Medicare Program; Prospective Payment System and Consolidated Billing for Skilled Nursing Facilities for FY 2018, SNF Value-Based Purchasing Program, SNF Quality Reporting Program, Survey Team Composition, and Correction of the Performance Period for the NHSN HCP Influenza Vaccination Immunization Reporting Measure in the ESRD QIP for PY 2020; Correction, 46163-46170 [2017-21327]
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<![CDATA[
Federal Register / Vol. 82, No. 191 / Wednesday, October 4, 2017 / Rules and Regulations
a. Lines 34, the figure ‘‘2.7’’ is
corrected to read ‘‘2.5’’.
b. Line 38, the figure ‘‘$226’’ is
corrected to read ‘‘$227’’.
Dated: September 29, 2017.
Ann C. Agnew,
Executive Secretary to the Department,
Department of Health and Human Services.
[FR Doc. 2017–21325 Filed 9–29–17; 4:15 pm]
II. Summary of Errors
BILLING CODE 4120–01–C
DEPARTMENT OF HEALTH AND
HUMAN SERVICES
Centers for Medicare & Medicaid
Services
42 CFR Parts 409, 411, 413, 424, and
488
[CMS–1679–CN]
RIN 0938–AS96
Medicare Program; Prospective
Payment System and Consolidated
Billing for Skilled Nursing Facilities for
FY 2018, SNF Value-Based Purchasing
Program, SNF Quality Reporting
Program, Survey Team Composition,
and Correction of the Performance
Period for the NHSN HCP Influenza
Vaccination Immunization Reporting
Measure in the ESRD QIP for PY 2020;
Correction
Centers for Medicare &
Medicaid Services (CMS), HHS.
ACTION: Final rule; correction.
AGENCY:
This document corrects
technical errors in the final rule that
appeared in the August 4, 2017 Federal
Register, which will update the
payment rates used under the
prospective payment system (PPS) for
skilled nursing facilities (SNFs) for
fiscal year (FY) 2018.
DATES: This correction is effective
October 1, 2017.
FOR FURTHER INFORMATION CONTACT: John
Kane, (410) 786–0557.
SUPPLEMENTARY INFORMATION:
SUMMARY:
sradovich on DSK3GMQ082PROD with RULES
I. Background
In FR Doc. 2017–16256 (82 FR 36530),
the final rule entitled ‘‘Medicare
Program; Prospective Payment System
and Consolidated Billing for Skilled
Nursing Facilities for FY 2018, SNF
Value-Based Purchasing Program, SNF
Quality Reporting Program, Survey
Team Composition, and Correction of
the Performance Period for the NHSN
HCP Influenza Vaccination
Immunization Reporting Measure in the
ESRD QIP for PY 2020’’, there were a
number of technical errors that are
VerDate Sep<11>2014
17:39 Oct 03, 2017
identified and corrected in section IV.,
Correction of Errors. The provisions in
this correcting document are effective as
if they had been included in the
document that appeared in the August
4, 2017, Federal Register (hereinafter
referred to as the FY 2018 SNF PPS final
rule). Accordingly, the corrections are
effective October 1, 2017.
Jkt 244001
A. Summary of Errors in the Preamble
As discussed in the FY 2018 SNF PPS
final rule (82 FR 36539), in developing
the wage index to be applied to skilled
nursing facilities (SNFs) under the SNF
prospective payment system (PPS), we
use the updated, pre-reclassified
hospital inpatient prospective payment
system (IPPS) wage data, exclusive of
the occupational mix adjustment. For
FY 2018, the updated, unadjusted, prereclassified IPPS wage data used under
the SNF PPS are for hospital cost
reporting periods beginning on or after
October 1, 2013, and before October 1,
2014 (FY 2014 cost report data), as
discussed in the FY 2018 IPPS final rule
(82 FR 38130). In calculating the wage
index under the FY 2018 IPPS final rule,
we made inadvertent errors related to
the wage data collected from the
Medicare cost reports of six hospitals
which are located in CBSAs 24860 and
40340. Specifically, we used incorrect
wage data for these six hospitals to
calculate the final FY 2018 IPPS wage
indexes, the geographic adjustment
factor (GAF) (which is computed from
the wage index), as well as certain other
IPPS factors and adjustments.
These errors are identified, discussed
and corrected in the Medicare Program;
Hospital Inpatient Prospective Payment
Systems for Acute Care Hospitals and
the Long Term Care Hospital
Prospective Payment System and Policy
Changes and Fiscal Year 2018 Rates;
Quality Reporting Requirements for
Specific Providers; Medicare and
Medicaid Electronic Health Record
(EHR) Incentive Program Requirements
for Eligible Hospitals, Critical Access
Hospitals, and Eligible Professionals;
Provider-Based Status of Indian Health
Services and Tribal Facilities and
Organizations; Cost Reporting and
Provider Requirements; Agreement
Termination Notices; Correction (CMS–
1677–CN) that appears elsewhere in this
issue of the Federal Register.
As discussed above, we use the
updated, pre-reclassified, unadjusted
IPPS wage data in developing the wage
index used under the SNF PPS. Due to
the technical errors described above, the
published FY 2018 SNF PPS wage
indexes were incorrect. Thus, the use of
PO 00000
Frm 00041
Fmt 4700
Sfmt 4700
46163
the corrected wage data for the six
hospitals required the recalculation of
the final FY 2018 SNF PPS wage
indexes. Additionally, as discussed on
page 36543 of the FY 2018 SNF PPS
final rule, section 1888(e)(4)(G)(ii) of the
Act requires that we apply the wage
index in a manner that does not result
in aggregate payments under the SNF
PPS that are greater or less than would
otherwise be made if the wage index
adjustment had not been made. To
achieve this, we apply a budget
neutrality factor to the unadjusted SNF
PPS federal per diem base rates. Due to
the recalculation and subsequent
revision of the final FY 2018 SNF PPS
wage indexes, it was necessary to
recalculate the FY 2018 SNF PPS wage
index budget neutrality factor as well.
Revising the wage index budget
neutrality factor causes a change in the
unadjusted SNF PPS federal per diem
rates (provided in Tables 2 and 3 of the
FY 2018 SNF PPS final rule (82 FR
36535)), which then causes changes in
the case-mix adjusted SNF PPS rates
(provided in Tables 4 and 5 in the FY
2018 SNF PPS final rule (82 FR 36537
through 36538), as well as the labor
adjusted SNF PPS rates (provided in
Tables 6 and 7 of the FY 2018 SNF PPS
final rule (82 FR 36541 through 36543).
Finally, due to the recalculated wage
indexes, we recalculated the impact
analysis provided in Table 26 of the FY
2018 SNF PPS final rule (82 FR 36629).
The corrections to these errors are found
in section IV. of this document.
B. Summary of Errors in and Corrections
to Tables Posted on the CMS Web Site
We are correcting the wage indexes in
Tables A and B setting forth the wage
indexes for urban (Table A) and nonurban (Table B) areas based on CBSA
labor market areas, which are available
exclusively on the CMS Web site at
https://www.cms.gov/Medicare/
Medicare-Fee-for-Service-Payment/
SNFPPS/WageIndex.html. These tables
have been updated to reflect the
revisions discussed in this correcting
document.
We are republishing the wage indexes
in Tables A and B accordingly on the
CMS Web site at https://www.cms.gov/
Medicare/Medicare-Fee-for-ServicePayment/SNFPPS/WageIndex.html.
III. Waiver of Proposed Rulemaking
and Delayed Effective Date
We ordinarily publish a notice of
proposed rulemaking in the Federal
Register to provide a period for public
comment before the provisions of a rule
take effect in accordance with section
553(b) of the Administrative Procedure
Act (APA) (5 U.S.C. 553(b)). However,
E:\FR\FM\04OCR1.SGM
04OCR1
46164
Federal Register / Vol. 82, No. 191 / Wednesday, October 4, 2017 / Rules and Regulations
we can waive this notice and comment
procedure if the Secretary finds, for
good cause, that the notice and
comment process is impracticable,
unnecessary, or contrary to the public
interest, and incorporates a statement of
the finding and the reasons therefor in
the notice.
Section 553(d) of the APA ordinarily
requires a 30-day delay in effective date
of final rules after the date of their
publication in the Federal Register.
This 30-day delay in effective date can
be waived, however, if an agency finds
for good cause that the delay is
impracticable, unnecessary, or contrary
to the public interest, and the agency
incorporates a statement of the findings
and its reasons in the rule issued.
We believe that this correcting
document does not constitute a rule that
would be subject to the APA notice and
comment or delayed effective date
requirements. The document corrects
technical errors in the FY 2018 SNF PPS
final rule and in the tables referenced in
the final rule, but does not make
substantive changes to the policies or
payment methodologies that were
adopted in the final rule. As a result,
this correcting document is intended to
ensure that the information in the FY
2018 SNF PPS final rule accurately
reflects the policies adopted in that final
rule.
In addition, even if this were a rule to
which the notice and comment
procedures and delayed effective date
requirements applied, we find that there
is good cause to waive such
requirements. Undertaking further
notice and comment procedures to
incorporate the corrections in this
document into the final rule or delaying
the effective date would be contrary to
the public interest because it is in the
public’s interest for providers to receive
appropriate payments in as timely a
manner as possible, and to ensure that
the FY 2018 SNF PPS final rule and the
tables referenced in the final rule
accurately reflect our methodologies,
payment rates, and policies.
Furthermore, such procedures would be
unnecessary, as we are not making
substantive changes to our payment
methodologies or policies, but rather,
we are simply implementing correctly
the methodologies and policies that we
previously proposed, requested
comment on, and subsequently
finalized. This correcting document is
intended solely to ensure that the FY
2018 SNF PPS final rule and the tables
referenced in the final rule accurately
reflect these methodologies and
policies. Therefore, we believe we have
good cause to waive the notice and
comment and effective date
requirements.
Correction of Errors
In FR Doc. 2017–16256 of August 4,
2017 (82 FR 36530), make the following
corrections:
1. On page 36535, TABLE 2—FY 2018
UNADJUSTED FEDERAL RATE PER
DIEM URBAN is corrected to read as
follows:
TABLE 2—FY 2018 UNADJUSTED FEDERAL RATE PER DIEM URBAN
Rate component
Nursing—
case-mix
Therapy—
case-mix
Therapy—noncase-mix
Non-case-mix
Per Diem Amount ............................................................................................
$177.21
$133.48
$17.58
$90.44
2. On page 36535, TABLE 3—FY 2018
UNADJUSTED FEDERAL RATE PER
DIEM RURAL is corrected to read as
follows:
TABLE 3—FY 2018 UNADJUSTED FEDERAL RATE PER DIEM RURAL
Rate component
Nursing—
case-mix
Therapy—
case-mix
Therapy—noncase-mix
Non-case-mix
Per Diem Amount ............................................................................................
$169.29
$153.92
$18.78
$92.11
3. On page 36536, third column, first
full paragraph,
a. Line 21, the figure ‘‘$443.08’’ is
corrected to read ‘‘$442.95’’.
b. Line 26, the figure ‘‘$1,010.22.’’ is
corrected to read ‘‘$1,009.93.’’.
4. On page 36537, TABLE 4—RUG-IV
CASE-MIX ADJUSTED FEDERAL
RATES AND ASSOCIATED INDEXES—
URBAN is corrected to read as follows:
TABLE 4—RUG-IV CASE-MIX ADJUSTED FEDERAL RATES AND ASSOCIATED INDEXES—URBAN
sradovich on DSK3GMQ082PROD with RULES
RUG-IV category
Nursing index
Therapy index
2.67
2.57
2.61
2.19
2.55
2.15
2.47
2.19
2.26
1.56
1.56
0.99
1.51
1.11
1.10
1.87
1.87
1.28
1.28
0.85
0.85
0.55
0.55
0.28
1.87
1.87
1.87
1.28
1.28
1.28
RUX ..............................
RUL ..............................
RVX ..............................
RVL ..............................
RHX ..............................
RHL ..............................
RMX .............................
RML ..............................
RLX ..............................
RUC .............................
RUB ..............................
RUA ..............................
RVC ..............................
RVB ..............................
RVA ..............................
VerDate Sep<11>2014
17:39 Oct 03, 2017
Jkt 244001
PO 00000
Frm 00042
Nursing
component
Therapy
component
$473.15
455.43
462.52
388.09
451.89
381.00
437.71
388.09
400.49
276.45
276.45
175.44
267.59
196.70
194.93
Fmt 4700
Sfmt 4700
$249.61
249.61
170.85
170.85
113.46
113.46
73.41
73.41
37.37
249.61
249.61
249.61
170.85
170.85
170.85
Non-case mix
therapy comp
Non-case mix
component
........................
........................
........................
........................
........................
........................
........................
........................
........................
........................
........................
........................
........................
........................
........................
$90.44
90.44
90.44
90.44
90.44
90.44
90.44
90.44
90.44
90.44
90.44
90.44
90.44
90.44
90.44
E:\FR\FM\04OCR1.SGM
04OCR1
Total rate
$813.20
795.48
723.81
649.38
655.79
584.90
601.56
551.94
528.30
616.50
616.50
515.49
528.88
457.99
456.22
46165
Federal Register / Vol. 82, No. 191 / Wednesday, October 4, 2017 / Rules and Regulations
TABLE 4—RUG-IV CASE-MIX ADJUSTED FEDERAL RATES AND ASSOCIATED INDEXES—URBAN—Continued
RUG-IV category
Nursing index
Therapy index
1.45
1.19
0.91
1.36
1.22
0.84
1.50
0.71
3.58
2.67
2.32
2.22
1.74
2.04
1.60
1.89
1.48
1.86
1.46
1.96
1.54
1.86
1.46
1.56
1.22
1.45
1.14
1.68
1.50
1.56
1.38
1.29
1.15
1.15
1.02
0.88
0.78
0.97
0.90
0.70
0.64
1.50
1.40
1.38
1.28
1.10
1.02
0.84
0.78
0.59
0.54
0.85
0.85
0.85
0.55
0.55
0.55
0.28
0.28
........................
........................
........................
........................
........................
........................
........................
........................
........................
........................
........................
........................
........................
........................
........................
........................
........................
........................
........................
........................
........................
........................
........................
........................
........................
........................
........................
........................
........................
........................
........................
........................
........................
........................
........................
........................
........................
........................
........................
........................
........................
........................
........................
RHC .............................
RHB ..............................
RHA ..............................
RMC .............................
RMB .............................
RMA .............................
RLB ..............................
RLA ..............................
ES3 ..............................
ES2 ..............................
ES1 ..............................
HE2 ..............................
HE1 ..............................
HD2 ..............................
HD1 ..............................
HC2 ..............................
HC1 ..............................
HB2 ..............................
HB1 ..............................
LE2 ...............................
LE1 ...............................
LD2 ...............................
LD1 ...............................
LC2 ...............................
LC1 ...............................
LB2 ...............................
LB1 ...............................
CE2 ..............................
CE1 ..............................
CD2 ..............................
CD1 ..............................
CC2 ..............................
CC1 ..............................
CB2 ..............................
CB1 ..............................
CA2 ..............................
CA1 ..............................
BB2 ..............................
BB1 ..............................
BA2 ..............................
BA1 ..............................
PE2 ..............................
PE1 ..............................
PD2 ..............................
PD1 ..............................
PC2 ..............................
PC1 ..............................
PB2 ..............................
PB1 ..............................
PA2 ..............................
PA1 ..............................
5. On page 36538, TABLE 5—RUG-IV
CASE-MIX ADJUSTED FEDERAL
Nursing
component
256.95
210.88
161.26
241.01
216.20
148.86
265.82
125.82
634.41
473.15
411.13
393.41
308.35
361.51
283.54
334.93
262.27
329.61
258.73
347.33
272.90
329.61
258.73
276.45
216.20
256.95
202.02
297.71
265.82
276.45
244.55
228.60
203.79
203.79
180.75
155.94
138.22
171.89
159.49
124.05
113.41
265.82
248.09
244.55
226.83
194.93
180.75
148.86
138.22
104.55
95.69
Therapy
component
Non-case mix
therapy comp
Non-case mix
component
113.46
113.46
113.46
73.41
73.41
73.41
37.37
37.37
........................
........................
........................
........................
........................
........................
........................
........................
........................
........................
........................
........................
........................
........................
........................
........................
........................
........................
........................
........................
........................
........................
........................
........................
........................
........................
........................
........................
........................
........................
........................
........................
........................
........................
........................
........................
........................
........................
........................
........................
........................
........................
........................
........................
........................
........................
........................
........................
........................
........................
........................
17.58
17.58
17.58
17.58
17.58
17.58
17.58
17.58
17.58
17.58
17.58
17.58
17.58
17.58
17.58
17.58
17.58
17.58
17.58
17.58
17.58
17.58
17.58
17.58
17.58
17.58
17.58
17.58
17.58
17.58
17.58
17.58
17.58
17.58
17.58
17.58
17.58
17.58
17.58
17.58
17.58
17.58
17.58
90.44
90.44
90.44
90.44
90.44
90.44
90.44
90.44
90.44
90.44
90.44
90.44
90.44
90.44
90.44
90.44
90.44
90.44
90.44
90.44
90.44
90.44
90.44
90.44
90.44
90.44
90.44
90.44
90.44
90.44
90.44
90.44
90.44
90.44
90.44
90.44
90.44
90.44
90.44
90.44
90.44
90.44
90.44
90.44
90.44
90.44
90.44
90.44
90.44
90.44
90.44
Total rate
460.85
414.78
365.16
404.86
380.05
312.71
393.63
253.63
742.43
581.17
519.15
501.43
416.37
469.53
391.56
442.95
370.29
437.63
366.75
455.35
380.92
437.63
366.75
384.47
324.22
364.97
310.04
405.73
373.84
384.47
352.57
336.62
311.81
311.81
288.77
263.96
246.24
279.91
267.51
232.07
221.43
373.84
356.11
352.57
334.85
302.95
288.77
256.88
246.24
212.57
203.71
RATES AND ASSOCIATED INDEXES—
RURAL is corrected to read as follows:
TABLE 5—RUG-IV CASE-MIX ADJUSTED FEDERAL RATES AND ASSOCIATED INDEXES—RURAL
sradovich on DSK3GMQ082PROD with RULES
RUG-IV
Category
Nursing
index
RUX ..............................
RUL ..............................
RVX ..............................
RVL ..............................
RHX ..............................
RHL ..............................
RMX .............................
RML ..............................
RLX ..............................
VerDate Sep<11>2014
17:39 Oct 03, 2017
Therapy
index
2.67
2.57
2.61
2.19
2.55
2.15
2.47
2.19
2.26
Jkt 244001
1.87
1.87
1.28
1.28
0.85
0.85
0.55
0.55
0.28
PO 00000
Frm 00043
Nursing
component
Therapy
component
$452.00
435.08
441.85
370.75
431.69
363.97
418.15
370.75
382.60
Fmt 4700
Sfmt 4700
$287.83
287.83
197.02
197.02
130.83
130.83
84.66
84.66
43.10
Non-case mix
therapy comp
Non-case mix
component
........................
........................
........................
........................
........................
........................
........................
........................
........................
$92.11
92.11
92.11
92.11
92.11
92.11
92.11
92.11
92.11
E:\FR\FM\04OCR1.SGM
04OCR1
Total
rate
$831.94
815.02
730.98
659.88
654.63
586.91
594.92
547.52
517.81
46166
Federal Register / Vol. 82, No. 191 / Wednesday, October 4, 2017 / Rules and Regulations
TABLE 5—RUG-IV CASE-MIX ADJUSTED FEDERAL RATES AND ASSOCIATED INDEXES—RURAL—Continued
RUG-IV
Category
Nursing
index
RUC .............................
RUB ..............................
RUA ..............................
RVC ..............................
RVB ..............................
RVA ..............................
RHC .............................
RHB ..............................
RHA ..............................
RMC .............................
RMB .............................
RMA .............................
RLB ..............................
RLA ..............................
ES3 ..............................
ES2 ..............................
ES1 ..............................
HE2 ..............................
HE1 ..............................
HD2 ..............................
HD1 ..............................
HC2 ..............................
HC1 ..............................
HB2 ..............................
HB1 ..............................
LE2 ...............................
LE1 ...............................
LD2 ...............................
LD1 ...............................
LC2 ...............................
LC1 ...............................
LB2 ...............................
LB1 ...............................
CE2 ..............................
CE1 ..............................
CD2 ..............................
CD1 ..............................
CC2 ..............................
CC1 ..............................
CB2 ..............................
CB1 ..............................
CA2 ..............................
CA1 ..............................
BB2 ..............................
BB1 ..............................
BA2 ..............................
BA1 ..............................
PE2 ..............................
PE1 ..............................
PD2 ..............................
PD1 ..............................
PC2 ..............................
PC1 ..............................
PB2 ..............................
PB1 ..............................
PA2 ..............................
PA1 ..............................
Therapy
index
1.56
1.56
0.99
1.51
1.11
1.10
1.45
1.19
0.91
1.36
1.22
0.84
1.50
0.71
3.58
2.67
2.32
2.22
1.74
2.04
1.60
1.89
1.48
1.86
1.46
1.96
1.54
1.86
1.46
1.56
1.22
1.45
1.14
1.68
1.50
1.56
1.38
1.29
1.15
1.15
1.02
0.88
0.78
0.97
0.90
0.70
0.64
1.50
1.40
1.38
1.28
1.10
1.02
0.84
0.78
0.59
0.54
sradovich on DSK3GMQ082PROD with RULES
6. On pages 36541 through 36542,
TABLE 6—RUG-IV CASE–MIX
1.87
1.87
1.87
1.28
1.28
1.28
0.85
0.85
0.85
0.55
0.55
0.55
0.28
0.28
........................
........................
........................
........................
........................
........................
........................
........................
........................
........................
........................
........................
........................
........................
........................
........................
........................
........................
........................
........................
........................
........................
........................
........................
........................
........................
........................
........................
........................
........................
........................
........................
........................
........................
........................
........................
........................
........................
........................
........................
........................
........................
........................
Nursing
component
264.09
264.09
167.60
255.63
187.91
186.22
245.47
201.46
154.05
230.23
206.53
142.20
253.94
120.20
606.06
452.00
392.75
375.82
294.56
345.35
270.86
319.96
250.55
314.88
247.16
331.81
260.71
314.88
247.16
264.09
206.53
245.47
192.99
284.41
253.94
264.09
233.62
218.38
194.68
194.68
172.68
148.98
132.05
164.21
152.36
118.50
108.35
253.94
237.01
233.62
216.69
186.22
172.68
142.20
132.05
99.88
91.42
Therapy
component
Non-case mix
therapy comp
Non-case mix
component
287.83
287.83
287.83
197.02
197.02
197.02
130.83
130.83
130.83
84.66
84.66
84.66
43.10
43.10
........................
........................
........................
........................
........................
........................
........................
........................
........................
........................
........................
........................
........................
........................
........................
........................
........................
........................
........................
........................
........................
........................
........................
........................
........................
........................
........................
........................
........................
........................
........................
........................
........................
........................
........................
........................
........................
........................
........................
........................
........................
........................
........................
........................
........................
........................
........................
........................
........................
........................
........................
........................
........................
........................
........................
........................
........................
18.78
18.78
18.78
18.78
18.78
18.78
18.78
18.78
18.78
18.78
18.78
18.78
18.78
18.78
18.78
18.78
18.78
18.78
18.78
18.78
18.78
18.78
18.78
18.78
18.78
18.78
18.78
18.78
18.78
18.78
18.78
18.78
18.78
18.78
18.78
18.78
18.78
18.78
18.78
18.78
18.78
18.78
18.78
92.11
92.11
92.11
92.11
92.11
92.11
92.11
92.11
92.11
92.11
92.11
92.11
92.11
92.11
92.11
92.11
92.11
92.11
92.11
92.11
92.11
92.11
92.11
92.11
92.11
92.11
92.11
92.11
92.11
92.11
92.11
92.11
92.11
92.11
92.11
92.11
92.11
92.11
92.11
92.11
92.11
92.11
92.11
92.11
92.11
92.11
92.11
92.11
92.11
92.11
92.11
92.11
92.11
92.11
92.11
92.11
92.11
ADJUSTED FEDERAL RATES FOR
URBAN SNFS BY LABOR AND NON-
Total
rate
644.03
644.03
547.54
544.76
477.04
475.35
468.41
424.40
376.99
407.00
383.30
318.97
389.15
255.41
716.95
562.89
503.64
486.71
405.45
456.24
381.75
430.85
361.44
425.77
358.05
442.70
371.60
425.77
358.05
374.98
317.42
356.36
303.88
395.30
364.83
374.98
344.51
329.27
305.57
305.57
283.57
259.87
242.94
275.10
263.25
229.39
219.24
364.83
347.90
344.51
327.58
297.11
283.57
253.09
242.94
210.77
202.31
LABOR COMPONENT is corrected to
read as follows:
TABLE 6—RUG-IV CASE-MIX ADJUSTED FEDERAL RATES FOR URBAN SNFS BY LABOR AND NON-LABOR COMPONENT
RUG-IV category
Total rate
RUX .............................................................................................................................................
RUL ..............................................................................................................................................
RVX ..............................................................................................................................................
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$813.20
795.48
723.81
E:\FR\FM\04OCR1.SGM
04OCR1
Labor portion
$575.75
563.20
512.46
Non-labor
portion
$237.45
232.28
211.35
Federal Register / Vol. 82, No. 191 / Wednesday, October 4, 2017 / Rules and Regulations
46167
TABLE 6—RUG-IV CASE-MIX ADJUSTED FEDERAL RATES FOR URBAN SNFS BY LABOR AND NON-LABOR COMPONENT—
Continued
sradovich on DSK3GMQ082PROD with RULES
RUG-IV category
Total rate
RVL ..............................................................................................................................................
RHX .............................................................................................................................................
RHL ..............................................................................................................................................
RMX .............................................................................................................................................
RML .............................................................................................................................................
RLX ..............................................................................................................................................
RUC .............................................................................................................................................
RUB .............................................................................................................................................
RUA .............................................................................................................................................
RVC .............................................................................................................................................
RVB ..............................................................................................................................................
RVA ..............................................................................................................................................
RHC .............................................................................................................................................
RHB .............................................................................................................................................
RHA .............................................................................................................................................
RMC .............................................................................................................................................
RMB .............................................................................................................................................
RMA .............................................................................................................................................
RLB ..............................................................................................................................................
RLA ..............................................................................................................................................
ES3 ..............................................................................................................................................
ES2 ..............................................................................................................................................
ES1 ..............................................................................................................................................
HE2 ..............................................................................................................................................
HE1 ..............................................................................................................................................
HD2 ..............................................................................................................................................
HD1 ..............................................................................................................................................
HC2 ..............................................................................................................................................
HC1 ..............................................................................................................................................
HB2 ..............................................................................................................................................
HB1 ..............................................................................................................................................
LE2 ...............................................................................................................................................
LE1 ...............................................................................................................................................
LD2 ..............................................................................................................................................
LD1 ..............................................................................................................................................
LC2 ..............................................................................................................................................
LC1 ..............................................................................................................................................
LB2 ...............................................................................................................................................
LB1 ...............................................................................................................................................
CE2 ..............................................................................................................................................
CE1 ..............................................................................................................................................
CD2 ..............................................................................................................................................
CD1 ..............................................................................................................................................
CC2 ..............................................................................................................................................
CC1 ..............................................................................................................................................
CB2 ..............................................................................................................................................
CB1 ..............................................................................................................................................
CA2 ..............................................................................................................................................
CA1 ..............................................................................................................................................
BB2 ..............................................................................................................................................
BB1 ..............................................................................................................................................
BA2 ..............................................................................................................................................
BA1 ..............................................................................................................................................
PE2 ..............................................................................................................................................
PE1 ..............................................................................................................................................
PD2 ..............................................................................................................................................
PD1 ..............................................................................................................................................
PC2 ..............................................................................................................................................
PC1 ..............................................................................................................................................
PB2 ..............................................................................................................................................
PB1 ..............................................................................................................................................
PA2 ..............................................................................................................................................
PA1 ..............................................................................................................................................
7. On pages 36542 through 36543,
TABLE 7–RUG-IV CASE-MIX
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ADJUSTED FEDERAL RATES FOR
RURAL SNFS BY LABOR AND NON-
PO 00000
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Fmt 4700
Sfmt 4700
649.38
655.79
584.90
601.56
551.94
528.30
616.50
616.50
515.49
528.88
457.99
456.22
460.85
414.78
365.16
404.86
380.05
312.71
393.63
253.63
742.43
581.17
519.15
501.43
416.37
469.53
391.56
442.95
370.29
437.63
366.75
455.35
380.92
437.63
366.75
384.47
324.22
364.97
310.04
405.73
373.84
384.47
352.57
336.62
311.81
311.81
288.77
263.96
246.24
279.91
267.51
232.07
221.43
373.84
356.11
352.57
334.85
302.95
288.77
256.88
246.24
212.57
203.71
Labor portion
459.76
464.30
414.11
425.90
390.77
374.04
436.48
436.48
364.97
374.45
324.26
323.00
326.28
293.66
258.53
286.64
269.08
221.40
278.69
179.57
525.64
411.47
367.56
355.01
294.79
332.43
277.22
313.61
262.17
309.84
259.66
322.39
269.69
309.84
259.66
272.20
229.55
258.40
219.51
287.26
264.68
272.20
249.62
238.33
220.76
220.76
204.45
186.88
174.34
198.18
189.40
164.31
156.77
264.68
252.13
249.62
237.07
214.49
204.45
181.87
174.34
150.50
144.23
Non-labor
portion
189.62
191.49
170.79
175.66
161.17
154.26
180.02
180.02
150.52
154.43
133.73
133.22
134.57
121.12
106.63
118.22
110.97
91.31
114.94
74.06
216.79
169.70
151.59
146.42
121.58
137.10
114.34
129.34
108.12
127.79
107.09
132.96
111.23
127.79
107.09
112.27
94.67
106.57
90.53
118.47
109.16
112.27
102.95
98.29
91.05
91.05
84.32
77.08
71.90
81.73
78.11
67.76
64.66
109.16
103.98
102.95
97.78
88.46
84.32
75.01
71.90
62.07
59.48
LABOR COMPONENT is corrected to
read as follows:
E:\FR\FM\04OCR1.SGM
04OCR1
46168
Federal Register / Vol. 82, No. 191 / Wednesday, October 4, 2017 / Rules and Regulations
TABLE 7—RUG–IV CASE-MIX ADJUSTED FEDERAL RATES FOR RURAL SNFS BY LABOR AND NON-LABOR COMPONENT
sradovich on DSK3GMQ082PROD with RULES
RUG–IV category
Total rate
RUX .............................................................................................................................................
RUL ..............................................................................................................................................
RVX ..............................................................................................................................................
RVL ..............................................................................................................................................
RHX .............................................................................................................................................
RHL ..............................................................................................................................................
RMX .............................................................................................................................................
RML .............................................................................................................................................
RLX ..............................................................................................................................................
RUC .............................................................................................................................................
RUB .............................................................................................................................................
RUA .............................................................................................................................................
RVC .............................................................................................................................................
RVB ..............................................................................................................................................
RVA ..............................................................................................................................................
RHC .............................................................................................................................................
RHB .............................................................................................................................................
RHA .............................................................................................................................................
RMC .............................................................................................................................................
RMB .............................................................................................................................................
RMA .............................................................................................................................................
RLB ..............................................................................................................................................
RLA ..............................................................................................................................................
ES3 ..............................................................................................................................................
ES2 ..............................................................................................................................................
ES1 ..............................................................................................................................................
HE2 ..............................................................................................................................................
HE1 ..............................................................................................................................................
HD2 ..............................................................................................................................................
HD1 ..............................................................................................................................................
HC2 ..............................................................................................................................................
HC1 ..............................................................................................................................................
HB2 ..............................................................................................................................................
HB1 ..............................................................................................................................................
LE2 ...............................................................................................................................................
LE1 ...............................................................................................................................................
LD2 ..............................................................................................................................................
LD1 ..............................................................................................................................................
LC2 ..............................................................................................................................................
LC1 ..............................................................................................................................................
LB2 ...............................................................................................................................................
LB1 ...............................................................................................................................................
CE2 ..............................................................................................................................................
CE1 ..............................................................................................................................................
CD2 ..............................................................................................................................................
CD1 ..............................................................................................................................................
CC2 ..............................................................................................................................................
CC1 ..............................................................................................................................................
CB2 ..............................................................................................................................................
CB1 ..............................................................................................................................................
CA2 ..............................................................................................................................................
CA1 ..............................................................................................................................................
BB2 ..............................................................................................................................................
BB1 ..............................................................................................................................................
BA2 ..............................................................................................................................................
BA1 ..............................................................................................................................................
PE2 ..............................................................................................................................................
PE1 ..............................................................................................................................................
PD2 ..............................................................................................................................................
PD1 ..............................................................................................................................................
PC2 ..............................................................................................................................................
PC1 ..............................................................................................................................................
PB2 ..............................................................................................................................................
PB1 ..............................................................................................................................................
PA2 ..............................................................................................................................................
PA1 ..............................................................................................................................................
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$831.94
815.02
730.98
659.88
654.63
586.91
594.92
547.52
517.81
644.03
644.03
547.54
544.76
477.04
475.35
468.41
424.40
376.99
407.00
383.30
318.97
389.15
255.41
716.95
562.89
503.64
486.71
405.45
456.24
381.75
430.85
361.44
425.77
358.05
442.70
371.60
425.77
358.05
374.98
317.42
356.36
303.88
395.30
364.83
374.98
344.51
329.27
305.57
305.57
283.57
259.87
242.94
275.10
263.25
229.39
219.24
364.83
347.90
344.51
327.58
297.11
283.57
253.09
242.94
210.77
202.31
E:\FR\FM\04OCR1.SGM
04OCR1
Labor portion
$589.01
577.03
517.53
467.20
463.48
415.53
421.20
387.64
366.61
455.97
455.97
387.66
385.69
337.74
336.55
331.63
300.48
266.91
288.16
271.38
225.83
275.52
180.83
507.60
398.53
356.58
344.59
287.06
323.02
270.28
305.04
255.90
301.45
253.50
313.43
263.09
301.45
253.50
265.49
224.73
252.30
215.15
279.87
258.30
265.49
243.91
233.12
216.34
216.34
200.77
183.99
172.00
194.77
186.38
162.41
155.22
258.30
246.31
243.91
231.93
210.35
200.77
179.19
172.00
149.23
143.24
Non-labor
portion
$242.93
237.99
213.45
192.68
191.15
171.38
173.72
159.88
151.20
188.06
188.06
159.88
159.07
139.30
138.80
136.78
123.92
110.08
118.84
111.92
93.14
113.63
74.58
209.35
164.36
147.06
142.12
118.39
133.22
111.47
125.81
105.54
124.32
104.55
129.27
108.51
124.32
104.55
109.49
92.69
104.06
88.73
115.43
106.53
109.49
100.60
96.15
89.23
89.23
82.80
75.88
70.94
80.33
76.87
66.98
64.02
106.53
101.59
100.60
95.65
86.76
82.80
73.90
70.94
61.54
59.07
Federal Register / Vol. 82, No. 191 / Wednesday, October 4, 2017 / Rules and Regulations
8. On page 36543, under Table 7,
a. Second column, first partial
paragraph, line 15, the figure ‘‘1.0013’’
is corrected to read ‘‘1.0010’’.
b. Third column, first full paragraph,
line 16, the figure ‘‘$47,596.42’’ is
corrected to read ‘‘$47,602.52’’.
9. On page 36543, TABLE 8—
ADJUSTED RATE COMPUTATION
46169
EXAMPLE SNF XYZ: LOCATED IN
FREDERICK, MD (URBAN CBSA 43524)
WAGE INDEX: 0.9863 [See Wage Index
in Table A] 1 is corrected to read as
follows:
TABLE 8—ADJUSTED RATE COMPUTATION EXAMPLE SNF XYZ: LOCATED IN FREDERICK, MD (URBAN CBSA 43524)
[WAGE INDEX: 0.9869 (See Wage Index in Table A)] 1
RUG-IV group
Labor
RVX ..................................
ES2 ..................................
RHA ..................................
CC2 * ................................
BA2 ..................................
Wage index
Adjusted
labor
Non-labor
Adjusted
rate
Percent adjustment
Medicare
days
Payment
$512.46
411.47
258.53
238.33
164.31
0.9869
0.9869
0.9869
0.9869
0.9869
$505.75
406.08
255.14
235.21
162.16
$211.35
169.70
106.63
98.29
67.76
$717.10
575.78
361.77
333.50
229.92
$717.10
575.78
361.77
760.38
229.92
14
30
16
10
30
$10,039.40
17,273.40
5,788.32
7,603.80
6,897.60
....................
....................
....................
....................
....................
....................
100
47,602.52
* Reflects a 128 percent adjustment from section 511 of the MMA.
1 Available on the CMS Web site at https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/SNFPPS/WageIndex.html.
10. On pages 36629, TABLE 26—
PROJECTED IMPACT TO THE SNF PPS
FOR FY 2018 is corrected to read as
follows:
TABLE 26—PROJECTED IMPACT TO THE SNF PPS FOR FY 2018
Number of
facilities
FY 2018
sradovich on DSK3GMQ082PROD with RULES
Group
Total .............................................................................................................................................
Urban ...........................................................................................................................................
Rural ............................................................................................................................................
Hospital-based urban ...................................................................................................................
Freestanding urban ......................................................................................................................
Hospital-based rural .....................................................................................................................
Freestanding rural ........................................................................................................................
Urban by region
New England ...............................................................................................................................
Middle Atlantic .............................................................................................................................
South Atlantic ...............................................................................................................................
East North Central .......................................................................................................................
East South Central ......................................................................................................................
West North Central ......................................................................................................................
West South Central .....................................................................................................................
Mountain ......................................................................................................................................
Pacific ..........................................................................................................................................
Outlying ........................................................................................................................................
Rural by region
New England ...............................................................................................................................
Middle Atlantic .............................................................................................................................
South Atlantic ...............................................................................................................................
East North Central .......................................................................................................................
East South Central ......................................................................................................................
West North Central ......................................................................................................................
West South Central .....................................................................................................................
Mountain ......................................................................................................................................
Pacific ..........................................................................................................................................
Ownership
Profit .............................................................................................................................................
Non-profit .....................................................................................................................................
Government .................................................................................................................................
Update wage
data
Total change
15,468
11,008
4,460
518
10,490
577
3,883
0.0%
0.1%
¥0.6%
0.2%
0.1%
¥0.7%
¥0.6%
1.0%
1.1%
0.4%
1.2%
1.1%
0.3%
0.4%
791
1,487
1,867
2,121
551
919
1,339
511
1,417
5
0.2%
0.4%
¥0.2%
0.0%
¥0.6%
0.4%
0.1%
¥0.2%
0.5%
¥2.0%
1.2%
1.4%
0.8%
1.0%
0.4%
1.4%
1.1%
0.8%
1.5%
¥1.0%
137
215
502
937
528
1,076
738
228
99
1.5%
¥0.5%
¥0.7%
¥1.1%
¥0.9%
¥0.4%
¥0.6%
¥0.3%
0.1%
2.5%
0.5%
0.3%
¥0.1%
0.1%
0.6%
0.4%
0.7%
1.1%
1,045
10,822
3,601
¥0.3%
0.0%
0.0%
0.7%
1.0%
1.0%
Note: The Total column includes the 1.0 percent market basket increase required by section 1888(e)(5)(B)(iii) of the Act. Additionally, we
found no SNFs in rural outlying areas.
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E:\FR\FM\04OCR1.SGM
04OCR1
46170
Federal Register / Vol. 82, No. 191 / Wednesday, October 4, 2017 / Rules and Regulations
Dated: September 29, 2017.
Ann C. Agnew,
Executive Secretary to the Department,
Department of Health and Human Services.
[FR Doc. 2017–21327 Filed 9–29–17; 4:15 pm]
BILLING CODE 4120–01–P
DEPARTMENT OF COMMERCE
National Oceanic and Atmospheric
Administration
50 CFR Part 622
[Docket Nos. 090206140–91081–03 and
120405260–4258–02]
RIN 0648–XF723
Authorization of Revised Reporting
Requirements Due to Catastrophic
Conditions for Federal Seafood
Dealers and Individual Fishing Quota
Dealers in Portions of Florida
National Marine Fisheries
Service (NMFS), National Oceanic and
Atmospheric Administration (NOAA),
Commerce.
ACTION: Temporary delay in reporting
requirements; determination of
catastrophic conditions.
AGENCY:
In accordance with the
regulations implementing the individual
fishing quota (IFQ) and Federal dealer
reporting programs specific to the
commercial reef fish fishery in the Gulf
of Mexico (Gulf), the coastal migratory
pelagic (CMP) fisheries in the Gulf and
the Atlantic, the spiny lobster fishery of
the Gulf and Atlantic, and the snappergrouper and dolphin-wahoo fisheries in
the South Atlantic, the Regional
Administrator, Southeast Region, NMFS
(RA) has determined that Hurricane
Irma has caused catastrophic conditions
in the following Florida counties:
Manatee, Sarasota, DeSoto, Charlotte,
Lee, Collier, Monroe, Miami-Dade, and
Broward. Consistent with those
regulations, the RA has authorized any
dealer in the affected area who does not
have access to electronic reporting to
delay reporting of trip tickets to NOAA
Fisheries from September 29, 2017,
through October 31, 2017. The RA has
also authorized IFQ participants within
this affected area to use paper-based
forms, if necessary, for basic required
administrative functions, e.g., landing
transactions, from September 29, 2017,
through October 31, 2017. This
temporary rule announcing the
determination of catastrophic
conditions and allowance of alternative
methods for completing required IFQ
and other dealer reporting
administrative functions is intended to
sradovich on DSK3GMQ082PROD with RULES
SUMMARY:
VerDate Sep<11>2014
17:39 Oct 03, 2017
Jkt 244001
facilitate continuation of IFQ and dealer
reporting operations during the period
of catastrophic conditions. NMFS will
continue to monitor and evaluate
conditions. A subsequent Federal
Register notice will be published, if
needed.
DATES: The RA is authorizing applicable
Federal dealers and IFQ participants
reporting within this affected area to use
revised reporting methods from
September 29, 2017, through October
31, 2017.
FOR FURTHER INFORMATION CONTACT: IFQ
Customer Service, telephone: 866–425–
7627, fax: 727–824–5308, email: SERIFQ.Support@noaa.gov. For federal
dealer reporting, Fisheries Monitoring
Branch, telephone: 305–361–4581.
SUPPLEMENTARY INFORMATION: The reef
fish fishery of the Gulf is managed
under the Fishery Management Plan
(FMP) for Reef Fish Resources of the
Gulf of Mexico, prepared by the Gulf of
Mexico Fishery Management Council.
The snapper-grouper fishery of the
South Atlantic is managed under the
Snapper-Grouper FMP of the South
Atlantic, prepared by the South Atlantic
Fishery Management Council. The
dolphin-wahoo fishery of the South
Atlantic is managed under the DolphinWahoo FMP of the South Atlantic,
prepared by the South Atlantic Fishery
Management Council. The fishery for
CMP fish (king mackerel, Spanish
mackerel, and cobia) is managed under
the FMP for the CMP Resources of the
Gulf of Mexico and South Atlantic,
prepared by both Councils. The fishery
for spiny lobster is managed under the
FMP for Spiny Lobster of the Gulf of
Mexico and South Atlantic, prepared by
both Councils. All FMPs are
implemented through regulations at 50
CFR part 622 under the authority of the
Magnuson-Stevens Fishery
Conservation and Management Act
(Magnuson-Stevens Act).
The Generic Dealer Amendment
established Federal dealer reporting
requirements for federally permitted
dealers in the Gulf and South Atlantic
(79 FR 19490, April 9, 2014).
Amendment 26 to the FMP established
an IFQ program for the commercial red
snapper component of the Gulf reef fish
fishery (71 FR 67447, November 22,
2006). Amendment 29 to the FMP
established an IFQ program for the
commercial grouper and tilefish
components of the Gulf reef fish fishery
(74 FR 44732, August 31, 2009).
Regulations implementing these IFQ
programs (50 CFR 622.21 and 622.22)
and the dealer reporting requirements
(50 CFR 622.5(c)) require that Federal
dealers and IFQ participants have access
PO 00000
Frm 00048
Fmt 4700
Sfmt 4700
to a computer and Internet and that they
conduct administrative functions
associated with dealer reporting and the
IFQ program, e.g., landing transactions,
online. However, these regulations also
specify that during catastrophic
conditions, as determined by the RA,
the RA may waive or modify the
reporting time requirements for dealers
and authorize IFQ participants to use
paper-based forms to complete
administrative functions for the
duration of the catastrophic conditions.
The RA must determine that
catastrophic conditions exist, specify
the duration of the catastrophic
conditions, and specify which
participants or geographic areas are
deemed affected.
Hurricane Irma made landfall in the
U.S. near Cudjoe Key, Florida, as a
Category 4 hurricane then made a
subsequent landfall near Marco Island,
Florida, as a Category 3 hurricane on
September 10, 2017. Strong winds and
flooding from this hurricane impacted
communities throughout Florida,
resulting in power outages and damage
to homes, businesses, and
infrastructure. As a result, the RA has
determined that catastrophic conditions
exist in the following Florida counties:
Manatee, Sarasota, DeSoto, Charlotte,
Lee, Collier, Monroe, Miami-Dade, and
Broward. Through this temporary rule,
the RA is authorizing Federal dealers to
delay reporting of trip tickets to NOAA
Fisheries and IFQ participants within
this affected area to use paper-based
forms, from September 29, 2017,
through October 31, 2017. NMFS will
provide additional notification to
affected participants via NOAA Weather
Radio, Fishery Bulletins, and other
appropriate means. NOAA Fisheries
will continue to monitor and re-evaluate
the areas and duration of the
catastrophic conditions.
Dealers may delay electronic
reporting of trip tickets to NMFS during
catastrophic conditions. Dealers are to
report all landings to NMFS as soon as
possible. Assistance for Federal dealers
in effected areas is available from the
Fisheries Monitoring Branch at 1–305–
361–4581. NMFS previously provided
IFQ dealers with the necessary paper
forms (sequentially coded) and
instructions for submission in the event
of catastrophic conditions. Paper forms
are also available from the RA upon
request. The electronic systems for
submitting information to NMFS will
continue to be available to all
participants, and participants in the
affected area are encouraged to continue
using these systems, if accessible.
The administrative program functions
available to IFQ participants in the area
E:\FR\FM\04OCR1.SGM
04OCR1
]]>Agencies
[Federal Register Volume 82, Number 191 (Wednesday, October 4, 2017)]
[Rules and Regulations]
[Pages 46163-46170]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2017-21327]
-----------------------------------------------------------------------
DEPARTMENT OF HEALTH AND HUMAN SERVICES
Centers for Medicare & Medicaid Services
42 CFR Parts 409, 411, 413, 424, and 488
[CMS-1679-CN]
RIN 0938-AS96
Medicare Program; Prospective Payment System and Consolidated
Billing for Skilled Nursing Facilities for FY 2018, SNF Value-Based
Purchasing Program, SNF Quality Reporting Program, Survey Team
Composition, and Correction of the Performance Period for the NHSN HCP
Influenza Vaccination Immunization Reporting Measure in the ESRD QIP
for PY 2020; Correction
AGENCY: Centers for Medicare & Medicaid Services (CMS), HHS.
ACTION: Final rule; correction.
-----------------------------------------------------------------------
SUMMARY: This document corrects technical errors in the final rule that
appeared in the August 4, 2017 Federal Register, which will update the
payment rates used under the prospective payment system (PPS) for
skilled nursing facilities (SNFs) for fiscal year (FY) 2018.
DATES: This correction is effective October 1, 2017.
FOR FURTHER INFORMATION CONTACT: John Kane, (410) 786-0557.
SUPPLEMENTARY INFORMATION:
I. Background
In FR Doc. 2017-16256 (82 FR 36530), the final rule entitled
``Medicare Program; Prospective Payment System and Consolidated Billing
for Skilled Nursing Facilities for FY 2018, SNF Value-Based Purchasing
Program, SNF Quality Reporting Program, Survey Team Composition, and
Correction of the Performance Period for the NHSN HCP Influenza
Vaccination Immunization Reporting Measure in the ESRD QIP for PY
2020'', there were a number of technical errors that are identified and
corrected in section IV., Correction of Errors. The provisions in this
correcting document are effective as if they had been included in the
document that appeared in the August 4, 2017, Federal Register
(hereinafter referred to as the FY 2018 SNF PPS final rule).
Accordingly, the corrections are effective October 1, 2017.
II. Summary of Errors
A. Summary of Errors in the Preamble
As discussed in the FY 2018 SNF PPS final rule (82 FR 36539), in
developing the wage index to be applied to skilled nursing facilities
(SNFs) under the SNF prospective payment system (PPS), we use the
updated, pre-reclassified hospital inpatient prospective payment system
(IPPS) wage data, exclusive of the occupational mix adjustment. For FY
2018, the updated, unadjusted, pre-reclassified IPPS wage data used
under the SNF PPS are for hospital cost reporting periods beginning on
or after October 1, 2013, and before October 1, 2014 (FY 2014 cost
report data), as discussed in the FY 2018 IPPS final rule (82 FR
38130). In calculating the wage index under the FY 2018 IPPS final
rule, we made inadvertent errors related to the wage data collected
from the Medicare cost reports of six hospitals which are located in
CBSAs 24860 and 40340. Specifically, we used incorrect wage data for
these six hospitals to calculate the final FY 2018 IPPS wage indexes,
the geographic adjustment factor (GAF) (which is computed from the wage
index), as well as certain other IPPS factors and adjustments.
These errors are identified, discussed and corrected in the
Medicare Program; Hospital Inpatient Prospective Payment Systems for
Acute Care Hospitals and the Long Term Care Hospital Prospective
Payment System and Policy Changes and Fiscal Year 2018 Rates; Quality
Reporting Requirements for Specific Providers; Medicare and Medicaid
Electronic Health Record (EHR) Incentive Program Requirements for
Eligible Hospitals, Critical Access Hospitals, and Eligible
Professionals; Provider-Based Status of Indian Health Services and
Tribal Facilities and Organizations; Cost Reporting and Provider
Requirements; Agreement Termination Notices; Correction (CMS-1677-CN)
that appears elsewhere in this issue of the Federal Register.
As discussed above, we use the updated, pre-reclassified,
unadjusted IPPS wage data in developing the wage index used under the
SNF PPS. Due to the technical errors described above, the published FY
2018 SNF PPS wage indexes were incorrect. Thus, the use of the
corrected wage data for the six hospitals required the recalculation of
the final FY 2018 SNF PPS wage indexes. Additionally, as discussed on
page 36543 of the FY 2018 SNF PPS final rule, section 1888(e)(4)(G)(ii)
of the Act requires that we apply the wage index in a manner that does
not result in aggregate payments under the SNF PPS that are greater or
less than would otherwise be made if the wage index adjustment had not
been made. To achieve this, we apply a budget neutrality factor to the
unadjusted SNF PPS federal per diem base rates. Due to the
recalculation and subsequent revision of the final FY 2018 SNF PPS wage
indexes, it was necessary to recalculate the FY 2018 SNF PPS wage index
budget neutrality factor as well. Revising the wage index budget
neutrality factor causes a change in the unadjusted SNF PPS federal per
diem rates (provided in Tables 2 and 3 of the FY 2018 SNF PPS final
rule (82 FR 36535)), which then causes changes in the case-mix adjusted
SNF PPS rates (provided in Tables 4 and 5 in the FY 2018 SNF PPS final
rule (82 FR 36537 through 36538), as well as the labor adjusted SNF PPS
rates (provided in Tables 6 and 7 of the FY 2018 SNF PPS final rule (82
FR 36541 through 36543). Finally, due to the recalculated wage indexes,
we recalculated the impact analysis provided in Table 26 of the FY 2018
SNF PPS final rule (82 FR 36629). The corrections to these errors are
found in section IV. of this document.
B. Summary of Errors in and Corrections to Tables Posted on the CMS Web
Site
We are correcting the wage indexes in Tables A and B setting forth
the wage indexes for urban (Table A) and non-urban (Table B) areas
based on CBSA labor market areas, which are available exclusively on
the CMS Web site at https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/SNFPPS/WageIndex.html. These tables have been updated
to reflect the revisions discussed in this correcting document.
We are republishing the wage indexes in Tables A and B accordingly
on the CMS Web site at https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/SNFPPS/WageIndex.html.
III. Waiver of Proposed Rulemaking and Delayed Effective Date
We ordinarily publish a notice of proposed rulemaking in the
Federal Register to provide a period for public comment before the
provisions of a rule take effect in accordance with section 553(b) of
the Administrative Procedure Act (APA) (5 U.S.C. 553(b)). However,
[[Page 46164]]
we can waive this notice and comment procedure if the Secretary finds,
for good cause, that the notice and comment process is impracticable,
unnecessary, or contrary to the public interest, and incorporates a
statement of the finding and the reasons therefor in the notice.
Section 553(d) of the APA ordinarily requires a 30-day delay in
effective date of final rules after the date of their publication in
the Federal Register. This 30-day delay in effective date can be
waived, however, if an agency finds for good cause that the delay is
impracticable, unnecessary, or contrary to the public interest, and the
agency incorporates a statement of the findings and its reasons in the
rule issued.
We believe that this correcting document does not constitute a rule
that would be subject to the APA notice and comment or delayed
effective date requirements. The document corrects technical errors in
the FY 2018 SNF PPS final rule and in the tables referenced in the
final rule, but does not make substantive changes to the policies or
payment methodologies that were adopted in the final rule. As a result,
this correcting document is intended to ensure that the information in
the FY 2018 SNF PPS final rule accurately reflects the policies adopted
in that final rule.
In addition, even if this were a rule to which the notice and
comment procedures and delayed effective date requirements applied, we
find that there is good cause to waive such requirements. Undertaking
further notice and comment procedures to incorporate the corrections in
this document into the final rule or delaying the effective date would
be contrary to the public interest because it is in the public's
interest for providers to receive appropriate payments in as timely a
manner as possible, and to ensure that the FY 2018 SNF PPS final rule
and the tables referenced in the final rule accurately reflect our
methodologies, payment rates, and policies. Furthermore, such
procedures would be unnecessary, as we are not making substantive
changes to our payment methodologies or policies, but rather, we are
simply implementing correctly the methodologies and policies that we
previously proposed, requested comment on, and subsequently finalized.
This correcting document is intended solely to ensure that the FY 2018
SNF PPS final rule and the tables referenced in the final rule
accurately reflect these methodologies and policies. Therefore, we
believe we have good cause to waive the notice and comment and
effective date requirements.
Correction of Errors
In FR Doc. 2017-16256 of August 4, 2017 (82 FR 36530), make the
following corrections:
1. On page 36535, TABLE 2--FY 2018 UNADJUSTED FEDERAL RATE PER DIEM
URBAN is corrected to read as follows:
Table 2--FY 2018 Unadjusted Federal Rate Per Diem Urban
----------------------------------------------------------------------------------------------------------------
Nursing--case- Therapy--case- Therapy--non-
Rate component mix mix case-mix Non-case-mix
----------------------------------------------------------------------------------------------------------------
Per Diem Amount............................. $177.21 $133.48 $17.58 $90.44
----------------------------------------------------------------------------------------------------------------
2. On page 36535, TABLE 3--FY 2018 UNADJUSTED FEDERAL RATE PER DIEM
RURAL is corrected to read as follows:
Table 3--FY 2018 Unadjusted Federal Rate Per Diem Rural
----------------------------------------------------------------------------------------------------------------
Nursing--case- Therapy--case- Therapy--non-
Rate component mix mix case-mix Non-case-mix
----------------------------------------------------------------------------------------------------------------
Per Diem Amount............................. $169.29 $153.92 $18.78 $92.11
----------------------------------------------------------------------------------------------------------------
3. On page 36536, third column, first full paragraph,
a. Line 21, the figure ``$443.08'' is corrected to read
``$442.95''.
b. Line 26, the figure ``$1,010.22.'' is corrected to read
``$1,009.93.''.
4. On page 36537, TABLE 4--RUG-IV CASE-MIX ADJUSTED FEDERAL RATES
AND ASSOCIATED INDEXES--URBAN is corrected to read as follows:
Table 4--RUG-IV Case-Mix Adjusted Federal Rates and Associated Indexes--Urban
--------------------------------------------------------------------------------------------------------------------------------------------------------
Nursing Therapy Non-case mix Non-case mix
RUG-IV category Nursing index Therapy index component component therapy comp component Total rate
--------------------------------------------------------------------------------------------------------------------------------------------------------
RUX..................................... 2.67 1.87 $473.15 $249.61 .............. $90.44 $813.20
RUL..................................... 2.57 1.87 455.43 249.61 .............. 90.44 795.48
RVX..................................... 2.61 1.28 462.52 170.85 .............. 90.44 723.81
RVL..................................... 2.19 1.28 388.09 170.85 .............. 90.44 649.38
RHX..................................... 2.55 0.85 451.89 113.46 .............. 90.44 655.79
RHL..................................... 2.15 0.85 381.00 113.46 .............. 90.44 584.90
RMX..................................... 2.47 0.55 437.71 73.41 .............. 90.44 601.56
RML..................................... 2.19 0.55 388.09 73.41 .............. 90.44 551.94
RLX..................................... 2.26 0.28 400.49 37.37 .............. 90.44 528.30
RUC..................................... 1.56 1.87 276.45 249.61 .............. 90.44 616.50
RUB..................................... 1.56 1.87 276.45 249.61 .............. 90.44 616.50
RUA..................................... 0.99 1.87 175.44 249.61 .............. 90.44 515.49
RVC..................................... 1.51 1.28 267.59 170.85 .............. 90.44 528.88
RVB..................................... 1.11 1.28 196.70 170.85 .............. 90.44 457.99
RVA..................................... 1.10 1.28 194.93 170.85 .............. 90.44 456.22
[[Page 46165]]
RHC..................................... 1.45 0.85 256.95 113.46 .............. 90.44 460.85
RHB..................................... 1.19 0.85 210.88 113.46 .............. 90.44 414.78
RHA..................................... 0.91 0.85 161.26 113.46 .............. 90.44 365.16
RMC..................................... 1.36 0.55 241.01 73.41 .............. 90.44 404.86
RMB..................................... 1.22 0.55 216.20 73.41 .............. 90.44 380.05
RMA..................................... 0.84 0.55 148.86 73.41 .............. 90.44 312.71
RLB..................................... 1.50 0.28 265.82 37.37 .............. 90.44 393.63
RLA..................................... 0.71 0.28 125.82 37.37 .............. 90.44 253.63
ES3..................................... 3.58 .............. 634.41 .............. 17.58 90.44 742.43
ES2..................................... 2.67 .............. 473.15 .............. 17.58 90.44 581.17
ES1..................................... 2.32 .............. 411.13 .............. 17.58 90.44 519.15
HE2..................................... 2.22 .............. 393.41 .............. 17.58 90.44 501.43
HE1..................................... 1.74 .............. 308.35 .............. 17.58 90.44 416.37
HD2..................................... 2.04 .............. 361.51 .............. 17.58 90.44 469.53
HD1..................................... 1.60 .............. 283.54 .............. 17.58 90.44 391.56
HC2..................................... 1.89 .............. 334.93 .............. 17.58 90.44 442.95
HC1..................................... 1.48 .............. 262.27 .............. 17.58 90.44 370.29
HB2..................................... 1.86 .............. 329.61 .............. 17.58 90.44 437.63
HB1..................................... 1.46 .............. 258.73 .............. 17.58 90.44 366.75
LE2..................................... 1.96 .............. 347.33 .............. 17.58 90.44 455.35
LE1..................................... 1.54 .............. 272.90 .............. 17.58 90.44 380.92
LD2..................................... 1.86 .............. 329.61 .............. 17.58 90.44 437.63
LD1..................................... 1.46 .............. 258.73 .............. 17.58 90.44 366.75
LC2..................................... 1.56 .............. 276.45 .............. 17.58 90.44 384.47
LC1..................................... 1.22 .............. 216.20 .............. 17.58 90.44 324.22
LB2..................................... 1.45 .............. 256.95 .............. 17.58 90.44 364.97
LB1..................................... 1.14 .............. 202.02 .............. 17.58 90.44 310.04
CE2..................................... 1.68 .............. 297.71 .............. 17.58 90.44 405.73
CE1..................................... 1.50 .............. 265.82 .............. 17.58 90.44 373.84
CD2..................................... 1.56 .............. 276.45 .............. 17.58 90.44 384.47
CD1..................................... 1.38 .............. 244.55 .............. 17.58 90.44 352.57
CC2..................................... 1.29 .............. 228.60 .............. 17.58 90.44 336.62
CC1..................................... 1.15 .............. 203.79 .............. 17.58 90.44 311.81
CB2..................................... 1.15 .............. 203.79 .............. 17.58 90.44 311.81
CB1..................................... 1.02 .............. 180.75 .............. 17.58 90.44 288.77
CA2..................................... 0.88 .............. 155.94 .............. 17.58 90.44 263.96
CA1..................................... 0.78 .............. 138.22 .............. 17.58 90.44 246.24
BB2..................................... 0.97 .............. 171.89 .............. 17.58 90.44 279.91
BB1..................................... 0.90 .............. 159.49 .............. 17.58 90.44 267.51
BA2..................................... 0.70 .............. 124.05 .............. 17.58 90.44 232.07
BA1..................................... 0.64 .............. 113.41 .............. 17.58 90.44 221.43
PE2..................................... 1.50 .............. 265.82 .............. 17.58 90.44 373.84
PE1..................................... 1.40 .............. 248.09 .............. 17.58 90.44 356.11
PD2..................................... 1.38 .............. 244.55 .............. 17.58 90.44 352.57
PD1..................................... 1.28 .............. 226.83 .............. 17.58 90.44 334.85
PC2..................................... 1.10 .............. 194.93 .............. 17.58 90.44 302.95
PC1..................................... 1.02 .............. 180.75 .............. 17.58 90.44 288.77
PB2..................................... 0.84 .............. 148.86 .............. 17.58 90.44 256.88
PB1..................................... 0.78 .............. 138.22 .............. 17.58 90.44 246.24
PA2..................................... 0.59 .............. 104.55 .............. 17.58 90.44 212.57
PA1..................................... 0.54 .............. 95.69 .............. 17.58 90.44 203.71
--------------------------------------------------------------------------------------------------------------------------------------------------------
5. On page 36538, TABLE 5--RUG-IV CASE-MIX ADJUSTED FEDERAL RATES
AND ASSOCIATED INDEXES--RURAL is corrected to read as follows:
Table 5--RUG-IV Case-Mix Adjusted Federal Rates and Associated Indexes--Rural
--------------------------------------------------------------------------------------------------------------------------------------------------------
Nursing Therapy Non-case mix Non-case mix
RUG-IV Category Nursing index Therapy index component component therapy comp component Total rate
--------------------------------------------------------------------------------------------------------------------------------------------------------
RUX..................................... 2.67 1.87 $452.00 $287.83 .............. $92.11 $831.94
RUL..................................... 2.57 1.87 435.08 287.83 .............. 92.11 815.02
RVX..................................... 2.61 1.28 441.85 197.02 .............. 92.11 730.98
RVL..................................... 2.19 1.28 370.75 197.02 .............. 92.11 659.88
RHX..................................... 2.55 0.85 431.69 130.83 .............. 92.11 654.63
RHL..................................... 2.15 0.85 363.97 130.83 .............. 92.11 586.91
RMX..................................... 2.47 0.55 418.15 84.66 .............. 92.11 594.92
RML..................................... 2.19 0.55 370.75 84.66 .............. 92.11 547.52
RLX..................................... 2.26 0.28 382.60 43.10 .............. 92.11 517.81
[[Page 46166]]
RUC..................................... 1.56 1.87 264.09 287.83 .............. 92.11 644.03
RUB..................................... 1.56 1.87 264.09 287.83 .............. 92.11 644.03
RUA..................................... 0.99 1.87 167.60 287.83 .............. 92.11 547.54
RVC..................................... 1.51 1.28 255.63 197.02 .............. 92.11 544.76
RVB..................................... 1.11 1.28 187.91 197.02 .............. 92.11 477.04
RVA..................................... 1.10 1.28 186.22 197.02 .............. 92.11 475.35
RHC..................................... 1.45 0.85 245.47 130.83 .............. 92.11 468.41
RHB..................................... 1.19 0.85 201.46 130.83 .............. 92.11 424.40
RHA..................................... 0.91 0.85 154.05 130.83 .............. 92.11 376.99
RMC..................................... 1.36 0.55 230.23 84.66 .............. 92.11 407.00
RMB..................................... 1.22 0.55 206.53 84.66 .............. 92.11 383.30
RMA..................................... 0.84 0.55 142.20 84.66 .............. 92.11 318.97
RLB..................................... 1.50 0.28 253.94 43.10 .............. 92.11 389.15
RLA..................................... 0.71 0.28 120.20 43.10 .............. 92.11 255.41
ES3..................................... 3.58 .............. 606.06 .............. 18.78 92.11 716.95
ES2..................................... 2.67 .............. 452.00 .............. 18.78 92.11 562.89
ES1..................................... 2.32 .............. 392.75 .............. 18.78 92.11 503.64
HE2..................................... 2.22 .............. 375.82 .............. 18.78 92.11 486.71
HE1..................................... 1.74 .............. 294.56 .............. 18.78 92.11 405.45
HD2..................................... 2.04 .............. 345.35 .............. 18.78 92.11 456.24
HD1..................................... 1.60 .............. 270.86 .............. 18.78 92.11 381.75
HC2..................................... 1.89 .............. 319.96 .............. 18.78 92.11 430.85
HC1..................................... 1.48 .............. 250.55 .............. 18.78 92.11 361.44
HB2..................................... 1.86 .............. 314.88 .............. 18.78 92.11 425.77
HB1..................................... 1.46 .............. 247.16 .............. 18.78 92.11 358.05
LE2..................................... 1.96 .............. 331.81 .............. 18.78 92.11 442.70
LE1..................................... 1.54 .............. 260.71 .............. 18.78 92.11 371.60
LD2..................................... 1.86 .............. 314.88 .............. 18.78 92.11 425.77
LD1..................................... 1.46 .............. 247.16 .............. 18.78 92.11 358.05
LC2..................................... 1.56 .............. 264.09 .............. 18.78 92.11 374.98
LC1..................................... 1.22 .............. 206.53 .............. 18.78 92.11 317.42
LB2..................................... 1.45 .............. 245.47 .............. 18.78 92.11 356.36
LB1..................................... 1.14 .............. 192.99 .............. 18.78 92.11 303.88
CE2..................................... 1.68 .............. 284.41 .............. 18.78 92.11 395.30
CE1..................................... 1.50 .............. 253.94 .............. 18.78 92.11 364.83
CD2..................................... 1.56 .............. 264.09 .............. 18.78 92.11 374.98
CD1..................................... 1.38 .............. 233.62 .............. 18.78 92.11 344.51
CC2..................................... 1.29 .............. 218.38 .............. 18.78 92.11 329.27
CC1..................................... 1.15 .............. 194.68 .............. 18.78 92.11 305.57
CB2..................................... 1.15 .............. 194.68 .............. 18.78 92.11 305.57
CB1..................................... 1.02 .............. 172.68 .............. 18.78 92.11 283.57
CA2..................................... 0.88 .............. 148.98 .............. 18.78 92.11 259.87
CA1..................................... 0.78 .............. 132.05 .............. 18.78 92.11 242.94
BB2..................................... 0.97 .............. 164.21 .............. 18.78 92.11 275.10
BB1..................................... 0.90 .............. 152.36 .............. 18.78 92.11 263.25
BA2..................................... 0.70 .............. 118.50 .............. 18.78 92.11 229.39
BA1..................................... 0.64 .............. 108.35 .............. 18.78 92.11 219.24
PE2..................................... 1.50 .............. 253.94 .............. 18.78 92.11 364.83
PE1..................................... 1.40 .............. 237.01 .............. 18.78 92.11 347.90
PD2..................................... 1.38 .............. 233.62 .............. 18.78 92.11 344.51
PD1..................................... 1.28 .............. 216.69 .............. 18.78 92.11 327.58
PC2..................................... 1.10 .............. 186.22 .............. 18.78 92.11 297.11
PC1..................................... 1.02 .............. 172.68 .............. 18.78 92.11 283.57
PB2..................................... 0.84 .............. 142.20 .............. 18.78 92.11 253.09
PB1..................................... 0.78 .............. 132.05 .............. 18.78 92.11 242.94
PA2..................................... 0.59 .............. 99.88 .............. 18.78 92.11 210.77
PA1..................................... 0.54 .............. 91.42 .............. 18.78 92.11 202.31
--------------------------------------------------------------------------------------------------------------------------------------------------------
6. On pages 36541 through 36542, TABLE 6--RUG-IV CASE-MIX ADJUSTED
FEDERAL RATES FOR URBAN SNFS BY LABOR AND NON-LABOR COMPONENT is
corrected to read as follows:
Table 6--RUG-IV Case-Mix Adjusted Federal Rates for Urban SNFS by Labor and Non-Labor Component
----------------------------------------------------------------------------------------------------------------
Non-labor
RUG-IV category Total rate Labor portion portion
----------------------------------------------------------------------------------------------------------------
RUX............................................................. $813.20 $575.75 $237.45
RUL............................................................. 795.48 563.20 232.28
RVX............................................................. 723.81 512.46 211.35
[[Page 46167]]
RVL............................................................. 649.38 459.76 189.62
RHX............................................................. 655.79 464.30 191.49
RHL............................................................. 584.90 414.11 170.79
RMX............................................................. 601.56 425.90 175.66
RML............................................................. 551.94 390.77 161.17
RLX............................................................. 528.30 374.04 154.26
RUC............................................................. 616.50 436.48 180.02
RUB............................................................. 616.50 436.48 180.02
RUA............................................................. 515.49 364.97 150.52
RVC............................................................. 528.88 374.45 154.43
RVB............................................................. 457.99 324.26 133.73
RVA............................................................. 456.22 323.00 133.22
RHC............................................................. 460.85 326.28 134.57
RHB............................................................. 414.78 293.66 121.12
RHA............................................................. 365.16 258.53 106.63
RMC............................................................. 404.86 286.64 118.22
RMB............................................................. 380.05 269.08 110.97
RMA............................................................. 312.71 221.40 91.31
RLB............................................................. 393.63 278.69 114.94
RLA............................................................. 253.63 179.57 74.06
ES3............................................................. 742.43 525.64 216.79
ES2............................................................. 581.17 411.47 169.70
ES1............................................................. 519.15 367.56 151.59
HE2............................................................. 501.43 355.01 146.42
HE1............................................................. 416.37 294.79 121.58
HD2............................................................. 469.53 332.43 137.10
HD1............................................................. 391.56 277.22 114.34
HC2............................................................. 442.95 313.61 129.34
HC1............................................................. 370.29 262.17 108.12
HB2............................................................. 437.63 309.84 127.79
HB1............................................................. 366.75 259.66 107.09
LE2............................................................. 455.35 322.39 132.96
LE1............................................................. 380.92 269.69 111.23
LD2............................................................. 437.63 309.84 127.79
LD1............................................................. 366.75 259.66 107.09
LC2............................................................. 384.47 272.20 112.27
LC1............................................................. 324.22 229.55 94.67
LB2............................................................. 364.97 258.40 106.57
LB1............................................................. 310.04 219.51 90.53
CE2............................................................. 405.73 287.26 118.47
CE1............................................................. 373.84 264.68 109.16
CD2............................................................. 384.47 272.20 112.27
CD1............................................................. 352.57 249.62 102.95
CC2............................................................. 336.62 238.33 98.29
CC1............................................................. 311.81 220.76 91.05
CB2............................................................. 311.81 220.76 91.05
CB1............................................................. 288.77 204.45 84.32
CA2............................................................. 263.96 186.88 77.08
CA1............................................................. 246.24 174.34 71.90
BB2............................................................. 279.91 198.18 81.73
BB1............................................................. 267.51 189.40 78.11
BA2............................................................. 232.07 164.31 67.76
BA1............................................................. 221.43 156.77 64.66
PE2............................................................. 373.84 264.68 109.16
PE1............................................................. 356.11 252.13 103.98
PD2............................................................. 352.57 249.62 102.95
PD1............................................................. 334.85 237.07 97.78
PC2............................................................. 302.95 214.49 88.46
PC1............................................................. 288.77 204.45 84.32
PB2............................................................. 256.88 181.87 75.01
PB1............................................................. 246.24 174.34 71.90
PA2............................................................. 212.57 150.50 62.07
PA1............................................................. 203.71 144.23 59.48
----------------------------------------------------------------------------------------------------------------
7. On pages 36542 through 36543, TABLE 7-RUG-IV CASE-MIX ADJUSTED
FEDERAL RATES FOR RURAL SNFS BY LABOR AND NON-LABOR COMPONENT is
corrected to read as follows:
[[Page 46168]]
Table 7--RUG-IV Case-Mix Adjusted Federal Rates for Rural SNFS by Labor and Non-Labor Component
----------------------------------------------------------------------------------------------------------------
Non-labor
RUG-IV category Total rate Labor portion portion
----------------------------------------------------------------------------------------------------------------
RUX............................................................. $831.94 $589.01 $242.93
RUL............................................................. 815.02 577.03 237.99
RVX............................................................. 730.98 517.53 213.45
RVL............................................................. 659.88 467.20 192.68
RHX............................................................. 654.63 463.48 191.15
RHL............................................................. 586.91 415.53 171.38
RMX............................................................. 594.92 421.20 173.72
RML............................................................. 547.52 387.64 159.88
RLX............................................................. 517.81 366.61 151.20
RUC............................................................. 644.03 455.97 188.06
RUB............................................................. 644.03 455.97 188.06
RUA............................................................. 547.54 387.66 159.88
RVC............................................................. 544.76 385.69 159.07
RVB............................................................. 477.04 337.74 139.30
RVA............................................................. 475.35 336.55 138.80
RHC............................................................. 468.41 331.63 136.78
RHB............................................................. 424.40 300.48 123.92
RHA............................................................. 376.99 266.91 110.08
RMC............................................................. 407.00 288.16 118.84
RMB............................................................. 383.30 271.38 111.92
RMA............................................................. 318.97 225.83 93.14
RLB............................................................. 389.15 275.52 113.63
RLA............................................................. 255.41 180.83 74.58
ES3............................................................. 716.95 507.60 209.35
ES2............................................................. 562.89 398.53 164.36
ES1............................................................. 503.64 356.58 147.06
HE2............................................................. 486.71 344.59 142.12
HE1............................................................. 405.45 287.06 118.39
HD2............................................................. 456.24 323.02 133.22
HD1............................................................. 381.75 270.28 111.47
HC2............................................................. 430.85 305.04 125.81
HC1............................................................. 361.44 255.90 105.54
HB2............................................................. 425.77 301.45 124.32
HB1............................................................. 358.05 253.50 104.55
LE2............................................................. 442.70 313.43 129.27
LE1............................................................. 371.60 263.09 108.51
LD2............................................................. 425.77 301.45 124.32
LD1............................................................. 358.05 253.50 104.55
LC2............................................................. 374.98 265.49 109.49
LC1............................................................. 317.42 224.73 92.69
LB2............................................................. 356.36 252.30 104.06
LB1............................................................. 303.88 215.15 88.73
CE2............................................................. 395.30 279.87 115.43
CE1............................................................. 364.83 258.30 106.53
CD2............................................................. 374.98 265.49 109.49
CD1............................................................. 344.51 243.91 100.60
CC2............................................................. 329.27 233.12 96.15
CC1............................................................. 305.57 216.34 89.23
CB2............................................................. 305.57 216.34 89.23
CB1............................................................. 283.57 200.77 82.80
CA2............................................................. 259.87 183.99 75.88
CA1............................................................. 242.94 172.00 70.94
BB2............................................................. 275.10 194.77 80.33
BB1............................................................. 263.25 186.38 76.87
BA2............................................................. 229.39 162.41 66.98
BA1............................................................. 219.24 155.22 64.02
PE2............................................................. 364.83 258.30 106.53
PE1............................................................. 347.90 246.31 101.59
PD2............................................................. 344.51 243.91 100.60
PD1............................................................. 327.58 231.93 95.65
PC2............................................................. 297.11 210.35 86.76
PC1............................................................. 283.57 200.77 82.80
PB2............................................................. 253.09 179.19 73.90
PB1............................................................. 242.94 172.00 70.94
PA2............................................................. 210.77 149.23 61.54
PA1............................................................. 202.31 143.24 59.07
----------------------------------------------------------------------------------------------------------------
[[Page 46169]]
8. On page 36543, under Table 7,
a. Second column, first partial paragraph, line 15, the figure
``1.0013'' is corrected to read ``1.0010''.
b. Third column, first full paragraph, line 16, the figure
``$47,596.42'' is corrected to read ``$47,602.52''.
9. On page 36543, TABLE 8--ADJUSTED RATE COMPUTATION EXAMPLE SNF
XYZ: LOCATED IN FREDERICK, MD (URBAN CBSA 43524) WAGE INDEX: 0.9863
[See Wage Index in Table A] \1\ is corrected to read as follows:
Table 8--Adjusted Rate Computation Example SNF XYZ: Located in Frederick, MD (Urban CBSA 43524)
[WAGE INDEX: 0.9869 (See Wage Index in Table A)] \1\
--------------------------------------------------------------------------------------------------------------------------------------------------------
Adjusted Adjusted Percent Medicare
RUG-IV group Labor Wage index labor Non-labor rate adjustment days Payment
--------------------------------------------------------------------------------------------------------------------------------------------------------
RVX............................................. $512.46 0.9869 $505.75 $211.35 $717.10 $717.10 14 $10,039.40
ES2............................................. 411.47 0.9869 406.08 169.70 575.78 575.78 30 17,273.40
RHA............................................. 258.53 0.9869 255.14 106.63 361.77 361.77 16 5,788.32
CC2 *........................................... 238.33 0.9869 235.21 98.29 333.50 760.38 10 7,603.80
BA2............................................. 164.31 0.9869 162.16 67.76 229.92 229.92 30 6,897.60
-------------------------------------------------------------------------------------------------------
........... ........... ........... ........... ........... ........... 100 47,602.52
--------------------------------------------------------------------------------------------------------------------------------------------------------
* Reflects a 128 percent adjustment from section 511 of the MMA.
\1\ Available on the CMS Web site at https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/SNFPPS/WageIndex.html.
10. On pages 36629, TABLE 26--PROJECTED IMPACT TO THE SNF PPS FOR
FY 2018 is corrected to read as follows:
Table 26--Projected impact to the SNF PPS for FY 2018
----------------------------------------------------------------------------------------------------------------
Number of
facilities FY Update wage Total change
2018 data
----------------------------------------------------------------------------------------------------------------
Group
Total........................................................... 15,468 0.0% 1.0%
Urban........................................................... 11,008 0.1% 1.1%
Rural........................................................... 4,460 -0.6% 0.4%
Hospital-based urban............................................ 518 0.2% 1.2%
Freestanding urban.............................................. 10,490 0.1% 1.1%
Hospital-based rural............................................ 577 -0.7% 0.3%
Freestanding rural.............................................. 3,883 -0.6% 0.4%
Urban by region
New England..................................................... 791 0.2% 1.2%
Middle Atlantic................................................. 1,487 0.4% 1.4%
South Atlantic.................................................. 1,867 -0.2% 0.8%
East North Central.............................................. 2,121 0.0% 1.0%
East South Central.............................................. 551 -0.6% 0.4%
West North Central.............................................. 919 0.4% 1.4%
West South Central.............................................. 1,339 0.1% 1.1%
Mountain........................................................ 511 -0.2% 0.8%
Pacific......................................................... 1,417 0.5% 1.5%
Outlying........................................................ 5 -2.0% -1.0%
Rural by region
New England..................................................... 137 1.5% 2.5%
Middle Atlantic................................................. 215 -0.5% 0.5%
South Atlantic.................................................. 502 -0.7% 0.3%
East North Central.............................................. 937 -1.1% -0.1%
East South Central.............................................. 528 -0.9% 0.1%
West North Central.............................................. 1,076 -0.4% 0.6%
West South Central.............................................. 738 -0.6% 0.4%
Mountain........................................................ 228 -0.3% 0.7%
Pacific......................................................... 99 0.1% 1.1%
Ownership
Profit.......................................................... 1,045 -0.3% 0.7%
Non-profit...................................................... 10,822 0.0% 1.0%
Government...................................................... 3,601 0.0% 1.0%
----------------------------------------------------------------------------------------------------------------
Note: The Total column includes the 1.0 percent market basket increase required by section 1888(e)(5)(B)(iii) of
the Act. Additionally, we found no SNFs in rural outlying areas.
[[Page 46170]]
Dated: September 29, 2017.
Ann C. Agnew,
Executive Secretary to the Department, Department of Health and Human
Services.
[FR Doc. 2017-21327 Filed 9-29-17; 4:15 pm]
BILLING CODE 4120-01-P
