Medicare Program: Hospital Outpatient Prospective Payment and Ambulatory Surgical Center Payment Systems and Quality Reporting Programs; Organ Procurement Organization Reporting and Communication; Transplant Outcome Measures and Documentation Requirements; Electronic Health Record (EHR) Incentive Programs; Payment to Nonexcepted Off-Campus Provider-Based Department of a Hospital; Hospital Value-Based Purchasing (VBP) Program; Establishment of Payment Rates Under the Medicare Physician Fee Schedule for Nonexcepted Items and Services Furnished by an Off-Campus Provider-Based Department of a Hospital; Correction and Extension of Comment Period, 24-37 [2016-31774]
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24
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307 of the CAA as amended (42 U.S.C.
7410, 7426 and 7607).
V. Judicial Review
Under section 307(b)(1) of the CAA,
judicial review of this final rule is
available only by the filing of a petition
for review in the U.S. Court of Appeals
for the appropriate circuit by March 6,
2017. Under section 307(b)(2) of the
CAA, the requirements that are the
subject of this final rule may not be
challenged later in civil or criminal
proceedings brought by us to enforce
these requirements.
List of Subjects in 40 CFR Part 52
Environmental protection,
Administrative practices and
procedures, Air pollution control,
Electric utilities, Incorporation by
reference, Intergovernmental relations,
Nitrogen oxides, Ozone.
Dated: December 15, 2016.
Gina McCarthy,
Administrator.
[FR Doc. 2016–31258 Filed 12–30–16; 8:45 am]
BILLING CODE 6560–50–P
DEPARTMENT OF HEALTH AND
HUMAN SERVICES
Centers for Medicare & Medicaid
Services
42 CFR Parts 414, 416, 419, 482, 486,
488, and 495
[CMS–1656–CN]
sradovich on DSK3GMQ082PROD with RULES
RIN 0938–AS82
Medicare Program: Hospital Outpatient
Prospective Payment and Ambulatory
Surgical Center Payment Systems and
Quality Reporting Programs; Organ
Procurement Organization Reporting
and Communication; Transplant
Outcome Measures and
Documentation Requirements;
Electronic Health Record (EHR)
Incentive Programs; Payment to
Nonexcepted Off-Campus ProviderBased Department of a Hospital;
Hospital Value-Based Purchasing
(VBP) Program; Establishment of
Payment Rates Under the Medicare
Physician Fee Schedule for
Nonexcepted Items and Services
Furnished by an Off-Campus ProviderBased Department of a Hospital;
Correction and Extension of Comment
Period
Centers for Medicare &
Medicaid Services (CMS), HHS.
AGENCY:
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Correction and extension of
comment period for final rule and
interim final rule.
ACTION:
This document corrects
technical errors that appeared in the
final rule with comment period and
interim final rule with comment period
published in the Federal Register on
November 14, 2016, entitled ‘‘Hospital
Outpatient Prospective Payment and
Ambulatory Surgical Center Payment
Systems and Quality Reporting
Programs; Organ Procurement
Organization Reporting and
Communication; Transplant Outcome
Measures and Documentation
Requirements; Electronic Health Record
(EHR) Incentive Programs; Payment to
Nonexcepted Off-Campus ProviderBased Department of a Hospital;
Hospital Value-Based Purchasing (VBP)
Program; Establishment of Payment
Rates under the Medicare Physician Fee
Schedule for Nonexcepted Items and
Services Furnished by an Off-Campus
Provider-Based Department of a
Hospital.’’
This document extends the comment
period to January 3, 2017 for both the
final rule with comment period and the
interim final rule with comment period.
DATES: Effective date: This correction is
effective January 1, 2017.
Comment period: The comment
period for the final rule and interim
final rule, published November 14, 2016
(81 FR 79562), is extended to 5 p.m.
E.S.T. on January 3, 2017.
FOR FURTHER INFORMATION CONTACT:
Hospital Outpatient Prospective
Payment System (OPPS), contact Lela
Strong (410) 786–3213.
Electronic Health Record (EHR)
Incentive Programs, contact Kathleen
Johnson (410) 786–3295 or Steven
Johnson (410) 786–3332.
Hospital Outpatient Quality Reporting
(OQR) Program Administration,
Validation, and Reconsideration Issues,
contact Elizabeth Bainger at (410) 786–
0529
SUPPLEMENTARY INFORMATION:
SUMMARY:
I. Background
In FR Doc. 2016–26515 of November
14, 2016 (81 FR 79562), titled ‘‘Medicare
Program: Hospital Outpatient
Prospective Payment and Ambulatory
Surgical Center Payment Systems and
Quality Reporting Programs; Organ
Procurement Organization Reporting
and Communication; Transplant
Outcome Measures and Documentation
Requirements; Electronic Health Record
(EHR) Incentive Programs; Payment to
Certain Off-Campus Outpatient
Departments of a Provider; Hospital
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Value-Based Purchasing (VBP) Program;
Establishment of Payment Rates Under
the Medicare Physician Fee Schedule
for Nonexcepted Items and Services
Furnished by an Off-Campus ProviderBased Department of a Hospital’’
(hereinafter referred to as the CY 2017
OPPS/ASC final rule), there were a
number of technical errors that are
identified and corrected in the
Correction of Errors section below. The
provisions in this correction document
are effective as if they had been
included in the document published
November 14, 2016. Accordingly, the
corrections are effective January 1, 2017.
II. Extension of Comment Period
We are extending the comment
period. We inadvertently scheduled the
comment period to end on December 31,
2016, a Saturday. We ordinarily do not
end the comment period on a weekend
or federal holiday. Therefore, we are
extending the comment period for the
final rule and interim final rule to end
on the next business day, January 3,
2017.
III. Summary of Errors
A. Errors in the Preamble
1. Hospital Outpatient Prospective
Payment System (OPPS) Corrections
On page 79566, in the Table of
Contents, we inadvertently included a
title that referred to the CY 2017 OPPS/
ASC proposed rule instead of the final
rule with comment period. We are
correcting the title in this correcting
document. On the same page, in the
table of contents, we made a
typographical error in the title of the
sixth item, which we are correcting to
match the title in the preamble of the
document.
On page 79569, we incorrectly stated
estimated total payments to OPPS
providers as $773 million. We have
corrected this figure to be $64 billion.
On page 79582, we incorrectly stated
that status indicator ‘‘J1’’ procedure
claims with modifier ‘‘50’’ were
included in the C–APC claims
accounting and the complexity
adjustment evaluations as of January 1,
2015.’’ Instead, these claims were
included in the C–APC complexity
adjustment evaluations presented in the
CY 2017 OPPS/ASC final rule with
comment period. The results of these
evaluations were included in the C–APC
complexity adjustment evaluations tab
of Addendum J to the CY 2017 OPPS/
ASC final rule with comment period.
On pages 79584, we inadvertently
omitted discussion of one of the
recommendations from the August 2016
meeting of the Advisory Panel on
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Hospital Outpatient Payment (HOP
Panel). The HOP Panel recommended
that, ‘‘CMS provide further information
and data for stakeholders to review on
how comprehensive APCs are created
and their effects; and CMS provide more
time for the public to review the
information and make proposals to the
Panel.’’ In this correcting document, we
address this recommendation.
On page 79587, due to the change in
OPPS payment rates as a result of the
updated OPPS weight scaler, we are also
updating the payment rate listed for C–
APC 5244 (Level 4 Blood Product
Exchange and Related Services).
On page 79595, we made technical
errors by inadvertently excluding the
wage index data for 6 providers in
Alaska, Virginia, Ohio, Mississippi, and
Puerto Rico when calculating the weight
scaler for budget neutrality. We have
corrected the weight scaler for budget
neutrality to include the wage index
data for those 6 providers, which results
in a change of the weight scaler from
1.4208 to 1.4214. This revised weight
scaler affects all payments that are
scaled for budget neutrality. As a result
we are also providing corrected addenda
as described in the ‘‘Summary of Errors
and Corrections to the OPPS and ASC
Addenda Posted on the CMS Web site’’
section below.
On pages 79607 through 79608, we
use the payment rates available in
Addenda A and B to display calculation
of adjusted payment and copayment.
Due to the change in OPPS payment
rates as a result of the updated OPPS
weight scaler, we are also updating the
payment and copayment numbers used
in the example to reflect the corrections.
On page 79621, due to the change in
OPPS payment rates as a result of the
updated OPPS weight scaler, we are also
updating the payment rates in Table
13—Final CY 2017 Status Indicator (SI),
APC Assignments, and Payment Rates
for the Auditory Osseointegrated
Procedures (81 FR 79621) for CPT codes
69714, 69715, 69717, and 69718.
On page 79622, due to the change in
OPPS payment rates as a result of the
updated OPPS weight scaler, we are also
updating the payment rates in Table
14—Final CY 2017 Status Indicator (SI),
APC Assignments, and Payment Rates
for CPT Codes 28297 and 28740.
On page 79624, due to the change in
OPPS payment rates as a result of the
updated OPPS weight scaler, we are also
updating the payment rates in Table
16—Final CY 2017 Status Indicator (SI),
APC Assignments, and Payment Rates
for the Percutaneous Vertebral
Augmentation/Kyphoplasty Procedures.
On page 79627, due to the change in
OPPS payment rates as a result of the
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updated OPPS weight scaler, we are also
updating the payment rates in Table
18—Final CY 2017 Status Indicator (SI),
APC Assignments, and Payment Rates
for the Transcranial Magnetic
Stimulation (TMS) Therapy Codes.
On page 79629, due to the change in
OPPS payment rates as a result of the
updated OPPS weight scaler, we are
updating the payment rates for CPT
code 75571 to $59.86, for CPT code
77080 to $112.73, and for APC 5822
(Level 2 Health and Behavior Services)
to $70.26 for CY 2017.
On pages 79636 through 79637, due to
the change in OPPS payment rates as a
result of the updated OPPS weight
scaler, we are also updating the
payment rates in Table 23—Final CY
2017 Status Indicator (SI), APC
Assignments, and Payment Rates for the
Transprostatic Urethral Implant
Procedures.
On pages 79638 through 79639, due to
the change in OPPS payment rates as a
result of the updated OPPS weight
scaler, we are also updating the
payment rates in Table 25—Final CY
2017 Status Indicator (SI), APC
Assignments, and Payment Rates
Certain Cryoablation Procedures.
On page 79641, due to the change in
OPPS payment rates as a result of the
updated OPPS weight scaler, we are also
updating the payment rates in Table
28—Final CY 2017 Status Indicator (SI),
APC Assignments, and Payment Rates
for the Dialysis Circuit Procedures.
On page 79643, due to the change in
OPPS payment rates as a result of the
updated OPPS weight scaler, we are also
updating the payment rate for CPT code
77371 to $7,455.99 as well as the
payment rates in Table 30—Final CY
2017 Status Indicator (SI), APC
Assignments, and Payment Rates for the
Magnetic Resonance Image Guided High
Intensity Focused Ultrasound (MRgFUS)
Procedures.
On page 79645, due to the change in
OPPS payment rates as a result of the
updated OPPS weight scaler, we are also
updating the payment rates in Table
32—Final CY 2017 Status Indicator (SI),
APC Assignments, and Payment Rates
for the Smoking and Tobacco Use
Cessation Counseling Services.
On page 79647, we used imprecise
language in describing HCPCS codes
G0237, G0238, and G0239. Specifically,
we stated that ‘‘we believe that we
should reassign HCPCS codes G0237,
G0238, and G0239 to status indictor ‘‘S’’
because these codes also describe
pulmonary rehabilitation services.’’ We
are clarifying that these codes describe
respiratory treatment services. We
acknowledge that the original language
could be interpreted to mean that these
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25
codes describe pulmonary rehabilitation
services, which was not our intent.
On page 79648, due to the change in
OPPS payment rates as a result of the
updated OPPS weight scaler, we are also
updating the payment rates in Table
34—Final CY 2017 Status Indicator (SI),
APC Assignments, and Payment Rates
for the Pulmonary Rehabilitation
Services.
On page 79662, we incorrectly made
certain Status Indicator (SI) and APC
assignments in Table 35—Drugs and
Biologicals For Which Pass-Through
Payment Status Expires December 31,
2016. Specifically, we incorrectly
assigned a SI of ‘‘N’’ (Items and Services
Packaged into APC Rates) to a number
of drugs that should have been assigned
a SI of ‘‘K’’ (Nonpass-Through Drugs
and Nonimplantable Biologicals,
Including Therapeutic
Radiopharmaceuticals). These drugs
have also been assigned to APCs for CY
2017. Additionally, on page 79662, we
incorrectly described two Long
Descriptors (for HCPCS codes J7181 and
7201) that were displayed in Table 35.
These Long Descriptors have been
revised for CY 2017.
On page 79664, we incorrectly
described two Long Descriptors (for
HCPCS codes A9587 and A9588) that
were displayed in Table 36—Drugs and
Biologicals With Pass-Through Payment
Status in CY 2017. These Long
Descriptors have been revised for CY
2017.
On page 79671, we made technical
errors to the description of certain
Healthcare Common Procedure Coding
System (HCPCS) codes that appeared in
Table 37—Skin Substitute Assignments
to High Cost and Low Cost Groups for
CY 2017. Specifically, we are removing
HCPCS codes Q4119, Q4120, and Q4129
to accurately show that these codes
were deleted on December 31, 2016, and
should not have appeared in Table 37.
These codes were correctly assigned to
OPPS SI ‘‘D’’ in the OPPS Addendum B
that was released with the CY 2017
OPPS/ASC final rule.
On page 79708, we used imprecise
language in the summary of final policy
on how we would apply the ‘‘billing
.–. . prior to November 2, 2015,’’
statutory language in determining
whether an off-campus PBD is excepted
or not. Specifically, we stated in the
preamble that ‘‘off campus PBDs would
be eligible to receive OPPS payment as
excepted off- campus PBDs for services
that were furnished prior to November
2, 2015, and billed under the OPPS in
accordance with timely filing limits.’’
We are clarifying that the policy is not
specific to services, but rather so long as
an off-campus PBD furnished a covered
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OPD service prior to November 2, 2015
and billed the OPPS within timely filing
limits for that service that the offcampus PBD would be excepted from
payment adjustment under the final
section 603 payment policy for the
items and services the off-campus PBD
furnishes on or after January 1, 2017. As
noted in the sentence prior (81 FR
79708), we agreed with the commenters
that an interpretation of the ‘‘billing
under this subsection with respect to
covered OPD services furnished prior to
[November 2, 2015]’’ statutory language
could allow for an exception for offcampus PBDs that furnished a covered
OPD service prior to November 2, 2015,
but had not submitted a bill to Medicare
for such service prior to November 2,
2015.
On page 79719, we described the
changes to regulation and incorrectly
stated the effective date to implement
section 603 of Public Law 114–74 is
effective January 1, 2017, for cost
reporting periods beginning January 1,
2017. The effective date is for items and
services furnished on or after January 1,
2017, regardless of when the cost
reporting period begins. We have
corrected this language to delete the
reference to cost reporting periods.
On pages 79869 through 79870, we
provided and described Table 52—
Estimated Impact of the CY 2017
Changes for the Hospital Outpatient
Prospective Payment System, based on
rates which applied the incorrect scaler.
We have updated the impact table and
the description of the table to reflect
these corrections.
On Page 79877, we incorrectly
described implementation of Section
603 of the Bipartisan Budget Act of 2015
as reducing OPPS payments by $500
million in 2017. We have corrected this
estimate to be a reduction of total Part
B payments by $50 million in 2017.
2. Ambulatory Surgical Center (ASC)
Payment System Corrections
On pages 79741 through 79742, in the
discussion of additions to the list of
ASC covered surgical procedures, we
incorrectly stated that CPT code 22851
(Application of intervertebral
biomechanical device(s) (e.g., synthetic
cage(s), methlmethacrylate) to vertebral
defect or interspace (List separately in
addition to code for primary procedure))
was deleted effective April 13, 2016.
This code was deleted effective
December 31, 2016.
On page 79743 in Table 51—
Additions to the List of ASC Covered
Surgical Procedures for CY 2017 (81 FR
79743), we inadvertently excluded CPT
code 22585 (Arthrodesis, anterior
interbody technique, including minimal
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discectomy to prepare interspace (other
than for decompression); each
additional interspace (List separately in
addition to code for primary
procedure)). This code has a CY 2017
ASC payment indicator of N1.
On pages 79752 through 79753, we
inadvertently published an incorrect
ASC conversion factor of $45.030 for
ASCs that meet the quality reporting
requirements. Also, on pages 79752
through 79753, we inadvertently
published an incorrect ASC wage index
budget neutrality adjustment of 0.9996
that is being corrected to 0.9997. For
ASCs that do not meet the quality
reporting requirements, we finalized an
ASC conversion factor of $44.330. The
ASC conversion factor for ASCs that
meet the quality reporting requirements
is the product of the CY 2016
conversion factor multiplied by the
wage index budget neutrality
adjustment of 0.9997 and the MFPadjusted CPI–U payment update (81 FR
79752 to 79753). We have since
determined that the 2016 conversion
factor of $44.190 used to calculate the
CY 2017 conversion factor is incorrect.
The corrected 2016 ASC conversion
factor for ASCs that meet the quality
reporting requirements is $44.177, as
finalized in the CY 2016 final rule with
comment period (80 FR 70501). Using
the correct 2016 ASC conversion factor
of $44.177, we have recalculated the
2017 ASC conversion factor to be
$45.003 for ASCs that meet quality
reporting requirements and a conversion
factor of $44.120 for ASCs that do not
meet quality reporting requirements.
The corrected conversion factor will
slightly change payment for some ASC
services; therefore we have revised
payment rates in ASC addendum AA
and addendum BB.
3. Interim Final Rule with Comment
Period Corrections
On page 79725, we referenced table
X.B.2, but did not include the table in
the interim final rule with comment
period. This table, Payment for
Nonexcepted Items and Services by
OPPS Status Indicator, has been posted
to the CMS Web site at https://
www.cms.gov/Medicare/Medicare-Feefor-Service-Payment/
HospitalOutpatientPPS/Downloads/
CMS-1656-FC-2017-OPPS-StatusIndicator.zip.
4. Hospital Outpatient Quality
Reporting Program Correction
On page 79784, there was a
typographical error in the table entitled
‘‘Previously Finalized and Newly
Finalized Hospital OQR Program
Measure Set for the CY 2020 Payment
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Determination and Subsequent Years’’.
As listed in the table, the measure OP–
30: Colonoscopy Interval for Patients
with a History of Adenomatous
Polyps—Avoidance of Inappropriate
Use incorrectly included three asterisks
after the name Three asterisks indicates
that a measure is voluntary. This
measure should have had only two
asterisks to indicate that the measure
name was updated to reflect the
National Quality Forum title, not three,
as it is not a voluntary measure.
Accordingly, we are correcting the table
and updating the number of asterisks
next to OP–30 from three to two
asterisks.
B. Regulation Text Corrections
1. OPPS Corrections
To implement the provisions of
section 1833(t) of the Act, as amended
by section 603 of Public Law 114–74, in
the CY 2017 OPPS/ASC final rule with
comment period, we amended the
Medicare regulations by (1) adding a
new paragraph (v) to § 419.22 to specify
that, effective January 1, 2017, for cost
reporting periods beginning January 1,
2017, excluded from payment under the
OPPS are items and services that are
furnished by an off-campus providerbased department that do not meet the
definition of excepted items and
services; and (2) adding a new § 419.48
that sets forth the definition of excepted
items and services, and also the
definition of ‘‘excepted off-campus
provider-based department’’. On page
79879, we incorrectly stated that the
effective date was based on cost
reporting periods and are striking that
language. Also, on page 79880, we
incorrectly implied that on-campus
provider-based departments that furnish
services after November 2, 2015, could
no longer bill under the OPPS in the
regulation text at 419.48(b). In addition,
on page 79880, in the regulation text at
419.48(b), the definition of an ‘‘excepted
off-campus provider-based department’’
does not accurately state that the
department of a provider must also have
billed within timely filing limits. The
revised regulation text corrects these
technical errors.
2. Electronic Health Record (EHR)
Incentive Programs Corrections
In the CY 2017 OPPS/ASC final rule,
we inadvertently omitted amendments
to § 495.40 that were included in an
earlier-published final rule with
comment period titled ‘‘Medicare
Program; Merit-Based Incentive
Payment System (MIPS) and Alternative
Payment Model (APM) Incentive Under
the Physician Fee Schedule, and Criteria
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for Physician-Focused Payment
Models’’ (referred to as the Quality
Payment Program (QPP) final rule) (81
FR 77008, 77556–77557, November 4,
2016). We are making the corrections to
§ 495.40 described below in order to
preserve the earlier amendments to that
section as finalized in the QPP final
rule.
On page 79892, in § 495.40,
‘‘Demonstration of meaningful use
criteria,’’ paragraph (a), ‘‘Demonstration
by EPs,’’ we inadvertently omitted a
reference to § 495.22 in the introductory
text. We are correcting the introductory
text to state that an EP must
demonstrate that he or she satisfies each
of the applicable objectives and
associated measures under § 495.20,
§ 495.22, or § 495.24. Additionally, we
are correcting the introductory text to
include the phrase ‘‘supports
information exchange and the
prevention of health information
blocking, and engages in activities
related to supporting providers with the
performance of CEHRT:’’ as finalized in
the QPP final rule (81 FR 77556), which
updates requirements for demonstration
of meaningful use to include activities
related to health information
technology.
On page 79892, in § 495.40,
‘‘Demonstration of meaningful use
criteria,’’ we are correcting the
inadvertent omission of
§ 495.40(a)(2)(i)(H) and (I) as finalized in
the QPP final rule (81 FR 77556), which
revise attestation requirements and
require EPs to attest their cooperation
with certain authorized health IT
surveillance and direct review activities
as part of demonstrating meaningful use
under the Medicare and Medicaid EHR
Incentive Programs.
On page 79892, in § 495.40,
‘‘Demonstration of meaningful use
criteria,’’ paragraph (b), ‘‘Demonstration
by eligible hospitals and CAHs,’’ we
inadvertently omitted a cross reference
to § 495.22 in the introductory text. We
are correcting the introductory text to
state that an eligible hospital or CAH
must demonstrate that it satisfies each
of the applicable objectives and
associated measures under § 495.20,
§ 495.22, or § 495.24. Additionally, we
are correcting the introductory text to
include the phrase ‘‘supports
information exchange and the
prevention of health information
blocking, and engages in activities
related to supporting providers with the
performance of CEHRT:’’ as finalized in
the QPP (81 FR 77556), which updates
the requirements for demonstration of
meaningful use to include activities
related to health information
technology.
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On page 79892, in § 495.40 (b),
‘‘Demonstration by eligible hospitals
and CAHs,’’ we are correcting the
inadvertent omission of § 495.40
(b)(2)(i)(H) and (I) as finalized in the
QPP final rule (81 FR 77556 through
77557), which revises attestation
requirements and requires eligible
hospitals and CAHs to attest their
cooperation with certain authorized
health IT surveillance and direct review
activities as part of demonstrating
meaningful use under the Medicare and
Medicaid EHR Incentive Programs.
C. Summary of Errors and Corrections to
the OPPS and ASC Addenda Posted on
the CMS Web site
In Addendum J, on the Complexity
Adjustment tab, CPT code 36908—
Transcatheter placement of an
intravascular stent(s), central dialysis
segment, performed through dialysis
circuit, including all imaging
radiological supervision and
interpretation required to perform the
stenting, and all angioplasty in the
central dialysis segment (List separately
in addition to code for primary
procedure) was incorrectly written as
368x8. Also, CPT code 24200 (Removal
of foreign body, upper arm or elbow;
subcutaneous) was incorrectly excluded
from Addendum J. The revised version
of Addendum J is available via the
Internet on the CMS Web site.
The payment and copayment rates in
Addendum A (Final OPPS APCs for CY
2017), Addendum B (Final OPPS
Payment by HCPCS Code for CY 2017),
Addendum C (Final HCPCS Codes
Payable Under the 2017 OPPS by APC),
ASC Addendum AA (Final ASC
Covered Surgical Procedures for CY
2016 (Including Surgical Procedures for
Which Payment is Packaged)), ASC
Addendum BB (Final ASC Covered
Ancillary Services Integral to Covered
Surgical Procedures for CY 2016
(Including Ancillary Services for Which
Payment is Packaged)) and the payment
rates in the 2017 Drug, Blood,
Brachytherapy Costs Statistics file that
were published on the CMS Web site in
conjunction with the CY 2017 OPPS/
ASC Final Rule with comment period
have been updated to reflect corrections
to the weight scaler. The payment rates
included in the corrected versions of the
Addenda have also been corrected
within the text of the CY 2017 OPPS/
ASC Final Rule with comment period,
as well as under the columns titled
‘‘Final CY 2017 OPPS Payment Rate’’ in
Tables 13, 14, 16, 18, 23, 25, 28, 30, 32,
and 34.
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27
IV. Waiver of Proposed Rulemaking
and Delay in Effective Date
Under 5 U.S.C. 553(b) of the
Administrative Procedure Act (APA),
the agency is required to publish a
notice of the proposed rule in the
Federal Register before the provisions
of a rule take effect. Similarly, section
1871(b)(1) of the Act requires the
Secretary to provide for notice of the
proposed rule in the Federal Register
and provide a period of not less than 60
days for public comment. In addition,
section 553(d) of the APA, and section
1871(e)(1)(B)(i) mandate a 30-day delay
in effective date after issuance or
publication of a rule. Sections 553(b)(B)
and 553(d)(3) of the APA provide for
exceptions from the notice and
comment and delay in effective date
APA requirements; in cases in which
these exceptions apply, sections
1871(b)(2)(C) and 1871(e)(1)(B)(ii) of the
Act provide exceptions from the notice
and 60-day comment period and delay
in effective date requirements of the Act
as well. Section 553(b)(B) of the APA
and section 1871(b)(2)(C) of the Act
authorize an agency to dispense with
normal rulemaking requirements for
good cause if the agency makes a
finding that the notice and comment
process are impracticable, unnecessary,
or contrary to the public interest. In
addition, both section 553(d)(3) of the
APA and section 1871(e)(1)(B)(ii) of the
Act allow the agency to avoid the 30day delay in effective date where such
delay is contrary to the public interest
and an agency includes a statement of
support.
We believe that this correcting
document does not constitute a
rulemaking that would be subject to
these requirements. This correcting
document corrects technical and
typographic errors in the preamble,
addenda, payment rates, tables, and
appendices included or referenced in
the CY 2017 OPPS/ASC final rule with
comment period and interim final rule
with comment period but does not make
substantive changes to the policies or
payment methodologies that were
adopted in the final rule with comment
period and interim final rule with
comment period. As a result, the
corrections made through this correcting
document are intended to ensure that
the information in the CY 2017 OPPS/
ASC final rule with comment period
and interim final rule with comment
period accurately reflects the policies
adopted in those rules.
In addition, even if this were a
rulemaking to which the notice and
comment procedures and delayed
effective date requirements applied, we
E:\FR\FM\03JAR1.SGM
03JAR1
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Federal Register / Vol. 82, No. 1 / Tuesday, January 3, 2017 / Rules and Regulations
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 with
comment period and interim final rule
with comment period or delaying the
effective date would be contrary to the
public interest because it is in the
public’s interest for providers to receive
appropriate payments in as timely a
manner as possible, and to ensure that
the CY 2017 OPPS/ASC final rule with
comment period and interim final rule
with comment period accurately reflect
our policies as of the date they take
effect and are applicable.
Furthermore, such procedures would
be unnecessary, as we are not altering
our payment methodologies or policies,
but rather, we are simply correctly
implementing the policies that we
previously proposed, received comment
on, and subsequently finalized. This
correcting document is intended solely
to ensure that the CY 2017 OPPS/ASC
final rule with comment period and
interim final rule with comment period
accurately reflects these payment
methodologies and policies. For these
reasons, we believe we have good cause
to waive the notice and comment and
effective date requirements.
V. Correction of Errors
In FR Doc. 2016–26515 of November
14, 2016 (81 FR 79562), make the
following corrections:
Preamble Corrections
1. On page 79566, third column,
a. In line 44, Table of Contents, the
title ‘‘5. Summary of Proposals’’ is
corrected to read ‘‘5. Summary of Final
Policies’’.
b. In line 45, Table of Contents, the
title ‘‘6. Final Changes to Regulations’’
is corrected to read ‘‘6. Changes to
Regulations’’.
2. On page 79569, second column,
second full paragraph, under the
bulleted item, ‘‘OPPS Update,’’ in line
20, replace ‘‘$773 million’’ with ‘‘$64
billion’’.
3. On page 79582, third column,
second full paragraph, under a response
to public comment, in lines 29 through
34, the last sentence of the paragraph is
corrected to read ‘‘Status indicator ‘‘J1’’
procedure claims with modifier ‘‘50’’
will be included in the complexity
adjustment evaluation for CY 2017. This
evaluation can be found in Addendum
J to the CY 2017 OPPS/ASC final rule
with comment period.’’
4. On page 79584, first column, first
partial paragraph, in line 21, the
following language is inserted after
‘‘. . . analyses of the C–APC payment
policy.’’ and before ‘‘Regarding the
comment about creating. . . .’’: We are
accepting the recommendation that the
HOP Panel made at the August 22, 2016
meeting to ‘‘provide further information
and data for stakeholders to review on
how comprehensive APCs are created
and their effects and to provide more
time for the public to review the
information and make proposals to the
Panel.’’ We plan to provide the results
of an analysis of our comprehensive
packaging policies in CY 2017. In
addition, we will consider scheduling
future HOP Panel meetings on a date
that allows stakeholders as much time
as is practicable subsequent to display
of the proposed rule to analyze and
review our proposed policies and other
data prior to the meeting.
5. On page 79587, third column, first
full paragraph, in line 16, replace
‘‘$27,752’’ with ‘‘$27,764’’.
6. On page 79595, third column, third
paragraph, replace ‘‘1.4208’’ with
‘‘1.4214.’’
7. On page 79607,
a. First column, bottom half of the
page, last full paragraph—
(1) In line 17, replace ‘‘$538.88’’ with
‘‘$539.11.’’
(2) In line 21, replace ‘‘$528.10’’ with
‘‘$528.33.’’
b. In the second column, first partial
paragraph,
(1) In lines 1 and 2, replace ‘‘$418.26
(.60 * $538.88 * 1.2936).’’ with ‘‘$418.44
(.60 * $539.11 * 1.2936).’’
(2) In line 5, replace ‘‘$409.89 (.60 *
$528.10 * 1.2936).’’ with ‘‘$410.07 (.60
* $528.33 * 1.2936).’’
(3) In line 8, replace ‘‘$215.55 (.40 *
$538.88).’’ with ‘‘$215.64 (.40 *
$539.11).’’
(4) In line, replace ‘‘$211.24 (.40 *
$528.10).’’ with ‘‘$211.33 (.40 *
$528.33).’’
(5) In lines 15 and 16, replace
‘‘$633.81 ($418.26 +$215.55).’’ with
‘‘$634.08 ($418.44 +$215.64).’’
(6) In lines 18 and 19, replace
‘‘$621.13 ($409.89 + $211.24).’’ with
‘‘$621.40 ($410.07 + $211.33).’’
8. On page 79608, second column,
third full paragraph, under ‘‘Step 1,’’ in
lines 5 and 8, replace ‘‘$107.78’’ with
$107.83’’ and ‘‘$538.88’’ with
‘‘$539.11.’’
9. On page 79621, Table 13—Final CY
2017 Status Indicator (SI), APC, and
Payment Rates for the Auditory
Osseointegrated Procedures, is corrected
to read as follows:
TABLE 13—FINAL CY 2017 STATUS INDICATOR (SI), APC ASSIGNMENTS, AND PAYMENT RATES FOR THE AUDITORY
OSSEOINTEGRATED PROCEDURES
Final CY
2017 OPPS
APC
Final CY 2017
OPPS
payment rate
J1
5115
$9,561.23
10,537.90
J1
5116
14,704.13
5123
4,969.26
J1
5114
5,221.57
Sfmt 4700
E:\FR\FM\03JAR1.SGM
Long descriptors
CY 2016
OPPS SI
69714 .......
Implantation, osseointegrated implant,
temporal
bone,
with
percutaneous attachment to external speech processor/cochlear
stimulator; without mastoidectomy.
Implantation, osseointegrated implant,
temporal
bone,
with
percutaneous attachment to external speech processor/cochlear
stimulator; with mastoidectomy.
Replacement (including removal of
existing device), osseointegrated
implant, temporal bone, with
percutaneous attachment to external speech processor/cochlear
stimulator; without mastoidectomy.
J1
5125
J1
5125
J1
sradovich on DSK3GMQ082PROD with RULES
Final CY
2017 OPPS
SI
$10,537.90
69715 .......
69717 .......
VerDate Sep<11>2014
22:11 Dec 30, 2016
Jkt 241001
PO 00000
Frm 00024
CY 2016
OPPS APC
CY 2016
OPPS
payment rate
CPT code
Fmt 4700
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TABLE 13—FINAL CY 2017 STATUS INDICATOR (SI), APC ASSIGNMENTS, AND PAYMENT RATES FOR THE AUDITORY
OSSEOINTEGRATED PROCEDURES—Continued
CPT code
Long descriptors
CY 2016
OPPS SI
69718 .......
Replacement (including removal of
existing device), osseointegrated
implant, temporal bone, with
percutaneous attachment to external speech processor/cochlear
stimulator; with mastoidectomy.
J1
10. On page 79622, Table 14—Final
CY 2017 Status Indicator (SI), APC
Assignments, and Payment Rates for
CY 2016
OPPS APC
CY 2016
OPPS
payment rate
5124
Final CY
2017 OPPS
SI
7,064.07
J1
Final CY
2017 OPPS
APC
Final CY 2017
OPPS
payment rate
5115
9,561.23
CPT Codes 28297 and 28740, is
corrected to read as follows:
TABLE 14—FINAL CY 2017 STAUS INDICATOR (SI), APC ASSIGNMENTS, AND PAYMENT RATES FOR CPT CODES 28297
AND 28740
Long descriptors
CY 2016
OPPS SI
28297 .......
Correction, hallux valgus (bunion),
with or without sesamoidectomy;
lapidus-type procedure.
Arthrodesis,
midtarsal
or
tarsometatarsal, single joint.
J1
5124
J1
5124
Final CY
2017 OPPS
SI
11. On page 79624, Table 16—Final
CY 2017 Status Indicator (SI), APC
Assignments, and Payment Rates for the
Percutaneous Vertebral Augmentation/
Final CY 2017
OPPS
payment rate
5114
$5,221.57
J1
7,064.07
Final CY
2017 OPPS
APC
J1
$7,064.07
28740 .......
CY 2016
OPPS APC
CY 2016
OPPS
payment rate
CPT code
5114
5,221.57
Kyphoplasty Procedures, is corrected to
read as follows:
TABLE 16—FINAL CY 2017 STATUS INDICATOR (SI), APC ASSIGNMENTS, AND PAYMENT RATES FOR THE PERCUTANEOUS
VERTEBRAL AUGMENTATION/KYPHOPLASTY PROCEDURES
Final CY
2017 OPPS
APC
Final CY 2017
OPPS
payment rate
J1
5114
$5,221.57
7,064.07
J1
5114
5,221.57
Packaged
N
N/A
Packaged
Long descriptors
CY 2016
OPPS SI
22513 .......
Percutaneous vertebral augmentation, including cavity creation (fracture reduction and bone biopsy included when performed) using mechanical device (eg, kyphoplasty),
1 vertebral body, unilateral or bilateral cannulation, inclusive of all imaging guidance; thoracic.
Percutaneous vertebral augmentation, including cavity creation (fracture reduction and bone biopsy included when performed) using mechanical device (eg, kyphoplasty),
1 vertebral body, unilateral or bilateral cannulation, inclusive of all imaging guidance; lumbar.
Percutaneous vertebral augmentation, including cavity creation (fracture reduction and bone biopsy included when performed) using mechanical device (eg, kyphoplasty),
1 vertebral body, unilateral or bilateral cannulation, inclusive of all imaging guidance; each additional
thoracic or lumbar vertebral body
(list separately in addition to code
for primary procedure).
J1
5124
J1
5124
N
N/A
22515 .......
sradovich on DSK3GMQ082PROD with RULES
Final CY
2017 OPPS
SI
$7,064.07
22514 .......
VerDate Sep<11>2014
22:11 Dec 30, 2016
Jkt 241001
PO 00000
Frm 00025
CY 2016
OPPS APC
CY 2016
OPPS
payment rate
CPT code
Fmt 4700
Sfmt 4700
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12. On page 79627, Table 18—Final
CY 2017 Status Indicator (SI), APC
Assignments, and Payment Rates for the
Transcranial Magnetic Stimulation
(TMS) Therapy Codes, is corrected to
read as follows:
TABLE 18—FINAL CY 2017 STATUS INDICATOR (SI), APC ASSIGNMENTS, AND PAYMENT RATES FOR THE TRANSCRANIAL
MAGNETIC STIMULATION (TMS) THERAPY CODES
Final CY
2017 OPPS
APC
Final CY 2017
OPPS
payment rate
S
5722
$232.31
220.35
S
5722
232.31
$220.35
S
5721
$127.10
Long descriptors
CY 2016
OPPS SI
90867 .......
Therapeutic repetitive transcranial
magnetic stimulation (tms) treatment; initial, including cortical mapping, motor threshold determination, delivery and management.
Therapeutic repetitive transcranial
magnetic stimulation (tms) treatment; subsequent delivery and
management, per session.
Therapeutic repetitive transcranial
magnetic stimulation (tms) treatment; subsequent motor threshold
re-determination with delivery and
management.
S
5722
S
5722
S
5722
Final CY
2017 OPPS
SI
$220.35
90868 .......
90869 .......
13. On page 79629,
a. Second column,
1. First partial paragraph, last
sentence, in line 19, replace ‘‘$59.84’’
with $59.86
CY 2016
OPPS APC
CY 2016
OPPS
payment rate
CPT code
14. On pages 79636 through 79637,
Table 23—Final CY 2017 Status
Indicator (SI), APC Assignments, and
Payment Rates for the Transprostatic
Urethral Implant Procedures, is
corrected to read as follows:
2. Second full paragraph, last
sentence, in line 27, replace ‘‘$112.69’’
with ‘‘$112.73’’.
b. Third column, first full paragraph,
in line 16, replace ‘‘70.23.’’ with
‘‘$70.26.’’
TABLE 23—FINAL CY 2017 STATUS INDICATOR (SI), APC ASSIGNMENTS AND PAYMENT RATES FOR THE
TRANSPROSTATIC URETHRAL IMPLANT PROCEDURES
CPT/
HCPCS
code
C9739 ......
C9740 ......
52441 .......
52442 .......
sradovich on DSK3GMQ082PROD with RULES
Final CY 2017
OPPS
payment rate
J1
5375
$3,484.01
5,250.00
J1
5376
7,452.66
N/A
N/A
B
N/A
N/A
N/A
N/A
B
N/A
N/A
CY 2016
OPPS SI
Cystourethroscopy, with insertion of
transprostatic implant; 1 to 3 implants.
Cystourethroscopy, with insertion of
transprostatic implant; 4 or more
implants.
Cystourethroscopy, with insertion of
permanent
adjustable
transprostatic implant; single implant.
Cystourethroscopy, with insertion of
permanent
adjustable
transprostatic implant; each additional
permanent
adjustable
transprostatic implant (list separately in addition to code for primary procedure).
J1
5375
T
1565
B
B
Final CY
2017 OPPS
SI
$3,393.73
15. On pages 79638 through 79639,
Table 25—Final CY 2017 Status
VerDate Sep<11>2014
Final CY
2017 OPPS
APC
22:11 Dec 30, 2016
Jkt 241001
CY 2016
OPPS APC
CY 2016
OPPS
payment rate
Long descriptors
Indicator (SI), APC Assignments, and
Payment Rates Certain Cryoablation
PO 00000
Frm 00026
Fmt 4700
Sfmt 4700
Procedures, is corrected to read as
follows:
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TABLE 25—FINAL CY 2017 STATUS INDICATOR (SI), APC ASSIGNMENTS, AND PAYMENT RATES FOR CERTAIN
CRYOABLATION PROCEDURES
CPT/
HCPCS
code
20983 .......
47383 .......
50593 .......
0340T .......
0440T .......
0441T .......
0442T .......
Final CY
2017 OPPS
APC
Final CY 2017
OPPS
payment rate
J1
5114
$5,221.57
4,118.23
J1
5361
4,199.13
5352
4,118.23
J1
5362
6,969.84
T
5352
4,118.23
J1
5361
4,199.13
J1
5361
4,001.15
J1
5432
4,151.86
J1
5361
4,001.15
J1
5432
4,151.86
T
5352
4,118.23
J1
5432
4,151.86
CY 2016
OPPS SI
Ablation therapy for reduction or
eradication of 1 or more bone tumors (eg, metastasis) including adjacent soft tissue when involved by
tumor extension, percutaneous, including imaging guidance when
performed; cryoablation.
Ablation, 1 or more liver tumor(s),
percutaneous, cryoablation.
Ablation, renal tumor(s), unilateral,
percutaneous, cryotherapy.
Ablation, pulmonary tumor(s), including pleura or chest wall when involved
by
tumor
extension,
percutaneous, cryoablation, unilateral, includes imaging guidance.
Ablation, percutaneous, cryoablation,
includes imaging guidance; upper
extremity distal/peripheral nerve.
Ablation, percutaneous, cryoablation,
includes imaging guidance; lower
extremity distal/peripheral nerve.
Ablation, percutaneous, cryoablation,
includes imaging guidance; nerve
plexus or other truncal nerve (eg,
brachial plexus, pudendal nerve).
T
5352
T
5352
T
Final CY
2017 OPPS
SI
$4,118.23
16. On page 79641, Table 28—Final
CY 2017 Status Indicator (SI), APC
Assignments, and Payment Rates for the
CY 2016
OPPS APC
CY 2016
OPPS
payment rate
Long descriptors
Dialysis Circuit Procedures, is corrected
to read as follows:
TABLE 28—FINAL CY 2017 STATUS INDICATOR (SI), APC ASSIGNMENTS, AND PAYMENT RATES FOR THE DIALYSIS
CIRCUIT PROCEDURES
Proposed
CY 2017
CPT code
36147
36148
369X1
369X2
369X3
369X4
369X5
369X6
369X7
369X8
369X9
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
.........
Short descriptors
CY 2016
OPPS SI
CY 2016
OPPS APC
CY 2016
OPPS
payment rate
Final CY
2017 OPPS
SI
Final CY
2017 OPPS
APC
Final CY 2017
OPPS
payment rate
Access av dial grft for eval ...................
Access av dial grft for proc ..................
Intro cath dialysis circuit .......................
Intro cath dialysis circuit .......................
Intro cath dialysis circuit .......................
Thrmbc/nfs dialysis circuit ....................
Thrmbc/nfs dialysis circuit ....................
Thrmbc/nfs dialysis circuit ....................
Balo angiop ctr dialysis seg .................
Stent plmt ctr dialysis seg ....................
Dialysis circuit embolj ...........................
T
N
....................
....................
....................
....................
....................
....................
....................
....................
....................
5181
....................
....................
....................
....................
....................
....................
....................
....................
....................
....................
$862.51
........................
........................
........................
........................
........................
........................
........................
........................
........................
........................
D
D
T
J1
J1
J1
J1
J1
N
N
N
....................
....................
5181
5192
5193
5192
5193
5194
N/A
N/A
N/A
........................
........................
$684.13
4,825.20
9,752.43
4,825.20
9,752.43
14,782.14
N/A
N/A
N/A
Final CY 2017
CPT code
36147
36148
36901
36902
36903
36904
36905
36906
36907
36908
36909
17. On page 79643,
a. First column, first partial
paragraph, in line 14, replace ‘‘$7, 453.’’
with ‘‘$7,456.’’
b. Table 30—Final CY 2017 Status
Indicator (SI), APC Assignments, and
Payment Rates for the Magnetic
Resonance Image Guided High Intensity
Focused Ultrasound (MRgFUS)
Procedures, is corrected to read as
follows:
sradovich on DSK3GMQ082PROD with RULES
TABLE 30—FINAL CY 2017 STATUS INDICATOR (SI), APC ASSIGNMENTS, AND PAYMENT RATES FOR THE MAGNETIC
RESONANCE IMAGE GUIDED HIGH INTENSITY FOCUSED ULTRASOUND (MRgFUS) PROCEDURES
CPT/
HCPCS
code
0071T .......
VerDate Sep<11>2014
Long descriptors
CY 2016
OPPS SI
Focused ultrasound ablation of uterine leiomyomata, including mr
guidance; total leiomyomata volume less than 200 cc of tissue.
T
22:11 Dec 30, 2016
Jkt 241001
PO 00000
Frm 00027
CY 2016
OPPS APC
5414
Fmt 4700
Sfmt 4700
CY 2016
OPPS
payment rate
Final CY
2017 OPPS
SI
$1,861.18
E:\FR\FM\03JAR1.SGM
J1
03JAR1
Final CY
2017 OPPS
APC
Final CY 2017
OPPS
payment rate
5414
$2,085.47
32
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TABLE 30—FINAL CY 2017 STATUS INDICATOR (SI), APC ASSIGNMENTS, AND PAYMENT RATES FOR THE MAGNETIC
RESONANCE IMAGE GUIDED HIGH INTENSITY FOCUSED ULTRASOUND (MRgFUS) PROCEDURES—Continued
CPT/
HCPCS
code
0072T .......
0398T .......
C9734 ......
Final CY
2017 OPPS
APC
Final CY 2017
OPPS
payment rate
J1
5414
2,085.47
N/A
S
1537
9,750.50
2,395.59
J1
5114
2,085.47
CY 2016
OPPS SI
Focused ultrasound ablation of uterine leiomyomata, including mr
guidance; total leiomyomata volume greater or equal to 200 cc of
tissue.
Magnetic resonance image guided
high intensity focused ultrasound
(mrgfus), stereotactic ablation lesion, intracranial for movement disorder including stereotactic navigation and frame placement when
performed.
Focused ultrasound ablation/therapeutic intervention, other than uterine leiomyomata, with magnetic
resonance (mr) guidance.
T
5414
E
N/A
T
5122
Final CY
2017 OPPS
SI
1,861.18
18. On page 79645, Table 32—Final
CY 2017 Status Indicator (SI), APC
CY 2016
OPPS APC
CY 2016
OPPS
payment rate
Long descriptors
Assignments, and Payment Rates for the
Smoking and Tobacco Use Cessation
Counseling Services, is corrected to read
as follows:
TABLE 32—FINAL CY 2017 STATUS INDICATOR (SI), APC ASSIGNMENT, AND PAYMENT RATE FOR THE SMOKING AND
TOBACCO USE CESSATION COUNSELING SERVICES
CPT/
HCPCS
code
99406 .......
99407 .......
G0436 ......
G0437 ......
sradovich on DSK3GMQ082PROD with RULES
Final CY 2017
OPPS
payment rate
S
5821
$25.23
27.12
S
5821
25.23
5821
27.12
D
N/A
N/A
5822
69.65
D
N/A
N/A
CY 2016
OPPS SI
Smoking and tobacco use cessation
counseling
visit;
intermediate,
greater than 3 minutes up to 10
minutes.
Smoking and tobacco use cessation
counseling visit; intensive, greater
than 10 minutes.
Smoking and tobacco cessation
counseling visit for the asymptomatic
patient;
intermediate,
greater than 3 minutes, up to 10
minutes.
Smoking and tobacco cessation
counseling visit for the asymptomatic patient; intensive, greater
than 10 minutes.
S
5821
S
5821
S
S
Final CY
2017 OPPS
SI
$27.12
19. On page 79647, first column,
second full paragraph, under a response
to public comment, the last two
sentences of the paragraph are corrected
to read ‘‘However, the rationale for this
modification of the proposal for these
codes is not related to the statutory
provision of section 144 of the Medicare
VerDate Sep<11>2014
Final CY
2017 OPPS
APC
22:11 Dec 30, 2016
Jkt 241001
CY 2016
OPPS APC
CY 2016
OPPS
payment rate
Long descriptors
Improvements for Patients and
Providers Act of 2008. We believe that
pulmonary rehabilitation (and the
related respiratory treatment services)
are not typically ancillary to the other
HOPD services that may be furnished to
beneficiaries. These services are
typically part of a course of treatment
PO 00000
Frm 00028
Fmt 4700
Sfmt 4700
that is prescribed after a diagnosis is
made and often after other treatments
are initiated or completed.’’
20. On page 79648, Table 34—Final
CY 2017 Status Indicator (SI), APC
Assignments, and Payment Rates for the
Pulmonary Rehabilitation Services, is
corrected to read as follows:
E:\FR\FM\03JAR1.SGM
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TABLE 34—FINAL CY 2017 STATUS INDICATOR (SI), APC ASSIGNMENTS, AND PAYMENT RATES FOR THE PULMONARY
REHABILITATION SERVICES
CY 2016
OPPS
payment
Final CY
2017 OPPS
APC
Final CY 2017
OPPS
payment
S
5732
$28.38
55.94
S
5732
28.38
5732
30.51
S
5732
28.38
5733
55.94
S
5733
54.55
HCPCS
code
Long descriptors
CY 2016
OPPS SI
G0237 ......
Therapeutic procedures to increase
strength or endurance of respiratory muscles, face to face, one
on one, each 15 minutes (includes
monitoring).
Therapeutic procedures to improve
respiratory function, other than described by g0237, one on one,
face to face, per 15 minutes (includes monitoring).
Therapeutic procedures to improve
respiratory function or increase
strength or endurance of respiratory muscles, two or more individuals (includes monitoring).
Pulmonary rehabilitation, including
exercise (includes monitoring), one
hour, per session, up to two sessions per day.
Q1
5734
Q1
5733
Q1
Q1
Final CY
2017 OPPS
SI
$91.18
G0238 ......
G0239 ......
G0424 ......
21. On page 79662, Table 35—Drugs
and Biologicals for Which Pass-Through
CY 2016
OPPS APC
Payment Status Expires December 31,
2016, is corrected to read as follows:
TABLE 35—DRUGS AND BIOLOGICALS FOR WHICH PASS–THROUGH PAYMENT STATUS EXPIRES DECEMBER 31, 2016
CY 2017
HCPCS code
CY 2017 Long descriptor
Final CY 2017
status
indicator
C9497 ...............
J1322 ................
J1439 ................
J1447 ................
J3145 ................
J3380 ................
J7181 ................
J7200 ................
J7201 ................
J7205 ................
J7508 ................
J9301 ................
J9308 ................
J9371 ................
Q4121 ...............
Loxapine, inhalation powder, 10 mg ........................................................................................
Injection, elosulfase alfa, 1mg ..................................................................................................
Injection, ferric carboxymaltose, 1 mg ......................................................................................
Injection, TBO-Filgrastim, 1 micrograms ..................................................................................
Injection, testosterone undecanoate, 1 mg ..............................................................................
Injection, vedolizumab, 1 mg ....................................................................................................
Factor XIII (antihemophilic factor, recombinant), Tretten, per i.u ............................................
Factor ix (antihemophilic factor, recombinant), Rixubus, per i.u ..............................................
Factor ix (antihemophilic factor, recombinant), Alprolix, per i.u ...............................................
Injection, factor viii, fc fusion protein, (recombinant), per i.u ...................................................
Tacrolimus, Extended Release, Oral, 0.1 mg ..........................................................................
Injection, obinutuzumab, 10 mg ...............................................................................................
Injection, ramucirumab, 5 mg ...................................................................................................
Injection, Vincristine Sulfate Liposome, 1 mg ..........................................................................
Theraskin, per square centimeter .............................................................................................
K
K
K
K
N
K
K
K
K
K
N
K
K
K
N
22. On page 79664, Table 36—Drugs
and Biologicals with Pass-Through
Payment Status in CY 2017, the Long
Descriptors for CY HCPCS codes A9588
Final CY 2017
APC
9497
1480
9441
1748
N/A
1489
1746
1467
1486
1656
N/A
1476
1488
1466
N/A
and A9587 are revised to read as
follows:
CORRECTIONS TO TABLE 36—DRUGS AND BIOLOGICALS WITH PASS–THROUGH PAYMENT STATUS IN CY 2017
CY 2017
HCPCS
code
CY 2017 Long descriptor
CY 2017
status
indicator
N/A ....................
N/A ....................
sradovich on DSK3GMQ082PROD with RULES
CY 2016
HCPCS code
A9588
A9587
Fluciclovine f-18, diagnostic, 1 mCi .....................................................................
Gallium Ga-68, dotatate, diagnostic, 0.1 mCi ......................................................
G
G
23. On page 79671, in Table 37—
Assignments to High Cost and Low Cost
Groups for CY 2017, remove HCPCS
codes Q4119, Q4120, and Q4129.
24. On page 79708, third column, in
lines 28 through 31, the words ‘‘for
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services that were furnished prior to
November 2, 2015, and billed under the
OPPS in accordance with timely filing
limits.’’ are corrected to read ‘‘if the PBD
furnished a covered OPD service prior
to November 2, 2015 and billed the
PO 00000
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CY 2017 APC
9052
9056
OPPS within timely filing limits for that
service.’’
25. On page 79719, third column, first
partial paragraph, in lines 6 and 7,
remove the words ‘‘for cost reporting
periods beginning January 1, 2017,’’.
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26. On page 79741, third column,
fourth full paragraph, in lines 10 and 11,
the words ‘‘was deleted by the AMA
Editorial Panel in April 2016.’’ are
corrected to read ‘‘will be deleted
effective December 31, 2016.’’
27. On page 79742, first column, first
full paragraph, in lines 2 and 3, the
words ‘‘was deleted effective April 13,
2016,’’ are corrected to read ‘‘will be
deleted effective December 31, 2016,’’.
28. On page 79743, Table 51—
Additions To The List of ASC Covered
Surgical Procedures For CY 2017, CPT
code 22585 is added in numerical order
to read as follows:
CORRECTIONS TO TABLE 51—ADDITIONS TO THE LIST OF ASC COVERED SURGICAL PROCEDURES FOR CY 2017
CY 2017
ASC
payment
indicator
CY 2017 CPT
code
CY 2017 long descriptor
22585 ................
Arthrodesis, anterior interbody technique, including minimal discectomy to prepare interspace (other than for decompression); each additional interspace (List separately in addition to code for primary procedure).
29. On page 79752, third column,
bottom half of the page, first full
paragraph,
a. In line 11, replace ‘‘0.9996’’ with
‘‘0.9997.’’
b. In line 27, replace ‘‘$45.030’’ with
‘‘$45.003.’’
c. In line 30, replace ‘‘$44.190’’ with
‘‘$44.177.’’
d. In line 32, replace ‘‘0.9996’’ with
‘‘0.9997.’’
30. On page 79753,
0659 ...................
a. First column, first partial
paragraph,
(1) In line 9, replace ‘‘$44.330’’ with
‘‘$44.120.’’
(2) In line 12, replace ‘‘$44.190’’ with
‘‘$44.177.’’
(3) In line 14, replace ‘‘0.9996’’ with
‘‘0.9997.’’
b. Second column, second full
paragraph, in line 7, replace ‘‘$45.030’’
with ‘‘$45.003.’’
N1
31. On page 79784, the un-numbered
table—PREVIOUSLY FINALIZED AND
NEWLY FINALIZED HOSPITAL OQR
PROGRAM MEASURE SET FOR THE
CY 2020 PAYMENT DETERMINATION
AND SUBSEQUENT YEARS, is
corrected by removing the three
asterisks, ‘‘***’’ after the OP–30
measure name and adding in its place
two asterisks, ‘‘**’’ to read as follows:
OP–30: Colonoscopy Interval for Patients with a History of Adenomatous Polyps—Avoidance of Inappropriate Use. **
32. On page 79868,
a. Second column, first full paragraph,
in line 3, replace ‘‘1.7’’ with ‘‘1.8.’’
b. Third column, first paragraph, in
lines 15 and 16, ‘‘an increase of 0.1
percent to 0.3 percent’’ is corrected to
read ‘‘no change to an increase of 0.3
percent.’’
33. On page 79869,
a. Second column, first full paragraph,
in line 11, replace ‘‘1.7’’ with ‘‘1.8.’’
b. Third column, first full paragraph,
in line 2, replace ‘‘1.7’’ with ‘‘1.8.’’
34. On pages 79869 through 79870,
Table 52—Estimated Impact of the CY
2017
Changes for the Hospital Outpatient
Prospective Payment System, is
corrected to read as follows:
TABLE 52—IMPACT OF CHANGES FOR FINAL CY 2017 HOSPITAL OUTPATIENT PROSPECTIVE PAYMENT SYSTEM
APC recalibration
(all changes)
New wage index
and provider
adjustments
All budget neutral
changes
(combined cols
2,3) with market
basket update
All changes
(1)
sradovich on DSK3GMQ082PROD with RULES
Number of
hospitals
(2)
(3)
(4)
(5)
All Providers * ...............................................
All Hospitals (excludes hospitals held harmless and CMHCs) .....................................
Urban Hospitals ...........................................
Large Urban (GT 1 Mill.) ......................
Other Urban (LE 1 Mill.) .......................
Rural Hospitals .............................................
Sole Community ...................................
Other Rural ...........................................
Beds (Urban):
0–99 Beds .............................................
100–199 Beds .......................................
200–299 Beds .......................................
300–499 Beds .......................................
500 + Beds ...........................................
Beds (Rural):
0–49 Beds .............................................
50–100 Beds .........................................
101–149 Beds .......................................
150–199 Beds .......................................
200 + Beds ...........................................
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3906
0.0
1.7
1.8
3789
2958
1616
1342
831
376
455
0.0
0.0
0.0
0.1
0.2
0.2
0.2
0.0
0.0
¥0.1
0.1
0.3
0.4
0.2
1.8
1.7
1.6
1.8
2.2
2.3
2.1
1.8
1.8
1.7
1.8
2.2
2.2
2.1
1045
834
465
405
209
¥0.3
0.2
0.2
0.1
¥0.2
0.2
¥0.1
0.0
0.0
0.0
1.6
1.8
1.9
1.8
1.4
1.7
1.8
1.9
1.9
1.5
340
299
108
45
39
PO 00000
0.0
0.3
0.2
0.1
0.0
0.2
0.5
0.4
¥0.2
0.4
0.2
2.6
2.4
1.6
2.2
2.1
2.5
2.3
1.7
2.1
2.1
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Federal Register / Vol. 82, No. 1 / Tuesday, January 3, 2017 / Rules and Regulations
TABLE 52—IMPACT OF CHANGES FOR FINAL CY 2017 HOSPITAL OUTPATIENT PROSPECTIVE PAYMENT SYSTEM—
Continued
Number of
hospitals
APC recalibration
(all changes)
New wage index
and provider
adjustments
All budget neutral
changes
(combined cols
2,3) with market
basket update
All changes
(1)
(2)
(3)
(4)
(5)
sradovich on DSK3GMQ082PROD with RULES
Region (Urban):
New England ........................................
Middle Atlantic ......................................
South Atlantic ........................................
East North Cent ....................................
East South Cent ...................................
West North Cent ...................................
West South Cent ..................................
Mountain ...............................................
Pacific ...................................................
Puerto Rico ...........................................
Region (Rural):
New England ........................................
Middle Atlantic ......................................
South Atlantic ........................................
East North Cent ....................................
East South Cent ...................................
West North Cent ...................................
West South Cent ..................................
Mountain ...............................................
Pacific ...................................................
Teaching Status:
Non-Teaching .......................................
Minor .....................................................
Major .....................................................
DSH Patient Percent:
0 ............................................................
GT 0–0.10 .............................................
0.10–0.16 ..............................................
0.16–0.23 ..............................................
0.23–0.35 ..............................................
GE 0.35 .................................................
DSH not Available ** .............................
Urban Teaching/DSH:
Teaching & DSH ...................................
No Teaching/DSH .................................
No Teaching/No DSH ...........................
DSH Not Available2 ..............................
Type of Ownership:
Voluntary ...............................................
Proprietary ............................................
Government ..........................................
CMHCs .........................................................
146
350
465
473
177
182
527
206
383
49
0.0
0.0
0.1
0.1
¥0.4
¥0.1
¥0.2
0.2
0.4
0.5
¥1.1
0.1
0.0
0.1
0.3
0.0
0.3
1.0
¥0.3
¥0.3
0.6
1.7
1.7
1.8
1.6
1.6
1.8
2.9
1.7
1.8
0.6
1.7
1.8
1.9
1.7
1.5
1.9
3.0
1.8
1.8
21
55
126
121
158
100
168
58
24
0.9
0.1
0.3
0.2
0.0
0.0
0.2
0.2
0.3
0.5
1.2
¥0.3
0.3
0.2
0.4
0.7
¥0.1
¥0.1
3.1
3.0
1.7
2.2
1.9
2.1
2.6
1.9
1.9
3.0
3.0
1.7
2.2
1.9
2.0
2.6
1.8
1.9
2712
731
346
0.1
0.1
¥0.2
0.1
0.0
¥0.1
1.9
1.9
1.4
2.0
1.9
1.5
10
305
270
600
1135
895
574
¥1.7
¥0.4
0.1
0.1
0.1
0.1
¥1.4
¥0.2
0.0
0.1
0.1
0.1
¥0.1
¥0.2
¥0.2
1.2
1.8
2.0
1.9
1.7
0.1
¥0.1
1.3
1.8
2.0
1.9
1.7
0.2
975
1425
10
548
0.0
0.1
¥1.7
¥1.4
0.0
0.1
¥0.2
¥0.3
1.6
1.9
¥0.2
0.0
1.7
1.9
¥0.1
0.1
1983
1306
500
50
0.1
0.0
¥0.1
¥15.0
0.1
0.1
¥0.1
¥0.4
1.8
1.7
1.5
¥13.9
1.9
1.8
1.6
¥13.7
Column (1) shows total hospitals and/or CMHCs.
Column (2) includes all final CY 2017 OPPS policies and compares those to the CY 2016 OPPS.
Column (3) shows the budget neutral impact of updating the wage index by applying the final FY 2017 hospital inpatient wage index, including
all hold harmless policies and transitional wages. The rural adjustment continues our current policy of 7.1 percent so the budget neutrality factor
is 1. The budget neutrality adjustment for the cancer hospital adjustment is 1.003 because the payment-to-cost ratio target changes from 0.92 in
CY 2016 to 0.91 in CY 2017.
Column (4) shows the impact of all budget neutrality adjustments and the addition of the final 1.65 percent OPD fee schedule update factor
(2.7 percent reduced by 0.3 percentage points for the final productivity adjustment and further reduced by 0.75 percentage point in order to satisfy statutory requirements set forth in the Affordable Care Act). It also includes the impact of the additional adjustment of 1.0004 for Lab services with L1 Modifiers packaged into the OPPS.
Column (5) shows the additional adjustments to the conversion factor resulting from the frontier adjustment, a change in the pass-through estimate, and adding estimated outlier payments.
These 3,906 providers include children and cancer hospitals, which are held harmless to pre-BBA amounts, and CMHCs.
** Complete DSH numbers are not available for providers that are not paid under IPPS, including rehabilitation, psychiatric, and long-term care
hospitals.
35. On page 79871, third column, first
partial paragraph, in the last line,
replace ‘‘$45.016’’ with ‘‘$45.003.’’
■ 36. On page 79877, third column, last
paragraph, in lines 2 and 3, the phrase
■
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‘‘OPPS payments by $500 million’’ is
corrected to read ‘‘Part B payments by
$50 million.’’
PO 00000
Regulations Text Corrections
§ 419.22
[Corrected]
37. On page 79879, second column, in
§ 419.22, ‘‘Hospital services excluded
■
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Federal Register / Vol. 82, No. 1 / Tuesday, January 3, 2017 / Rules and Regulations
from payment under the hospital
outpatient prospective payment
system,’’ the words ‘‘for cost reporting
periods beginning on or after January 1,
2017,’’ are removed.
■ 38. On page 79880, first column, in
§ 419.48, paragraph (b) is corrected to
read as follows:
§ 419.48, ‘‘Definition of excepted items and
services
*
*
*
*
*
(b) For the purpose of this section,
‘‘excepted off-campus provider-based
department’’ means a ‘‘department of a
provider’’ (as defined at § 413.65(a)(2) of
this chapter) that is located on the
campus (as defined in § 413.65(a)(2) of
this chapter) or within the distance
described in such definition from a
‘‘remote location of a hospital’’ (as
defined in § 413.65(a)(2) of this chapter)
that meets the requirements for
provider-based status under § 413.65 of
this chapter. This definition also
includes an off-campus department of a
provider that was furnishing services
prior to November 2, 2015 that were
billed under the OPPS in accordance
with timely filing limits.
*
*
*
*
*
■ 39. Section 495.40 is corrected as
follows:
■ a. On page 79892, in the first column,
in amendment 27, redesignate
instructions d through f as instructions
e through g respectively and add a new
instruction d to read ‘‘d. Adding
paragraphs (a)(2)(i)(H) and (I).’’
■ b. On page 79892, in the second
column, in amendment 27, correct
redesignated instruction g to read ‘‘g.
Adding new paragraphs (b)(2)(i)(G), (H),
and (I).’’
■ c. On page 79892, in the second
column, paragraph (a) introductory text
is correctly revised.
■ d. On page 79892, in the second
column, paragraphs (a)(2)(i)(H) and (I)
are added.
■ e. On page 79892, in the second
column, paragraph (b) introductory text
is correctly revised.
■ f. On page 79892, in the third column
paragraphs (b)(2)(i)(H) and (I) are added.
The revisions and additions read as
follows:
sradovich on DSK3GMQ082PROD with RULES
§ 495.40
criteria.
Demonstration of meaningful use
(a) Demonstration by EPs. An EP must
demonstrate that he or she satisfies each
of the applicable objectives and
associated measures under § 495.20,
§ 495.22 or § 495.24, supports
information exchange and the
prevention of health information
blocking, and engages in activities
VerDate Sep<11>2014
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Jkt 241001
related to supporting providers with the
performance of CEHRT:
*
*
*
*
*
(2) * * *
(i) * * *
(H) Supporting providers with the
performance of CEHRT (SPPC). To
engage in activities related to supporting
providers with the performance of
CEHRT, the EP—
(1) Must attest that he or she:
(i) Acknowledges the requirement to
cooperate in good faith with ONC direct
review of his or her health information
technology certified under the ONC
Health IT Certification Program if a
request to assist in ONC direct review is
received; and
(ii) If requested, cooperated in good
faith with ONC direct review of his or
her health information technology
certified under the ONC Health IT
Certification Program as authorized by
45 CFR part 170, subpart E, to the extent
that such technology meets (or can be
used to meet) the definition of CEHRT,
including by permitting timely access to
such technology and demonstrating its
capabilities as implemented and used
by the EP in the field.
(2) Optionally, may also attest that he
or she:
(i) Acknowledges the option to
cooperate in good faith with ONC–ACB
surveillance of his or her health
information technology certified under
the ONC Health IT Certification Program
if a request to assist in ONC–ACB
surveillance is received; and
(ii) If requested, cooperated in good
faith with ONC–ACB surveillance of his
or her health information technology
certified under the ONC Health IT
Certification Program as authorized by
45 CFR part 170, subpart E, to the extent
that such technology meets (or can be
used to meet) the definition of CEHRT,
including by permitting timely access to
such technology and demonstrating
capabilities as implemented and used
by the EP in the field.
(I) Support for health information
exchange and the prevention of
information blocking. For an EHR
reporting period in CY 2017 and
subsequent years, the EP must attest that
he or she—
(1) Did not knowingly and willfully
take action (such as to disable
functionality) to limit or restrict the
compatibility or interoperability of
certified EHR technology.
(2) Implemented technologies,
standards, policies, practices, and
agreements reasonably calculated to
ensure, to the greatest extent practicable
and permitted by law, that the certified
EHR technology was, at all relevant
times—
PO 00000
Frm 00032
Fmt 4700
Sfmt 4700
(i) Connected in accordance with
applicable law;
(ii) Compliant with all standards
applicable to the exchange of
information, including the standards,
implementation specifications, and
certification criteria adopted at 45 CFR
part 170;
(iii) Implemented in a manner that
allowed for timely access by patients to
their electronic health information; and
(iv) Implemented in a manner that
allowed for the timely, secure, and
trusted bidirectional exchange of
structured electronic health information
with other health care providers (as
defined by 42 U.S.C. 300jj(3)), including
unaffiliated providers, and with
disparate Certified EHR technology and
vendors.
(3) Responded in good faith and in a
timely manner to requests to retrieve or
exchange electronic health information,
including from patients, health care
providers (as defined by 42 U.S.C.
300jj(3)), and other persons, regardless
of the requestor’s affiliation or
technology vendor.’’
*
*
*
*
*
(b) Demonstration by eligible
hospitals and CAHs. An eligible
hospital or CAH must demonstrate that
it satisfies each of the applicable
objectives and associated measures
under § 495.20, § 495.22, or § 495.24,
supports information exchange and the
prevention of health information
blocking, and engages in activities
related to supporting providers with the
performance of CEHRT:
*
*
*
*
*
(2) * * *
(i) * * *
(H) Supporting providers with the
performance of CEHRT (SPPC). To
engage in activities related to supporting
providers with the performance of
CEHRT, the eligible hospital or CAH—
(1) Must attest that it:
(i) Acknowledges the requirement to
cooperate in good faith with ONC direct
review of his or her health information
technology certified under the ONC
Health IT Certification Program if a
request to assist in ONC direct review is
received; and
(ii) If requested, cooperated in good
faith with ONC direct review of its
health information technology certified
under the ONC Health IT Certification
Program as authorized by 45 CFR part
170, subpart E, to the extent that such
technology meets (or can be used to
meet) the definition of CEHRT,
including by permitting timely access to
such technology and demonstrating its
capabilities as implemented and used
by the eligible hospital or CAH in the
field.
E:\FR\FM\03JAR1.SGM
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Federal Register / Vol. 82, No. 1 / Tuesday, January 3, 2017 / Rules and Regulations
(2) Optionally, may attest that it:
(i) Acknowledges the option to
cooperate in good faith with ONC–ACB
surveillance of his or her health
information technology certified under
the ONC Health IT Certification Program
if a request to assist in ONC–ACB
surveillance is received; and
(ii) If requested, cooperated in good
faith with ONC–ACB surveillance of his
or her health information technology
certified under the ONC Health IT
Certification Program as authorized by
45 CFR part 170, subpart E, to the extent
that such technology meets (or can be
used to meet) the definition of CEHRT,
including by permitting timely access to
such technology and demonstrating its
capabilities as implemented and used
by the eligible hospital or CAH in the
field.
(I) Support for health information
exchange and the prevention of
information blocking. For an EHR
reporting period in CY 2017 and
subsequent years, the eligible hospital
or CAH must attest that it—
(1) Did not knowingly and willfully
take action (such as to disable
functionality) to limit or restrict the
compatibility or interoperability of
certified EHR technology.
(2) Implemented technologies,
standards, policies, practices, and
agreements reasonably calculated to
ensure, to the greatest extent practicable
and permitted by law, that the certified
EHR technology was, at all relevant
times—
(i) Connected in accordance with
applicable law;
(ii) Compliant with all standards
applicable to the exchange of
information, including the standards,
implementation specifications, and
certification criteria adopted at 45 CFR
part 170;
(iii) Implemented in a manner that
allowed for timely access by patients to
their electronic health information; and
(iv) Implemented in a manner that
allowed for the timely, secure, and
trusted bidirectional exchange of
structured electronic health information
with other health care providers (as
defined by 42 U.S.C. 300jj(3)), including
unaffiliated providers, and with
disparate certified EHR technology and
vendors.
(3) Responded in good faith and in a
timely manner to requests to retrieve or
exchange electronic health information,
including from patients, health care
providers (as defined by 42 U.S.C.
300jj(3)), and other persons, regardless
of the requestor’s affiliation or
technology vendor.’’.
*
*
*
*
*
VerDate Sep<11>2014
22:11 Dec 30, 2016
Jkt 241001
Dated: December 27, 2016.
Madhura Valverde,
Executive Secretary to the Department,
Department of Health and Human Services.
[FR Doc. 2016–31774 Filed 12–30–16; 8:45 am]
DEPARTMENT OF HEALTH AND
HUMAN SERVICES
Centers for Medicare & Medicaid
Services
42 CFR Parts 431, 433, 438, 440, 457,
and 495
[CMS–2390–F3]
RIN–0938–AS25
Medicaid and Children’s Health
Insurance Program (CHIP) Programs;
Medicaid Managed Care, CHIP
Delivered in Managed Care, and
Revisions Related to Third Party
Liability; Corrections
Centers for Medicare &
Medicaid Services (CMS), HHS.
ACTION: Final rule; correcting
amendment.
AGENCY:
This document corrects
technical errors that appeared in the
final rule published in the May 6, 2016
Federal Register (81 FR 27498 through
27901) entitled, ‘‘Medicaid and
Children’s Health Insurance Program
(CHIP) Programs; Medicaid Managed
Care, CHIP Delivered in Managed Care,
and Revisions Related to Third Party
Liability.’’ The effective date for the rule
was July 5, 2016.
DATES: Effective Date: This correcting
document is effective December 30,
2016.
Applicability Date: The corrections
indicated in this document are
applicable beginning immediately.
FOR FURTHER INFORMATION CONTACT:
John Giles, (410) 786–1255, Medicaid
Managed Care Operations.
Heather Hostetler, (410) 786–4515,
Medicaid Managed Care Quality.
Melissa Williams, (410) 786–4435,
CHIP.
Nancy Dieter, (410) 786–7219, Third
Party Liability.
SUPPLEMENTARY INFORMATION:
SUMMARY:
I. Background
In FR Doc. 2016–09581 (81 FR 27498
through 27901), the final rule entitled,
‘‘Medicaid and Children’s Health
Insurance Program (CHIP) Programs;
Medicaid Managed Care, CHIP
Delivered in Managed Care, and
Revisions Related to Third Party
Liability’’ there were technical errors
Frm 00033
Fmt 4700
that are identified and corrected in this
correcting document. These corrections
are applicable immediately.
II. Summary of Errors
A. Summary of Errors in the Preamble
BILLING CODE 4120–01–P
PO 00000
37
Sfmt 4700
On page 27560 we made a technical
error in the response to comments of
§ 438.6(e). In this response, we
inadvertently identified the effective
date and the date by which we would
enforce compliance for the regulation,
which is correctly identified in the
Compliance section on page 27499.
On page 27679 we made a technical
error in the preamble text of § 438.330
(Quality Assessment and Performance
Improvement Program) in a response to
comment. We stated, ‘‘Note that
standards for risk adjustment are
provided in §§ 438.5(g) and 438.7(b)(5).’’
We inadvertently omitted the words
‘‘for payment purposes’’ after ‘‘risk
adjustment’’ in this sentence to clarify
that these cross-referenced sections are
related to risk adjustment for payment
purposes.
On page 27708 we made a technical
error in the preamble text of § 438.358
(Activities Related to External Quality
Review) in a response to comment about
§ 438.358(b)(iv) (Validation of MCO,
PIHP, or PAHP validation of network
adequacy). We inadvertently included
PIHPs and PAHPs in a statement about
the match rate for this EQR-related
activity for MCOs. We stated, ‘‘. . . the
validation of MCOs, PIHPs, and PAHPs
would be eligible for the 75 percent
match rate under § 438.370(a).’’ This
was in error, as it conflicts with
§ 438.370 of the final rule and the
preamble discussion of that section on
pages 27715 through 27717.
On page 27712 we made a technical
error in the preamble text of § 438.360
(Nonduplication of mandatory activities
with Medicare or accreditation review)
in a response to comment about
updating the EQR protocols to
incorporate data from a Medicare or
private accrediting entity review. We
referenced three of the mandatory EQRrelated activities using the citation from
the proposed rule (§ 438.358(b)(1) to
(b)(3)), rather than the citation from the
final rule (§ 438.358(b)(1)(i) to
(b)(1)(iii)).
On page 27738 we made a technical
error in the response to comments of
§ 438.242(b)(2). In this response, we
inadvertently mistyped ‘‘T–MSIS.’’
On page 27766 we made a technical
error in the preamble text of § 457.1233.
We inadvertently did not note that CHIP
is also adopting the changes discussed
in the Medicaid preamble to include
PCCM entities as subject to § 438.230 in
E:\FR\FM\03JAR1.SGM
03JAR1
Agencies
[Federal Register Volume 82, Number 1 (Tuesday, January 3, 2017)]
[Rules and Regulations]
[Pages 24-37]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2016-31774]
=======================================================================
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DEPARTMENT OF HEALTH AND HUMAN SERVICES
Centers for Medicare & Medicaid Services
42 CFR Parts 414, 416, 419, 482, 486, 488, and 495
[CMS-1656-CN]
RIN 0938-AS82
Medicare Program: Hospital Outpatient Prospective Payment and
Ambulatory Surgical Center Payment Systems and Quality Reporting
Programs; Organ Procurement Organization Reporting and Communication;
Transplant Outcome Measures and Documentation Requirements; Electronic
Health Record (EHR) Incentive Programs; Payment to Nonexcepted Off-
Campus Provider-Based Department of a Hospital; Hospital Value-Based
Purchasing (VBP) Program; Establishment of Payment Rates Under the
Medicare Physician Fee Schedule for Nonexcepted Items and Services
Furnished by an Off-Campus Provider-Based Department of a Hospital;
Correction and Extension of Comment Period
AGENCY: Centers for Medicare & Medicaid Services (CMS), HHS.
ACTION: Correction and extension of comment period for final rule and
interim final rule.
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SUMMARY: This document corrects technical errors that appeared in the
final rule with comment period and interim final rule with comment
period published in the Federal Register on November 14, 2016, entitled
``Hospital Outpatient Prospective Payment and Ambulatory Surgical
Center Payment Systems and Quality Reporting Programs; Organ
Procurement Organization Reporting and Communication; Transplant
Outcome Measures and Documentation Requirements; Electronic Health
Record (EHR) Incentive Programs; Payment to Nonexcepted Off-Campus
Provider-Based Department of a Hospital; Hospital Value-Based
Purchasing (VBP) Program; Establishment of Payment Rates under the
Medicare Physician Fee Schedule for Nonexcepted Items and Services
Furnished by an Off-Campus Provider-Based Department of a Hospital.''
This document extends the comment period to January 3, 2017 for
both the final rule with comment period and the interim final rule with
comment period.
DATES: Effective date: This correction is effective January 1, 2017.
Comment period: The comment period for the final rule and interim
final rule, published November 14, 2016 (81 FR 79562), is extended to 5
p.m. E.S.T. on January 3, 2017.
FOR FURTHER INFORMATION CONTACT:
Hospital Outpatient Prospective Payment System (OPPS), contact Lela
Strong (410) 786-3213.
Electronic Health Record (EHR) Incentive Programs, contact Kathleen
Johnson (410) 786-3295 or Steven Johnson (410) 786-3332.
Hospital Outpatient Quality Reporting (OQR) Program Administration,
Validation, and Reconsideration Issues, contact Elizabeth Bainger at
(410) 786-0529
SUPPLEMENTARY INFORMATION:
I. Background
In FR Doc. 2016-26515 of November 14, 2016 (81 FR 79562), titled
``Medicare Program: Hospital Outpatient Prospective Payment and
Ambulatory Surgical Center Payment Systems and Quality Reporting
Programs; Organ Procurement Organization Reporting and Communication;
Transplant Outcome Measures and Documentation Requirements; Electronic
Health Record (EHR) Incentive Programs; Payment to Certain Off-Campus
Outpatient Departments of a Provider; Hospital Value-Based Purchasing
(VBP) Program; Establishment of Payment Rates Under the Medicare
Physician Fee Schedule for Nonexcepted Items and Services Furnished by
an Off-Campus Provider-Based Department of a Hospital'' (hereinafter
referred to as the CY 2017 OPPS/ASC final rule), there were a number of
technical errors that are identified and corrected in the Correction of
Errors section below. The provisions in this correction document are
effective as if they had been included in the document published
November 14, 2016. Accordingly, the corrections are effective January
1, 2017.
II. Extension of Comment Period
We are extending the comment period. We inadvertently scheduled the
comment period to end on December 31, 2016, a Saturday. We ordinarily
do not end the comment period on a weekend or federal holiday.
Therefore, we are extending the comment period for the final rule and
interim final rule to end on the next business day, January 3, 2017.
III. Summary of Errors
A. Errors in the Preamble
1. Hospital Outpatient Prospective Payment System (OPPS) Corrections
On page 79566, in the Table of Contents, we inadvertently included
a title that referred to the CY 2017 OPPS/ASC proposed rule instead of
the final rule with comment period. We are correcting the title in this
correcting document. On the same page, in the table of contents, we
made a typographical error in the title of the sixth item, which we are
correcting to match the title in the preamble of the document.
On page 79569, we incorrectly stated estimated total payments to
OPPS providers as $773 million. We have corrected this figure to be $64
billion.
On page 79582, we incorrectly stated that status indicator ``J1''
procedure claims with modifier ``50'' were included in the C-APC claims
accounting and the complexity adjustment evaluations as of January 1,
2015.'' Instead, these claims were included in the C-APC complexity
adjustment evaluations presented in the CY 2017 OPPS/ASC final rule
with comment period. The results of these evaluations were included in
the C-APC complexity adjustment evaluations tab of Addendum J to the CY
2017 OPPS/ASC final rule with comment period.
On pages 79584, we inadvertently omitted discussion of one of the
recommendations from the August 2016 meeting of the Advisory Panel on
[[Page 25]]
Hospital Outpatient Payment (HOP Panel). The HOP Panel recommended
that, ``CMS provide further information and data for stakeholders to
review on how comprehensive APCs are created and their effects; and CMS
provide more time for the public to review the information and make
proposals to the Panel.'' In this correcting document, we address this
recommendation.
On page 79587, due to the change in OPPS payment rates as a result
of the updated OPPS weight scaler, we are also updating the payment
rate listed for C-APC 5244 (Level 4 Blood Product Exchange and Related
Services).
On page 79595, we made technical errors by inadvertently excluding
the wage index data for 6 providers in Alaska, Virginia, Ohio,
Mississippi, and Puerto Rico when calculating the weight scaler for
budget neutrality. We have corrected the weight scaler for budget
neutrality to include the wage index data for those 6 providers, which
results in a change of the weight scaler from 1.4208 to 1.4214. This
revised weight scaler affects all payments that are scaled for budget
neutrality. As a result we are also providing corrected addenda as
described in the ``Summary of Errors and Corrections to the OPPS and
ASC Addenda Posted on the CMS Web site'' section below.
On pages 79607 through 79608, we use the payment rates available in
Addenda A and B to display calculation of adjusted payment and
copayment. Due to the change in OPPS payment rates as a result of the
updated OPPS weight scaler, we are also updating the payment and
copayment numbers used in the example to reflect the corrections.
On page 79621, due to the change in OPPS payment rates as a result
of the updated OPPS weight scaler, we are also updating the payment
rates in Table 13--Final CY 2017 Status Indicator (SI), APC
Assignments, and Payment Rates for the Auditory Osseointegrated
Procedures (81 FR 79621) for CPT codes 69714, 69715, 69717, and 69718.
On page 79622, due to the change in OPPS payment rates as a result
of the updated OPPS weight scaler, we are also updating the payment
rates in Table 14--Final CY 2017 Status Indicator (SI), APC
Assignments, and Payment Rates for CPT Codes 28297 and 28740.
On page 79624, due to the change in OPPS payment rates as a result
of the updated OPPS weight scaler, we are also updating the payment
rates in Table 16--Final CY 2017 Status Indicator (SI), APC
Assignments, and Payment Rates for the Percutaneous Vertebral
Augmentation/Kyphoplasty Procedures.
On page 79627, due to the change in OPPS payment rates as a result
of the updated OPPS weight scaler, we are also updating the payment
rates in Table 18--Final CY 2017 Status Indicator (SI), APC
Assignments, and Payment Rates for the Transcranial Magnetic
Stimulation (TMS) Therapy Codes.
On page 79629, due to the change in OPPS payment rates as a result
of the updated OPPS weight scaler, we are updating the payment rates
for CPT code 75571 to $59.86, for CPT code 77080 to $112.73, and for
APC 5822 (Level 2 Health and Behavior Services) to $70.26 for CY 2017.
On pages 79636 through 79637, due to the change in OPPS payment
rates as a result of the updated OPPS weight scaler, we are also
updating the payment rates in Table 23--Final CY 2017 Status Indicator
(SI), APC Assignments, and Payment Rates for the Transprostatic
Urethral Implant Procedures.
On pages 79638 through 79639, due to the change in OPPS payment
rates as a result of the updated OPPS weight scaler, we are also
updating the payment rates in Table 25--Final CY 2017 Status Indicator
(SI), APC Assignments, and Payment Rates Certain Cryoablation
Procedures.
On page 79641, due to the change in OPPS payment rates as a result
of the updated OPPS weight scaler, we are also updating the payment
rates in Table 28--Final CY 2017 Status Indicator (SI), APC
Assignments, and Payment Rates for the Dialysis Circuit Procedures.
On page 79643, due to the change in OPPS payment rates as a result
of the updated OPPS weight scaler, we are also updating the payment
rate for CPT code 77371 to $7,455.99 as well as the payment rates in
Table 30--Final CY 2017 Status Indicator (SI), APC Assignments, and
Payment Rates for the Magnetic Resonance Image Guided High Intensity
Focused Ultrasound (MRgFUS) Procedures.
On page 79645, due to the change in OPPS payment rates as a result
of the updated OPPS weight scaler, we are also updating the payment
rates in Table 32--Final CY 2017 Status Indicator (SI), APC
Assignments, and Payment Rates for the Smoking and Tobacco Use
Cessation Counseling Services.
On page 79647, we used imprecise language in describing HCPCS codes
G0237, G0238, and G0239. Specifically, we stated that ``we believe that
we should reassign HCPCS codes G0237, G0238, and G0239 to status
indictor ``S'' because these codes also describe pulmonary
rehabilitation services.'' We are clarifying that these codes describe
respiratory treatment services. We acknowledge that the original
language could be interpreted to mean that these codes describe
pulmonary rehabilitation services, which was not our intent.
On page 79648, due to the change in OPPS payment rates as a result
of the updated OPPS weight scaler, we are also updating the payment
rates in Table 34--Final CY 2017 Status Indicator (SI), APC
Assignments, and Payment Rates for the Pulmonary Rehabilitation
Services.
On page 79662, we incorrectly made certain Status Indicator (SI)
and APC assignments in Table 35--Drugs and Biologicals For Which Pass-
Through Payment Status Expires December 31, 2016. Specifically, we
incorrectly assigned a SI of ``N'' (Items and Services Packaged into
APC Rates) to a number of drugs that should have been assigned a SI of
``K'' (Nonpass-Through Drugs and Nonimplantable Biologicals, Including
Therapeutic Radiopharmaceuticals). These drugs have also been assigned
to APCs for CY 2017. Additionally, on page 79662, we incorrectly
described two Long Descriptors (for HCPCS codes J7181 and 7201) that
were displayed in Table 35. These Long Descriptors have been revised
for CY 2017.
On page 79664, we incorrectly described two Long Descriptors (for
HCPCS codes A9587 and A9588) that were displayed in Table 36--Drugs and
Biologicals With Pass-Through Payment Status in CY 2017. These Long
Descriptors have been revised for CY 2017.
On page 79671, we made technical errors to the description of
certain Healthcare Common Procedure Coding System (HCPCS) codes that
appeared in Table 37--Skin Substitute Assignments to High Cost and Low
Cost Groups for CY 2017. Specifically, we are removing HCPCS codes
Q4119, Q4120, and Q4129 to accurately show that these codes were
deleted on December 31, 2016, and should not have appeared in Table 37.
These codes were correctly assigned to OPPS SI ``D'' in the OPPS
Addendum B that was released with the CY 2017 OPPS/ASC final rule.
On page 79708, we used imprecise language in the summary of final
policy on how we would apply the ``billing .-. . prior to November 2,
2015,'' statutory language in determining whether an off-campus PBD is
excepted or not. Specifically, we stated in the preamble that ``off
campus PBDs would be eligible to receive OPPS payment as excepted off-
campus PBDs for services that were furnished prior to November 2, 2015,
and billed under the OPPS in accordance with timely filing limits.'' We
are clarifying that the policy is not specific to services, but rather
so long as an off-campus PBD furnished a covered
[[Page 26]]
OPD service prior to November 2, 2015 and billed the OPPS within timely
filing limits for that service that the off-campus PBD would be
excepted from payment adjustment under the final section 603 payment
policy for the items and services the off-campus PBD furnishes on or
after January 1, 2017. As noted in the sentence prior (81 FR 79708), we
agreed with the commenters that an interpretation of the ``billing
under this subsection with respect to covered OPD services furnished
prior to [November 2, 2015]'' statutory language could allow for an
exception for off-campus PBDs that furnished a covered OPD service
prior to November 2, 2015, but had not submitted a bill to Medicare for
such service prior to November 2, 2015.
On page 79719, we described the changes to regulation and
incorrectly stated the effective date to implement section 603 of
Public Law 114-74 is effective January 1, 2017, for cost reporting
periods beginning January 1, 2017. The effective date is for items and
services furnished on or after January 1, 2017, regardless of when the
cost reporting period begins. We have corrected this language to delete
the reference to cost reporting periods.
On pages 79869 through 79870, we provided and described Table 52--
Estimated Impact of the CY 2017 Changes for the Hospital Outpatient
Prospective Payment System, based on rates which applied the incorrect
scaler. We have updated the impact table and the description of the
table to reflect these corrections.
On Page 79877, we incorrectly described implementation of Section
603 of the Bipartisan Budget Act of 2015 as reducing OPPS payments by
$500 million in 2017. We have corrected this estimate to be a reduction
of total Part B payments by $50 million in 2017.
2. Ambulatory Surgical Center (ASC) Payment System Corrections
On pages 79741 through 79742, in the discussion of additions to the
list of ASC covered surgical procedures, we incorrectly stated that CPT
code 22851 (Application of intervertebral biomechanical device(s)
(e.g., synthetic cage(s), methlmethacrylate) to vertebral defect or
interspace (List separately in addition to code for primary procedure))
was deleted effective April 13, 2016. This code was deleted effective
December 31, 2016.
On page 79743 in Table 51--Additions to the List of ASC Covered
Surgical Procedures for CY 2017 (81 FR 79743), we inadvertently
excluded CPT code 22585 (Arthrodesis, anterior interbody technique,
including minimal discectomy to prepare interspace (other than for
decompression); each additional interspace (List separately in addition
to code for primary procedure)). This code has a CY 2017 ASC payment
indicator of N1.
On pages 79752 through 79753, we inadvertently published an
incorrect ASC conversion factor of $45.030 for ASCs that meet the
quality reporting requirements. Also, on pages 79752 through 79753, we
inadvertently published an incorrect ASC wage index budget neutrality
adjustment of 0.9996 that is being corrected to 0.9997. For ASCs that
do not meet the quality reporting requirements, we finalized an ASC
conversion factor of $44.330. The ASC conversion factor for ASCs that
meet the quality reporting requirements is the product of the CY 2016
conversion factor multiplied by the wage index budget neutrality
adjustment of 0.9997 and the MFP-adjusted CPI-U payment update (81 FR
79752 to 79753). We have since determined that the 2016 conversion
factor of $44.190 used to calculate the CY 2017 conversion factor is
incorrect. The corrected 2016 ASC conversion factor for ASCs that meet
the quality reporting requirements is $44.177, as finalized in the CY
2016 final rule with comment period (80 FR 70501). Using the correct
2016 ASC conversion factor of $44.177, we have recalculated the 2017
ASC conversion factor to be $45.003 for ASCs that meet quality
reporting requirements and a conversion factor of $44.120 for ASCs that
do not meet quality reporting requirements. The corrected conversion
factor will slightly change payment for some ASC services; therefore we
have revised payment rates in ASC addendum AA and addendum BB.
3. Interim Final Rule with Comment Period Corrections
On page 79725, we referenced table X.B.2, but did not include the
table in the interim final rule with comment period. This table,
Payment for Nonexcepted Items and Services by OPPS Status Indicator,
has been posted to the CMS Web site at https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/HospitalOutpatientPPS/Downloads/CMS-1656-FC-2017-OPPS-Status-Indicator.zip.
4. Hospital Outpatient Quality Reporting Program Correction
On page 79784, there was a typographical error in the table
entitled ``Previously Finalized and Newly Finalized Hospital OQR
Program Measure Set for the CY 2020 Payment Determination and
Subsequent Years''. As listed in the table, the measure OP-30:
Colonoscopy Interval for Patients with a History of Adenomatous
Polyps--Avoidance of Inappropriate Use incorrectly included three
asterisks after the name Three asterisks indicates that a measure is
voluntary. This measure should have had only two asterisks to indicate
that the measure name was updated to reflect the National Quality Forum
title, not three, as it is not a voluntary measure. Accordingly, we are
correcting the table and updating the number of asterisks next to OP-30
from three to two asterisks.
B. Regulation Text Corrections
1. OPPS Corrections
To implement the provisions of section 1833(t) of the Act, as
amended by section 603 of Public Law 114-74, in the CY 2017 OPPS/ASC
final rule with comment period, we amended the Medicare regulations by
(1) adding a new paragraph (v) to Sec. 419.22 to specify that,
effective January 1, 2017, for cost reporting periods beginning January
1, 2017, excluded from payment under the OPPS are items and services
that are furnished by an off-campus provider-based department that do
not meet the definition of excepted items and services; and (2) adding
a new Sec. 419.48 that sets forth the definition of excepted items and
services, and also the definition of ``excepted off-campus provider-
based department''. On page 79879, we incorrectly stated that the
effective date was based on cost reporting periods and are striking
that language. Also, on page 79880, we incorrectly implied that on-
campus provider-based departments that furnish services after November
2, 2015, could no longer bill under the OPPS in the regulation text at
419.48(b). In addition, on page 79880, in the regulation text at
419.48(b), the definition of an ``excepted off-campus provider-based
department'' does not accurately state that the department of a
provider must also have billed within timely filing limits. The revised
regulation text corrects these technical errors.
2. Electronic Health Record (EHR) Incentive Programs Corrections
In the CY 2017 OPPS/ASC final rule, we inadvertently omitted
amendments to Sec. 495.40 that were included in an earlier-published
final rule with comment period titled ``Medicare Program; Merit-Based
Incentive Payment System (MIPS) and Alternative Payment Model (APM)
Incentive Under the Physician Fee Schedule, and Criteria
[[Page 27]]
for Physician-Focused Payment Models'' (referred to as the Quality
Payment Program (QPP) final rule) (81 FR 77008, 77556-77557, November
4, 2016). We are making the corrections to Sec. 495.40 described below
in order to preserve the earlier amendments to that section as
finalized in the QPP final rule.
On page 79892, in Sec. 495.40, ``Demonstration of meaningful use
criteria,'' paragraph (a), ``Demonstration by EPs,'' we inadvertently
omitted a reference to Sec. 495.22 in the introductory text. We are
correcting the introductory text to state that an EP must demonstrate
that he or she satisfies each of the applicable objectives and
associated measures under Sec. 495.20, Sec. 495.22, or Sec. 495.24.
Additionally, we are correcting the introductory text to include the
phrase ``supports information exchange and the prevention of health
information blocking, and engages in activities related to supporting
providers with the performance of CEHRT:'' as finalized in the QPP
final rule (81 FR 77556), which updates requirements for demonstration
of meaningful use to include activities related to health information
technology.
On page 79892, in Sec. 495.40, ``Demonstration of meaningful use
criteria,'' we are correcting the inadvertent omission of Sec.
495.40(a)(2)(i)(H) and (I) as finalized in the QPP final rule (81 FR
77556), which revise attestation requirements and require EPs to attest
their cooperation with certain authorized health IT surveillance and
direct review activities as part of demonstrating meaningful use under
the Medicare and Medicaid EHR Incentive Programs.
On page 79892, in Sec. 495.40, ``Demonstration of meaningful use
criteria,'' paragraph (b), ``Demonstration by eligible hospitals and
CAHs,'' we inadvertently omitted a cross reference to Sec. 495.22 in
the introductory text. We are correcting the introductory text to state
that an eligible hospital or CAH must demonstrate that it satisfies
each of the applicable objectives and associated measures under Sec.
495.20, Sec. 495.22, or Sec. 495.24. Additionally, we are correcting
the introductory text to include the phrase ``supports information
exchange and the prevention of health information blocking, and engages
in activities related to supporting providers with the performance of
CEHRT:'' as finalized in the QPP (81 FR 77556), which updates the
requirements for demonstration of meaningful use to include activities
related to health information technology.
On page 79892, in Sec. 495.40 (b), ``Demonstration by eligible
hospitals and CAHs,'' we are correcting the inadvertent omission of
Sec. 495.40 (b)(2)(i)(H) and (I) as finalized in the QPP final rule
(81 FR 77556 through 77557), which revises attestation requirements and
requires eligible hospitals and CAHs to attest their cooperation with
certain authorized health IT surveillance and direct review activities
as part of demonstrating meaningful use under the Medicare and Medicaid
EHR Incentive Programs.
C. Summary of Errors and Corrections to the OPPS and ASC Addenda Posted
on the CMS Web site
In Addendum J, on the Complexity Adjustment tab, CPT code 36908--
Transcatheter placement of an intravascular stent(s), central dialysis
segment, performed through dialysis circuit, including all imaging
radiological supervision and interpretation required to perform the
stenting, and all angioplasty in the central dialysis segment (List
separately in addition to code for primary procedure) was incorrectly
written as 368x8. Also, CPT code 24200 (Removal of foreign body, upper
arm or elbow; subcutaneous) was incorrectly excluded from Addendum J.
The revised version of Addendum J is available via the Internet on the
CMS Web site.
The payment and copayment rates in Addendum A (Final OPPS APCs for
CY 2017), Addendum B (Final OPPS Payment by HCPCS Code for CY 2017),
Addendum C (Final HCPCS Codes Payable Under the 2017 OPPS by APC), ASC
Addendum AA (Final ASC Covered Surgical Procedures for CY 2016
(Including Surgical Procedures for Which Payment is Packaged)), ASC
Addendum BB (Final ASC Covered Ancillary Services Integral to Covered
Surgical Procedures for CY 2016 (Including Ancillary Services for Which
Payment is Packaged)) and the payment rates in the 2017 Drug, Blood,
Brachytherapy Costs Statistics file that were published on the CMS Web
site in conjunction with the CY 2017 OPPS/ASC Final Rule with comment
period have been updated to reflect corrections to the weight scaler.
The payment rates included in the corrected versions of the Addenda
have also been corrected within the text of the CY 2017 OPPS/ASC Final
Rule with comment period, as well as under the columns titled ``Final
CY 2017 OPPS Payment Rate'' in Tables 13, 14, 16, 18, 23, 25, 28, 30,
32, and 34.
IV. Waiver of Proposed Rulemaking and Delay in Effective Date
Under 5 U.S.C. 553(b) of the Administrative Procedure Act (APA),
the agency is required to publish a notice of the proposed rule in the
Federal Register before the provisions of a rule take effect.
Similarly, section 1871(b)(1) of the Act requires the Secretary to
provide for notice of the proposed rule in the Federal Register and
provide a period of not less than 60 days for public comment. In
addition, section 553(d) of the APA, and section 1871(e)(1)(B)(i)
mandate a 30-day delay in effective date after issuance or publication
of a rule. Sections 553(b)(B) and 553(d)(3) of the APA provide for
exceptions from the notice and comment and delay in effective date APA
requirements; in cases in which these exceptions apply, sections
1871(b)(2)(C) and 1871(e)(1)(B)(ii) of the Act provide exceptions from
the notice and 60-day comment period and delay in effective date
requirements of the Act as well. Section 553(b)(B) of the APA and
section 1871(b)(2)(C) of the Act authorize an agency to dispense with
normal rulemaking requirements for good cause if the agency makes a
finding that the notice and comment process are impracticable,
unnecessary, or contrary to the public interest. In addition, both
section 553(d)(3) of the APA and section 1871(e)(1)(B)(ii) of the Act
allow the agency to avoid the 30-day delay in effective date where such
delay is contrary to the public interest and an agency includes a
statement of support.
We believe that this correcting document does not constitute a
rulemaking that would be subject to these requirements. This correcting
document corrects technical and typographic errors in the preamble,
addenda, payment rates, tables, and appendices included or referenced
in the CY 2017 OPPS/ASC final rule with comment period and interim
final rule with comment period but does not make substantive changes to
the policies or payment methodologies that were adopted in the final
rule with comment period and interim final rule with comment period. As
a result, the corrections made through this correcting document are
intended to ensure that the information in the CY 2017 OPPS/ASC final
rule with comment period and interim final rule with comment period
accurately reflects the policies adopted in those rules.
In addition, even if this were a rulemaking to which the notice and
comment procedures and delayed effective date requirements applied, we
[[Page 28]]
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 with comment period and interim final
rule with comment period or delaying the effective date would be
contrary to the public interest because it is in the public's interest
for providers to receive appropriate payments in as timely a manner as
possible, and to ensure that the CY 2017 OPPS/ASC final rule with
comment period and interim final rule with comment period accurately
reflect our policies as of the date they take effect and are
applicable.
Furthermore, such procedures would be unnecessary, as we are not
altering our payment methodologies or policies, but rather, we are
simply correctly implementing the policies that we previously proposed,
received comment on, and subsequently finalized. This correcting
document is intended solely to ensure that the CY 2017 OPPS/ASC final
rule with comment period and interim final rule with comment period
accurately reflects these payment methodologies and policies. For these
reasons, we believe we have good cause to waive the notice and comment
and effective date requirements.
V. Correction of Errors
In FR Doc. 2016-26515 of November 14, 2016 (81 FR 79562), make the
following corrections:
Preamble Corrections
1. On page 79566, third column,
a. In line 44, Table of Contents, the title ``5. Summary of
Proposals'' is corrected to read ``5. Summary of Final Policies''.
b. In line 45, Table of Contents, the title ``6. Final Changes to
Regulations'' is corrected to read ``6. Changes to Regulations''.
2. On page 79569, second column, second full paragraph, under the
bulleted item, ``OPPS Update,'' in line 20, replace ``$773 million''
with ``$64 billion''.
3. On page 79582, third column, second full paragraph, under a
response to public comment, in lines 29 through 34, the last sentence
of the paragraph is corrected to read ``Status indicator ``J1''
procedure claims with modifier ``50'' will be included in the
complexity adjustment evaluation for CY 2017. This evaluation can be
found in Addendum J to the CY 2017 OPPS/ASC final rule with comment
period.''
4. On page 79584, first column, first partial paragraph, in line
21, the following language is inserted after ``. . . analyses of the C-
APC payment policy.'' and before ``Regarding the comment about
creating. . . .'': We are accepting the recommendation that the HOP
Panel made at the August 22, 2016 meeting to ``provide further
information and data for stakeholders to review on how comprehensive
APCs are created and their effects and to provide more time for the
public to review the information and make proposals to the Panel.'' We
plan to provide the results of an analysis of our comprehensive
packaging policies in CY 2017. In addition, we will consider scheduling
future HOP Panel meetings on a date that allows stakeholders as much
time as is practicable subsequent to display of the proposed rule to
analyze and review our proposed policies and other data prior to the
meeting.
5. On page 79587, third column, first full paragraph, in line 16,
replace ``$27,752'' with ``$27,764''.
6. On page 79595, third column, third paragraph, replace ``1.4208''
with ``1.4214.''
7. On page 79607,
a. First column, bottom half of the page, last full paragraph--
(1) In line 17, replace ``$538.88'' with ``$539.11.''
(2) In line 21, replace ``$528.10'' with ``$528.33.''
b. In the second column, first partial paragraph,
(1) In lines 1 and 2, replace ``$418.26 (.60 * $538.88 * 1.2936).''
with ``$418.44 (.60 * $539.11 * 1.2936).''
(2) In line 5, replace ``$409.89 (.60 * $528.10 * 1.2936).'' with
``$410.07 (.60 * $528.33 * 1.2936).''
(3) In line 8, replace ``$215.55 (.40 * $538.88).'' with ``$215.64
(.40 * $539.11).''
(4) In line, replace ``$211.24 (.40 * $528.10).'' with ``$211.33
(.40 * $528.33).''
(5) In lines 15 and 16, replace ``$633.81 ($418.26 +$215.55).''
with ``$634.08 ($418.44 +$215.64).''
(6) In lines 18 and 19, replace ``$621.13 ($409.89 + $211.24).''
with ``$621.40 ($410.07 + $211.33).''
8. On page 79608, second column, third full paragraph, under ``Step
1,'' in lines 5 and 8, replace ``$107.78'' with $107.83'' and
``$538.88'' with ``$539.11.''
9. On page 79621, Table 13--Final CY 2017 Status Indicator (SI),
APC, and Payment Rates for the Auditory Osseointegrated Procedures, is
corrected to read as follows:
Table 13--Final CY 2017 Status Indicator (SI), APC Assignments, and Payment Rates for the Auditory Osseointegrated Procedures
--------------------------------------------------------------------------------------------------------------------------------------------------------
Final CY Final CY 2017
CPT code Long descriptors CY 2016 OPPS CY 2016 CY 2016 OPPS Final CY 2017 OPPS OPPS payment
SI OPPS APC payment rate 2017 OPPS SI APC rate
--------------------------------------------------------------------------------------------------------------------------------------------------------
69714........................ Implantation, osseointegrated J1 5125 $10,537.90 J1 5115 $9,561.23
implant, temporal bone, with
percutaneous attachment to
external speech processor/cochlear
stimulator; without mastoidectomy.
69715........................ Implantation, osseointegrated J1 5125 10,537.90 J1 5116 14,704.13
implant, temporal bone, with
percutaneous attachment to
external speech processor/cochlear
stimulator; with mastoidectomy.
69717........................ Replacement (including removal of J1 5123 4,969.26 J1 5114 5,221.57
existing device), osseointegrated
implant, temporal bone, with
percutaneous attachment to
external speech processor/cochlear
stimulator; without mastoidectomy.
[[Page 29]]
69718........................ Replacement (including removal of J1 5124 7,064.07 J1 5115 9,561.23
existing device), osseointegrated
implant, temporal bone, with
percutaneous attachment to
external speech processor/cochlear
stimulator; with mastoidectomy.
--------------------------------------------------------------------------------------------------------------------------------------------------------
10. On page 79622, Table 14--Final CY 2017 Status Indicator (SI),
APC Assignments, and Payment Rates for CPT Codes 28297 and 28740, is
corrected to read as follows:
Table 14--Final CY 2017 Staus Indicator (SI), APC Assignments, and Payment Rates for CPT Codes 28297 and 28740
--------------------------------------------------------------------------------------------------------------------------------------------------------
Final CY Final CY 2017
CPT code Long descriptors CY 2016 OPPS CY 2016 CY 2016 OPPS Final CY 2017 OPPS OPPS payment
SI OPPS APC payment rate 2017 OPPS SI APC rate
--------------------------------------------------------------------------------------------------------------------------------------------------------
28297........................ Correction, hallux valgus (bunion), J1 5124 $7,064.07 J1 5114 $5,221.57
with or without sesamoidectomy;
lapidus-type procedure.
28740........................ Arthrodesis, midtarsal or J1 5124 7,064.07 J1 5114 5,221.57
tarsometatarsal, single joint.
--------------------------------------------------------------------------------------------------------------------------------------------------------
11. On page 79624, Table 16--Final CY 2017 Status Indicator (SI),
APC Assignments, and Payment Rates for the Percutaneous Vertebral
Augmentation/Kyphoplasty Procedures, is corrected to read as follows:
Table 16--Final CY 2017 Status Indicator (SI), APC Assignments, and Payment Rates for the Percutaneous Vertebral Augmentation/Kyphoplasty Procedures
--------------------------------------------------------------------------------------------------------------------------------------------------------
Final CY Final CY 2017
CPT code Long descriptors CY 2016 OPPS CY 2016 CY 2016 OPPS Final CY 2017 OPPS OPPS payment
SI OPPS APC payment rate 2017 OPPS SI APC rate
--------------------------------------------------------------------------------------------------------------------------------------------------------
22513........................ Percutaneous vertebral J1 5124 $7,064.07 J1 5114 $5,221.57
augmentation, including cavity
creation (fracture reduction and
bone biopsy included when
performed) using mechanical device
(eg, kyphoplasty), 1 vertebral
body, unilateral or bilateral
cannulation, inclusive of all
imaging guidance; thoracic.
22514........................ Percutaneous vertebral J1 5124 7,064.07 J1 5114 5,221.57
augmentation, including cavity
creation (fracture reduction and
bone biopsy included when
performed) using mechanical device
(eg, kyphoplasty), 1 vertebral
body, unilateral or bilateral
cannulation, inclusive of all
imaging guidance; lumbar.
22515........................ Percutaneous vertebral N N/A Packaged N N/A Packaged
augmentation, including cavity
creation (fracture reduction and
bone biopsy included when
performed) using mechanical device
(eg, kyphoplasty), 1 vertebral
body, unilateral or bilateral
cannulation, inclusive of all
imaging guidance; each additional
thoracic or lumbar vertebral body
(list separately in addition to
code for primary procedure).
--------------------------------------------------------------------------------------------------------------------------------------------------------
[[Page 30]]
12. On page 79627, Table 18--Final CY 2017 Status Indicator (SI),
APC Assignments, and Payment Rates for the Transcranial Magnetic
Stimulation (TMS) Therapy Codes, is corrected to read as follows:
Table 18--Final CY 2017 Status Indicator (SI), APC Assignments, and Payment Rates for the Transcranial Magnetic Stimulation (TMS) Therapy Codes
--------------------------------------------------------------------------------------------------------------------------------------------------------
Final CY Final CY 2017
CPT code Long descriptors CY 2016 OPPS CY 2016 CY 2016 OPPS Final CY 2017 OPPS OPPS payment
SI OPPS APC payment rate 2017 OPPS SI APC rate
--------------------------------------------------------------------------------------------------------------------------------------------------------
90867........................ Therapeutic repetitive transcranial S 5722 $220.35 S 5722 $232.31
magnetic stimulation (tms)
treatment; initial, including
cortical mapping, motor threshold
determination, delivery and
management.
90868........................ Therapeutic repetitive transcranial S 5722 220.35 S 5722 232.31
magnetic stimulation (tms)
treatment; subsequent delivery and
management, per session.
90869........................ Therapeutic repetitive transcranial S 5722 $220.35 S 5721 $127.10
magnetic stimulation (tms)
treatment; subsequent motor
threshold re-determination with
delivery and management.
--------------------------------------------------------------------------------------------------------------------------------------------------------
13. On page 79629,
a. Second column,
1. First partial paragraph, last sentence, in line 19, replace
``$59.84'' with $59.86
2. Second full paragraph, last sentence, in line 27, replace
``$112.69'' with ``$112.73''.
b. Third column, first full paragraph, in line 16, replace
``70.23.'' with ``$70.26.''
14. On pages 79636 through 79637, Table 23--Final CY 2017 Status
Indicator (SI), APC Assignments, and Payment Rates for the
Transprostatic Urethral Implant Procedures, is corrected to read as
follows:
Table 23--Final CY 2017 Status Indicator (SI), APC Assignments and Payment Rates for the Transprostatic Urethral Implant Procedures
--------------------------------------------------------------------------------------------------------------------------------------------------------
Final CY Final CY 2017
CPT/HCPCS code Long descriptors CY 2016 OPPS CY 2016 CY 2016 OPPS Final CY 2017 OPPS OPPS payment
SI OPPS APC payment rate 2017 OPPS SI APC rate
--------------------------------------------------------------------------------------------------------------------------------------------------------
C9739........................ Cystourethroscopy, with insertion J1 5375 $3,393.73 J1 5375 $3,484.01
of transprostatic implant; 1 to 3
implants.
C9740........................ Cystourethroscopy, with insertion T 1565 5,250.00 J1 5376 7,452.66
of transprostatic implant; 4 or
more implants.
52441........................ Cystourethroscopy, with insertion B N/A N/A B N/A N/A
of permanent adjustable
transprostatic implant; single
implant.
52442........................ Cystourethroscopy, with insertion B N/A N/A B N/A N/A
of permanent adjustable
transprostatic implant; each
additional permanent adjustable
transprostatic implant (list
separately in addition to code for
primary procedure).
--------------------------------------------------------------------------------------------------------------------------------------------------------
15. On pages 79638 through 79639, Table 25--Final CY 2017 Status
Indicator (SI), APC Assignments, and Payment Rates Certain Cryoablation
Procedures, is corrected to read as follows:
[[Page 31]]
Table 25--Final CY 2017 Status Indicator (SI), APC Assignments, and Payment Rates for Certain Cryoablation Procedures
--------------------------------------------------------------------------------------------------------------------------------------------------------
Final CY Final CY 2017
CPT/HCPCS code Long descriptors CY 2016 OPPS CY 2016 CY 2016 OPPS Final CY 2017 OPPS OPPS payment
SI OPPS APC payment rate 2017 OPPS SI APC rate
--------------------------------------------------------------------------------------------------------------------------------------------------------
20983........................ Ablation therapy for reduction or T 5352 $4,118.23 J1 5114 $5,221.57
eradication of 1 or more bone
tumors (eg, metastasis) including
adjacent soft tissue when involved
by tumor extension, percutaneous,
including imaging guidance when
performed; cryoablation.
47383........................ Ablation, 1 or more liver tumor(s), T 5352 4,118.23 J1 5361 4,199.13
percutaneous, cryoablation.
50593........................ Ablation, renal tumor(s), T 5352 4,118.23 J1 5362 6,969.84
unilateral, percutaneous,
cryotherapy.
0340T........................ Ablation, pulmonary tumor(s), T 5352 4,118.23 J1 5361 4,199.13
including pleura or chest wall
when involved by tumor extension,
percutaneous, cryoablation,
unilateral, includes imaging
guidance.
0440T........................ Ablation, percutaneous, J1 5361 4,001.15 J1 5432 4,151.86
cryoablation, includes imaging
guidance; upper extremity distal/
peripheral nerve.
0441T........................ Ablation, percutaneous, J1 5361 4,001.15 J1 5432 4,151.86
cryoablation, includes imaging
guidance; lower extremity distal/
peripheral nerve.
0442T........................ Ablation, percutaneous, T 5352 4,118.23 J1 5432 4,151.86
cryoablation, includes imaging
guidance; nerve plexus or other
truncal nerve (eg, brachial
plexus, pudendal nerve).
--------------------------------------------------------------------------------------------------------------------------------------------------------
16. On page 79641, Table 28--Final CY 2017 Status Indicator (SI),
APC Assignments, and Payment Rates for the Dialysis Circuit Procedures,
is corrected to read as follows:
Table 28--Final CY 2017 Status Indicator (SI), APC Assignments, and Payment Rates for the Dialysis Circuit Procedures
--------------------------------------------------------------------------------------------------------------------------------------------------------
Final CY Final CY 2017
Proposed CY 2017 CPT Final CY 2017 Short descriptors CY 2016 OPPS CY 2016 CY 2016 OPPS Final CY 2017 OPPS OPPS payment
code CPT code SI OPPS APC payment rate 2017 OPPS SI APC rate
--------------------------------------------------------------------------------------------------------------------------------------------------------
36147.................. 36147 Access av dial grft for T 5181 $862.51 D ........... ..............
eval.
36148.................. 36148 Access av dial grft for N ........... .............. D ........... ..............
proc.
369X1.................. 36901 Intro cath dialysis ............ ........... .............. T 5181 $684.13
circuit.
369X2.................. 36902 Intro cath dialysis ............ ........... .............. J1 5192 4,825.20
circuit.
369X3.................. 36903 Intro cath dialysis ............ ........... .............. J1 5193 9,752.43
circuit.
369X4.................. 36904 Thrmbc/nfs dialysis ............ ........... .............. J1 5192 4,825.20
circuit.
369X5.................. 36905 Thrmbc/nfs dialysis ............ ........... .............. J1 5193 9,752.43
circuit.
369X6.................. 36906 Thrmbc/nfs dialysis ............ ........... .............. J1 5194 14,782.14
circuit.
369X7.................. 36907 Balo angiop ctr dialysis ............ ........... .............. N N/A N/A
seg.
369X8.................. 36908 Stent plmt ctr dialysis ............ ........... .............. N N/A N/A
seg.
369X9.................. 36909 Dialysis circuit embolj.. ............ ........... .............. N N/A N/A
--------------------------------------------------------------------------------------------------------------------------------------------------------
17. On page 79643,
a. First column, first partial paragraph, in line 14, replace ``$7,
453.'' with ``$7,456.''
b. Table 30--Final CY 2017 Status Indicator (SI), APC Assignments,
and Payment Rates for the Magnetic Resonance Image Guided High
Intensity Focused Ultrasound (MRgFUS) Procedures, is corrected to read
as follows:
Table 30--Final CY 2017 Status Indicator (SI), APC Assignments, and Payment Rates for the Magnetic Resonance Image Guided High Intensity Focused
Ultrasound (MRgFUS) Procedures
--------------------------------------------------------------------------------------------------------------------------------------------------------
Final CY Final CY 2017
CPT/HCPCS code Long descriptors CY 2016 OPPS CY 2016 CY 2016 OPPS Final CY 2017 OPPS OPPS payment
SI OPPS APC payment rate 2017 OPPS SI APC rate
--------------------------------------------------------------------------------------------------------------------------------------------------------
0071T........................ Focused ultrasound ablation of T 5414 $1,861.18 J1 5414 $2,085.47
uterine leiomyomata, including mr
guidance; total leiomyomata volume
less than 200 cc of tissue.
[[Page 32]]
0072T........................ Focused ultrasound ablation of T 5414 1,861.18 J1 5414 2,085.47
uterine leiomyomata, including mr
guidance; total leiomyomata volume
greater or equal to 200 cc of
tissue.
0398T........................ Magnetic resonance image guided E N/A N/A S 1537 9,750.50
high intensity focused ultrasound
(mrgfus), stereotactic ablation
lesion, intracranial for movement
disorder including stereotactic
navigation and frame placement
when performed.
C9734........................ Focused ultrasound ablation/ T 5122 2,395.59 J1 5114 2,085.47
therapeutic intervention, other
than uterine leiomyomata, with
magnetic resonance (mr) guidance.
--------------------------------------------------------------------------------------------------------------------------------------------------------
18. On page 79645, Table 32--Final CY 2017 Status Indicator (SI),
APC Assignments, and Payment Rates for the Smoking and Tobacco Use
Cessation Counseling Services, is corrected to read as follows:
Table 32--Final CY 2017 Status Indicator (SI), APC Assignment, and Payment Rate for the Smoking and Tobacco Use Cessation Counseling Services
--------------------------------------------------------------------------------------------------------------------------------------------------------
Final CY Final CY 2017
CPT/HCPCS code Long descriptors CY 2016 OPPS CY 2016 CY 2016 OPPS Final CY 2017 OPPS OPPS payment
SI OPPS APC payment rate 2017 OPPS SI APC rate
--------------------------------------------------------------------------------------------------------------------------------------------------------
99406........................ Smoking and tobacco use cessation S 5821 $27.12 S 5821 $25.23
counseling visit; intermediate,
greater than 3 minutes up to 10
minutes.
99407........................ Smoking and tobacco use cessation S 5821 27.12 S 5821 25.23
counseling visit; intensive,
greater than 10 minutes.
G0436........................ Smoking and tobacco cessation S 5821 27.12 D N/A N/A
counseling visit for the
asymptomatic patient;
intermediate, greater than 3
minutes, up to 10 minutes.
G0437........................ Smoking and tobacco cessation S 5822 69.65 D N/A N/A
counseling visit for the
asymptomatic patient; intensive,
greater than 10 minutes.
--------------------------------------------------------------------------------------------------------------------------------------------------------
19. On page 79647, first column, second full paragraph, under a
response to public comment, the last two sentences of the paragraph are
corrected to read ``However, the rationale for this modification of the
proposal for these codes is not related to the statutory provision of
section 144 of the Medicare Improvements for Patients and Providers Act
of 2008. We believe that pulmonary rehabilitation (and the related
respiratory treatment services) are not typically ancillary to the
other HOPD services that may be furnished to beneficiaries. These
services are typically part of a course of treatment that is prescribed
after a diagnosis is made and often after other treatments are
initiated or completed.''
20. On page 79648, Table 34--Final CY 2017 Status Indicator (SI),
APC Assignments, and Payment Rates for the Pulmonary Rehabilitation
Services, is corrected to read as follows:
[[Page 33]]
Table 34--Final CY 2017 Status Indicator (SI), APC Assignments, and Payment Rates for the Pulmonary Rehabilitation Services
--------------------------------------------------------------------------------------------------------------------------------------------------------
Final CY
HCPCS code Long descriptors CY 2016 OPPS CY 2016 CY 2016 OPPS Final CY 2017 OPPS Final CY 2017
SI OPPS APC payment 2017 OPPS SI APC OPPS payment
--------------------------------------------------------------------------------------------------------------------------------------------------------
G0237........................ Therapeutic procedures to increase Q1 5734 $91.18 S 5732 $28.38
strength or endurance of
respiratory muscles, face to face,
one on one, each 15 minutes
(includes monitoring).
G0238........................ Therapeutic procedures to improve Q1 5733 55.94 S 5732 28.38
respiratory function, other than
described by g0237, one on one,
face to face, per 15 minutes
(includes monitoring).
G0239........................ Therapeutic procedures to improve Q1 5732 30.51 S 5732 28.38
respiratory function or increase
strength or endurance of
respiratory muscles, two or more
individuals (includes monitoring).
G0424........................ Pulmonary rehabilitation, including Q1 5733 55.94 S 5733 54.55
exercise (includes monitoring),
one hour, per session, up to two
sessions per day.
--------------------------------------------------------------------------------------------------------------------------------------------------------
21. On page 79662, Table 35--Drugs and Biologicals for Which Pass-
Through Payment Status Expires December 31, 2016, is corrected to read
as follows:
Table 35--Drugs and Biologicals for Which Pass-Through Payment Status
Expires December 31, 2016
------------------------------------------------------------------------
Final CY 2017
CY 2017 HCPCS code CY 2017 Long status Final CY 2017
descriptor indicator APC
------------------------------------------------------------------------
C9497................ Loxapine, K 9497
inhalation
powder, 10 mg.
J1322................ Injection, K 1480
elosulfase
alfa, 1mg.
J1439................ Injection, K 9441
ferric
carboxymaltose,
1 mg.
J1447................ Injection, TBO- K 1748
Filgrastim, 1
micrograms.
J3145................ Injection, N N/A
testosterone
undecanoate, 1
mg.
J3380................ Injection, K 1489
vedolizumab, 1
mg.
J7181................ Factor XIII K 1746
(antihemophilic
factor,
recombinant),
Tretten, per
i.u.
J7200................ Factor ix K 1467
(antihemophilic
factor,
recombinant),
Rixubus, per
i.u.
J7201................ Factor ix K 1486
(antihemophilic
factor,
recombinant),
Alprolix, per
i.u.
J7205................ Injection, K 1656
factor viii, fc
fusion protein,
(recombinant),
per i.u.
J7508................ Tacrolimus, N N/A
Extended
Release, Oral,
0.1 mg.
J9301................ Injection, K 1476
obinutuzumab,
10 mg.
J9308................ Injection, K 1488
ramucirumab, 5
mg.
J9371................ Injection, K 1466
Vincristine
Sulfate
Liposome, 1 mg.
Q4121................ Theraskin, per N N/A
square
centimeter.
------------------------------------------------------------------------
22. On page 79664, Table 36--Drugs and Biologicals with Pass-
Through Payment Status in CY 2017, the Long Descriptors for CY HCPCS
codes A9588 and A9587 are revised to read as follows:
Corrections To Table 36--Drugs and Biologicals With Pass-Through Payment Status in CY 2017
----------------------------------------------------------------------------------------------------------------
CY 2017
CY 2016 HCPCS code CY 2017 CY 2017 Long descriptor status CY 2017 APC
HCPCS code indicator
----------------------------------------------------------------------------------------------------------------
N/A................................. A9588 Fluciclovine f-18, diagnostic, G 9052
1 mCi.
N/A................................. A9587 Gallium Ga-68, dotatate, G 9056
diagnostic, 0.1 mCi.
----------------------------------------------------------------------------------------------------------------
23. On page 79671, in Table 37--Assignments to High Cost and Low
Cost Groups for CY 2017, remove HCPCS codes Q4119, Q4120, and Q4129.
24. On page 79708, third column, in lines 28 through 31, the words
``for services that were furnished prior to November 2, 2015, and
billed under the OPPS in accordance with timely filing limits.'' are
corrected to read ``if the PBD furnished a covered OPD service prior to
November 2, 2015 and billed the OPPS within timely filing limits for
that service.''
25. On page 79719, third column, first partial paragraph, in lines
6 and 7, remove the words ``for cost reporting periods beginning
January 1, 2017,''.
[[Page 34]]
26. On page 79741, third column, fourth full paragraph, in lines 10
and 11, the words ``was deleted by the AMA Editorial Panel in April
2016.'' are corrected to read ``will be deleted effective December 31,
2016.''
27. On page 79742, first column, first full paragraph, in lines 2
and 3, the words ``was deleted effective April 13, 2016,'' are
corrected to read ``will be deleted effective December 31, 2016,''.
28. On page 79743, Table 51--Additions To The List of ASC Covered
Surgical Procedures For CY 2017, CPT code 22585 is added in numerical
order to read as follows:
Corrections To Table 51--Additions To The List of ASC Covered Surgical
Procedures For CY 2017
------------------------------------------------------------------------
CY 2017 ASC
CY 2017 CPT code CY 2017 long descriptor payment indicator
------------------------------------------------------------------------
22585.................... Arthrodesis, anterior N1
interbody technique,
including minimal
discectomy to prepare
interspace (other than
for decompression); each
additional interspace
(List separately in
addition to code for
primary procedure).
------------------------------------------------------------------------
29. On page 79752, third column, bottom half of the page, first
full paragraph,
a. In line 11, replace ``0.9996'' with ``0.9997.''
b. In line 27, replace ``$45.030'' with ``$45.003.''
c. In line 30, replace ``$44.190'' with ``$44.177.''
d. In line 32, replace ``0.9996'' with ``0.9997.''
30. On page 79753,
a. First column, first partial paragraph,
(1) In line 9, replace ``$44.330'' with ``$44.120.''
(2) In line 12, replace ``$44.190'' with ``$44.177.''
(3) In line 14, replace ``0.9996'' with ``0.9997.''
b. Second column, second full paragraph, in line 7, replace
``$45.030'' with ``$45.003.''
31. On page 79784, the un-numbered table--PREVIOUSLY FINALIZED AND
NEWLY FINALIZED HOSPITAL OQR PROGRAM MEASURE SET FOR THE CY 2020
PAYMENT DETERMINATION AND SUBSEQUENT YEARS, is corrected by removing
the three asterisks, ``***'' after the OP-30 measure name and adding in
its place two asterisks, ``**'' to read as follows:
------------------------------------------------------------------------
------------------------------------------------------------------------
0659.......................... OP-30: Colonoscopy Interval for Patients
with a History of Adenomatous Polyps--
Avoidance of Inappropriate Use. **
------------------------------------------------------------------------
32. On page 79868,
a. Second column, first full paragraph, in line 3, replace ``1.7''
with ``1.8.''
b. Third column, first paragraph, in lines 15 and 16, ``an increase
of 0.1 percent to 0.3 percent'' is corrected to read ``no change to an
increase of 0.3 percent.''
33. On page 79869,
a. Second column, first full paragraph, in line 11, replace ``1.7''
with ``1.8.''
b. Third column, first full paragraph, in line 2, replace ``1.7''
with ``1.8.''
34. On pages 79869 through 79870, Table 52--Estimated Impact of the
CY 2017
Changes for the Hospital Outpatient Prospective Payment System, is
corrected to read as follows:
Table 52--Impact of Changes for Final CY 2017 Hospital Outpatient Prospective Payment System
--------------------------------------------------------------------------------------------------------------------------------------------------------
All budget
New wage index neutral changes
Number of APC recalibration and provider (combined cols All changes
hospitals (all changes) adjustments 2,3) with market
basket update
(1) (2) (3) (4) (5)
--------------------------------------------------------------------------------------------------------------------------------------------------------
All Providers *............................................. 3906 0.0 0.0 1.7 1.8
All Hospitals (excludes hospitals held harmless and CMHCs).. 3789 0.0 0.0 1.8 1.8
Urban Hospitals............................................. 2958 0.0 0.0 1.7 1.8
Large Urban (GT 1 Mill.)................................ 1616 0.0 -0.1 1.6 1.7
Other Urban (LE 1 Mill.)................................ 1342 0.1 0.1 1.8 1.8
Rural Hospitals............................................. 831 0.2 0.3 2.2 2.2
Sole Community.......................................... 376 0.2 0.4 2.3 2.2
Other Rural............................................. 455 0.2 0.2 2.1 2.1
Beds (Urban):
0-99 Beds............................................... 1045 -0.3 0.2 1.6 1.7
100-199 Beds............................................ 834 0.2 -0.1 1.8 1.8
200-299 Beds............................................ 465 0.2 0.0 1.9 1.9
300-499 Beds............................................ 405 0.1 0.0 1.8 1.9
500 + Beds.............................................. 209 -0.2 0.0 1.4 1.5
Beds (Rural):
0-49 Beds............................................... 340 0.3 0.5 2.6 2.5
50-100 Beds............................................. 299 0.2 0.4 2.4 2.3
101-149 Beds............................................ 108 0.1 -0.2 1.6 1.7
150-199 Beds............................................ 45 0.0 0.4 2.2 2.1
200 + Beds.............................................. 39 0.2 0.2 2.1 2.1
[[Page 35]]
Region (Urban):
New England............................................. 146 0.0 -1.1 0.6 0.6
Middle Atlantic......................................... 350 0.0 0.1 1.7 1.7
South Atlantic.......................................... 465 0.1 0.0 1.7 1.8
East North Cent......................................... 473 0.1 0.1 1.8 1.9
East South Cent......................................... 177 -0.4 0.3 1.6 1.7
West North Cent......................................... 182 -0.1 0.0 1.6 1.5
West South Cent......................................... 527 -0.2 0.3 1.8 1.9
Mountain................................................ 206 0.2 1.0 2.9 3.0
Pacific................................................. 383 0.4 -0.3 1.7 1.8
Puerto Rico............................................. 49 0.5 -0.3 1.8 1.8
Region (Rural):
New England............................................. 21 0.9 0.5 3.1 3.0
Middle Atlantic......................................... 55 0.1 1.2 3.0 3.0
South Atlantic.......................................... 126 0.3 -0.3 1.7 1.7
East North Cent......................................... 121 0.2 0.3 2.2 2.2
East South Cent......................................... 158 0.0 0.2 1.9 1.9
West North Cent......................................... 100 0.0 0.4 2.1 2.0
West South Cent......................................... 168 0.2 0.7 2.6 2.6
Mountain................................................ 58 0.2 -0.1 1.9 1.8
Pacific................................................. 24 0.3 -0.1 1.9 1.9
Teaching Status:
Non-Teaching............................................ 2712 0.1 0.1 1.9 2.0
Minor................................................... 731 0.1 0.0 1.9 1.9
Major................................................... 346 -0.2 -0.1 1.4 1.5
DSH Patient Percent:
0....................................................... 10 -1.7 -0.2 -0.2 -0.1
GT 0-0.10............................................... 305 -0.4 0.0 1.2 1.3
0.10-0.16............................................... 270 0.1 0.1 1.8 1.8
0.16-0.23............................................... 600 0.1 0.1 2.0 2.0
0.23-0.35............................................... 1135 0.1 0.1 1.9 1.9
GE 0.35................................................. 895 0.1 -0.1 1.7 1.7
DSH not Available **.................................... 574 -1.4 -0.2 0.1 0.2
Urban Teaching/DSH:
Teaching & DSH.......................................... 975 0.0 0.0 1.6 1.7
No Teaching/DSH......................................... 1425 0.1 0.1 1.9 1.9
No Teaching/No DSH...................................... 10 -1.7 -0.2 -0.2 -0.1
DSH Not Available2...................................... 548 -1.4 -0.3 0.0 0.1
Type of Ownership:
Voluntary............................................... 1983 0.1 0.1 1.8 1.9
Proprietary............................................. 1306 0.0 0.1 1.7 1.8
Government.............................................. 500 -0.1 -0.1 1.5 1.6
CMHCs....................................................... 50 -15.0 -0.4 -13.9 -13.7
--------------------------------------------------------------------------------------------------------------------------------------------------------
Column (1) shows total hospitals and/or CMHCs.
Column (2) includes all final CY 2017 OPPS policies and compares those to the CY 2016 OPPS.
Column (3) shows the budget neutral impact of updating the wage index by applying the final FY 2017 hospital inpatient wage index, including all hold
harmless policies and transitional wages. The rural adjustment continues our current policy of 7.1 percent so the budget neutrality factor is 1. The
budget neutrality adjustment for the cancer hospital adjustment is 1.003 because the payment-to-cost ratio target changes from 0.92 in CY 2016 to 0.91
in CY 2017.
Column (4) shows the impact of all budget neutrality adjustments and the addition of the final 1.65 percent OPD fee schedule update factor (2.7 percent
reduced by 0.3 percentage points for the final productivity adjustment and further reduced by 0.75 percentage point in order to satisfy statutory
requirements set forth in the Affordable Care Act). It also includes the impact of the additional adjustment of 1.0004 for Lab services with L1
Modifiers packaged into the OPPS.
Column (5) shows the additional adjustments to the conversion factor resulting from the frontier adjustment, a change in the pass-through estimate, and
adding estimated outlier payments.
These 3,906 providers include children and cancer hospitals, which are held harmless to pre-BBA amounts, and CMHCs.
** Complete DSH numbers are not available for providers that are not paid under IPPS, including rehabilitation, psychiatric, and long-term care
hospitals.
0
35. On page 79871, third column, first partial paragraph, in the last
line, replace ``$45.016'' with ``$45.003.''
0
36. On page 79877, third column, last paragraph, in lines 2 and 3, the
phrase ``OPPS payments by $500 million'' is corrected to read ``Part B
payments by $50 million.''
Regulations Text Corrections
Sec. 419.22 [Corrected]
0
37. On page 79879, second column, in Sec. 419.22, ``Hospital services
excluded
[[Page 36]]
from payment under the hospital outpatient prospective payment
system,'' the words ``for cost reporting periods beginning on or after
January 1, 2017,'' are removed.
0
38. On page 79880, first column, in Sec. 419.48, paragraph (b) is
corrected to read as follows:
Sec. 419.48, ``Definition of excepted items and services
* * * * *
(b) For the purpose of this section, ``excepted off-campus
provider-based department'' means a ``department of a provider'' (as
defined at Sec. 413.65(a)(2) of this chapter) that is located on the
campus (as defined in Sec. 413.65(a)(2) of this chapter) or within the
distance described in such definition from a ``remote location of a
hospital'' (as defined in Sec. 413.65(a)(2) of this chapter) that
meets the requirements for provider-based status under Sec. 413.65 of
this chapter. This definition also includes an off-campus department of
a provider that was furnishing services prior to November 2, 2015 that
were billed under the OPPS in accordance with timely filing limits.
* * * * *
0
39. Section 495.40 is corrected as follows:
0
a. On page 79892, in the first column, in amendment 27, redesignate
instructions d through f as instructions e through g respectively and
add a new instruction d to read ``d. Adding paragraphs (a)(2)(i)(H) and
(I).''
0
b. On page 79892, in the second column, in amendment 27, correct
redesignated instruction g to read ``g. Adding new paragraphs
(b)(2)(i)(G), (H), and (I).''
0
c. On page 79892, in the second column, paragraph (a) introductory text
is correctly revised.
0
d. On page 79892, in the second column, paragraphs (a)(2)(i)(H) and (I)
are added.
0
e. On page 79892, in the second column, paragraph (b) introductory text
is correctly revised.
0
f. On page 79892, in the third column paragraphs (b)(2)(i)(H) and (I)
are added.
The revisions and additions read as follows:
Sec. 495.40 Demonstration of meaningful use criteria.
(a) Demonstration by EPs. An EP must demonstrate that he or she
satisfies each of the applicable objectives and associated measures
under Sec. 495.20, Sec. 495.22 or Sec. 495.24, supports information
exchange and the prevention of health information blocking, and engages
in activities related to supporting providers with the performance of
CEHRT:
* * * * *
(2) * * *
(i) * * *
(H) Supporting providers with the performance of CEHRT (SPPC). To
engage in activities related to supporting providers with the
performance of CEHRT, the EP--
(1) Must attest that he or she:
(i) Acknowledges the requirement to cooperate in good faith with
ONC direct review of his or her health information technology certified
under the ONC Health IT Certification Program if a request to assist in
ONC direct review is received; and
(ii) If requested, cooperated in good faith with ONC direct review
of his or her health information technology certified under the ONC
Health IT Certification Program as authorized by 45 CFR part 170,
subpart E, to the extent that such technology meets (or can be used to
meet) the definition of CEHRT, including by permitting timely access to
such technology and demonstrating its capabilities as implemented and
used by the EP in the field.
(2) Optionally, may also attest that he or she:
(i) Acknowledges the option to cooperate in good faith with ONC-ACB
surveillance of his or her health information technology certified
under the ONC Health IT Certification Program if a request to assist in
ONC-ACB surveillance is received; and
(ii) If requested, cooperated in good faith with ONC-ACB
surveillance of his or her health information technology certified
under the ONC Health IT Certification Program as authorized by 45 CFR
part 170, subpart E, to the extent that such technology meets (or can
be used to meet) the definition of CEHRT, including by permitting
timely access to such technology and demonstrating capabilities as
implemented and used by the EP in the field.
(I) Support for health information exchange and the prevention of
information blocking. For an EHR reporting period in CY 2017 and
subsequent years, the EP must attest that he or she--
(1) Did not knowingly and willfully take action (such as to disable
functionality) to limit or restrict the compatibility or
interoperability of certified EHR technology.
(2) Implemented technologies, standards, policies, practices, and
agreements reasonably calculated to ensure, to the greatest extent
practicable and permitted by law, that the certified EHR technology
was, at all relevant times--
(i) Connected in accordance with applicable law;
(ii) Compliant with all standards applicable to the exchange of
information, including the standards, implementation specifications,
and certification criteria adopted at 45 CFR part 170;
(iii) Implemented in a manner that allowed for timely access by
patients to their electronic health information; and
(iv) Implemented in a manner that allowed for the timely, secure,
and trusted bidirectional exchange of structured electronic health
information with other health care providers (as defined by 42 U.S.C.
300jj(3)), including unaffiliated providers, and with disparate
Certified EHR technology and vendors.
(3) Responded in good faith and in a timely manner to requests to
retrieve or exchange electronic health information, including from
patients, health care providers (as defined by 42 U.S.C. 300jj(3)), and
other persons, regardless of the requestor's affiliation or technology
vendor.''
* * * * *
(b) Demonstration by eligible hospitals and CAHs. An eligible
hospital or CAH must demonstrate that it satisfies each of the
applicable objectives and associated measures under Sec. 495.20, Sec.
495.22, or Sec. 495.24, supports information exchange and the
prevention of health information blocking, and engages in activities
related to supporting providers with the performance of CEHRT:
* * * * *
(2) * * *
(i) * * *
(H) Supporting providers with the performance of CEHRT (SPPC). To
engage in activities related to supporting providers with the
performance of CEHRT, the eligible hospital or CAH--
(1) Must attest that it:
(i) Acknowledges the requirement to cooperate in good faith with
ONC direct review of his or her health information technology certified
under the ONC Health IT Certification Program if a request to assist in
ONC direct review is received; and
(ii) If requested, cooperated in good faith with ONC direct review
of its health information technology certified under the ONC Health IT
Certification Program as authorized by 45 CFR part 170, subpart E, to
the extent that such technology meets (or can be used to meet) the
definition of CEHRT, including by permitting timely access to such
technology and demonstrating its capabilities as implemented and used
by the eligible hospital or CAH in the field.
[[Page 37]]
(2) Optionally, may attest that it:
(i) Acknowledges the option to cooperate in good faith with ONC-ACB
surveillance of his or her health information technology certified
under the ONC Health IT Certification Program if a request to assist in
ONC-ACB surveillance is received; and
(ii) If requested, cooperated in good faith with ONC-ACB
surveillance of his or her health information technology certified
under the ONC Health IT Certification Program as authorized by 45 CFR
part 170, subpart E, to the extent that such technology meets (or can
be used to meet) the definition of CEHRT, including by permitting
timely access to such technology and demonstrating its capabilities as
implemented and used by the eligible hospital or CAH in the field.
(I) Support for health information exchange and the prevention of
information blocking. For an EHR reporting period in CY 2017 and
subsequent years, the eligible hospital or CAH must attest that it--
(1) Did not knowingly and willfully take action (such as to disable
functionality) to limit or restrict the compatibility or
interoperability of certified EHR technology.
(2) Implemented technologies, standards, policies, practices, and
agreements reasonably calculated to ensure, to the greatest extent
practicable and permitted by law, that the certified EHR technology
was, at all relevant times--
(i) Connected in accordance with applicable law;
(ii) Compliant with all standards applicable to the exchange of
information, including the standards, implementation specifications,
and certification criteria adopted at 45 CFR part 170;
(iii) Implemented in a manner that allowed for timely access by
patients to their electronic health information; and
(iv) Implemented in a manner that allowed for the timely, secure,
and trusted bidirectional exchange of structured electronic health
information with other health care providers (as defined by 42 U.S.C.
300jj(3)), including unaffiliated providers, and with disparate
certified EHR technology and vendors.
(3) Responded in good faith and in a timely manner to requests to
retrieve or exchange electronic health information, including from
patients, health care providers (as defined by 42 U.S.C. 300jj(3)), and
other persons, regardless of the requestor's affiliation or technology
vendor.''.
* * * * *
Dated: December 27, 2016.
Madhura Valverde,
Executive Secretary to the Department, Department of Health and Human
Services.
[FR Doc. 2016-31774 Filed 12-30-16; 8:45 am]
BILLING CODE 4120-01-P