Accordingly, the corrections are effective October 1, 
2016.

II. Summary of Errors

A. Summary of Errors in the Preamble

    On page 56775, we made a typographical error in stating the cost 
reduction.
    On page 56796, we are correcting errors and inadvertent omissions 
in the summary and response to a comment on the assignment of 18 
additional diagnosis codes.
    On page 56797, we erroneously referred to the wrong table.
    On page 56801, we are correcting errors and inadvertent omissions 
in our response to comments on our proposal to redesignate four ICD-10-
PCS procedure codes.
    On page 56803 and in the table on page 56804 describing ICD-10-PCS 
Endovascular Thrombectomy Procedure Codes Reassigned to MS-DRGs 270, 
271, and 272 for FY 2017, we are correcting technical errors in our 
discussion in response to comments to remove 34 ICD-10-PCS procedure 
codes describing endovascular thrombectomy of non-lower limbs from the 
proposed list of codes to be reassigned to MS-DRGs 270, 271 and 272. In 
this response, we erroneously referred to 34 procedure codes describing 
non-lower limb procedures (as included in the list submitted by the 
commenter) rather than 32 non-lower limb procedure codes. Two of the 34 
procedure codes identified by the commenter, ICD-10-PCS procedure codes 
04CT3ZZ (Extirpation of matter from right peroneal artery, percutaneous 
approach) and 04CU3ZZ (Extirpation of matter from left peroneal artery, 
percutaneous approach), describe endovascular thrombectomy of lower 
limbs. These codes are assigned to MS-DRGs 270, 271 and 272, accurately 
replicating the logic of ICD-9-CM MS-DRGs Version 32 and supporting 
clinical and resource use homogeneity as originally proposed and in 
accordance with the finalized policy to add procedures describing 
endovascular thrombectomy of lower limbs to ICD-10 Version 34 MS-DRGS 
270, 271 and 272.
    On page 56804, as a result of our correction of the MS-DRG 
assignment in Table 6B--New Procedure Codes for 13 ICD-10-PCS procedure 
codes that describe endovascular thrombectomy procedures of the lower 
limb, as described in section II.D. of this correction document, we are 
making additional conforming corrections to the table describing ICD-
10-PCS Endovascular Thrombectomy Procedure Codes Reassigned to MS-DRGs 
270, 271, and 272 for FY 2017.
    On pages 56821 and 56823, we erroneously stated there were 58 
additional combination codes for removal and replacement of knee 
joints. There were 57 additional combination codes.
    On pages 56822 and 56823, we erroneously listed the code number for 
(Replacement of Left Knee Joint, Femoral Surface with Synthetic 
Substitute, Cemented, Open Approach) as code 0SRU0JA three times within 
the table. The correct code number should be 0SRU0J9 (Replacement of 
Left Knee Joint, Femoral Surface with Synthetic Substitute, Cemented, 
Open Approach).
    As a result of the corrections to pages 56803, 56804, 56821, 56822, 
and 56823, we have made conforming changes to the ICD-10 MS-DRG 
Definitions Manual Version 34 and ICD-10 MS-DRG Grouper Software 
Version 34 for FY 2017.
    On page 56858, we erroneously omitted MS-DRG 265 from the table of 
MS-DRGs subject to the policy for replaced devices offered without cost 
or with a credit.
    On pages 56895 and 56897, we inadvertently made an error to the 
title of ICD-10-PCS procedure code XW03331 and omitted an additional 
procedure code that describes Idarucizumab. Cases involving 
Idarucizumab that are eligible for new technology add-on payments will 
be identified by ICD-10-PCS procedure codes XW03331 (Introduction of 
Idarucizumab, Dabigatran reversal agent into peripheral vein, 
percutaneous approach, New Technology Group 1) and XW04331 
(Introduction of Idarucizumab, Dabigatran reversal agent into central 
vein, percutaneous approach, New Technology Group 1).
    On page 56927, as a result of the correction of the technical 
errors described in section II.B of this correction document, we have 
made conforming changes to the following: The number of hospitals 
approved for wage index reclassifications by the Medicare Geographic 
Classification Review Board (MGCRB) starting in FY 2017 and the number 
of hospitals in a

[[Page 68948]]

MGCRB reclassification status for FY 2017.
    On page 57002 in the table titled, ``Previously Adopted and Newly 
Finalized Baseline and Performance Periods for the FY 2021 Program 
Year'' we erroneously repeated the same information three times, and in 
the first instance provided incorrect performance period years for the 
Mortality (MORT-30-AMI, MORT-30-HF, MORT-30-COPD) and THA/TKA measures.
    On page 57033, we made a typographical error and omitted a dash 
within the web link address creating a non-functional link.
    On pages 57195, 57196, 57199, 57211, 57213, 57218, and 57220 
through 57223 we inadvertently made technical and typographical errors 
to the Long-Term Care Hospital Quality Reporting Program section and 
have corrected those errors for clarification.

B. Summary of Errors in the Addendum

    As discussed in section II.D. of this correcting document, we made 
technical errors with regard to the calculation of Factor 3 of the 
uncompensated care payment methodology. The revisions made to address 
some of these errors directly affected and required the recalculation 
of all the budget neutrality factors and final outlier threshold. 
Factor 3 is used to determine the amount of total uncompensated care 
payment a hospital is eligible to receive as well as the amount of the 
uncompensated care payment a hospital receives per discharge. Per 
discharge uncompensated care payments are then included when 
determining total payments for purposes of all of the budget neutrality 
factors and the final outlier threshold. Therefore, we made conforming 
changes to pages 57278 through 57280, 57286, and 57291 to take into 
account the updated per-discharge uncompensated care payments 
determined using revised Factor 3 amounts. We made further conforming 
corrections to the national outlier adjustment factors on page 57286 
and the table on page 57288 as a result of these changes. Finally, we 
made conforming corrections to the national operating standardized 
amounts.
    We made inadvertent errors related to the MGCRB reclassification 
status of one provider as well as the status of three providers 
reclassified as urban to rural under section 1886(d)(8)(E) of the Act 
(codified in the regulations under Sec.  412.103 and hereinafter 
referred to as Sec.  412.103).
    Specifically, the reclassification status in the FY 2017 IPPS/LTCH 
PPS final rule did not properly reflect the following:
     Withdrawal of a MGCRB reclassification for FY 2017 for one 
provider.
     Application of urban to rural reclassification under Sec.  
412.103 for three providers.
    Therefore, on page 57279, we recalculated the reclassification 
hospital budget neutrality adjustment.
    The reclassification errors also required the recalculation of 
additional budget neutrality adjustment factors, the fixed-loss cost 
threshold, the final wage indexes, and the national operating 
standardized amounts. Therefore, we made conforming changes to the 
following:
     On page 57280, the rural floor budget neutrality 
adjustment and the wage index transition budget neutrality adjustment.
     On page 57286, the calculation of the outlier fixed-loss 
cost threshold and the national outlier adjustment factors.
     On page 57288, the table titled ``Change of FY 2016 
Standardized Amounts to the FY 2017 Standardized Amounts''.
    On pages 57291 and 57293 through 57295, in our discussion of the 
determination of the Federal hospital inpatient capital related 
prospective payment rate update, we have made conforming corrections to 
the increase in the capital Federal rate, the incremental and 
cumulative budget neutrality adjustment factors for changes in the GAFs 
and the MS-DRG relative weights, the GAF/MS-DRG budget neutrality 
adjustment factor (due to the errors in our calculation of the GAFs, 
which are computed from the wage index), the capital Federal rate, and 
the outlier threshold (as discussed previously).
    Also, as a result of these errors, on pages 57294 and 57295, we 
have made conforming corrections in the tables showing the comparison 
of factors and adjustments for the FY 2016 capital Federal rate and FY 
2017 capital Federal rate and the proposed FY 2017 capital Federal rate 
and final FY 2017 capital Federal rate.
    On page 57307, we are making conforming corrections the fixed-loss 
amount for site neutral discharges due to corrections in the IPPS rates 
and factors discussed previously.
    On page 57312, we have made conforming corrections to the national 
operating standardized amounts and capital standard Federal payment 
rate (which also include the rates payable to hospitals located in 
Puerto Rico) in Tables 1A, 1B, 1C, and 1D as a result of the conforming 
corrections to certain budget neutrality factors and the outlier 
threshold (as described previously).

C. Summary of Errors in the Appendices

    On pages 57312, 57315 through 57317, 57319 through 57323, 57330 
through 57332 in our regulatory impact analyses, we made conforming 
corrections to the factors, values, and tables and accompanying 
discussion of the changes in operating and capital IPPS payments for FY 
2017 and the effects of certain budget neutrality factors as a result 
of the technical errors that lead to conforming changes in our 
calculation of the operating and capital IPPS budget neutrality 
factors, outlier threshold, final wage indexes, operating standardized 
amounts, and capital Federal rate (as described in section II.B. of 
this correction document).
    On pages 57324 through 57326, in the table titled ``Modeled 
Disproportionate Share Hospital Payments for Estimated FY 2017 DSHs by 
Hospital Type: Model DSH $ (In Millions) From FY 2016 To FY 2017'' and 
the accompanying discussion, we made corrections to address technical 
and formatting errors in the estimated impacts resulting from 
inadvertent errors in the calculation of Factor 3 for certain 
hospitals.
    On pages 57331 through 57332, we made conforming corrections to 
Table III--Comparison of Total Payments Per Case [FY 2016 Payments 
Compared to FY 2017 Payments].
    On page 57342, we made conforming corrections to the discussion of 
the estimated changes in operating and capital IPPS payments and the 
accounting statement and table for acute care hospitals that arose from 
the corrections of errors and conforming changes as described in 
sections II.B. and II.D. of this correcting document.

D. Summary of Errors in and Corrections to Files and Tables Posted on 
the CMS Web Site

    We are correcting the errors in the following IPPS tables that are 
listed on page 57311 of the FY 2017 IPPS/LTCH PPS final rule and are 
available on the Internet on the CMS Web site at https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/AcuteInpatientPPS/FY2017-IPPS-Final-Rule-Home-Page.html. The tables that are available on the 
Internet have been updated to reflect the revisions discussed in this 
correcting document.
    Table 2--Case-Mix Index and Wage Index Table--FY 2017. Because the 
uncompensated care and reclassification errors discussed in section 
II.B. of this correction document required that we recalculate the 
rural and imputed floor budget neutrality factor, we are

[[Page 68949]]

correcting the values in the column titled FY 2017 Wage Index for all 
providers. For the three providers for which we are applying urban to 
rural reclassification under Sec.  412.103, we are correcting the 
values in the column titled ``FY 2017 Wage Index'', inserting the rural 
reclassified CBSA in the column titled ``Reclassified/Redesignated 
CBSA'', and inserting a ``Y'' in the column titled ``Hospital 
Reclassified as Rural Under Section 1886(d)(8)(E) of the Act (Sec.  
412.103)''. For the provider that withdrew its MGCRB reclassification 
for FY 2017, we are revising the wage index in the column titled FY 
2017 Wage Index, and we are removing the MGCRB flag in the column 
titled MGCRB Reclass.
    Table 3--Wage Index Table by CBSA--FY 2017. Because the 
uncompensated care and reclassification errors discussed in section 
II.B. of this correction document required that we recalculate the 
rural and imputed floor budget neutrality factor, we are making 
corresponding changes to the wage indexes and GAFs of all CBSAs listed 
in Table 3. Specifically, we are correcting the values and flags in the 
columns titled ``Wage Index'', ``Reclassified Wage Index'', ``GAF'', 
``Reclassified GAF'', ``Pre-Frontier and/or Pre-Rural Floor Wage 
Index'' and ``Eligible for Rural Floor Wage Index''.
    Table 6B--New Procedure Codes for FY 2017. In Table 6B--New 
Procedure Codes, we inadvertently listed the incorrect MS-DRG 
assignment for 13 ICD-10-PCS procedure codes that describe endovascular 
thrombectomy procedures of the lower limb involving a bifurcation. We 
are correcting the MS-DRG assignment of these 13 ICD-10-PCS codes in 
Table 6B.
    Table 10--New Technology Add-On Payment Thresholds for Applications 
for FY 2018. We are correcting the thresholds in this table as a result 
of the corrections to the operating standardized amounts discussed in 
section II.B. of this correcting document.
    Table 18--FY 2017 Medicare DSH Uncompensated Care Payment Factor 3 
and Projected DSH Eligibility. For the FY 2017 IPPS/LTCH PPS final 
rule, we published a list of hospitals that we identified to be 
subsection (d) hospitals and subsection (d) Puerto Rico hospitals 
eligible to receive empirically justified Medicare DSH payment 
adjustments and uncompensated care payments for FY 2017. We also 
published, in the Supplemental Medicare DSH File located in the FY 2017 
IPPS/LTCH PPS final rule data files page at https://www.cms.gov/Medicare/Medicare-Feefor-Service-Payment/AcuteInpatientPPS/FY2017-IPPS-FinalRule-Home-Page-Items/FY2017-IPPSFinal-Rule-Data-Files.html, the 
data used to calculate each hospital's Factor 3, total uncompensated 
care payment, and estimated uncompensated care payment per discharge.
    Shortly after the publication of the FY2017 IPPS/LTCH PPS final 
rule, we discovered that, in calculating Factor 3 of the uncompensated 
care payment methodology, we had understated the low-income insured 
days of hospitals that merged after 2011 with one surviving provider 
number because we inadvertently excluded the low income insured days of 
acquired hospitals from the low income insured days used in the Factor 
3 calculation of surviving hospitals that were projected to receive 
Medicare DSH in FY 2017. In addition, we discovered that we had 
calculated a Factor 3 for hospitals that have ceased operations and 
erroneously calculated Factor 3 using Medicaid days reported on 
Worksheet S-3 instead of Worksheet S-2 of certain hospitals' FY 2013 
cost reports. We are revising Factor 3 for all hospitals to correct 
these errors. These corrections to the uncompensated care payments 
impacted the calculation of all the budget neutrality factors as well 
as the outlier fixed-loss cost threshold for outlier payments.
    In addition, we discovered that we had inadvertently excluded the 
Medicaid days from the 2011 cost report for a provider as well as the 
Medicaid days from the 2012 cost report for another provider from the 
calculation of Factor 3. Due to technical errors by our Medicare 
Administrative Contractors the Medicaid days from these cost reports 
were not included in the March 2016 update of HCRIS. We projected that 
both providers would be eligible to receive Medicare DSH in FY 2017. 
Accordingly, we are revising Factor 3 for all hospitals to reflect 
these Medicaid days; however, the impact of these revisions is too 
small to affect other aspects of the IPPS ratesetting, such as the 
calculation of the fixed-loss threshold for outlier payments.
    We are also correcting the errors in the following LTCH PPS table 
that is listed on page 57311 of the FY 2017 IPPS/LTCH PPS final rule 
and is available on the Internet on the CMS Web site at https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/LongTermCareHospitalPPS/ under the list item for regulation 
number CMS-1655-F. The table that is available on the Internet has been 
updated to reflect the revisions discussed in this correcting document.
    Table 11--MS-LTC-DRGs, Relative Weights, Geometric Average Length 
of Stay, Short Stay Outlier (SSO) Threshold, and ``IPPS Comparable 
Threshold'' for LTCH PPS Discharges Occurring from October 1, 2016 
through September 30, 2017. We are correcting this table by correcting 
typographical errors for MS-LTC-DRGs 627 and 658 in the columns titled 
``Relative Weight,'' ``Geometric Average Length of Stay,'' ``Short-Stay 
Outlier (SSO) Threshold,'' and ``IPPS Comparable Threshold.''

III. Waiver of Proposed Rulemaking and Delay in Effective Date

    We ordinarily publish a notice of proposed rulemaking in the 
Federal Register to provide a period for public comment before the 
provisions of a rule take effect in accordance with section 553(b) of 
the Administrative Procedure Act (APA) (5 U.S.C. 553(b)). However, we 
can waive this notice and comment procedure if the Secretary finds, for 
good cause, that the notice and comment process is impracticable, 
unnecessary, or contrary to the public interest, and incorporates a 
statement of the finding and the reasons therefore in the notice.
    Section 553(d) of the APA ordinarily requires a 30-day delay in the 
effective date of final rules after the date of their publication in 
the Federal Register. This 30-day delay in effective date can be 
waived, however, if an agency finds for good cause that the delay is 
impracticable, unnecessary, or contrary to the public interest, and the 
agency incorporates a statement of the findings and its reasons in the 
rule issued.
    We believe that this correcting document does not constitute a rule 
that would be subject to the APA notice and comment or delayed 
effective date requirements. This correcting document corrects 
technical and typographic errors in the preamble, addendum, payment 
rates, tables, and appendices included or referenced in the FY 2017 
IPPS/LTCH PPS final rule but does not make substantive changes to the 
policies or payment methodologies that were adopted in the final rule. 
As a result, this correcting document is intended to ensure that the 
information in the FY 2017 IPPS/LTCH PPS final rule accurately reflects 
the policies adopted in that final rule.
    In addition, even if this were a rule to which the notice and 
comment procedures and delayed effective date requirements applied, we 
find that there is good cause to waive such requirements. Undertaking 
further notice and comment procedures to incorporate the corrections in 
this document into the final rule or delaying the effective date would 
be contrary to the public interest because it is in the public's 
interest for providers to receive

[[Page 68950]]

appropriate payments in as timely a manner as possible, and to ensure 
that the FY 2017 IPPS/LTCH PPS final rule accurately reflects our 
policies. Furthermore, such procedures would be unnecessary, as we are 
not altering our payment methodologies or policies, but rather, we are 
simply implementing correctly the policies that we previously proposed, 
received comment on, and subsequently finalized. This correcting 
document is intended solely to ensure that the FY 2017 IPPS/LTCH PPS 
final rule accurately reflects these payment methodologies and 
policies. Therefore, we believe we have good cause to waive the notice 
and comment and effective date requirements.

IV. Correction of Errors

    In FR Doc. 2016-18476 of August 22, 2016 (81 FR 56761), we are 
making the following corrections:

A. Corrections of Errors in the Preamble

    1. On page 56775, third column, second bulleted paragraph, line 25, 
the figure ``$50.4 million'' is corrected to read ``$56.4 million''.
    2. On page 56796--
    a. Top half of the page, third column, third full paragraph,
    (1) Lines 4 and 5, the phrase ``describing similar conditions'' is 
corrected to read ``displayed in Table 6A--New Diagnosis Codes 
associated with the proposed rule (which is available via the Internet 
on the CMS Web site at: https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/AcuteInpatientPPS/) that describe similar 
conditions''.
    (2) Lines 9 and 10, the phrase, ``18 ICD-10-CN diagnosis codes in 
the following table be reassigned'' is corrected to read ``18 ICD-10-CM 
diagnosis codes in the following table also be reassigned''.
    b. Lower half of the page, first column, last paragraph--
    (1) Lines 6 and 7, the phrase ``describing procedures performed 
on'' is corrected to read ``describing conditions affecting''.
    (2) Line 14, the phrase ``MS DRGs 091, 092 and 093.'' is corrected 
to read ``MS-DRGs 091, 092, and 093 because they are also nervous 
system codes.''
    3. On page 56797, first column, first paragraph, lines 15 and 16, 
the phrase ``These 18 codes also are reflected in Table 6E'' is 
corrected to read ``These 18 codes are reflected in Table 6A''.
    4. On page 56801, second column, second full paragraph--
    a. Lines 11 and 12, the phrase ``performing such procedures because 
loop'' is corrected to read ``performing such procedures because, as 
noted in the FY 2017 IPPS/LTCH PPS proposed rule, loop''.
    b. Lines 25 and 26, the phrase ``were not able to finalize that 
specific request.'' is corrected to read ``were not able to replicate 
that specific request in the ICD-9-CM based MS-DRGs.''.
    c. Lines 26 through 29, the sentence ``Rather, we finalized an 
alternative option, which was to change the designation for four of the 
six codes requested.'' is corrected to read ``Rather, we proposed an 
alternative option, which was to change the designation for four of the 
six codes requested, because we believed that if we limited the change 
in designation to these four codes, the change would not have any 
impact.''.
    d. Lines 40 through 41, the phrase ``not finalizing the proposal to 
change the two'' is corrected to read ``not changing the designation of 
the two''.
    5. On page 56803, bottom of the page--
    a. First column, last paragraph, lines 7 and 8, the phrase 
``removing the 34 codes'' is corrected to read ``removing 32 of the 34 
codes''.
    b. Second column, first partial paragraph--
    (1) Lines 5 and 6, the phrase ``34 non-lower'' is corrected to read 
``32 non-lower''.
    (2) Lines 8 and 9, the phrase ``These 34 non-lower'' is corrected 
to read ``These 32 non-lower''.
    (3) Line 13, after the phrase ``for FY 2017.'' the paragraph is 
corrected by adding sentences to read as follows:
    ``Two of the procedure codes identified by the commenter, ICD-10-
PCS procedure codes 04CT3ZZ (Extirpation of matter from right peroneal 
artery, percutaneous approach) and 04CU3ZZ (Extirpation of matter from 
left peroneal artery, percutaneous approach) describe endovascular 
thrombectomy of lower limbs and are not non-lower limb procedure 
codes.''.
    c. Third column, first full paragraph, line 11, the phrase ``34 
procedure'' is corrected to read ``32 procedure''.
    6. On page 56804, top of page, the table titled ``ICD-10-PCS 
ENDOVASCULAR THROMBECTOMY PROCEDURE CODES REASSIGNED TO MS-DRGs 270, 
271, AND 272 FOR FY 2017'' is corrected by adding the following 
entries:

------------------------------------------------------------------------
 
------------------------------------------------------------------------
04CK3Z6...........................  Extirpation of Matter from Right
                                     Femoral Artery, Bifurcation,
                                     Percutaneous Approach.
04CL3Z6...........................  Extirpation of Matter from Left
                                     Femoral Artery, Bifurcation,
                                     Percutaneous Approach.
04CM3Z6...........................  Extirpation of Matter from Right
                                     Popliteal Artery, Bifurcation,
                                     Percutaneous Approach.
04CN3Z6...........................  Extirpation of Matter from Left
                                     Popliteal Artery, Bifurcation,
                                     Percutaneous Approach.
04CP3Z6...........................  Extirpation of Matter from Right
                                     Anterior Tibial Artery,
                                     Bifurcation, Percutaneous Approach.
04CQ3Z6...........................  Extirpation of Matter from Left
                                     Anterior Tibial Artery,
                                     Bifurcation, Percutaneous Approach.
04CR3Z6...........................  Extirpation of Matter from Right
                                     Posterior Tibial Artery,
                                     Bifurcation, Percutaneous Approach.
04CS3Z6...........................  Extirpation of Matter from Left
                                     Posterior Tibial Artery,
                                     Bifurcation, Percutaneous Approach.
04CT3Z6...........................  Extirpation of Matter from Right
                                     Peroneal Artery, Bifurcation,
                                     Percutaneous Approach.
04CT3ZZ...........................  Extirpation of Matter from Right
                                     Peroneal Artery, Percutaneous
                                     Approach.
04CU3Z6...........................  Extirpation of Matter from Left
                                     Peroneal Artery, Bifurcation,
                                     Percutaneous Approach.
04CU3ZZ...........................  Extirpation of Matter from Left
                                     Peroneal Artery, Percutaneous
                                     Approach.
04CV3Z6...........................  Extirpation of Matter from Right
                                     Foot Artery, Bifurcation,
                                     Percutaneous Approach.
04CW3Z6...........................  Extirpation of Matter from Left Foot
                                     Artery, Bifurcation, Percutaneous
                                     Approach.
04CY3Z6...........................  Extirpation of Matter from Lower
                                     Artery, Bifurcation, Percutaneous
                                     Approach.
------------------------------------------------------------------------

    7. On page 56821, middle of the page--
    a. Second column, first partial paragraph, line 2, the phrase 
``identified 58'' is corrected to read ``identified 57''.
    b. Third column, first partial paragraph, line 3, the phrase 
``following 58'' is corrected to read ``following 57''.
    8. On pages 56821 through 56823, in the table titled ``ICD-10-PCS 
CODE PAIRS PROPOSED TO BE ADDED TO VERSION 34 ICD-10 MS-DRGs 466, 467, 
and 468: PROPOSED NEW KNEE REVISION ICD-10-PCS COMBINATIONS'', the 
codes (in the 4th column) for the following entries are corrected to 
read as follows:

[[Page 68951]]



  ICD-10-PCS Code Pairs Proposed To Be Added to Version 34 ICD-10 MS-DRGs 466, 467, and 468: Proposed New Knee
                                        Revision ICD-10-PCS Combinations
----------------------------------------------------------------------------------------------------------------
           Code                Code description                         Code                Code description
----------------------------------------------------------------------------------------------------------------
0SPD08Z..................  Removal of Spacer from      and   0SRU0J9..................  Replacement of Left Knee
                            Left Knee Joint, Open                                        Joint, Femoral Surface
                            Approach.                                                    with Synthetic
                                                                                         Substitute, Cemented,
                                                                                         Open Approach.
0SPD38Z..................  Removal of Spacer from      and   0SRU0J9..................  Replacement of Left Knee
                            Left Knee Joint,                                             Joint, Femoral Surface
                            Percutaneous Approach.                                       with Synthetic
                                                                                         Substitute, Cemented,
                                                                                         Open Approach.
0SPD48Z..................  Removal of Spacer from      and   0SRU0J9..................  Replacement of Left Knee
                            Left Knee Joint,                                             Joint, Femoral Surface
                            Percutaneous Endoscopic                                      with Synthetic
                            Approach.                                                    Substitute, Cemented,
                                                                                         Open Approach.
----------------------------------------------------------------------------------------------------------------

    9. On page 56823, lower half of the page--
    a. First column, second paragraph, line 10, the phrase ``58 new'' 
is corrected to read ``57 new''.
    b. Second column--
    (1) First partial paragraph, line 11, the phrase ``58 new'' is 
corrected to read `` new''.
    (2) First full paragraph, lines 3 and 4, the phrase ``58 new'' is 
corrected to read ``57 new''.
    10. On page 56858, top of the page, the untitled table is corrected 
by adding the following entry after line 34 (which is the entry for MDC 
5, MS-DRG 262):

------------------------------------------------------------------------
            MDC                MS-DRG             MS-DRG Title
------------------------------------------------------------------------
5                                  265  AICD Lead Procedures.
------------------------------------------------------------------------

    11. On page 56895, third column, first partial paragraph--
    a. Lines 8 and 9, the phrase ``a unique ICD-10-PCS procedure code'' 
is corrected to read ``two unique ICD-10-PCS procedure codes''.
    b. Lines 10 through 15, the sentence ``The approved procedure code 
is XW0331 (Introduction of Idarucizumab, Dabigatran reversal agent into 
central vein, percutaneous approach, New Technology Group 1).'' is 
corrected to read ``The approved procedure codes are XW0331 
(Introduction of Idarucizumab, Dabigatran reversal agent into 
peripheral vein, percutaneous approach, New Technology Group 1) and 
XW04331 (Introduction of Idarucizumab, Dabigatran reversal agent into 
central vein, percutaneous approach, New Technology Group 1).''.
    12. On page 56897, third column, third full paragraph, line 11, the 
phrase ``procedure code XW03331.'' is corrected to read ``procedure 
codes XW03331 and XW04331.''.
    13. On page 56927--
    a. Second column, last partial paragraph, line 5 the phrase ``265 
hospitals'' is corrected to read ``264 hospitals''.
    b. Third column, first partial paragraph, line 12, the phrase ``817 
hospitals'' is corrected to read ``816 hospitals''.
    14. On page 57002, bottom of the page, the table titled 
``PREVIOUSLY ADOPTED AND NEWLY FINALIZED BASELINE AND PERFORMANCE 
PERIODS FOR THE FY 2021 PROGRAM YEAR'' is corrected to read as follows:

 Previously Adopted and Newly Finalized Baseline and Performance Periods
                      for the FY 2021 Program Year
------------------------------------------------------------------------
             Domain                 Baseline period   Performance period
------------------------------------------------------------------------
Clinical Care
 Mortality (MORT-30-AMI,   July 1,     July 1,
 MORT-30-HF, MORT-30-COPD) *       2011-June 30,       2016-June 30,
                                   2014.               2019
 THA/TKA *..............   April 1,    April 1,
                                   2011-March 31,      2016-March 31,
                                   2014.               2019
 MORT-30-PN (updated       July 1,     September
 cohort).                          2012-June 30,       1, 2017-June 30,
                                   2015.               2019
Efficiency and Cost Reduction
 MSPB...................   January     January
                                   1, 2017-December    1, 2019-December
                                   31, 2017.           31, 2019
 Payment (AMI Payment      July 1,     July 1,
 and HF Payment).                  2012-June 30,       2017-June 30,
                                   2015.               2019
------------------------------------------------------------------------
* Previously adopted baseline and performance periods that remain
  unchanged (80 FR 49562 through 49563).

    15. On page 57033, first column, last paragraph, lines 2 through 4, 
the web link ``https://www.cms.gov/Medicare/Medicare-Fee-for-ServicePayment/AcuteInpatientPPS/dgme.html'' is corrected to read 
``https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/AcuteInpatientPPS/dgme.html.''
    16. On page 57195--
    a. First column, last partial paragraph, lines 4 and 5, the phrase 
``it recommended'' is corrected to read ``the commenters recommended''.
    b. Third column, third full paragraph--
    (1). Line 14, the phrase ``This measure'' is corrected to read 
``The Drug Regimen Review Conducted with Follow-Up for Identified 
Issues-PAC LTCH QRP quality measure''.
    (2) Lines 23 through 25, the phrase `` and Potentially Preventable 
30-Day Post-Discharge Readmission Measure for LTCH QRP,'' is corrected 
to read ``, Potentially Preventable 30-Day Post-Discharge Readmission 
Measure for LTCH QRP and Medicare Spending Per Beneficiary-PAC LTCH 
QRP,''.
    17. On page 57196, third column, first full paragraph, lines 13 
through 16, the phrase ``with information more frequently, such as 
unadjusted counts of potentially preventable readmissions (PPRs) and 
discharge data.'' is corrected to read ``with information, such as 
unadjusted counts of potentially preventable readmissions (PPRs) and 
discharge data, more frequently.''
    18. On page 57199, first column, second full paragraph, lines 3 and 
4, the phrase ``SES or SDS status.'' is corrected to read ``SES or 
SDS.''
    19. On page 57211, third column, second full paragraph, line 16, 
the phrase ``to discharge'' is corrected to read ``to be discharged''.
    20. On page 57213--
    a. Second column, last partial paragraph, lines 6 through 8, the 
phrase

[[Page 68952]]

``and a SNF stay within a 30-day window, the SNF stay is a candidate to 
for'' is corrected to read ``and then a SNF stay within a 30-day 
window, the SNF stay is a candidate for''.
    b. Third column, after the last paragraph, Footnote 280, lines 1 
and 2, the measure name ``Hospital-Wide All-Cause Readmission Measure 
(HWR) (CMS/Yale).'' is corrected to read ``Hospital-Wide All-Cause 
Unplanned Readmission Measure (HWR) (CMS/Yale).''
    21. On page 57218, third column, first full paragraph, lines 4 and 
5, the phrase ``The commenter was correct in its interpretation of'' is 
corrected to read ``The commenter's interpretation was correct 
regarding''.
    22. On page 57220, second column, second footnoted full paragraph 
(Footnote 311), lines 1 through 6, the footnote ``\311\Greenwald, J.L., 
Halasyamani, L., Greene, J., LaCivita, C., et al. (2010). Making 
inpatient medication reconciliation patient centered, clinically 
relevant and implementable: A consensus statement on key principles and 
necessary first steps. Journal of Hospital Medicine, 5(8), 477-485.'' 
is corrected to read ``\311\Institute of Medicine. Preventing 
Medication Errors. Washington, DC: National Academies Press; 2006.''
    23. On page 57221, second column, second full paragraph, lines 3 
and 4, the phrase ``cross-setting and quality measure'' is corrected to 
read ``cross-setting quality measure''.
    24. On page 57222--
    a. Second column, first full paragraph, lines 11 and 12, the phrase 
``however, the adoption of the measure'' is corrected to read 
``however, the measure''.
    b. Third column, first full paragraph--
    (1) Line 4, the word ``facilities'' is corrected to read 
``facility's''.
    (2) Line 22, the phrase ``collected admission'' is corrected to 
read ``collected at admission''.
    25. On page 57223--
    a. First column, second paragraph--
    (1) Lines 1 through 4, the phrase ``Since the time of the MAP 
consideration, with our measure contractor, we tested this measure in a 
pilot test involving twelve PAC facilities,'' is corrected to read 
``Since the time of the NQF-convened MAP consideration we have further 
tested this measure in a pilot test involving twelve PAC facilities''.
    (2) Lines 7 and 8, the phrase, ``record collection system'' is 
corrected to read ``records system''.
    b. Second column, third full paragraph, lines 9 and 10, the phrase 
``PAC facility.'' is corrected to read ``PAC facility. We appreciate 
MedPAC and other commenters' recommendation for a quality measure that 
assesses post-discharge medication communication with primary care 
providers for patients discharged to home.''

B. Correction of Errors in the Addendum

    1. On page 57278, third column, fifth full paragraph,
    a. Line 3, the figure ``0.999079'' is corrected to read 
``0.999078''.
    b. Line 9, the figure ``0.999079'' is corrected to read 
``0.999078''.
    2. On page 57279--
    a. Second column, first full paragraph, line 9, the figure 
``1.000209'' is corrected to read ``1.00021''.
    b. Third column, third full paragraph, line 12, the figure 
``0.988224'' is corrected to read ``0.988136''.
    3. On page 57280--
    a. First column, fifth full paragraph, line 4, the figure 
``0.993200'' is corrected to read ``0.991987''.
    b. Third column, second full paragraph,
    (1) Line 3, the figure ``0.999994'' is corrected to read 
``0.999997''.
    (2) Line 6, the figure ``0.999994'' is corrected to read 
``0.999997''.
    4. On page 57286--
    a. Second column, last paragraph--
    (1) Line 6, the figure ``$23,570'' is corrected to read 
``$23,573''.
    (2) Line 8, the figure ``$83,347,416,971'' is corrected to read 
``$83,364,479,923''.
    (3) Line 9, the figure ``$4,479,256,519'' is corrected to read 
``$4,479,256,368''.
    b. Third column--
    (1) First partial paragraph, line 11, the figure ``$23,570'' is 
corrected to read ``$23,573''.
    (2) Following the third full paragraph, the untitled table is 
corrected to read as follows:

------------------------------------------------------------------------
                                             Operating
                                           standardized       Capital
                                              amounts      Federal rate
------------------------------------------------------------------------
National................................       0.948998        0.938602
------------------------------------------------------------------------

    5. On page 57288, middle of the page, the table titled ``CHANGE OF 
FY 2016 STANDARDIZED AMOUNTS TO THE FY 2017 STANDARDIZED AMOUNTS'', is 
corrected to read as follows:

                   Change of FY 2016 Standardized Amounts to the FY 2017 Standardized Amounts
----------------------------------------------------------------------------------------------------------------
                                                      Hospital submitted   Hospital did NOT    Hospital did NOT
                                  Hospital submitted   quality data and     submit quality      submit quality
                                   quality data and        is NOT a          data and is a     data and is NOT a
                                    is a meaningful     meaningful EHR      meaningful EHR      meaningful EHR
                                       EHR user              user                user                user
----------------------------------------------------------------------------------------------------------------
FY 2016 Base Rate after           If Wage Index is    If Wage Index is    If Wage Index is    If Wage Index is
 removing:                         Greater Than        Greater Than        Greater Than        Greater Than
1. FY 2016 Geographic              1.0000:             1.0000:             1.0000:             1.0000:
 Reclassification Budget          Labor (69.6         Labor (69.6         Labor (69.6         Labor (69.6
 Neutrality (0.988169).            percent):           percent):           percent):           percent):
2. FY 2016 Rural Community         $4,394.09..         $4,394.09..         $4,394.09..         $4,394.09.
 Hospital Demonstration Program   Nonlabor (30.4      Nonlabor (30.4      Nonlabor (30.4      Nonlabor (30.4
 Budget Neutrality (0.999837).     percent):           percent):           percent):           percent):
                                   $1,919.26..         $1,919.26..         $1,919.26..         $1,919.26.

[[Page 68953]]

 
3. Cumulative FY 2008, FY 2009,   If Wage Index is    If Wage Index is    If Wage Index is    If Wage Index is
 FY 2012, FY 2013, FY 2014, FY     less Than or        less Than or        less Than or        less Than or
 2015 and FY 2016 Documentation    Equal to 1.0000:    Equal to 1.0000:    Equal to 1.0000:    Equal to 1.0000:
 and Coding Adjustments as        Labor (62           Labor (62           Labor (62           Labor (62
 Required under Sections           percent):           percent):           percent):           percent):
 7(b)(1)(A) and 7(b)(1)(B) of      $3,914.28..         $3,914.28..         $3,914.28..         $3,914.28.
 Public Law 110-90 and            Nonlabor (38        Nonlabor (38        Nonlabor (38        Nonlabor (38
 Documentation and Coding          percent):           percent):           percent):           percent):
 Recoupment Adjustment as          $2,399.07..         $2,399.07..         $2,399.07..         $2,399.07.
 required under Section 631 of
 the American Taxpayer Relief
 Act of 2012 (0.9255).
4. FY 2016 Operating Outlier
 Offset (0.948998).
5. FY 2016 New Labor Market
 Delineation Wage Index
 Transition Budget Neutrality
 Factor (0.999998).
6. FY 2017 2-Midnight Rule
 Permanent Adjustment (1/0.998).
FY 2017 Update Factor...........  1.0165............  0.99625...........  1.00975...........  0.9895.
FY 2017 MS[dash]DRG               0.999078..........  0.999078..........  0.999078..........  0.999078.
 Recalibration Budget Neutrality
 Factor.
FY 2017 Wage Index Budget         1.00021...........  1.00021...........  1.00021...........  1.00021.
 Neutrality Factor.
FY 2017 Reclassification Budget   0.988136..........  0.988136..........  0.988136..........  0.988136.
 Neutrality Factor.
FY 2017 Operating Outlier Factor  0.948998..........  0.948998..........  0.948998..........  0.98998.
Cumulative Factor: FY 2008, FY    0.9118............  0.9118............  0.9118............  0.9118.
 2009, FY 2012, FY 2013, FY
 2014, FY 2015, FY 2016 and FY
 2017 Documentation and Coding
 Adjustment as Required under
 Sections 7(b)(1)(A) and
 7(b)(1)(B) of Public Law 110-90
 and Documentation and Coding
 Recoupment Adjustment as
 required under Section 631 of
 the American Taxpayer Relief
 Act of 2012.
FY 2017 New Labor Market          0.999997..........  0.999997..........  0.999997..........  0.999997.
 Delineation Wage Index 3-Year
 Hold Harmless Transition Budget
 Neutrality Factor.
FY 2017 2[dash]Midnight Rule One- 1.006.............  1.006.............  1.006.............  1.006.
 Time Prospective Increase.
National Standardized Amount for  Labor: $3,839.23..  Labor: $3,762.75..  Labor: $3,8143.74.  Labor: $3,737.25.
 FY 2017 if Wage Index is         Nonlabor:           Nonlabor:           Nonlabor:           Nonlabor:
 Greater Than 1.0000; Labor/Non-   $1,676.91.          $1,643.50.          $1,665.77.          $1,632.37.
 Labor Share Percentage (69.6/
 30.4).

[[Page 68954]]

 
National Standardized Amount for  Labor: $3,420.01..  Labor: $3,351.88..  Labor: $3,397.30..  Labor: $3,329.16.
 FY 2017 if Wage Index is less    Nonlabor:           Nonlabor:           Nonlabor:           Nonlabor:
 Than or Equal to 1.0000; Labor/   $2,096.13.          $2,054.37.          $2,082.21.          $2,040.46.
 Non-Labor Share Percentage (62/
 38).
----------------------------------------------------------------------------------------------------------------

    6. On page 57291--
    a. First column, second full paragraph, line 15, the figure 
``0.999079'' is corrected to read ``0.999078''.
    b. Third column, first full paragraph line 6, the figure ``1.84'' 
is corrected to read ``1.83''.
    7. On page 57293, third column--
    a. First partial paragraph--
    (1) Line 1, the figure ``0.9995'' is corrected to read ``0.9994''.
    (2) Line 4, ``0.9855'' is corrected to read ``0.9854''.
    b. First full paragraph, line 16, the figure ``0.9851'' is 
corrected to read ``0.9850''.
    c. Last paragraph--
    (1) Line 2, the figure ``0.9991''is corrected to read ``0.9990''.
    (2) Line 4, ``0.9995'' is corrected to read ``0.9994''.
    8. On page 57294--
    a. Top of the page--
    (1) Second column--
    (a) First full paragraph, line 17, the figure ``$446.81'' is 
corrected to read ``$446.79''.
    (b) Second bulleted paragraph, line 6, the figure ``0.9991'' is 
corrected to read ``0.9990''.
    (2) Third column, second full paragraph--
    (a) Line 13, the figure, ``0.09'' is corrected to read ``0.10''.
    (b) Line 26, the figure, ``1.84'' is corrected to read ``1.832''.
    b. Bottom of the page, the table titled ``COMPARISON OF FACTORS AND 
ADJUSTMENTS: FY 2016 CAPITAL FEDERAL RATE AND FY 2017 CAPITAL FEDERAL 
RATE'' is corrected to read as follows:

      Comparison of Factors and Adjustments: FY 2016 Capital Federal Rate and FY 2017 Capital Federal Rate
----------------------------------------------------------------------------------------------------------------
                                                                                                  Percent change
                                                      FY 2016         FY 2017         Change            \3\
----------------------------------------------------------------------------------------------------------------
Update Factor \1\...............................          1.0130           1.009           1.009             0.9
GAF/DRG Adjustment Factor \1\...................          0.9976          0.9990          0.9990           -0.10
Outlier Adjustment Factor \2\...................          0.9365          0.9386          1.0022            0.22
Permanent 2-midnight Policy Adjustment Factor...             N/A           1.002           1.002             0.2
One-Time 2-midnight Policy Adjustment Factor....             N/A           1.006           1.006             0.6
Capital Federal Rate............................         $438.75         $446.79          1.0183            1.83
----------------------------------------------------------------------------------------------------------------
\1\ The update factor and the GAF/DRG budget neutrality adjustment factors are built permanently into the
  capital Federal rates. Thus, for example, the incremental change from FY 2016 to FY 2017 resulting from the
  application of the 0.9990 GAF/DRG budget neutrality adjustment factor for FY 2017 is a net change of 0.9990
  (or -0.10 percent).
\2\ The outlier reduction factor is not built permanently into the capital Federal rate; that is, the factor is
  not applied cumulatively in determining the capital Federal rate. Thus, for example, the net change resulting
  from the application of the FY 2017 outlier adjustment factor is 0.9386/0.9365, or 1.0022 (or 0.22 percent).
\3\ Sum of individual changes may not match percent change in capital rate due to rounding.

    9. On page 57295--
    a. The top of the page, the table titled ``COMPARISON OF FACTORS 
AND ADJUSTMENTS: PROPOSED FY 2017 CAPITAL FEDERAL RATE AND FINAL FY 
2017 CAPITAL FEDERAL RATE'' is corrected to read as follows:

 Comparison of Factors and Adjustments: Proposed FY 2017 Capital Federal Rate and Final FY 2017 Capital Federal
                                                      Rate
----------------------------------------------------------------------------------------------------------------
                                                    Proposed FY
                                                       2017        Final FY 2017      Change      Percent change
----------------------------------------------------------------------------------------------------------------
Update Factor \1\...............................          1.0090          1.0090          1.0000            0.00
GAF/DRG Adjustment Factor \1\...................          0.9993          0.9990          0.9997           -0.03
Outlier Adjustment Factor \2\...................          0.9374          0.9386          1.0013            0.13
Permanent 2-midnight Policy Adjustment Factor...           1.002           1.002           1.000            0.00
One-Time 2-midnight Policy Adjustment Factor....           1.006           1.006           1.000            0.00
Capital Federal Rate............................         $446.35         $446.79          1.0010            0.10
----------------------------------------------------------------------------------------------------------------

    b. Lower three-fourths of the page, first column, second paragraph, 
line 21, the figure, ``$23,570.'' is corrected to read ``$23,573.''
    10. On page 57307, second column, first full paragraph--
    a. Line 15, the figure ``$23,570'' is corrected to read 
``$23,573''.
    b. Line 35, the figure ``$23,570'' is corrected to read 
``$23,573''.
    11. On page 57312--
    a. Top of the page--

[[Page 68955]]

    (1) Table 1A titled ``NATIONAL ADJUSTED OPERATING STANDARDIZED 
AMOUNTS, LABOR/NONLABOR (69.6 PERCENT LABOR SHARE/30.4 PERCENT NONLABOR 
SHARE IF WAGE INDEX IS GREATER THAN 1)--FY 2017'' is corrected to read 
as follows:

    Table 1A--National Adjusted Operating Standardized Amounts, Labor/Nonlabor (69.6 Percent Labor Share/30.4 Percent Nonlabor Share if Wage Index Is
                                                                Greater Than 1)--FY 2017
--------------------------------------------------------------------------------------------------------------------------------------------------------
Hospital submitted quality data and is   Hospital submitted quality data and  Hospital did NOT submit quality data  Hospital did NOT submit quality data
 a meaningful EHR user  (update = 1.65      is NOT a meaningful EHR user          and is a meaningful EHR user        and is NOT a meaningful EHR user
               percent)                       (update = -0.375 percent)             (update = 0.975 percent)              (update = -1.05 percent)
--------------------------------------------------------------------------------------------------------------------------------------------------------
       Labor             Nonlabor             Labor             Nonlabor            Labor             Nonlabor            Labor             Nonlabor
--------------------------------------------------------------------------------------------------------------------------------------------------------
       $3,839.23           $1,677.91          $3,762.75          $1,643.50          $3,813.74          $1,665.77          $3,737.25          $1,632.37
--------------------------------------------------------------------------------------------------------------------------------------------------------

    (2) Table 1B titled ``NATIONAL ADJUSTED OPERATING STANDARDIZED 
AMOUNTS, LABOR/NONLABOR (62 PERCENT LABOR SHARE/38 PERCENT NONLABOR 
SHARE IF WAGE INDEX IS LESS THAN OR EQUAL TO 1)--FY 2017'' is corrected 
to read as follows:

 Table 1B--National Adjusted Operating Standardized Amounts, Labor/Nonlabor (62 Percent Labor Share/38 Percent Nonlabor Share if Wage Index Is Less Than
                                                                 or Equal to 1)--FY 2017
--------------------------------------------------------------------------------------------------------------------------------------------------------
Hospital submitted quality data and is   Hospital submitted quality data and  Hospital did NOT submit quality data  Hospital did NOT submit quality data
 a meaningful EHR user (update = 1.65   is NOT a meaningful EHR user (update  and is a meaningful EHR user (update    and is NOT a meaningful EHR user
               percent)                           = -0.375 percent)                     = 0.975 percent)                  (update = -1.05 percent)
--------------------------------------------------------------------------------------------------------------------------------------------------------
       Labor             Nonlabor             Labor             Nonlabor            Labor             Nonlabor            Labor             Nonlabor
--------------------------------------------------------------------------------------------------------------------------------------------------------
       $3,420.01           $2,096.13          $3,351.88          $2,054.37          $3,397.30          $2,082.21          $3,329.16          $2,040.46
--------------------------------------------------------------------------------------------------------------------------------------------------------

    b. Middle of the page--
    (1) Table 1C titled ``ADJUSTED OPERATING STANDARDIZED AMOUNTS FOR 
HOSPITALS IN PUERTO RICO, LABOR/NONLABOR (NATIONAL: 62 PERCENT LABOR 
SHARE/38 PERCENT NONLABOR SHARE BECAUSE WAGE INDEX IS LESS THAN OR 
EQUAL TO 1);--FY 2017'' is corrected to read as follows:

  Table 1C--Adjusted Operating Standardized Amounts for Hospitals in Puerto Rico, Labor/Nonlabor (National: 62
      Percent Labor Share/38 Percent Nonlabor Share Because Wage Index Is Less Than or Equal to 1)--FY 2017
----------------------------------------------------------------------------------------------------------------
                                       Rates if wage index is greater than 1    Rates if wage index is less than
                                   --------------------------------------------           or equal to 1
        Standardized amount                                                    ---------------------------------
                                            Labor               Nonlabor             Labor           Nonlabor
----------------------------------------------------------------------------------------------------------------
National \1\......................  Not Applicable......  Not Applicable......       $3,420.01        $2,096.13
----------------------------------------------------------------------------------------------------------------
\1\ For FY 2017, there are no CBSAs in Puerto Rico with a national wage index greater than 1.

    (2) Table 1D titled ``CAPITAL STANDARD FEDERAL PAYMENT RATE--FY 
2017'' is corrected as follows:

        Table 1D--Capital Standard Federal Payment Rate--FY 2017
------------------------------------------------------------------------
                                                               Rate
------------------------------------------------------------------------
National...............................................         $446.79
------------------------------------------------------------------------

C. Corrections of Errors in the Appendices

    1. On page 57312, bottom of the page, third column, first partial 
paragraph,
    a. Line 8, the figure ``$987'' is corrected to read ``$990''.
    b. Line 10, the figure ``$66'' is corrected to read ``$72''.
    2. On page 57315, upper three-fourths of the page--
    a. Second column, third full paragraph,
    (1) Line 7, the figure ``1,380'' is corrected to read ``1,369''.
    (2) Line 9, the figure ``1,135'' is corrected to read ``1,146''.
    b. Third column, first full paragraph, line 13--
    (1) The figure ``1,372'' is corrected to read ``1,369''.
    (2) The figure ``1,150'' is corrected to read ``1,153''.
    3. On pages 57315 through 57317, the table titled ``TABLE I--IMPACT 
ANALYSIS OF CHANGES TO THE IPPS FOR OPERATING COSTS FOR FY 2017'' is 
corrected to read as follows:

[[Page 68956]]



                                                         Table I--Impact Analysis of Changes to the IPPS for Operating Costs for FY 2017
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
                                                                                                  FY 2017      FY 2017 Wage                         Rural and
                                                                                                weights and   data under new                      imputed floor
                                                                               Hospital rate    DRG changes        CBSA                               with       Application of the
                                                                  Number of     update and         with        designations     FY 2017 MGCRB    application of     frontier wage    All FY 2017
                                                                  hospitals    documentation  application of       with       reclassifications  national rural       index and        changes
                                                                     \1\        and coding     recalibration  application of                       and imputed   out[dash]migration
                                                                                adjustment        budget        wage budget                       floor budget       adjustment
                                                                                                neutrality      neutrality                         neutrality
                                                                 ...........         (1) \2\         (2) \3\         (3) \4\         (4) \5\            (5) \6\           (6) \7\        (7) \8\
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
All Hospitals..................................................        3,330             1.0             0.0             0.0             0.0                0.0               0.1            0.9
By Geographic Location:
Urban hospitals................................................        2,515             0.9             0.0             0.0            -0.1                0.0               0.1            0.9
    Large urban areas..........................................        1,369             0.9             0.1             0.0            -0.3               -0.1               0.0            0.9
    Other urban areas..........................................        1,146             1.0             0.0             0.0             0.1                0.2               0.2            1.0
Rural hospitals................................................          815             1.6            -0.4             0.1             1.3               -0.2               0.1            1.2
Bed Size (Urban):
    0-99 beds..................................................          659             0.9            -0.2             0.2            -0.5                0.1               0.2            0.9
    100-199 beds...............................................          767             1.0            -0.1             0.0             0.0                0.3               0.2            0.7
    200-299 beds...............................................          446             1.0            -0.1            -0.1             0.1                0.0               0.1            0.8
    300-499 beds...............................................          431             1.0             0.1             0.0            -0.2                0.1               0.2            0.9
    500 or more beds...........................................          212             0.9             0.2             0.0            -0.2               -0.2               0.0            1.1
Bed Size (Rural):
    0-49 beds..................................................          317             1.5            -0.5             0.1             0.2               -0.2               0.3            1.0
    50-99 beds.................................................          292             1.8            -0.6             0.1             0.8               -0.2               0.1            1.2
    100-149 beds...............................................          120             1.6            -0.4             0.0             1.5               -0.2               0.2            1.0
    150-199 beds...............................................           46             1.7            -0.2             0.2             1.7               -0.3               0.0            1.3
    200 or more beds...........................................           40             1.6            -0.1             0.2             2.5               -0.3               0.0            1.5
Urban by Region:
    New England................................................          116             0.8             0.0            -0.5             1.1                0.9               0.1           -0.4
    Middle Atlantic............................................          315             0.9             0.1            -0.1             0.8               -0.2               0.1            0.9
    South Atlantic.............................................          407             1.0             0.0            -0.2            -0.5               -0.3               0.1            0.9
    East North Central.........................................          390             0.9             0.0            -0.1            -0.2               -0.4               0.0            1.0
    East South Central.........................................          147             1.0             0.0            -0.1            -0.4               -0.3               0.0            1.2
    West North Central.........................................          163             1.1             0.1            -0.1            -0.8               -0.4               0.7            1.0
    West South Central.........................................          385             0.9             0.0             0.2            -0.5               -0.4               0.0            1.2
    Mountain...................................................          163             1.1             0.0             0.1            -0.3                1.2               0.2            2.2
    Pacific....................................................          378             0.9             0.0             0.4            -0.4                1.0               0.1            0.5
    Puerto Rico................................................           51             0.9             0.1            -0.5            -1.0                0.1               0.1            0.3
Rural by Region:
    New England................................................           21             1.3            -0.2             0.3             1.4               -0.3               0.2            1.6
    Middle Atlantic............................................           54             1.7            -0.4             0.1             0.8               -0.2               0.1            1.6
    South Atlantic.............................................          128             1.7            -0.5            -0.1             2.3               -0.3               0.1            1.0
    East North Central.........................................          115             1.7            -0.4             0.0             1.0               -0.2               0.1            1.2
    East South Central.........................................          155             1.1            -0.3             0.4             2.2               -0.4               0.1            1.0
    West North Central.........................................           98             2.2            -0.4             0.0             0.2               -0.1               0.3            1.5
    West South Central.........................................          160             1.5            -0.4             0.4             1.3               -0.3               0.1            1.2
    Mountain...................................................           60             1.7            -0.4             0.1             0.2               -0.1               0.2            1.3
    Pacific....................................................           24             1.9            -0.4            -0.3             1.3               -0.1               0.0            1.3
By Payment Classification:                                                 0             0.0             0.0             0.0             0.0                0.0               0.0            0.0
    Urban hospitals............................................        2,522             0.9             0.0             0.0            -0.1                0.0               0.1            0.9
    Large urban areas..........................................        1,369             0.9             0.1             0.0            -0.3               -0.1               0.0            0.9
    Other urban areas..........................................        1,153             1.0             0.0             0.0             0.1                0.2               0.2            1.0
    Rural areas................................................          808             1.6            -0.4             0.1             1.4               -0.2               0.1            1.2
Teaching Status:
    Nonteaching................................................        2,266             1.1            -0.2             0.0             0.1                0.2               0.1            0.8
    Fewer than 100 residents...................................          815             1.0             0.0             0.0            -0.1                0.0               0.2            0.9
    100 or more residents......................................          249             0.9             0.2             0.0            -0.1               -0.2               0.0            1.1
Urban DSH:
    Non-DSH....................................................          589             0.9            -0.1            -0.2             0.2                0.0               0.2            0.8
    100 or more beds...........................................        1,642             0.9             0.1             0.0            -0.1                0.0               0.1            0.9
    Less than 100 beds.........................................          363             1.0            -0.3             0.0            -0.5                0.1               0.1            0.7
Rural DSH:
    SCH........................................................          240             2.0            -0.6             0.1             0.1               -0.1               0.0            1.4
    RRC........................................................          325             1.7            -0.3             0.1             1.8               -0.2               0.0            1.3
    100 or more beds...........................................           29             0.9            -0.4             0.1             2.9               -0.4               0.1            0.5
    Less than 100 beds.........................................          142             0.8            -0.4             0.2             1.3               -0.4               0.7            0.2
Urban teaching and DSH:
    Both teaching and DSH......................................          898             0.9             0.1             0.0            -0.2               -0.1               0.1            1.0
    Teaching and no DSH........................................          109             0.9             0.0            -0.1             1.1                0.0               0.0            0.7
    No teaching and DSH........................................        1,107             1.0            -0.1             0.1            -0.1                0.3               0.1            0.8
    No teaching and no DSH.....................................          408             0.9            -0.1            -0.2            -0.4                0.0               0.2            0.9
Special Hospital Types:
    RRC........................................................          189             0.8            -0.1             0.1             1.9                0.0               0.5            1.2
    SCH........................................................          324             2.1            -0.3            -0.1             0.0                0.0               0.0            1.7
    MDH........................................................          148             1.7            -0.6             0.0             0.6               -0.1               0.1            1.3
    SCH and RRC................................................          126             2.2            -0.3             0.1             0.4               -0.1               0.0            1.8
    MDH and RRC................................................           12             2.1            -0.6            -0.1             1.3               -0.2               0.0            2.2
Type of Ownership:
    Voluntary..................................................        1,927             1.0             0.0             0.0             0.0                0.0               0.1            0.9
    Proprietary................................................          881             1.0             0.0             0.1             0.0                0.0               0.1            0.9
    Government.................................................          522             1.0             0.0            -0.1            -0.2                0.0               0.1            0.9

[[Page 68957]]

 
Medicare Utilization as a Percent of Inpatient Days:
    0-25.......................................................          523             0.8             0.1             0.1            -0.3                0.2               0.0            1.1
    25-50......................................................        2,122             1.0             0.0             0.0             0.0               -0.1               0.1            0.9
    50-65......................................................          545             1.2            -0.2            -0.1             0.6                0.0               0.1            0.9
    Over 65....................................................           89             1.2            -0.3             0.3            -0.4                0.2               0.2            1.0
FY 2017 Reclassifications by the Medicare Geographic
 Classification Review Board:
    All Reclassified Hospitals.................................          791             1.1            -0.1             0.0             2.3               -0.2               0.0            0.9
    Non-Reclassified Hospitals.................................        2,539             1.0             0.0             0.0            -0.8                0.1               0.1            0.9
    Urban Hospitals Reclassified...............................          532             1.0             0.0            -0.1             2.3               -0.1               0.0            0.9
    Urban Nonreclassified Hospitals............................        1,936             0.9             0.1             0.0            -0.9                0.1               0.1            0.9
    Rural Hospitals Reclassified Full Year.....................          277             1.7            -0.3             0.1             2.2               -0.2               0.0            1.3
    Rural Nonreclassified Hospitals Full Year..................          489             1.6            -0.4             0.2            -0.2               -0.2               0.3            1.1
    All Section 401 Reclassified Hospitals:....................           72             1.7            -0.2             0.0             0.3               -0.1               0.9            1.5
    Other Reclassified Hospitals (Section 1886(d)(8)(B)).......           48             1.2            -0.4             0.1             3.1               -0.4               0.0            0.8
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
\1\ Because data necessary to classify some hospitals by category were missing, the total number of hospitals in each category may not equal the national total. Discharge data are from FY
  2015, and hospital cost report data are from reporting periods beginning in FY 2012 and FY 2013.
\2\ This column displays the payment impact of the hospital rate update and other adjustments including the 1.65 percent adjustment to the national standardized amount and hospital-specific
  rate (the estimated 2.7 percent market basket update reduced by 0.3 percentage points for the multifactor productivity adjustment and the 0.75 percentage point reduction under the Affordable
  Care Act), the -1.5 percent documentation and coding adjustment to the national standardized amount and the adjustment of (1/0.998) to permanently remove the -0.2 percent reduction, and the
  1.006 temporary adjustment to address the effects of the 0.2 percent reduction in effect for FYs 2014 through 2016 related to the 2-midnight policy.
\3\ This column displays the payment impact of the changes to the Version 34 GROUPER, the changes to the relative weights and the recalibration of the MS DRG weights based on FY 2015 MedPAR
  data in accordance with section 1886(d)(4)(C)(iii) of the Act. This column displays the application of the recalibration budget neutrality factor of 0.999078 in accordance with section
  1886(d)(4)(C)(iii) of the Act.
\4\ This column displays the payment impact of the update to wage index data using FY 2013 cost report data and the OMB labor market area delineations based on 2010 Decennial Census data. This
  column displays the payment impact of the application of the wage budget neutrality factor, which is calculated separately from the recalibration budget neutrality factor, and is calculated
  in accordance with section 1886(d)(3)(E)(i) of the Act. The wage budget neutrality factor is 1.000210.
\5\ Shown here are the effects of geographic reclassifications by the Medicare Geographic Classification Review Board (MGCRB) along with the effects of the continued implementation of the new
  OMB labor market area delineations on these reclassifications. The effects demonstrate the FY 2017 payment impact of going from no reclassifications to the reclassifications scheduled to be
  in effect for FY 2017. Reclassification for prior years has no bearing on the payment impacts shown here. This column reflects the geographic budget neutrality factor of 0.988136.
\6\ This column displays the effects of the rural and imputed floor based on the continued implementation of the new OMB labor market area delineations. The Affordable Care Act requires the
  rural floor budget neutrality adjustment to be 100 percent national level adjustment. The rural floor budget neutrality factor (which includes the imputed floor) applied to the wage index is
  0.991987. This column also shows the effect of the 3-year transition for hospitals that were located in urban counties that became rural under the new OMB delineations or hospitals deemed
  urban where the urban area became rural under the new OMB delineations, with a budget neutrality factor of 0.999997.
\7\ This column shows the combined impact of the policy required under section 10324 of the Affordable Care Act that hospitals located in frontier States have a wage index no less than 1.0 and
  of section 1886(d)(13) of the Act, as added by section 505 of Public Law 108-173, which provides for an increase in a hospital's wage index if a threshold percentage of residents of the
  county where the hospital is located commute to work at hospitals in counties with higher wage indexes. These are not budget neutral policies.
\8\ This column shows the estimated change in payments from FY 2016 to FY 2017.

    4. On page 57319,
    a. First column, second full paragraph,
    (1) Line 6, the figure ``0.988224'' is corrected to read 
``0.988136''.
    (2) Line 13, the figure ``1.4'' is corrected to read ``1.3''.
    b. Second column--
    (1) First full paragraph--
    (a) Line 8, the figure ``0.9930'' is corrected to read 
``0.991987''.
    (b) Line 9, the figure ``0.7'' is corrected to read ``0.8''.
    (2) Third full paragraph--
    (a) Line 1, the figure ``397'' is corrected to read ``436''.
    (b) Line 5--
    (1) The figure ``0.9930'' is corrected to read ``0.991987''.
    (2) The figure ``0.7'' is corrected to read ``0.8''.
    (c) Line 23, the figure ``1.0'' is corrected to read ``0.9''.
    (d) Line 31, the figure ``$24'' is corrected to read ``$22''.
    (e) Line 33, the figure ``0.7'' is corrected to read ``0.6''.
    c. Third column--
    (1) First full paragraph,
    (a) Line 7, the figure ``$10'' is corrected to read ``$6.4''.
    (b) Line 18, the figure ``$17'' is corrected to read ``$18''.
    (2) Second full paragraph, line 28, the figure ``0.999994'' is 
corrected to read ``0.999997''.
    5. On page 57320, the table titled ``FY 2017 IPPS Estimated 
Payments Due to Rural Floor and Imputed Floor with National Budget 
Neutrality'' is corrected to read as follows:

[[Page 68958]]



         FY 2017 IPPS Estimated Payments Due to Rural and Imputed Floor With National Budget Neutrality
----------------------------------------------------------------------------------------------------------------
                                                                            Percent change in
                                                             Number of       payments due to
                                                           hospitals that     application of
                State                     Number of       will receive the   rural floor and    Difference (in $
                                          hospitals        rural floor or     imputed floor        millions)
                                                           imputed floor       with budget
                                                                                neutrality
                                                    (1)                (2)                (3)                (4)
----------------------------------------------------------------------------------------------------------------
Alabama.............................                 83                  6               -0.3                 -6
Alaska..............................                  6                  4                2.1                  4
Arizona.............................                 57                 46                3.5                 63
Arkansas............................                 44                  0               -0.4                 -4
California..........................                301                186                1.3                131
Colorado............................                 48                  3                0.2                  3
Connecticut.........................                 31                  8                0.2                  4
Delaware............................                  6                  2                  0                  0
Washington, DC......................                  7                  0               -0.4                 -1
Florida.............................                171                 16               -0.3                 -2
Georgia.............................                105                  0               -0.4                -18
Hawaii..............................                 12                  0               -0.3                -10
Idaho...............................                 14                  0               -0.3                 -1
Illinois............................                126                  3               -0.4                 -1
Indiana.............................                 89                  0               -0.4                -19
Iowa................................                 35                  0               -0.4                -11
Kansas..............................                 53                  0               -0.3                 -4
Kentucky............................                 65                  0               -0.4                 -3
Louisiana...........................                 95                  2               -0.4                 -6
Maine...............................                 18                  0               -0.4                 -5
Massachusetts.......................                 58                 15                0.6                 -2
Michigan............................                 95                  0               -0.4                 22
Minnesota...........................                 49                  0               -0.3                -18
Mississippi.........................                 62                  0               -0.4                 -6
Missouri............................                 74                  2               -0.3                 -4
Montana.............................                 12                  4                0.3                 -8
Nebraska............................                 26                  0               -0.3                  1
Nevada..............................                 24                  3               -0.2                 -2
New Hampshire.......................                 13                  9                2.2                 -2
New Jersey..........................                 64                 18                0.2                 11
New Mexico..........................                 25                  0               -0.3                  6
New York............................                154                 21               -0.3                 -1
North Carolina......................                 84                  1               -0.4                -20
North Dakota........................                  6                  1               -0.3                -12
Ohio................................                130                 10               -0.4                 -1
Oklahoma............................                 86                  2               -0.3                -13
Oregon..............................                 34                  2               -0.4                 -4
Pennsylvania........................                151                  5               -0.4                 -4
Puerto Rico.........................                 51                 12                0.1                -20
Rhode Island........................                 11                 10                4.7                  0
South Carolina......................                 57                  5               -0.1                 18
South Dakota........................                 18                  0               -0.2                 -2
Tennessee...........................                 92                 20               -0.3                 -1
Texas...............................                320                  3               -0.4                 -7
Utah................................                 33                  1               -0.3                -26
Vermont.............................                  6                  0               -0.2                 -2
Virginia............................                 76                  1               -0.3                 -1
Washington..........................                 49                  6               -0.1                 -8
West Virginia.......................                 29                  3               -0.2                 -1
Wisconsin...........................                 65                  6               -0.3                 -5
Wyoming.............................                 10                  0               -0.1                  0
----------------------------------------------------------------------------------------------------------------

    6. On page 57321, second column, first partial paragraph --
    a Line 1, the figure ``277'' is corrected to read ``278''.
    b Line 7, the figure ``1.0'' is corrected to read ``0.9''.
    7. On pages 57321 through 57323, the table titled ``TABLE II--
IMPACT ANALYSIS OF CHANGES FOR FY 2017 ACUTE CARE HOSPITAL OPERATING 
PROSPECTIVE PAYMENT SYSTEM [PAYMENTS PER DISCHARGE]'' is corrected to 
read as follows:

[[Page 68959]]



    Table II--Impact Analysis of Changes for FY 2017 Acute Care Hospital Operating Prospective Payment System
                                            [Payments per discharge]
----------------------------------------------------------------------------------------------------------------
                                                                     Estimated       Estimated
                                                     Number of      average FY      average FY        FY 2017
                                                     hospitals     2016 payment    2017 payment       changes
                                                                   per discharge   per discharge
                                                             (1)             (2)             (3)             (4)
----------------------------------------------------------------------------------------------------------------
All Hospitals...................................           3,330         $11,542         $11,649             0.9
By Geographic Location:
    Urban hospitals.............................           2,515          11,890          11,997             0.9
    Large urban areas...........................           1,369          12,690          12,799             0.9
    Other urban areas...........................           1,146          10,946          11,051             1.0
    Rural hospitals.............................             815           8,602           8,707             1.2
Bed Size (Urban):
    0-99 beds...................................             659           9,392           9,478             0.9
    100-199 beds................................             767          10,050          10,117             0.7
    200-299 beds................................             446          10,757          10,840             0.8
    300-499 beds................................             431          12,092          12,202             0.9
    500 or more beds............................             212          14,613          14,772             1.1
Bed Size (Rural):
    0-49 beds...................................             317           7,208           7,279             1.0
    50-99 beds..................................             292           8,192           8,292             1.2
    100-149 beds................................             120           8,434           8,519             1.0
    150-199 beds................................              46           9,243           9,367             1.3
    200 or more beds............................              40          10,171          10,320             1.5
Urban by Region:
    New England.................................             116          12,957          12,901            -0.4
    Middle Atlantic.............................             315          13,471          13,593             0.9
    South Atlantic..............................             407          10,498          10,595             0.9
    East North Central..........................             390          11,190          11,303             1.0
    East South Central..........................             147          10,042          10,160             1.2
    West North Central..........................             163          11,578          11,692             1.0
    West South Central..........................             385          10,693          10,820             1.2
    Mountain....................................             163          12,279          12,549             2.2
    Pacific.....................................             378          15,372          15,452             0.5
    Puerto Rico.................................              51           8,491           8,513             0.3
Rural by Region:
    New England.................................              21          11,818          12,009             1.6
    Middle Atlantic.............................              54           8,655           8,791             1.6
    South Atlantic..............................             128           8,043           8,122             1.0
    East North Central..........................             115           8,918           9,023             1.2
    East South Central..........................             155           7,639           7,716             1.0
    West North Central..........................              98           9,420           9,560             1.5
    West South Central..........................             160           7,243           7,328             1.2
    Mountain....................................              60          10,100          10,228             1.3
    Pacific.....................................              24          12,045          12,197             1.3
By Payment Classification:
    Urban hospitals.............................           2,522          11,886          11,993             0.9
    Large urban areas...........................           1,369          12,690          12,799             0.9
    Other urban areas...........................           1,153          10,940          11,046             1.0
    Rural areas.................................             808           8,602           8,706             1.2
Teaching Status:
    Nonteaching.................................           2,266           9,600           9,680             0.8
    Fewer than 100 residents....................             815          11,133          11,231             0.9
    100 or more residents.......................             249          16,764          16,949             1.1
Urban DSH:
    Non-DSH.....................................             589          10,055          10,140             0.8
    100 or more beds............................           1,642          12,247          12,359             0.9
    Less than 100 beds..........................             363           8,853           8,914             0.7
Rural DSH:
    SCH.........................................             240           8,584           8,702             1.4
    RRC.........................................             325           9,006           9,123             1.3
    100 or more beds............................              29           7,018           7,054             0.5
    Less than 100 beds..........................             142           6,823           6,838             0.2
Urban teaching and DSH:
    Both teaching and DSH.......................             898          13,344          13,474             1.0
    Teaching and no DSH.........................             109          11,361          11,442             0.7
    No teaching and DSH.........................           1,107          10,047          10,124             0.8
    No teaching and no DSH......................             408           9,455           9,539             0.9
Special Hospital Types:
    RRC.........................................             189           9,709           9,824             1.2

[[Page 68960]]

 
    SCH.........................................             324          10,344          10,516             1.7
    MDH.........................................             148           7,321           7,415             1.3
    SCH and RRC.................................             126          10,767          10,957             1.8
    MDH and RRC.................................              12           8,822           9,019             2.2
Type of Ownership:
    Voluntary...................................           1,927          11,719          11,830             0.9
    Proprietary.................................             881          10,130          10,218             0.9
    Government..................................             522          12,485          12,596             0.9
Medicare Utilization as a Percent of Inpatient
 Days:
    0-25........................................             523          14,996          15,160             1.1
    25-50.......................................           2,122          11,460          11,562             0.9
    50-65.......................................             545           9,343           9,431             0.9
    Over 65.....................................              89           6,948           7,019             1.0
FY 2017 Reclassifications by the Medicare
 Geographic Classification Review Board:
    All Reclassified Hospitals..................             791          11,399          11,507             0.9
    Non-Reclassified Hospitals..................           2,539          11,595          11,701             0.9
    Urban Hospitals Reclassified................             532          12,008          12,115             0.9
    Urban Nonreclassified Hospitals.............           1,936          11,849          11,955             0.9
    Rural Hospitals Reclassified Full Year......             277           8,984           9,101             1.3
    Rural Nonreclassified Hospitals Full Year...             489           8,173           8,266             1.1
    All Section 401 Reclassified Hospitals......              72          11,307          11,474             1.5
    Other Reclassified Hospitals (Section                     48           7,889           7,954             0.8
     1886(d)(8)(B)).............................
----------------------------------------------------------------------------------------------------------------

    7. On page 57324, top of the page, third column, last paragraph, 
line 1, the figure ``2,426'' is corrected to read ``2,419''.
    8. On pages 57324 and 57325, the table titled ``Modeled 
Disproportionate Share Hospital Payments for Estimated FY 2017 DSHs by 
Hospital Type: Model DSH $ (In Millions) From FY 2016 to FY 2017'' is 
corrected to read as follows:

  Modeled Disproportionate Share Hospital Payments for Estimated FY 2017 DSHS by Hospital Type: Model DSH $ (in
                                        Millions) From FY 2016 to FY 2017
----------------------------------------------------------------------------------------------------------------
                                                   FY 2016 final   FY 2017 final      Dollar
                                     Number of    rule estimated  rule estimated  difference: FY  Percent change
                                  DSHs (FY 2017)    DSH $ * (in     DSH $ * (in    2017- FY 2016        **
                                                     millions)       millions)     (in millions)
                                             (1)             (2)             (3)             (4)             (5)
----------------------------------------------------------------------------------------------------------------
Total...........................           2,419          $9,767          $9,551           -$216            -2.2
By Geographic Location:
    Urban Hospitals.............           1,921           9,294           9,106            -188            -2.0
        Large Urban Areas.......           1,045           5,885           5,765            -120            -2.0
        Other Urban Areas.......             876           3,408           3,341             -68            -2.0
    Rural Hospitals.............             498             473             445             -28            -5.9
Bed Size (Urban):
    0 to 99 Beds................             336             189             185              -4            -2.2
    100 to 249 Beds.............             837           2,211           2,154             -57            -2.6
    250+ Beds...................             748           6,894           6,767            -127            -1.8
Bed Size (Rural):
    0 to 99 Beds................             368             206             190             -16            -7.8
    100 to 249 Beds.............             116             211             199             -12            -5.5
    250+ Beds...................              14              56              56               0            -0.2
Urban by Region:
    East North Central..........             322           1,273           1,252             -22            -1.7
    East South Central..........             129             574             566              -8            -1.4
    Middle Atlantic.............             232           1,614           1,570             -44            -2.7
    Mountain....................             125             448             448               0            -0.1
    New England.................              90             394             385              -9            -2.4
    Pacific.....................             312           1,459           1,448             -10            -0.7
    Puerto Rico.................              41             104             116              12            11.3

[[Page 68961]]

 
    South Atlantic..............             314           1,777           1,721             -56            -3.2
    West North Central..........             104             451             439             -11            -2.5
    West South Central..........             252           1,200           1,161             -39            -3.2
Rural by Region:
    East North Central..........              64              49              44              -4            -8.3
    East South Central..........             141             149             141              -8            -5.3
    Middle Atlantic.............              28              34              33              -1            -2.4
    Mountain....................              21              16              15               0            -0.2
    New England.................              11              15              16               1             7.2
    Pacific.....................               7               9               7              -3           -27.4
    South Atlantic..............              86              98              92              -6            -6.4
    West North Central..........              31              20              19              -1            -6.3
    West South Central..........             109              83              78              -6            -7.0
By Payment Classification:
    Urban Hospitals.............           1,886           9,243           9,055            -188            -2.0
        Large Urban Areas.......           1,043           5,884           5,764            -120            -2.0
        Other Urban Areas.......             843           3,359           3,292             -68            -2.0
    Rural Hospitals.............             533             523             496             -28            -5.3
Teaching Status:
    Nonteaching.................           1,544           3,117           3,053             -64            -2.1
    Fewer than 100 residents....             637           3,213           3,132             -81            -2.5
    100 or more residents.......             238           3,437           3,366             -71            -2.1
Type of Ownership:
    Voluntary...................           1,405           6,044           5,913            -131            -2.2
    Proprietary.................             541           1,672           1,629             -43            -2.6
    Government..................             471           2,023           1,983             -40            -2.0
    Unknown.....................               2              27              25              -2            -6.1
Medicare Utilization Percent:
    Missing or Unknown..........               4               1               1               0             0.9
    0 to 25.....................             428           3,013           2,974             -39            -1.3
    25 to 50....................           1,617           6,356           6,189            -166            -2.6
    50 to 65....................             319             385             375             -10            -2.5
    Greater than 65.............              51              12              11              -1            -8.2
----------------------------------------------------------------------------------------------------------------
Source: Dobson [bond] DaVanzo analysis of 2011-2013 Hospital Cost Reports.
* Dollar DSH calculated by [0.25 * estimated section 1886(d)(5)(F) payments] + [0.75 * estimated section
  1886(d)(5)(F) payments * Factor 2 * Factor 3]. When summed across all hospitals projected to receive DSH
  payments, DSH payments are estimated to be $9,767 million in FY 2016 and $9,551 million in FY 2017.
** Percentage change is determined as the difference between Medicare DSH payments modeled for the FY 2017 IPPS/
  LTCH PPS final rule (column 3) and Medicare DSH payments modeled for the FY 2016 IPPS/LTCH PPS final rule
  (column 2) divided by Medicare DSH payments modeled for the FY 2016 final rule (column 2) times 100 percent.

    9. On page 57325, bottom of the page, third column, last paragraph, 
line 8, the figure ``6.4'' is corrected to read ``5.9''.
    10. On page 57326, first column--
    a. First partial paragraph--
    (1) Line 7 the figure ``5.2'' is corrected to read ``5.5''.
    (2) Line 8, the figure ``5.9'' is corrected to read ``0.2''.
    b. First full paragraph, line 12, the figure ``11.4'' is corrected 
to read ``11.3''.
    c. Third full paragraph (last paragraph)--
    (1) Line 12, the figure ``11.4'' is corrected to read ``11.3''.
    (2) Line 18, the figure ``$9.5 million'' is corrected to read 
``$9.4 million''.
    11. On page 57330, third column--
    a. Fourth bulleted paragraph, line 4, the figure ``0.9991'' is 
corrected to read ``0.9990''.
    b. Last paragraph, line 6, the figure ``1.84'' is corrected to read 
``1.83''.
    12. On page 57331, top half of the page--
    a. First column--
    (1) First partial paragraph--
    (a) Line 1, the phrase ``Less than half of the hospitals'' is 
corrected to read ``Most of the hospitals''.
    (b) Lines 4 through 6, the phrase ``the effects of changes to the 
GAFs, while the remainder of these urban area hospitals would 
experience no change or a decrease in'' is corrected to read ``the 
effects of changes to the GAFs, while hospitals in one urban area are 
expected to experience a decrease in''.
    (c) Line 11, the phrase ``except for two rural areas where changes 
in'' is corrected to read, ``except for one rural area where changes 
in''.
    (2) Third paragraph, lines 8 and line 9, the phrase ``0.7 percent, 
while hospitals in rural areas, on average, are expected to experience 
a 0.8'' is corrected to read ``0.7 percent, and hospitals in rural 
areas, on average, are also expected to experience a 0.7''.
    b. Second column--
    (1) First partial paragraph, lines 2 through 6, the sentence ``The 
primary factor contributing to the small difference in the projected 
increase in capital IPPS payments per case for urban hospitals as 
compared to rural hospitals is the changes to the GAFs.'' is corrected 
by deleting the sentence.
    (2) First full paragraph--
    (a) Lines 4 through 8, ``range from a 4.2 percent increase for the 
Puerto Rico urban hospitals, and a 1.4 percent

[[Page 68962]]

increase for the West South Central urban region to a 0.7 percent 
increase for the Mountain urban region.'' is corrected to read ``range 
from a 4.1 percent increase for the Puerto Rico urban hospitals, and a 
2.1 percent increase for the Mountain urban region to a 0.7 percent 
increase for several other urban regions.''.
    (b) Line 13, the figure ``4.2'' is corrected to read ``4.1''.
    (c) Line 23, the figure ``1.6'' is corrected to read ``2.1''.
    (d) Line 26, the figure ``0.4'' should read ``0.1''.
    c. Third column--
    (1) First full paragraph, line 9, the figure ``0.7'' is corrected 
to read ``0.6''.
    (2) Second full paragraph--
    (a) Line 13, the figure ``1.0'' is corrected to read ``0.9''.
    (b) Line 17, the figure ``1.0'' is corrected to read ``0.9''.
    (c) Line 20, the figure ``0.2'' is corrected to read ``0.3''.
    13. On pages 57331 and 57332, the table titled ``Table III.--
Comparison of Total Payments Per Case [FY 2016 Payments Compared To FY 
2017 Payments]'' is corrected to read as follows:

                                Table III--Comparison of Total Payments per Case
                                 [FY 2016 payments compared to FY 2017 payments]
----------------------------------------------------------------------------------------------------------------
                                                                    Average FY      Average FY
                                                     Number of    2016 payments/  2017 payments/      Change
                                                     hospitals         case            case
----------------------------------------------------------------------------------------------------------------
By Geographic Location:
    All hospitals...............................           3,330             912             920             0.8
        Large urban areas (populations over 1              1,369           1,011           1,019             0.7
         million)...............................
        Other urban areas (populations of 1                1,146             871             879             0.9
         million of fewer)......................
        Rural areas.............................             815             618             623             0.7
    Urban hospitals.............................           2,515             947             955             0.8
        0-99 beds...............................             659             768             774             0.8
        100-199 beds............................             767             824             829             0.6
        200-299 beds............................             446             865             871             0.7
        300-499 beds............................             431             958             967             0.9
        500 or more beds........................             212           1,139           1,149             0.9
    Rural hospitals.............................             815             618             623             0.7
        0-49 beds...............................             317             520             524             0.7
        50-99 beds..............................             292             577             582             0.8
        100-149 beds............................             120             610             614             0.6
        150-199 beds............................              46             669             673             0.6
        200 or more beds........................              40             738             745             0.9
By Region:
    Urban by Region.............................           2,515             947             955             0.8
        New England.............................             116           1,031           1,024            -0.6
        Middle Atlantic.........................             315           1,056           1,064             0.7
        South Atlantic..........................             407             840             847             0.8
        East North Central......................             390             908             915             0.8
        East South Central......................             147             793             804             1.3
        West North Central......................             163             923             930             0.7
        West South Central......................             385             858             868             1.1
        Mountain................................             163             977             998             2.1
        Pacific.................................             378           1,219           1,227             0.7
        Puerto Rico.............................              51             435             453             4.1
    Rural by Region.............................             815             618             623             0.7
        New England.............................              21             868             878             1.1
        Middle Atlantic.........................              54             591             603             2.1
        South Atlantic..........................             128             584             584             0.0
        East North Central......................             115             638             643             0.9
        East South Central......................             155             562             566             0.9
        West North Central......................              98             666             668             0.4
        West South Central......................             160             536             542             1.2
        Mountain................................              60             718             717            -0.1
        Pacific.................................              24             804             812             1.0
By Payment Classification:
    All hospitals...............................           3,330             912             920             0.8
        Large urban areas (populations over 1              1,369           1,011           1,019             0.7
         million)...............................
        Other urban areas (populations of 1                1,153             870             878             0.9
         million of fewer)......................
    Rural areas.................................             808             619             623             0.7
    Teaching Status:
        Non-teaching............................           2,266             771             776             0.7
        Fewer than 100 Residents................             815             885             892             0.8
        100 or more Residents...................             249           1,287           1,298             0.9
        Urban DSH:
            100 or more beds....................           1,642             968             976             0.8
            Less than 100 beds..................             363             696             702             0.8
        Rural DSH:
            Sole Community (SCH/EACH)...........             240             575             581             1.0
            Referral Center (RRC/EACH)..........             325             649             654             0.7
            Other Rural:
                100 or more beds................              29             538             540             0.4

[[Page 68963]]

 
                Less than 100 beds..............             142             526             528             0.3
    Urban teaching and DSH:
        Both teaching and DSH...................             898           1,043           1,052             0.9
        Teaching and no DSH.....................             109             942             948             0.6
        No teaching and DSH.....................           1,107             813             820             0.8
        No teaching and no DSH..................             408             815             820             0.6
    Rural Hospital Types:
        Non special status hospitals............           2,529             948             955             0.7
        RRC/EACH................................             189             772             782             1.4
        SCH/EACH................................             324             706             716             1.4
        SCH, RRC and EACH.......................             126             748             756             1.1
Hospitals Reclassified by the Medicare
 Geographic Classification Review Board:
    FY2017 Reclassifications:
        All Urban Reclassified..................             532             953             962             0.9
        All Urban Non-Reclassified..............           1,936             948             955             0.7
        All Rural Reclassified..................             277             650             655             0.9
        All Rural Non-Reclassified..............             489             578             580             0.3
        Other Reclassified Hospitals (Section                 42             599             602             0.5
         1886(d)(8)(B)).........................
    Type of Ownership:
        Voluntary...............................           1,927             926             934             0.8
        Proprietary.............................             881             820             827             0.8
        Government..............................             522             963             969             0.6
    Medicare Utilization as a Percent of
     Inpatient Days:
        0-25....................................             523           1,103           1,114             1.0
        25-50...................................           2,122             916             923             0.8
        50-65...................................             545             745             750             0.7
        Over 65.................................              89             529             531             0.4
----------------------------------------------------------------------------------------------------------------

    14. On page 57342--
    a. Top of the page--
    (1) First column, first full paragraph--
    (a) Line 11, the figure ``987'' is corrected to read ``990''.
    (b) Line 23, the figure ``809'' is corrected to read ``811''.
    (2) Second column, first partial paragraph--
    (a) Line 12, the figure ``809'' is corrected to read ``811''.
    (b) Line 14, the figure''680'' is corrected to read ``683''.
    (c) Line 19, the figure ``66'' is corrected to read ``72''.
    (d) Line 23, the figure ``746'' is corrected to read ``755''.
    b. Middle of the page, the table titled ``TABLE V--ACCOUNTING 
STATEMENT: CLASSIFICATION OF ESTIMATED EXPENDITURES UNDER THE IPPS FROM 
FY 2016 TO FY 2017'' is corrected to read as follows:

 Table V--Accounting Statement: Classification of Estimated Expenditures
                 Under the IPPS From FY 2016 to FY 2017
------------------------------------------------------------------------
                Category                            Transfers
------------------------------------------------------------------------
Annualized Monetized Transfers.........  $755 million.
From Whom to Whom......................  Federal Government to IPPS
                                          Medicare Providers.
------------------------------------------------------------------------


    Dated: September 29, 2016.
Madhura Valverde,
Executive Secretary to the Department, Department of Health and Human 
Services.
[FR Doc. 2016-24042 Filed 9-30-16; 11:15 am]
BILLING CODE 4120-01-P

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