Medicare Program: Hospital Outpatient Prospective Payment and Ambulatory Surgical Center Payment Systems and Quality Reporting Programs; Correction, 61184-61190 [2017-27949]
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Federal Register / Vol. 82, No. 247 / Wednesday, December 27, 2017 / Rules and Regulations
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Centers for Medicare & Medicaid
Services
42 CFR Parts 414, 416, and 419
[CMS–1678–CN]
RIN 0938–AT03
Medicare Program: Hospital Outpatient
Prospective Payment and Ambulatory
Surgical Center Payment Systems and
Quality Reporting Programs;
Correction
Centers for Medicare &
Medicaid Services (CMS), HHS.
ACTION: Final rule; correction.
AGENCY:
This document corrects
technical errors that appeared in the
final rule with comment period
published in the Federal Register on
December 14, 2017 entitled ‘‘Hospital
Outpatient Prospective Payment and
Ambulatory Surgical Center Payment
Systems and Quality Reporting
Programs.’’
DATES: Effective Date: January 1, 2018.
FOR FURTHER INFORMATION CONTACT: Lela
Strong (410) 786–3213.
SUMMARY:
This action is subject to the CRA, and
EPA will submit a rule report to each
House of the Congress and to the
Comptroller General of the United
States. This action is not a ‘‘major rule’’
as defined by 5 U.S.C. 804(2).
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DEPARTMENT OF HEALTH AND
HUMAN SERVICES
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I. Background
In FR Doc. R1–2017–23932 of
December 14, 2017 (82 FR 59216), titled
‘‘Medicare Program: Hospital Outpatient
Prospective Payment and Ambulatory
Surgical Center Payment Systems and
Quality Reporting Programs’’
(hereinafter referred to as the CY 2018
OPPS/ASC final rule), there were a
number of technical errors that are
identified and corrected in the
Correction of Errors section below. The
provisions in this correction document
are effective as if they had been
included in the document published
December 14, 2017. Accordingly, the
corrections are effective January 1, 2018.
We note that the CY 2018 OPPS/ASC
final rule was originally published on
pages 52356 through 52637 in the issue
of Monday, November 13, 2017. In that
publication, a section of the document
was omitted due to a printing error.
Therefore, on December 14, 2017, the
CY 2018 OPPS/ASC final rule was
republished in its entirety. Accordingly,
any corrections made in this document
are made to the December 14, 2017
republished version.
II. Summary of Errors
A. Errors in the Preamble
1. Hospital Outpatient Prospective
Payment System (OPPS) Corrections
On page 59256, we are correcting the
OPPS weight scalar based on the
conforming policy correction to the
Ambulatory Payment Classification
(APC) assignment of Healthcare
Common Procedure Coding System
(HCPCS) code 93880 in APC 5522 (Level
2 Imaging without Contrast) to APC
5523 (Level 3 Imaging without
Contrast).
On page 59262, we are correcting
language related to hospital-specific
Cost-to-Charge Ratios (CCRs) and their
application on payments for passthrough devices.
On pages 59269 through 59271, we
use the payment rates available in
Addenda A and B to display calculation
of adjusted payment and copayment.
Due to the correction of OPPS payment
rates as a result of the corrected OPPS
weight scalar, we are also correcting the
payment and copayment numbers used
in the example.
On page 59277, due to the corrected
OPPS APC geometric mean cost as a
result of the conforming policy
correction to the imaging without
contrast APCs, we are correcting the list
of APCs excepted from the 2 times rule
for calendar year (CY) 2018.
Specifically, we are revising Table 14 to
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include APC 5523 (Level 3 Imaging
without Contrast) to this list, for a total
of 12 APCs.
On page 59295, we inadvertently
excluded a summary of a comment and
our response to that comment. We are
revising the discussion to include the
comment and response.
On page 59311, due to the correction
in OPPS APC geometric mean cost as a
result of the conforming policy
correction to the imaging without
contrast APCs in Addendum A and
Addendum B, we are also correcting the
CY 2018 APC geometric mean cost for
APC 5522 (Level 2 Imaging without
Contrast) and APC 5523 (Level 3
Imaging without Contrast) in Table 54 as
well as in the OPPS Addenda A and B.
On page 59323, we incorrectly listed
the HCPCS code that describes Lung
biopsy plug with delivery system as
C2623 instead of C2613.
On page 59369, we inadvertently
omitted vaccines assigned to OPPS
status indicator ‘‘F’’ from the 340B
payment adjustment exclusion.
Specifically, we stated in the preamble
that ‘‘We remind readers that our 340B
payment policy applies to only OPPS
separately payable drugs (status
indicator ‘‘K’’) and does not apply to
vaccines (status indicator ‘‘L’’ or ‘‘M’’),
or drugs with transitional pass-through
payment status (status indicator ‘‘G’’).’’
We are correcting this statement to read
‘‘We remind readers that our 340B
payment policy applies to only OPPS
separately payable drugs (status
indicator ‘‘K’’) and does not apply to
vaccines (status indicator ‘‘F’’, ‘‘L’’ or
‘‘M’’), or drugs with transitional passthrough payment status (status indicator
‘‘G’’).’’ In addition, we are also
correcting the statement on page 59369
that reads ‘‘Part B drugs or biologicals
excluded from the 340B payment
adjustment include vaccines (assigned
status indicator ‘‘L’’ or ‘‘M’’) and drugs
with OPPS transitional pass-through
payment status (assigned status
indicator ‘‘G’’)’’ to correctly state our
final policy that ‘‘Part B drugs or
biologicals excluded from the 340B
payment adjustment include vaccines
(assigned status indicator ‘‘F’’, ‘‘L’’ or
‘‘M’’) and drugs with OPPS transitional
pass-through payment status (assigned
status indicator ‘‘G’’).’’
On pages 59412 through 59413, we
are correcting a typographical error in
the title of Table 87.
On pages 59482 through 59483, we
are correcting the count of excepted
Rural Sole Community Hospitals as well
as the count of other providers that were
listed in regards to the 340B Program.
On pages 59486 through 59488, we
provided and described Table 88—
Estimated Impact of the CY 2018
Changes for the Hospital Outpatient
Prospective Payment System, based on
rates which applied an incorrect scalar.
We have updated Table 88 and the
description of the table to reflect the
corrections to the scalar as a result of
the corrections to geometric mean costs
in APCs 5522 and 5523.
2. Ambulatory Surgical Center (ASC)
Payment System Corrections
On page 59413, the discussion of ASC
Payment for Covered Ancillary Services
for CY 2018 was inadvertently omitted.
We are including that discussion in this
correcting document.
On page 59422, we inadvertently
published an incorrect ASC conversion
factor of $44.663 for ASCs that do not
meet the quality reporting requirements.
With the correct application of our
established policy, the corrected 2018
ASC conversion factor for ASCs that do
not meet the quality reporting
requirements is $44.674.
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HCPCS code
81105
81106
81107
81108
81109
81110
81111
81112
81120
81121
81175
81176
81448
81520
81521
81541
81551
...........
...........
...........
...........
...........
...........
...........
...........
...........
...........
...........
...........
...........
...........
...........
...........
...........
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61185
3. Partial Hospitalization Program
Corrections
On page 59375, the text states: ‘‘We
proposed to apply our established
methodologies in developing the CY
2018 geometric mean per diem costs
and payment rates, including the
application of a ±2 standard deviation
trim on costs per day for CMHCs and a
CCR≤5 hospital service day trim for
hospital-based PHP providers.’’ The less
than or equal to sign that appears in this
sentence is incorrect and misstates our
trim policy. Therefore, we are correcting
‘‘CCR≤5’’ to read ‘‘CCR>5.’’
B. Summary of Errors and Corrections to
the OPPS and ASC Addenda Posted on
the CMS Website
1. OPPS Addenda Posted on the CMS
Website
The payment and copayment rates in
Addendum A (Final OPPS APCs for CY
2018), Addendum B (Final OPPS
Payment by HCPCS Code for CY 2018),
Addendum C (Final HCPCS Codes
Payable Under the 2018 OPPS by APC),
and the payment rates in the 2018 OPPS
APC Offset File and the 2018 OPPS
HCPCS Device Offset File that were
published on the CMS website in
conjunction with the CY 2018 OPPS/
ASC final rule are corrected to reflect
the corrected assignment of HCPCS code
93880 to APC 5522 (Level 2 Imaging
without Contrast) and APC 5523 (Level
3 Imaging without Contrast).
In addition, in Addendum B, 17
HCPCS codes were incorrectly assigned
to OPPS status indicator ‘‘Q4’’ when
they should have been assigned to status
indicator ‘‘A.’’ We are correcting the
mistake by assigning status indicator
‘‘A’’ to these codes as shown in the
chart that follows.
Short descriptor
CI
SI
Hpa-1 genotyping ..........................................................................................................................
Hpa-2 genotyping ..........................................................................................................................
Hpa-3 genotyping ..........................................................................................................................
Hpa-4 genotyping ..........................................................................................................................
Hpa-5 genotyping ..........................................................................................................................
Hpa-6 genotyping ..........................................................................................................................
Hpa-9 genotyping ..........................................................................................................................
Hpa-15 genotyping ........................................................................................................................
Idh1 common variants ...................................................................................................................
Idh2 common variants ...................................................................................................................
Asxl1 full gene sequence ..............................................................................................................
Asxl1 gene target seq alys ............................................................................................................
Hrdtry perph neurphy panel ..........................................................................................................
Onc breast mrna 58 genes ...........................................................................................................
Onc breast mrna 70 genes ...........................................................................................................
Onc prostate mrna 46 genes ........................................................................................................
Onc prostate 3 genes ....................................................................................................................
NC
NC
NC
NC
NC
NC
NC
NC
NC
NC
NC
NC
NC
NC
NC
NC
NC
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
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In Addendum M, we inadvertently
excluded Current Procedural
Terminology (CPT) codes 71045
(Radiologic examination, chest; single
view) and 71046 (Radiologic
examination, chest; 2 views). The
revised Addendum M includes these
codes. CPT codes 71045 and 71046
replaced CPT codes 71010 (Radiologic
examination, chest; single view, frontal)
and 71020 (Radiologic examination,
chest, 2 views, frontal and lateral; with
apical lordotic procedure) effective
January 1, 2018. Since the predecessor
codes were assigned to composite APC
5041 (Critical Care) and APC 5045
(Trauma Response with Critical Care)
before January 1, 2018, the replacement
codes are assigned to the same
composite APCs effective January 1,
2018.
In Addendum P, we inadvertently
excluded the following 7 CPT codes:
• 0409T (Insertion or replacement of
permanent cardiac contractility
modulation system, including
contractility evaluation when
performed, and programming of sensing
and therapeutic parameters; pulse
generator only);
• 0410T (Insertion or replacement of
permanent cardiac contractility
modulation system, including
contractility evaluation when
performed, and programming of sensing
and therapeutic parameters; atrial
electrode only);
• 0411T (Insertion or replacement of
permanent cardiac contractility
modulation system, including
contractility evaluation when
performed, and programming of sensing
and therapeutic parameters; ventricular
electrode only);
• 0414T (Removal and replacement of
permanent cardiac contractility
modulation system pulse generator
only);
• 0446T (Creation of subcutaneous
pocket with insertion of implantable
interstitial glucose sensor, including
system activation and patient training);
• 0449T (Insertion of aqueous
drainage device, without extraocular
reservoir, internal approach, into the
subconjunctival space; initial device);
and
• 28291 (Hallux rigidus correction
with cheilectomy, debridement and
capsular release of the first
metatarsophalangeal joint; with
implant).
CPT codes 0409T, 0410T, 0411T,
0414T, 0446T, 0449T represent
procedures requiring the implantation
of medical devices that do not have yet
have associated claims data and
therefore have been granted deviceintensive status with a default device
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18:49 Dec 26, 2017
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offset percentage of 41 percent, per our
current policy outlined in the CY 2017
OPPS/ASC final rule with comment (81
FR 79658). CPT code 28291 replaced
CPT code 28293 (Correction, hallux
valgus (bunion), with or without
sesamoidectomy; resection of joint with
implant) which previously held the
device-intensive designation with a
device offset percentage of 43.78
percent. Since the predecessor code was
device-intensive, CPT code 28291 is
also device-intensive status and a device
offset percentage of 43.78 percent based
on the offset from the predecessor code.
To view the corrected CY 2018 OPPS
status indicator, payment and
copayment rates, that result from these
technical corrections as well as CPT
codes that were inadvertently excluded,
we refer readers to the Addenda and
supporting files that are posted on the
CMS website at: https://www.cms.gov/
Medicare/Medicare-Fee-for-ServicePayment/HospitalOutpatientPPS/
index.html. Select ‘‘CMS–1678–CN’’
from the list of regulations. All
corrected Addenda for this correcting
document are contained in the zipped
folder titled ‘‘2018 OPPS Final Rule
Addenda’’ at the bottom of the page for
CMS–1678–CN.
2. ASC Payment System Addenda
Posted on the CMS Website
As a result of the technical corrections
described in Section II.A. and II.B.1. of
this correction notice, we have updated
Addenda AA and BB to reflect the final
corrected payment rates and indicators
for CY 2018 for ASC covered surgical
procedures and covered ancillary
services. In addition, in addendum BB,
we inadvertently included HCPCS code
Q2040 (Tisagenlecleucel, up to 250
million car-positive viable t cells,
including leukapheresis and dose
preparation procedures, per infusion) as
a separately payable drug when
furnished in the ASC setting. Because
the complement of services required to
furnish the drug described by HCPCS
code Q2040 are not all covered ASC
surgical procedures, we are correcting
the error by removing HCPCS code
Q2040 from Addendum BB.
To view the corrected final CY 2018
ASC payment rates and indicators that
result from these technical corrections,
we refer readers to the Addenda and
supporting files on the CMS website at:
https://www.cms.gov/Medicare/
Medicare-Fee-for-Service-Payment/
ASCPayment/ASC-Regulations-andNotices.html. Select ‘‘CMS–1678–CN’’
from the list of regulations. All
corrected ASC addenda for this
correcting document are contained in
the zipped folder entitled ‘‘Addendum
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AA, BB, DD1, DD2, and EE’’ at the
bottom of the page for CMS–1678–CN.
In addition, we inadvertently
excluded the below nine codes from the
file labeled ‘‘CY 2018 ASC Procedures
to which the No Cost/Full Credit and
Partial Credit Device Adjustment Policy
Applies’’. These nine codes were
included as ASC device-intensive
procedures to which the no cost/full
credit and partial credit device
adjustment policy applies in the CY
2017 final rule, and we did not intend
any changes to them for CY 2018.
• 0409T (Insertion or replacement of
permanent cardiac contractility
modulation system, including
contractility evaluation when
performed, and programming of sensing
and therapeutic parameters; pulse
generator only);
• 0410T (Insertion or replacement of
permanent cardiac contractility
modulation system, including
contractility evaluation when
performed, and programming of sensing
and therapeutic parameters; atrial
electrode only);
• 0411T (Insertion or replacement of
permanent cardiac contractility
modulation system, including
contractility evaluation when
performed, and programming of sensing
and therapeutic parameters; ventricular
electrode only);
• 0414T (Removal and replacement of
permanent cardiac contractility
modulation system pulse generator
only);
• 0446T (Creation of subcutaneous
pocket with insertion of implantable
interstitial glucose sensor, including
system activation and patient training);
• 0449T (Insertion of aqueous
drainage device, without extraocular
reservoir, internal approach, into the
subconjunctival space; initial device);
• 22867 (Insertion of interlaminar/
interspinous process stabilization/
distraction device, without fusion,
including image guidance when
performed, with open decompression,
lumbar; single level);
• 22869 (Insertion of interlaminar/
interspinous process stabilization/
distraction device, without open
decompression or fusion, including
image guidance when performed,
lumbar; single level); and
• 28291 (Hallux rigidus correction
with cheilectomy, debridement and
capsular release of the first
metatarsophalangeal joint; with
implant).
To view the revised version of the
‘‘CY 2018 ASC Procedures to which the
No Cost/Full Credit and Partial Credit
Device Adjustment Policy Applies,’’ we
refer readers to the CMS website at:
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https://www.cms.gov/Medicare/
Medicare-Fee-for-Service-Payment/
ASCPayment/ASC-Policy-Files.html.
III. Waiver of Proposed Rulemaking
Under 5 U.S.C. 553(b) of the
Administrative Procedure Act (APA),
the agency is required to publish a
notice of the proposed rule in the
Federal Register before the provisions
of a rule take effect. Similarly, section
1871(b)(1) of the Act requires the
Secretary to provide for notice of the
proposed rule in the Federal Register
and provide a period of not less than 60
days for public comment. In addition,
section 553(d) of the APA, and section
1871(e)(1)(B)(i) mandate a 30-day delay
in effective date after issuance or
publication of a rule. Sections 553(b)(B)
and 553(d)(3) of the APA provide for
exceptions from the notice and
comment and delay in effective date of
the APA requirements; in cases in
which these exceptions apply, sections
1871(b)(2)(C) and 1871(e)(1)(B)(ii) of the
Act provide exceptions from the notice
and 60-day comment period and delay
in effective date requirements of the Act
as well. Section 553(b)(B) of the APA
and section 1871(b)(2)(C) of the Act
authorize an agency to dispense with
normal rulemaking requirements for
good cause if the agency makes a
finding that the notice and comment
process is impracticable, unnecessary,
or contrary to the public interest. In
addition, both section 553(d)(3) of the
APA and section 1871(e)(1)(B)(ii) of the
Act allow the agency to avoid the 30day delay in effective date where such
delay is contrary to the public interest
and an agency includes a statement of
support.
We believe that this correcting
document does not constitute a
rulemaking that would be subject to
these requirements. This correcting
document corrects technical and
typographic errors in the preamble,
addenda, payment rates, tables, and
appendices included or referenced in
the CY 2018 OPPS/ASC final rule but
does not make substantive changes to
the policies or payment methodologies
that were adopted in the final rule. As
a result, the corrections made through
this correcting document are intended
to ensure that the information in the CY
2018 OPPS/ASC final rule accurately
reflects the policies adopted in that rule.
In addition, even if this were a
rulemaking 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 CY 2018 OPPS/ASC final rule
accurately reflects our policies as of the
date they take effect and are applicable.
Furthermore, such procedures would
be unnecessary, as we are not altering
our payment methodologies or policies,
but rather, we are simply correctly
implementing the policies that we
previously proposed, received comment
on, and subsequently finalized. This
correcting document is intended solely
to ensure that the CY 2018 OPPS/ASC
final rule accurately reflects these
payment methodologies and policies.
For these reasons, we believe we have
good cause to waive the notice and
comment and effective date
requirements.
IV. Correction of Errors
In FR Doc. R1–2017–23932 of
December 14, 2017 (82 FR 59216), make
the following corrections:
61187
1. On page 59256, third column, first
paragraph, in line 11, correct ‘‘1.4457’’
to read ‘‘1.4458’’.
2. On page 59262, second column,
second full paragraph, in line 7, add the
parenthetical phrase ‘‘(in cases where
we are unable to use the implantable
device CCR)’’ after the words ‘‘passthrough devices’’.
3. On page 59269,
a. Third column, last full paragraph,
(1) In line 17, correct ‘‘$572.81’’ to
read ‘‘$575.85.’’
(2) In line 21, correct ‘‘$561.35’’ to
read ‘‘$561.39.’’
b. Third column, last partial
paragraph,
(1) In lines 5 and 6, correct ‘‘$442.53
(.60 * $572.81 * 1.2876).’’ to read
‘‘$442.56 (.60 * $575.85 * 1.2876).’’
(2) In line 9, correct ‘‘$443.68 (.60 *
$561.35 * 1.2876).’’ to read ‘‘$443.70
(.60 * $561.39 * 1.2876).’’
(3) In line 12, correct ‘‘$229.12 (.40 *
$572.81).’’ to read ‘‘$229.14 (.40 *
$575.85).’’
4. On page 59270, first column, first
partial paragraph,
a. In line 2, correct ‘‘$224.54 (.40 *
$561.35).’’ to read ‘‘$224.56 (.40 *
$561.39).’’
b. In lines 6 and 7, correct ‘‘$671.65
($442.53 + $229.12).’’ to read ‘‘$671.70
($442.56 + $229.14).’’
c. In lines 9 and 10, correct ‘‘$658.22
($433.68 + $224.54).’’ to read ‘‘$658.26
($443.70 + $224.56).’’
5. On page 59271, first column,
second full paragraph, under ‘‘Step 1,’’
in line 8, correct ‘‘$572.81’’ to read
‘‘$575.85.’’
6. On page 59277, Table 14—APC
Exceptions to the 2 Times Rule for CY
2018, is corrected to read as follows:
TABLE 14—APC EXCEPTIONS TO THE 2 TIMES RULE FOR CY 2018
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APC
5112
5521
5522
5523
5524
5571
5691
5721
5731
5732
5771
5823
CY 2018 APC title
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7. On page 59295, third column,
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Level 2
Level 1
Level 2
Level 3
Level 4
Level 1
Level 1
Level 1
Level 1
Level 2
Cardiac
Level 3
a. After the first partial paragraph, add
the following comment and response:
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Musculoskeletal Procedures
Imaging without Contrast
Imaging without Contrast
Imaging without Contrast
Imaging without Contrast
Imaging with Contrast
Drug Administration
Diagnostic Tests and Related Services
Minor Procedures
Minor Procedures
Rehabilitation
Health and Behavior Services
Comment: We received a comment to
the CY 2018 OPPS/ASC proposed rule
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requesting the reassignment of the
procedures assigned to APCs 5361
(Level 1 Laparoscopy and Related
Services) and 5362 (Level 2
Laparoscopy and Related Services) to
ensure a more logical distribution of
procedure costs between these two
APCs.
Response: We appreciate the
suggestion and will consider for future
rulemaking. We note that in the CY
2018 OPPS/ASC proposed rule, there
was no violation of the 2 times rule for
either APC 5361 or APC 5362.
b. First full paragraph, in line 2,
correct ‘‘comment’’ to read ‘‘comments’’.
8. On page 59311, Table 54—
Comparison of CY 2017 and CY 2018
Geometric Mean Costs For The Imaging
APCs, is corrected to read as follows:
TABLE 54–COMPARISON OF CY 2017 AND CY 2018 GEOMETRIC MEAN COSTS FOR THE IMAGING APCS
APC
5521
5522
5523
5524
5571
5572
5573
.............
.............
.............
.............
.............
.............
.............
CY 2017 APC
geometric
mean cost
APC group title
Level
Level
Level
Level
Level
Level
Level
1
2
3
4
1
2
3
Imaging
Imaging
Imaging
Imaging
Imaging
Imaging
Imaging
without Contrast ...............................................................................................
without Contrast ...............................................................................................
without Contrast ...............................................................................................
without Contrast ...............................................................................................
with Contrast ....................................................................................................
with Contrast ....................................................................................................
with Contrast ....................................................................................................
9. On page 59323, second column,
second full paragraph, in line 4, correct
‘‘C2623’’ to read ‘‘C2613’’.
10. On page 59369,
a. Second column, second full
paragraph, in line 5, correct ‘‘status
indicator ‘‘L’’ or ‘‘M’’’’ to read ‘‘status
indicator ‘‘F’’, ‘‘L’’, or ‘‘M’’’’.
b. Third column, first full paragraph,
in line 19, correct ‘‘status indicator ‘‘L’’
or ‘‘M’’’’ to read ‘‘status indicator ‘‘F’’,
‘‘L’’, or ‘‘M’’’’.
11. On page 59375, second column,
third full paragraph, in line 7, correct
‘‘CCR ≤5’’ to read ‘‘CCR≤5’’.
12. On pages 59412 and 59413, in the
title for Table 87, correct ‘‘ASDC’’ to
read ‘‘ASC’’.
13. On page 59413, second column,
after the second full paragraph, add the
following paragraphs before the section
titled, ‘‘D. ASC Payment for Covered
Surgical Procedures and Covered
Ancillary Services’’:
‘‘2. Covered Ancillary Services
Consistent with the established ASC
payment system policy, in the CY 2018
OPPS/ASC proposed rule (82 FR 33662)
we proposed to update the ASC list of
covered ancillary services to reflect the
payment status for the services under
the CY 2018 OPPS. We noted that
maintaining consistency with the OPPS
may result in proposed changes to ASC
payment indicators for some covered
ancillary services because of changes
that are being finalized under the OPPS
for CY 2018. For example, a covered
ancillary service that was separately
paid under the ASC payment system in
CY 2017 may be proposed for packaged
status under the CY 2018 OPPS and,
therefore, also under the ASC payment
system for CY 2018.
To maintain consistency with the
OPPS, we proposed to continue this
reconciliation of packaged status for the
ASC payment system for CY 2018.
Comment indicator ‘‘CH,’’ discussed in
section XII.F. of the proposed rule, was
used in Addendum BB to the proposed
rule (which is available via the internet
on the CMS website) to indicate covered
ancillary services for which we
proposed a change in the ASC payment
indicator to reflect a proposed change in
the OPPS treatment of the service for CY
2018.
We included all ASC covered
ancillary services and their proposed
payment indicators for CY 2018 in
Addendum BB to the proposed rule. We
invited public comments on this
proposal.
CY 2018 APC
geometric
mean cost
$61.53
115.88
232.21
462.23
272.40
438.42
675.23
$62.08
114.39
232.17
486.38
252.58
456.08
681.45
We did not receive any public
comments on these proposals.
Therefore, we are finalizing, without
modification, our proposal to update the
ASC list of covered ancillary services to
reflect the payment status for the
services under the OPPS. All CY 2018
ASC covered ancillary services and their
final payment indicators are included in
Addendum BB to this final rule (which
is available via the internet on the CMS
website).’’
14. On page 59422, first column, first
partial paragraph, in line 1, correct
‘‘44.663’’ to read ‘‘44.674’’.
15. On page 59482, third column,
second partial paragraph, in line 43,
correct ‘‘270’’ to read ‘‘247’’.
16. On page 59483, first column, third
partial paragraph, in line 29, correct
‘‘$199’’ to read ‘‘$169’’.
17. On page 59486,
a. First column, first full paragraph, in
line 16, correct ‘‘0.5’’ to read ‘‘0.6’’.
b. Third column, first full paragraph,
in line 6, correct ‘‘1.2’’ to read ‘‘1.3’’.
18. On page 59487 through 59488,
Table 88—Estimated Impact of the CY
2018 Changes for the Hospital
Outpatient Prospective Payment
System, is corrected to read as follows:
daltland on DSKBBV9HB2PROD with RULES
TABLE 88—ESTIMATED IMPACT OF THE CY 2018 CHANGES FOR THE HOSPITAL OUTPATIENT PROSPECTIVE PAYMENT
SYSTEM
APC
recalibration
(all changes)
(1)
(2)
(3)
ALL PROVIDERS * ..................................
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3,878
PO 00000
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0.0
Fmt 4700
Sfmt 4700
340B
adjustment
All budget
neutral
changes
(combined
cols 2–4)
with market
basket update
All changes
(4)
Number of
hospitals
New wage
index and
provider
adjustments
(5)
(6)
0.0
E:\FR\FM\27DER1.SGM
0.0
27DER1
1.3
1.4
Federal Register / Vol. 82, No. 247 / Wednesday, December 27, 2017 / Rules and Regulations
61189
TABLE 88—ESTIMATED IMPACT OF THE CY 2018 CHANGES FOR THE HOSPITAL OUTPATIENT PROSPECTIVE PAYMENT
SYSTEM—Continued
(1)
daltland on DSKBBV9HB2PROD with RULES
APC
recalibration
(all changes)
(2)
(3)
ALL HOSPITALS (excludes hospitals
held harmless and CMHCs) .................
URBAN HOSPITALS ...............................
LARGE URBAN (GT 1 MILL.) ..........
OTHER URBAN (LE 1 MILL.) ..........
RURAL HOSPITALS ................................
SOLE COMMUNITY .........................
OTHER RURAL ................................
BEDS (URBAN):
0–99 BEDS .......................................
100–199 BEDS .................................
200–299 BEDS .................................
300–499 BEDS .................................
500 + BEDS ......................................
BEDS (RURAL):
0–49 BEDS .......................................
50–100 BEDS ...................................
101–149 BEDS .................................
150–199 BEDS .................................
200 + BEDS ......................................
REGION (URBAN):
NEW ENGLAND ...............................
MIDDLE ATLANTIC ..........................
SOUTH ATLANTIC ...........................
EAST NORTH CENT ........................
EAST SOUTH CENT ........................
WEST NORTH CENT .......................
WEST SOUTH CENT .......................
MOUNTAIN .......................................
PACIFIC ............................................
PUERTO RICO .................................
REGION (RURAL):
NEW ENGLAND ...............................
MIDDLE ATLANTIC ..........................
SOUTH ATLANTIC ...........................
EAST NORTH CENT ........................
EAST SOUTH CENT ........................
WEST NORTH CENT .......................
WEST SOUTH CENT .......................
MOUNTAIN .......................................
PACIFIC ............................................
TEACHING STATUS:
NON-TEACHING ..............................
MINOR ..............................................
MAJOR .............................................
DSH PATIENT PERCENT:
0 ........................................................
GT 0–0.10 .........................................
0.10–0.16 ..........................................
0.16–0.23 ..........................................
0.23–0.35 ..........................................
GE 0.35 .............................................
DSH NOT AVAILABLE ** ..................
URBAN TEACHING/DSH:
TEACHING & DSH ...........................
NO TEACHING/DSH ........................
NO TEACHING/NO DSH ..................
DSH NOT AVAILABLE2 ...................
TYPE OF OWNERSHIP:
VOLUNTARY ....................................
PROPRIETARY ................................
GOVERNMENT ................................
VerDate Sep<11>2014
18:49 Dec 26, 2017
Jkt 244001
340B
adjustment
All budget
neutral
changes
(combined
cols 2–4)
with market
basket update
All changes
(4)
Number of
hospitals
New wage
index and
provider
adjustments
(5)
(6)
3,765
2,951
1,589
1,362
814
372
442
0.1
0.1
0.0
0.2
0.0
0.1
¥0.2
¥0.1
¥0.3
¥0.2
¥0.3
1.4
2.6
0.0
1.4
1.3
1.2
1.3
2.5
3.9
0.8
1.5
1.3
1.3
1.4
2.7
4.0
0.9
1,021
850
468
399
213
0.0
0.0
0.1
0.1
0.0
0.0
0.2
0.1
0.0
0.1
1.9
1.2
0.5
¥0.4
¥2.2
3.3
2.8
2.0
1.1
¥0.7
3.4
2.9
2.1
1.2
¥0.6
333
297
97
49
38
¥0.6
¥0.2
¥0.3
¥0.2
¥0.3
¥0.2
¥0.2
0.1
0.1
0.4
2.1
1.9
1.1
0.7
0.8
2.7
2.8
2.3
2.0
2.4
2.9
3.0
2.4
2.1
2.5
144
348
463
471
178
191
513
211
383
49
0.2
0.1
0.0
0.0
¥0.1
0.1
0.0
0.3
0.1
¥0.4
0.4
¥0.2
0.3
0.1
¥0.1
0.5
0.3
¥0.9
0.0
0.2
¥0.2
¥0.1
¥0.4
¥0.2
¥1.6
¥0.6
0.9
¥0.2
¥0.6
2.9
1.7
1.2
1.3
1.3
¥0.4
1.4
2.5
0.5
0.8
4.1
1.8
1.3
1.4
1.4
¥0.3
1.5
2.6
0.7
0.9
4.2
21
53
124
122
155
98
161
56
24
0.1
¥0.1
¥0.4
¥0.2
¥0.6
¥0.1
¥0.7
0.0
¥0.2
1.5
¥0.5
¥0.6
0.0
¥0.1
0.2
0.3
¥0.3
0.1
1.2
1.8
0.7
1.5
0.0
2.4
2.6
1.9
1.7
4.2
2.5
1.1
2.7
0.7
3.9
3.6
2.9
3.0
4.2
2.7
1.2
2.8
0.8
4.1
3.7
3.3
3.0
2,655
761
349
¥0.1
0.1
0.1
0.1
0.1
0.0
1.3
0.1
¥2.4
2.8
1.6
¥1.0
2.9
1.7
¥0.9
10
272
263
572
1132
935
581
0.0
0.2
0.2
0.1
0.0
0.0
¥2.0
0.2
¥0.1
0.0
0.3
0.1
0.0
0.1
3.2
2.8
2.7
2.6
¥0.4
¥2.2
2.0
4.8
4.4
4.3
4.4
1.0
¥0.9
1.4
4.9
4.5
4.4
4.5
1.2
¥0.8
1.6
1,002
1,386
10
553
0.1
0.1
0.0
¥1.9
0.0
0.2
0.2
0.1
¥1.1
1.3
3.2
1.9
0.3
2.9
4.8
1.4
0.4
3.0
4.9
1.6
1,979
1,293
493
PO 00000
0.0
0.1
0.1
0.0
¥0.3
¥0.2
¥0.4
0.0
0.1
¥0.1
0.0
0.1
0.2
¥0.3
2.7
¥1.6
1.2
4.3
¥0.1
1.3
4.5
0.0
Frm 00061
Fmt 4700
Sfmt 4700
E:\FR\FM\27DER1.SGM
27DER1
61190
Federal Register / Vol. 82, No. 247 / Wednesday, December 27, 2017 / Rules and Regulations
TABLE 88—ESTIMATED IMPACT OF THE CY 2018 CHANGES FOR THE HOSPITAL OUTPATIENT PROSPECTIVE PAYMENT
SYSTEM—Continued
APC
recalibration
(all changes)
(1)
(2)
(3)
CMHCs .....................................................
49
12.5
340B
adjustment
All budget
neutral
changes
(combined
cols 2–4)
with market
basket update
All changes
(4)
Number of
hospitals
New wage
index and
provider
adjustments
(5)
(6)
0.2
3.2
17.8
17.9
Column (1) shows total hospitals and/or CMHCs.
Column (2) includes all final CY 2018 OPPS policies and compares those to the CY 2017 OPPS.
Column (3) shows the budget neutral impact of updating the wage index by applying the FY 2018 hospital inpatient wage index, including all
hold harmless policies and transitional wages. The rural adjustment continues our current policy of 7.1 percent so the budget neutrality factor is
1. The budget neutrality adjustment for the cancer hospital adjustment is 1.0008 because the target payment-to-cost ratio changes from 0.91 in
CY 2017 to 0.89 in CY 2018 and is further reduced by 1 percentage point to 0.88 in accordance with the 21st Century Cures Act. However, this
reduction does not affect the budget neutrality adjustment consistent with statute.
Column (4) shows the impact of the 340B drug payment reductions and the corresponding increase in non-drug payments.
Column (5) shows the impact of all budget neutrality adjustments and the addition of the 1.35 percent OPD fee schedule update factor (2.7
percent reduced by 0.6 percentage points for the productivity adjustment and further reduced by 0.75 percentage point as required by law).
Column (6) shows the additional adjustments to the conversion factor resulting from the frontier adjustment, a change in the pass-through estimate, and adding estimated outlier payments.
These 3,878 providers include children and cancer hospitals, which are held harmless to pre-BBA amounts, and CMHCs.
** Complete DSH numbers are not available for providers that are not paid under IPPS, including rehabilitation, psychiatric, and long-term care
hospitals.
19. On page 59488, bottom third of
the page,
a. Second column, first partial
paragraph, in line 6, correct ‘‘17.2’’ to
read ‘‘17.9’’.
b. Third column, first partial
paragraph, in line 10, correct ‘‘17.2’’ to
read ‘‘17.9’’.
Dated: December 20, 2017.
Ann C. Agnew,
Executive Secretary to the Department,
Department of Health and Human Services.
[FR Doc. 2017–27949 Filed 12–22–17; 4:15 pm]
BILLING CODE 4120–01–P
DEPARTMENT OF COMMERCE
National Oceanic and Atmospheric
Administration
50 CFR Part 679
[Docket No. 161020985–7181–02]
RIN 0648–XF908
Fisheries of the Exclusive Economic
Zone Off Alaska; Reallocation of
Pacific Cod in the Bering Sea and
Aleutian Islands Management Area
National Marine Fisheries
Service (NMFS), National Oceanic and
Atmospheric Administration (NOAA),
Commerce.
ACTION: Temporary rule; reallocation.
daltland on DSKBBV9HB2PROD with RULES
AGENCY:
NMFS is reallocating the
projected unused amount of Pacific cod
from catcher vessels equal to or greater
than 60 feet (18.3 meters) length overall
(LOA) using pot gear to catcher/
SUMMARY:
VerDate Sep<11>2014
18:49 Dec 26, 2017
Jkt 244001
processors (C/Ps) using pot gear, catcher
vessels less than 60 feet (18.3 meters)
LOA using hook-and-line or pot gear,
and C/Ps using hook-and-line gear in
the Bering Sea and Aleutian Islands
management area. This action is
necessary to allow the 2017 total
allowable catch of Pacific cod to be
harvested.
DATES: Effective December 21, 2017,
through 2400 hours, Alaska local time
(A.l.t.), December 31, 2017.
FOR FURTHER INFORMATION CONTACT: Josh
Keaton, 907–586–7228.
SUPPLEMENTARY INFORMATION: NMFS
manages the groundfish fishery in the
Bering Sea and Aleutian Islands (BSAI)
according to the Fishery Management
Plan for Groundfish of the Bering Sea
and Aleutian Islands Management Area
(FMP) prepared by the North Pacific
Fishery Management Council under
authority of the Magnuson-Stevens
Fishery Conservation and Management
Act. Regulations governing fishing by
U.S. vessels in accordance with the FMP
appear at subpart H of 50 CFR part 600
and 50 CFR part 679.
The 2017 Pacific cod total allowable
catch (TAC) specified for catcher vessels
greater than or equal to 60 feet LOA
using pot gear in the BSAI is 15,389
metric tons (mt) as established by the
final 2017 and 2018 harvest
specifications for groundfish in the
BSAI (82 FR 11826, February 27, 2017)
and reallocation (82 FR 47162, October
11, 2017).
The Administrator, Alaska Region,
NMFS, (Regional Administrator) has
determined that catcher vessels greater
PO 00000
Frm 00062
Fmt 4700
Sfmt 4700
than or equal to 60 feet LOA using pot
gear will not be able to harvest 1,500 mt
of the remaining 2017 Pacific cod TAC
allocated to those vessels under
§ 679.20(a)(7)(ii)(A)(5). Therefore, in
accordance with § 679.20(a)(7)(iii),
taking into account the capabilities of
the sectors to harvest reallocated
amounts of Pacific cod, and following
the hierarchies set forth in
§ 679.20(a)(7)(iii)(A) and
§ 679.20(a)(7)(iii)(B), NMFS reallocates
155 mt of Pacific cod to C/Ps using pot
gear, 200 mt to catcher vessels less than
60 feet (18.3 m) LOA using hook-andline or pot gear, and 1,145 mt to C/Ps
using hook-and-line gear.
The harvest specifications for Pacific
cod included in the final 2017 harvest
specifications for groundfish in the
BSAI (82 FR 11826, February 27, 2017)
and reallocations (FR 57162, December
4, 2017; 82 FR 43503, September 18,
2017; 82 FR 41899, September 5, 2017;
and 82 FR 8905, February 1, 2017; 82)
are revised as follows: 13,889 mt for
catcher vessels greater than or equal to
60 feet (18.3 m) LOA using pot gear,
4,999 mt for C/Ps using pot gear, 9,271
mt for catcher vessels less than 60 feet
(18.3 m) LOA using hook-and-line or
pot gear, and 107,589 mt for C/Ps using
hook-and-line gear.
Classification
This action responds to the best
available information recently obtained
from the fishery. The Assistant
Administrator for Fisheries, NOAA
(AA), finds good cause to waive the
requirement to provide prior notice and
E:\FR\FM\27DER1.SGM
27DER1
]]>Agencies
[Federal Register Volume 82, Number 247 (Wednesday, December 27, 2017)]
[Rules and Regulations]
[Pages 61184-61190]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2017-27949]
=======================================================================
-----------------------------------------------------------------------
DEPARTMENT OF HEALTH AND HUMAN SERVICES
Centers for Medicare & Medicaid Services
42 CFR Parts 414, 416, and 419
[CMS-1678-CN]
RIN 0938-AT03
Medicare Program: Hospital Outpatient Prospective Payment and
Ambulatory Surgical Center Payment Systems and Quality Reporting
Programs; Correction
AGENCY: Centers for Medicare & Medicaid Services (CMS), HHS.
ACTION: Final rule; correction.
-----------------------------------------------------------------------
SUMMARY: This document corrects technical errors that appeared in the
final rule with comment period published in the Federal Register on
December 14, 2017 entitled ``Hospital Outpatient Prospective Payment
and Ambulatory Surgical Center Payment Systems and Quality Reporting
Programs.''
DATES: Effective Date: January 1, 2018.
FOR FURTHER INFORMATION CONTACT: Lela Strong (410) 786-3213.
SUPPLEMENTARY INFORMATION:
I. Background
In FR Doc. R1-2017-23932 of December 14, 2017 (82 FR 59216), titled
``Medicare Program: Hospital Outpatient Prospective Payment and
Ambulatory Surgical Center Payment Systems and Quality Reporting
Programs'' (hereinafter referred to as the CY 2018 OPPS/ASC final
rule), there were a number of technical errors that are identified and
corrected in the Correction of Errors section below. The provisions in
this correction document are effective as if they had been included in
the document published December 14, 2017. Accordingly, the corrections
are effective January 1, 2018.
We note that the CY 2018 OPPS/ASC final rule was originally
published on pages 52356 through 52637 in the issue of Monday, November
13, 2017. In that publication, a section of the document was omitted
due to a printing error. Therefore, on December 14, 2017, the CY 2018
OPPS/ASC final rule was republished in its entirety. Accordingly, any
corrections made in this document are made to the December 14, 2017
republished version.
II. Summary of Errors
A. Errors in the Preamble
1. Hospital Outpatient Prospective Payment System (OPPS) Corrections
On page 59256, we are correcting the OPPS weight scalar based on
the conforming policy correction to the Ambulatory Payment
Classification (APC) assignment of Healthcare Common Procedure Coding
System (HCPCS) code 93880 in APC 5522 (Level 2 Imaging without
Contrast) to APC 5523 (Level 3 Imaging without Contrast).
On page 59262, we are correcting language related to hospital-
specific Cost-to-Charge Ratios (CCRs) and their application on payments
for pass-through devices.
On pages 59269 through 59271, we use the payment rates available in
Addenda A and B to display calculation of adjusted payment and
copayment. Due to the correction of OPPS payment rates as a result of
the corrected OPPS weight scalar, we are also correcting the payment
and copayment numbers used in the example.
On page 59277, due to the corrected OPPS APC geometric mean cost as
a result of the conforming policy correction to the imaging without
contrast APCs, we are correcting the list of APCs excepted from the 2
times rule for calendar year (CY) 2018. Specifically, we are revising
Table 14 to
[[Page 61185]]
include APC 5523 (Level 3 Imaging without Contrast) to this list, for a
total of 12 APCs.
On page 59295, we inadvertently excluded a summary of a comment and
our response to that comment. We are revising the discussion to include
the comment and response.
On page 59311, due to the correction in OPPS APC geometric mean
cost as a result of the conforming policy correction to the imaging
without contrast APCs in Addendum A and Addendum B, we are also
correcting the CY 2018 APC geometric mean cost for APC 5522 (Level 2
Imaging without Contrast) and APC 5523 (Level 3 Imaging without
Contrast) in Table 54 as well as in the OPPS Addenda A and B.
On page 59323, we incorrectly listed the HCPCS code that describes
Lung biopsy plug with delivery system as C2623 instead of C2613.
On page 59369, we inadvertently omitted vaccines assigned to OPPS
status indicator ``F'' from the 340B payment adjustment exclusion.
Specifically, we stated in the preamble that ``We remind readers that
our 340B payment policy applies to only OPPS separately payable drugs
(status indicator ``K'') and does not apply to vaccines (status
indicator ``L'' or ``M''), or drugs with transitional pass-through
payment status (status indicator ``G'').'' We are correcting this
statement to read ``We remind readers that our 340B payment policy
applies to only OPPS separately payable drugs (status indicator ``K'')
and does not apply to vaccines (status indicator ``F'', ``L'' or
``M''), or drugs with transitional pass-through payment status (status
indicator ``G'').'' In addition, we are also correcting the statement
on page 59369 that reads ``Part B drugs or biologicals excluded from
the 340B payment adjustment include vaccines (assigned status indicator
``L'' or ``M'') and drugs with OPPS transitional pass-through payment
status (assigned status indicator ``G'')'' to correctly state our final
policy that ``Part B drugs or biologicals excluded from the 340B
payment adjustment include vaccines (assigned status indicator ``F'',
``L'' or ``M'') and drugs with OPPS transitional pass-through payment
status (assigned status indicator ``G'').''
On pages 59412 through 59413, we are correcting a typographical
error in the title of Table 87.
On pages 59482 through 59483, we are correcting the count of
excepted Rural Sole Community Hospitals as well as the count of other
providers that were listed in regards to the 340B Program.
On pages 59486 through 59488, we provided and described Table 88--
Estimated Impact of the CY 2018 Changes for the Hospital Outpatient
Prospective Payment System, based on rates which applied an incorrect
scalar. We have updated Table 88 and the description of the table to
reflect the corrections to the scalar as a result of the corrections to
geometric mean costs in APCs 5522 and 5523.
2. Ambulatory Surgical Center (ASC) Payment System Corrections
On page 59413, the discussion of ASC Payment for Covered Ancillary
Services for CY 2018 was inadvertently omitted. We are including that
discussion in this correcting document.
On page 59422, we inadvertently published an incorrect ASC
conversion factor of $44.663 for ASCs that do not meet the quality
reporting requirements. With the correct application of our established
policy, the corrected 2018 ASC conversion factor for ASCs that do not
meet the quality reporting requirements is $44.674.
3. Partial Hospitalization Program Corrections
On page 59375, the text states: ``We proposed to apply our
established methodologies in developing the CY 2018 geometric mean per
diem costs and payment rates, including the application of a 2 standard deviation trim on costs per day for CMHCs and a CCR<=5
hospital service day trim for hospital-based PHP providers.'' The less
than or equal to sign that appears in this sentence is incorrect and
misstates our trim policy. Therefore, we are correcting ``CCR<=5'' to
read ``CCR>5.''
B. Summary of Errors and Corrections to the OPPS and ASC Addenda Posted
on the CMS Website
1. OPPS Addenda Posted on the CMS Website
The payment and copayment rates in Addendum A (Final OPPS APCs for
CY 2018), Addendum B (Final OPPS Payment by HCPCS Code for CY 2018),
Addendum C (Final HCPCS Codes Payable Under the 2018 OPPS by APC), and
the payment rates in the 2018 OPPS APC Offset File and the 2018 OPPS
HCPCS Device Offset File that were published on the CMS website in
conjunction with the CY 2018 OPPS/ASC final rule are corrected to
reflect the corrected assignment of HCPCS code 93880 to APC 5522 (Level
2 Imaging without Contrast) and APC 5523 (Level 3 Imaging without
Contrast).
In addition, in Addendum B, 17 HCPCS codes were incorrectly
assigned to OPPS status indicator ``Q4'' when they should have been
assigned to status indicator ``A.'' We are correcting the mistake by
assigning status indicator ``A'' to these codes as shown in the chart
that follows.
------------------------------------------------------------------------
HCPCS code Short descriptor CI SI
------------------------------------------------------------------------
81105.............. Hpa-1 genotyping. NC A
81106.............. Hpa-2 genotyping. NC A
81107.............. Hpa-3 genotyping. NC A
81108.............. Hpa-4 genotyping. NC A
81109.............. Hpa-5 genotyping. NC A
81110.............. Hpa-6 genotyping. NC A
81111.............. Hpa-9 genotyping. NC A
81112.............. Hpa-15 genotyping NC A
81120.............. Idh1 common NC A
variants.
81121.............. Idh2 common NC A
variants.
81175.............. Asxl1 full gene NC A
sequence.
81176.............. Asxl1 gene target NC A
seq alys.
81448.............. Hrdtry perph NC A
neurphy panel.
81520.............. Onc breast mrna NC A
58 genes.
81521.............. Onc breast mrna NC A
70 genes.
81541.............. Onc prostate mrna NC A
46 genes.
81551.............. Onc prostate 3 NC A
genes.
------------------------------------------------------------------------
[[Page 61186]]
In Addendum M, we inadvertently excluded Current Procedural
Terminology (CPT) codes 71045 (Radiologic examination, chest; single
view) and 71046 (Radiologic examination, chest; 2 views). The revised
Addendum M includes these codes. CPT codes 71045 and 71046 replaced CPT
codes 71010 (Radiologic examination, chest; single view, frontal) and
71020 (Radiologic examination, chest, 2 views, frontal and lateral;
with apical lordotic procedure) effective January 1, 2018. Since the
predecessor codes were assigned to composite APC 5041 (Critical Care)
and APC 5045 (Trauma Response with Critical Care) before January 1,
2018, the replacement codes are assigned to the same composite APCs
effective January 1, 2018.
In Addendum P, we inadvertently excluded the following 7 CPT codes:
0409T (Insertion or replacement of permanent cardiac
contractility modulation system, including contractility evaluation
when performed, and programming of sensing and therapeutic parameters;
pulse generator only);
0410T (Insertion or replacement of permanent cardiac
contractility modulation system, including contractility evaluation
when performed, and programming of sensing and therapeutic parameters;
atrial electrode only);
0411T (Insertion or replacement of permanent cardiac
contractility modulation system, including contractility evaluation
when performed, and programming of sensing and therapeutic parameters;
ventricular electrode only);
0414T (Removal and replacement of permanent cardiac
contractility modulation system pulse generator only);
0446T (Creation of subcutaneous pocket with insertion of
implantable interstitial glucose sensor, including system activation
and patient training);
0449T (Insertion of aqueous drainage device, without
extraocular reservoir, internal approach, into the subconjunctival
space; initial device); and
28291 (Hallux rigidus correction with cheilectomy,
debridement and capsular release of the first metatarsophalangeal
joint; with implant).
CPT codes 0409T, 0410T, 0411T, 0414T, 0446T, 0449T represent
procedures requiring the implantation of medical devices that do not
have yet have associated claims data and therefore have been granted
device-intensive status with a default device offset percentage of 41
percent, per our current policy outlined in the CY 2017 OPPS/ASC final
rule with comment (81 FR 79658). CPT code 28291 replaced CPT code 28293
(Correction, hallux valgus (bunion), with or without sesamoidectomy;
resection of joint with implant) which previously held the device-
intensive designation with a device offset percentage of 43.78 percent.
Since the predecessor code was device-intensive, CPT code 28291 is also
device-intensive status and a device offset percentage of 43.78 percent
based on the offset from the predecessor code.
To view the corrected CY 2018 OPPS status indicator, payment and
copayment rates, that result from these technical corrections as well
as CPT codes that were inadvertently excluded, we refer readers to the
Addenda and supporting files that are posted on the CMS website at:
https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/HospitalOutpatientPPS/. Select ``CMS-1678-CN'' from the list
of regulations. All corrected Addenda for this correcting document are
contained in the zipped folder titled ``2018 OPPS Final Rule Addenda''
at the bottom of the page for CMS-1678-CN.
2. ASC Payment System Addenda Posted on the CMS Website
As a result of the technical corrections described in Section II.A.
and II.B.1. of this correction notice, we have updated Addenda AA and
BB to reflect the final corrected payment rates and indicators for CY
2018 for ASC covered surgical procedures and covered ancillary
services. In addition, in addendum BB, we inadvertently included HCPCS
code Q2040 (Tisagenlecleucel, up to 250 million car-positive viable t
cells, including leukapheresis and dose preparation procedures, per
infusion) as a separately payable drug when furnished in the ASC
setting. Because the complement of services required to furnish the
drug described by HCPCS code Q2040 are not all covered ASC surgical
procedures, we are correcting the error by removing HCPCS code Q2040
from Addendum BB.
To view the corrected final CY 2018 ASC payment rates and
indicators that result from these technical corrections, we refer
readers to the Addenda and supporting files on the CMS website at:
https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/ASCPayment/ASC-Regulations-and-Notices.html. Select ``CMS-1678-CN''
from the list of regulations. All corrected ASC addenda for this
correcting document are contained in the zipped folder entitled
``Addendum AA, BB, DD1, DD2, and EE'' at the bottom of the page for
CMS-1678-CN.
In addition, we inadvertently excluded the below nine codes from
the file labeled ``CY 2018 ASC Procedures to which the No Cost/Full
Credit and Partial Credit Device Adjustment Policy Applies''. These
nine codes were included as ASC device-intensive procedures to which
the no cost/full credit and partial credit device adjustment policy
applies in the CY 2017 final rule, and we did not intend any changes to
them for CY 2018.
0409T (Insertion or replacement of permanent cardiac
contractility modulation system, including contractility evaluation
when performed, and programming of sensing and therapeutic parameters;
pulse generator only);
0410T (Insertion or replacement of permanent cardiac
contractility modulation system, including contractility evaluation
when performed, and programming of sensing and therapeutic parameters;
atrial electrode only);
0411T (Insertion or replacement of permanent cardiac
contractility modulation system, including contractility evaluation
when performed, and programming of sensing and therapeutic parameters;
ventricular electrode only);
0414T (Removal and replacement of permanent cardiac
contractility modulation system pulse generator only);
0446T (Creation of subcutaneous pocket with insertion of
implantable interstitial glucose sensor, including system activation
and patient training);
0449T (Insertion of aqueous drainage device, without
extraocular reservoir, internal approach, into the subconjunctival
space; initial device);
22867 (Insertion of interlaminar/interspinous process
stabilization/distraction device, without fusion, including image
guidance when performed, with open decompression, lumbar; single
level);
22869 (Insertion of interlaminar/interspinous process
stabilization/distraction device, without open decompression or fusion,
including image guidance when performed, lumbar; single level); and
28291 (Hallux rigidus correction with cheilectomy,
debridement and capsular release of the first metatarsophalangeal
joint; with implant).
To view the revised version of the ``CY 2018 ASC Procedures to
which the No Cost/Full Credit and Partial Credit Device Adjustment
Policy Applies,'' we refer readers to the CMS website at:
[[Page 61187]]
https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/ASCPayment/ASC-Policy-Files.html.
III. Waiver of Proposed Rulemaking
Under 5 U.S.C. 553(b) of the Administrative Procedure Act (APA),
the agency is required to publish a notice of the proposed rule in the
Federal Register before the provisions of a rule take effect.
Similarly, section 1871(b)(1) of the Act requires the Secretary to
provide for notice of the proposed rule in the Federal Register and
provide a period of not less than 60 days for public comment. In
addition, section 553(d) of the APA, and section 1871(e)(1)(B)(i)
mandate a 30-day delay in effective date after issuance or publication
of a rule. Sections 553(b)(B) and 553(d)(3) of the APA provide for
exceptions from the notice and comment and delay in effective date of
the APA requirements; in cases in which these exceptions apply,
sections 1871(b)(2)(C) and 1871(e)(1)(B)(ii) of the Act provide
exceptions from the notice and 60-day comment period and delay in
effective date requirements of the Act as well. Section 553(b)(B) of
the APA and section 1871(b)(2)(C) of the Act authorize an agency to
dispense with normal rulemaking requirements for good cause if the
agency makes a finding that the notice and comment process is
impracticable, unnecessary, or contrary to the public interest. In
addition, both section 553(d)(3) of the APA and section
1871(e)(1)(B)(ii) of the Act allow the agency to avoid the 30-day delay
in effective date where such delay is contrary to the public interest
and an agency includes a statement of support.
We believe that this correcting document does not constitute a
rulemaking that would be subject to these requirements. This correcting
document corrects technical and typographic errors in the preamble,
addenda, payment rates, tables, and appendices included or referenced
in the CY 2018 OPPS/ASC final rule but does not make substantive
changes to the policies or payment methodologies that were adopted in
the final rule. As a result, the corrections made through this
correcting document are intended to ensure that the information in the
CY 2018 OPPS/ASC final rule accurately reflects the policies adopted in
that rule.
In addition, even if this were a rulemaking 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 CY 2018 OPPS/ASC final rule
accurately reflects our policies as of the date they take effect and
are applicable.
Furthermore, such procedures would be unnecessary, as we are not
altering our payment methodologies or policies, but rather, we are
simply correctly implementing the policies that we previously proposed,
received comment on, and subsequently finalized. This correcting
document is intended solely to ensure that the CY 2018 OPPS/ASC final
rule accurately reflects these payment methodologies and policies. For
these reasons, we believe we have good cause to waive the notice and
comment and effective date requirements.
IV. Correction of Errors
In FR Doc. R1-2017-23932 of December 14, 2017 (82 FR 59216), make
the following corrections:
1. On page 59256, third column, first paragraph, in line 11,
correct ``1.4457'' to read ``1.4458''.
2. On page 59262, second column, second full paragraph, in line 7,
add the parenthetical phrase ``(in cases where we are unable to use the
implantable device CCR)'' after the words ``pass-through devices''.
3. On page 59269,
a. Third column, last full paragraph,
(1) In line 17, correct ``$572.81'' to read ``$575.85.''
(2) In line 21, correct ``$561.35'' to read ``$561.39.''
b. Third column, last partial paragraph,
(1) In lines 5 and 6, correct ``$442.53 (.60 * $572.81 * 1.2876).''
to read ``$442.56 (.60 * $575.85 * 1.2876).''
(2) In line 9, correct ``$443.68 (.60 * $561.35 * 1.2876).'' to
read ``$443.70 (.60 * $561.39 * 1.2876).''
(3) In line 12, correct ``$229.12 (.40 * $572.81).'' to read
``$229.14 (.40 * $575.85).''
4. On page 59270, first column, first partial paragraph,
a. In line 2, correct ``$224.54 (.40 * $561.35).'' to read
``$224.56 (.40 * $561.39).''
b. In lines 6 and 7, correct ``$671.65 ($442.53 + $229.12).'' to
read ``$671.70 ($442.56 + $229.14).''
c. In lines 9 and 10, correct ``$658.22 ($433.68 + $224.54).'' to
read ``$658.26 ($443.70 + $224.56).''
5. On page 59271, first column, second full paragraph, under ``Step
1,'' in line 8, correct ``$572.81'' to read ``$575.85.''
6. On page 59277, Table 14--APC Exceptions to the 2 Times Rule for
CY 2018, is corrected to read as follows:
Table 14--APC Exceptions to the 2 Times Rule for CY 2018
----------------------------------------------------------------------------------------------------------------
APC CY 2018 APC title
----------------------------------------------------------------------------------------------------------------
5112................................ Level 2 Musculoskeletal Procedures
5521................................ Level 1 Imaging without Contrast
5522................................ Level 2 Imaging without Contrast
5523................................ Level 3 Imaging without Contrast
5524................................ Level 4 Imaging without Contrast
5571................................ Level 1 Imaging with Contrast
5691................................ Level 1 Drug Administration
5721................................ Level 1 Diagnostic Tests and Related Services
5731................................ Level 1 Minor Procedures
5732................................ Level 2 Minor Procedures
5771................................ Cardiac Rehabilitation
5823................................ Level 3 Health and Behavior Services
----------------------------------------------------------------------------------------------------------------
7. On page 59295, third column,
a. After the first partial paragraph, add the following comment and
response:
Comment: We received a comment to the CY 2018 OPPS/ASC proposed
rule
[[Page 61188]]
requesting the reassignment of the procedures assigned to APCs 5361
(Level 1 Laparoscopy and Related Services) and 5362 (Level 2
Laparoscopy and Related Services) to ensure a more logical distribution
of procedure costs between these two APCs.
Response: We appreciate the suggestion and will consider for future
rulemaking. We note that in the CY 2018 OPPS/ASC proposed rule, there
was no violation of the 2 times rule for either APC 5361 or APC 5362.
b. First full paragraph, in line 2, correct ``comment'' to read
``comments''.
8. On page 59311, Table 54--Comparison of CY 2017 and CY 2018
Geometric Mean Costs For The Imaging APCs, is corrected to read as
follows:
Table 54-Comparison of CY 2017 and CY 2018 Geometric Mean Costs for the
Imaging APCs
------------------------------------------------------------------------
CY 2017 APC CY 2018 APC
APC APC group title geometric mean geometric mean
cost cost
------------------------------------------------------------------------
5521................ Level 1 Imaging $61.53 $62.08
without Contrast.
5522................ Level 2 Imaging 115.88 114.39
without Contrast.
5523................ Level 3 Imaging 232.21 232.17
without Contrast.
5524................ Level 4 Imaging 462.23 486.38
without Contrast.
5571................ Level 1 Imaging 272.40 252.58
with Contrast.
5572................ Level 2 Imaging 438.42 456.08
with Contrast.
5573................ Level 3 Imaging 675.23 681.45
with Contrast.
------------------------------------------------------------------------
9. On page 59323, second column, second full paragraph, in line 4,
correct ``C2623'' to read ``C2613''.
10. On page 59369,
a. Second column, second full paragraph, in line 5, correct
``status indicator ``L'' or ``M'''' to read ``status indicator ``F'',
``L'', or ``M''''.
b. Third column, first full paragraph, in line 19, correct ``status
indicator ``L'' or ``M'''' to read ``status indicator ``F'', ``L'', or
``M''''.
11. On page 59375, second column, third full paragraph, in line 7,
correct ``CCR <=5'' to read ``CCR>5''.
12. On pages 59412 and 59413, in the title for Table 87, correct
``ASDC'' to read ``ASC''.
13. On page 59413, second column, after the second full paragraph,
add the following paragraphs before the section titled, ``D. ASC
Payment for Covered Surgical Procedures and Covered Ancillary
Services'':
``2. Covered Ancillary Services
Consistent with the established ASC payment system policy, in the
CY 2018 OPPS/ASC proposed rule (82 FR 33662) we proposed to update the
ASC list of covered ancillary services to reflect the payment status
for the services under the CY 2018 OPPS. We noted that maintaining
consistency with the OPPS may result in proposed changes to ASC payment
indicators for some covered ancillary services because of changes that
are being finalized under the OPPS for CY 2018. For example, a covered
ancillary service that was separately paid under the ASC payment system
in CY 2017 may be proposed for packaged status under the CY 2018 OPPS
and, therefore, also under the ASC payment system for CY 2018.
To maintain consistency with the OPPS, we proposed to continue this
reconciliation of packaged status for the ASC payment system for CY
2018. Comment indicator ``CH,'' discussed in section XII.F. of the
proposed rule, was used in Addendum BB to the proposed rule (which is
available via the internet on the CMS website) to indicate covered
ancillary services for which we proposed a change in the ASC payment
indicator to reflect a proposed change in the OPPS treatment of the
service for CY 2018.
We included all ASC covered ancillary services and their proposed
payment indicators for CY 2018 in Addendum BB to the proposed rule. We
invited public comments on this proposal.
We did not receive any public comments on these proposals.
Therefore, we are finalizing, without modification, our proposal to
update the ASC list of covered ancillary services to reflect the
payment status for the services under the OPPS. All CY 2018 ASC covered
ancillary services and their final payment indicators are included in
Addendum BB to this final rule (which is available via the internet on
the CMS website).''
14. On page 59422, first column, first partial paragraph, in line
1, correct ``44.663'' to read ``44.674''.
15. On page 59482, third column, second partial paragraph, in line
43, correct ``270'' to read ``247''.
16. On page 59483, first column, third partial paragraph, in line
29, correct ``$199'' to read ``$169''.
17. On page 59486,
a. First column, first full paragraph, in line 16, correct ``0.5''
to read ``0.6''.
b. Third column, first full paragraph, in line 6, correct ``1.2''
to read ``1.3''.
18. On page 59487 through 59488, Table 88--Estimated Impact of the
CY 2018 Changes for the Hospital Outpatient Prospective Payment System,
is corrected to read as follows:
Table 88--Estimated Impact of the CY 2018 Changes for the Hospital Outpatient Prospective Payment System
--------------------------------------------------------------------------------------------------------------------------------------------------------
All budget
neutral
APC New wage index changes
Number of recalibration and provider 340B (combined cols All changes
hospitals (all changes) adjustments adjustment 2-4) with
market basket
update
(1) (2) (3) (4) (5) (6)
--------------------------------------------------------------------------------------------------------------------------------------------------------
ALL PROVIDERS *......................................... 3,878 0.0 0.0 0.0 1.3 1.4
[[Page 61189]]
ALL HOSPITALS (excludes hospitals held harmless and 3,765 0.0 0.1 -0.1 1.4 1.5
CMHCs).................................................
URBAN HOSPITALS......................................... 2,951 0.1 0.1 -0.3 1.3 1.3
LARGE URBAN (GT 1 MILL.)............................ 1,589 0.1 0.0 -0.2 1.2 1.3
OTHER URBAN (LE 1 MILL.)............................ 1,362 0.0 0.2 -0.3 1.3 1.4
RURAL HOSPITALS......................................... 814 -0.3 0.0 1.4 2.5 2.7
SOLE COMMUNITY...................................... 372 -0.2 0.1 2.6 3.9 4.0
OTHER RURAL......................................... 442 -0.4 -0.2 0.0 0.8 0.9
BEDS (URBAN):
0-99 BEDS........................................... 1,021 0.0 0.0 1.9 3.3 3.4
100-199 BEDS........................................ 850 0.0 0.2 1.2 2.8 2.9
200-299 BEDS........................................ 468 0.1 0.1 0.5 2.0 2.1
300-499 BEDS........................................ 399 0.1 0.0 -0.4 1.1 1.2
500 + BEDS.......................................... 213 0.0 0.1 -2.2 -0.7 -0.6
BEDS (RURAL):
0-49 BEDS........................................... 333 -0.6 -0.2 2.1 2.7 2.9
50-100 BEDS......................................... 297 -0.2 -0.2 1.9 2.8 3.0
101-149 BEDS........................................ 97 -0.3 0.1 1.1 2.3 2.4
150-199 BEDS........................................ 49 -0.2 0.1 0.7 2.0 2.1
200 + BEDS.......................................... 38 -0.3 0.4 0.8 2.4 2.5
REGION (URBAN):
NEW ENGLAND......................................... 144 0.2 0.4 -0.2 1.7 1.8
MIDDLE ATLANTIC..................................... 348 0.1 -0.2 -0.1 1.2 1.3
SOUTH ATLANTIC...................................... 463 0.0 0.3 -0.4 1.3 1.4
EAST NORTH CENT..................................... 471 0.0 0.1 -0.2 1.3 1.4
EAST SOUTH CENT..................................... 178 -0.1 -0.1 -1.6 -0.4 -0.3
WEST NORTH CENT..................................... 191 0.1 0.5 -0.6 1.4 1.5
WEST SOUTH CENT..................................... 513 0.0 0.3 0.9 2.5 2.6
MOUNTAIN............................................ 211 0.3 -0.9 -0.2 0.5 0.7
PACIFIC............................................. 383 0.1 0.0 -0.6 0.8 0.9
PUERTO RICO......................................... 49 -0.4 0.2 2.9 4.1 4.2
REGION (RURAL):
NEW ENGLAND......................................... 21 0.1 1.5 1.2 4.2 4.2
MIDDLE ATLANTIC..................................... 53 -0.1 -0.5 1.8 2.5 2.7
SOUTH ATLANTIC...................................... 124 -0.4 -0.6 0.7 1.1 1.2
EAST NORTH CENT..................................... 122 -0.2 0.0 1.5 2.7 2.8
EAST SOUTH CENT..................................... 155 -0.6 -0.1 0.0 0.7 0.8
WEST NORTH CENT..................................... 98 -0.1 0.2 2.4 3.9 4.1
WEST SOUTH CENT..................................... 161 -0.7 0.3 2.6 3.6 3.7
MOUNTAIN............................................ 56 0.0 -0.3 1.9 2.9 3.3
PACIFIC............................................. 24 -0.2 0.1 1.7 3.0 3.0
TEACHING STATUS:
NON-TEACHING........................................ 2,655 -0.1 0.1 1.3 2.8 2.9
MINOR............................................... 761 0.1 0.1 0.1 1.6 1.7
MAJOR............................................... 349 0.1 0.0 -2.4 -1.0 -0.9
DSH PATIENT PERCENT:
0................................................... 10 0.0 0.2 3.2 4.8 4.9
GT 0-0.10........................................... 272 0.2 -0.1 2.8 4.4 4.5
0.10-0.16........................................... 263 0.2 0.0 2.7 4.3 4.4
0.16-0.23........................................... 572 0.1 0.3 2.6 4.4 4.5
0.23-0.35........................................... 1132 0.0 0.1 -0.4 1.0 1.2
GE 0.35............................................. 935 0.0 0.0 -2.2 -0.9 -0.8
DSH NOT AVAILABLE **................................ 581 -2.0 0.1 2.0 1.4 1.6
URBAN TEACHING/DSH:
TEACHING & DSH...................................... 1,002 0.1 0.0 -1.1 0.3 0.4
NO TEACHING/DSH..................................... 1,386 0.1 0.2 1.3 2.9 3.0
NO TEACHING/NO DSH.................................. 10 0.0 0.2 3.2 4.8 4.9
DSH NOT AVAILABLE2.................................. 553 -1.9 0.1 1.9 1.4 1.6
TYPE OF OWNERSHIP:
VOLUNTARY........................................... 1,979 0.0 0.0 -0.3 1.2 1.3
PROPRIETARY......................................... 1,293 0.1 0.1 2.7 4.3 4.5
GOVERNMENT.......................................... 493 -0.1 0.2 -1.6 -0.1 0.0
[[Page 61190]]
CMHCs................................................... 49 12.5 0.2 3.2 17.8 17.9
--------------------------------------------------------------------------------------------------------------------------------------------------------
Column (1) shows total hospitals and/or CMHCs.
Column (2) includes all final CY 2018 OPPS policies and compares those to the CY 2017 OPPS.
Column (3) shows the budget neutral impact of updating the wage index by applying the FY 2018 hospital inpatient wage index, including all hold harmless
policies and transitional wages. The rural adjustment continues our current policy of 7.1 percent so the budget neutrality factor is 1. The budget
neutrality adjustment for the cancer hospital adjustment is 1.0008 because the target payment-to-cost ratio changes from 0.91 in CY 2017 to 0.89 in CY
2018 and is further reduced by 1 percentage point to 0.88 in accordance with the 21st Century Cures Act. However, this reduction does not affect the
budget neutrality adjustment consistent with statute.
Column (4) shows the impact of the 340B drug payment reductions and the corresponding increase in non-drug payments.
Column (5) shows the impact of all budget neutrality adjustments and the addition of the 1.35 percent OPD fee schedule update factor (2.7 percent
reduced by 0.6 percentage points for the productivity adjustment and further reduced by 0.75 percentage point as required by law).
Column (6) shows the additional adjustments to the conversion factor resulting from the frontier adjustment, a change in the pass-through estimate, and
adding estimated outlier payments.
These 3,878 providers include children and cancer hospitals, which are held harmless to pre-BBA amounts, and CMHCs.
** Complete DSH numbers are not available for providers that are not paid under IPPS, including rehabilitation, psychiatric, and long-term care
hospitals.
19. On page 59488, bottom third of the page,
a. Second column, first partial paragraph, in line 6, correct
``17.2'' to read ``17.9''.
b. Third column, first partial paragraph, in line 10, correct
``17.2'' to read ``17.9''.
Dated: December 20, 2017.
Ann C. Agnew,
Executive Secretary to the Department, Department of Health and Human
Services.
[FR Doc. 2017-27949 Filed 12-22-17; 4:15 pm]
BILLING CODE 4120-01-P
