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, 75328-75330 [2016-26182]

Agencies

• Centers for Medicare & Medicaid Services
• DEPARTMENT OF HEALTH AND HUMAN SERVICES

[Federal Register Volume 81, Number 210 (Monday, October 31, 2016)]
[Rules and Regulations]
[Pages 75328-75330]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2016-26182]


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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-CN3]
RINs 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.

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SUMMARY: This document corrects a typographical error in the final rule 
that appeared in the August 22, 2016 Federal Register as well as 
additional typographical errors in a related correction to that rule 
that appeared in the October 5, 2016 Federal Register. The final rule 
was 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: 
    Effective Date: This correcting document is effective on October 
28, 2016.
    Applicability Date: This correcting document is applicable for 
discharges beginning October 1, 2016.

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

SUPPLEMENTARY INFORMATION: 

I. Background

    In the final rule which appeared in the August 22, 2016 Federal 
Register (81 FR 56761) entitled ``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'' 
(hereinafter referred to as the FY 2017 IPPS/LTCH PPS final rule), 
there were a number of technical and typographical errors. To correct 
the typographical and technical errors in the FY 2017 IPPS/LTCH PPS 
final rule, we published a correcting document that appeared in the 
October 5, 2016 Federal Register (81 FR 68947) (hereinafter referred to 
as the FY 2017 IPPS/LTCH PPS correcting document).

II. Summary of Errors

A. Summary of Errors in the FY 2017 IPPS/LTCH PPS Final Rule

    On page 57105, we inadvertently made a typographical error in 
defining an MSA-dominant hospital.

B. Summary of Errors in the FY 2017 IPPS/LTCH PPS Correcting Document

    On page 68953 in the table titled ``CHANGE OF FY 2016 STANDARDIZED 
AMOUNTS TO THE FY 2017 STANDARDIZED AMOUNTS,'' we inadvertently made a 
typographical error in the Labor figure for the ``National Standardized 
Amount for FY 2017 if Wage Index is Greater than

[[Page 75329]]

1.0000; Labor/Non-Labor Share Percentage (69.6/30.4)'' under the 
classification of ``Hospital did NOT submit quality data and is a 
meaningful EHR user''.
    On page 68955 in the table titled ``Table 1A--NATIONAL ADJUSTED 
OPERATING STANDARDIZED AMOUNTS, LABOR/NONLABOR (69.6 PERCENT LABOR 
SHARE/30.4 PERCENT NONLABOR SHARE IF WAGE INDEX IS GREATER THAN 1)--FY 
2017,'' we inadvertently made a typographical error in the Nonlabor 
figure under the classification of ``Hospital submitted quality data 
and is a meaningful EHR user (update = 1.65 percent)''.
    On page 68958 in the table titled ``FY 2017 IPPS ESTIMATED PAYMENTS 
DUE TO RURAL AND IMPUTED FLOOR WITH NATIONAL BUDGET NEUTRALITY,'' we 
made errors in the alignment of the data in the fourth column titled 
``Difference (in $ millions)''. Specifically, when creating the table 
in the correcting document, the data in the fourth column was 
inadvertently misaligned starting with the entry for Washington, DC and 
continuing to the end, resulting in incorrect values in that column.

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 
typographical errors in the FY 2017 IPPS/LTCH PPS final rule and the FY 
2017 IPPS/LTCH PPS correcting document 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 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

A. Correction of Errors in the Final Rule

    In FR Doc. 2016-18476 of August 22, 2016 (81 FR 56761), we are 
making the following correction:
    1. On page 57105, first column, first partial paragraph, lines 6 
and 7, the phrase ``total hospital's Medicare discharges'' is corrected 
to read ``total hospital Medicare discharges''.

B. Correction of Errors in the Correcting Document

    In FR Doc. 2016-24042 of October 5, 2016 (81 FR 68947), we are 
making the following corrections:
    1. On pages 68952 through 68954 in the table titled, ``CHANGE OF FY 
2016 STANDARDIZED AMOUNTS TO THE FY 2017 STANDARDIZED AMOUNTS'', the 
last entry on page 68953 is corrected to read as follows:

--------------------------------------------------------------------------------------------------------------------------------------------------------
                                 Hospital submitted quality     Hospital submitted quality      Hospital did NOT submit        Hospital did NOT submit
                                data and is a meaningful EHR   data and is NOT a meaningful      quality data and is a        quality data and is NOT a
                                            user                         EHR user                 meaningful EHR user            meaningful EHR user
--------------------------------------------------------------------------------------------------------------------------------------------------------
National Standardized Amount   Labor: $3,839.23.............  Labor: $3,762.75.............  Labor: $3,813.74.............  Labor: $3,737.25.
 for FY 2017 if Wage Index is  Nonlabor: $1,676.91..........  Nonlabor: $1,643.50..........  Nonlabor: $1,665.77..........  Nonlabor: $1,632.37.
 Greater Than 1.0000; Labor/
 Non-Labor Share Percentage
 (69.6/30.4).
--------------------------------------------------------------------------------------------------------------------------------------------------------

    2. On page 68955, top of the page in the table titled, ``Table 1A--
NATIONAL ADJUSTED OPERATING STANDARDIZED AMOUNTS, LABOR/NONLABOR (69.6 
PERCENT LABOR SHARE/30.4 PERCENT NONLABOR SHARE IF WAGE INDEX IS 
GREATER THAN 1)--FY 2017'', the first column of the table is corrected 
to read as follows:

------------------------------------------------------------------------
 Hospital submitted quality data and is a meaningful EHR User (update =
                              1.65 percent)
-------------------------------------------------------------------------
                         Labor                               Nonlabor
------------------------------------------------------------------------
$3,839.23..............................................       $1,676.91
------------------------------------------------------------------------

    3. On page 68958, top of the page, the table titled, ``FY 2017 IPPS 
ESTIMATED PAYMENTS DUE TO RURAL AND IMPUTED FLOOR WITH NATIONAL BUDGET 
NEUTRALITY'' is corrected to read as follows:

[[Page 75330]]



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


    Dated: October 26, 2016.
Madhura Valverde,
Executive Secretary to the Department, Department of Health and Human 
Services.
[FR Doc. 2016-26182 Filed 10-28-16; 8:45 am]
BILLING CODE 4120-01-P