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 2019 Rates; Quality Reporting Requirements for Specific Providers; Medicare and Medicaid Electronic Health Record (EHR) Incentive Programs (Promoting Interoperability Programs) Requirements for Eligible Hospitals, Critical Access Hospitals, and Eligible Professionals; Medicare Cost Reporting Requirements; and Physician Certification and Recertification of Claims; Correction, 49836-49856 [2018-21500]
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TABLE 45—IMPACT TO THE SNF PPS FOR FY 2019—Continued
Number
of
facilities
FY 2019
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
(%)
1,421
6
1.0
¥0.5
3.4
1.9
134
215
494
931
523
1,074
734
229
95
¥0.7
0.1
0.1
0.1
¥0.3
0.3
1.0
0.2
¥0.5
1.6
2.5
2.5
2.5
2.1
2.7
3.5
2.6
1.9
10,887
3,570
1,014
0.0
¥0.1
0.0
2.4
2.3
2.4
Note: The Total column includes the 2.4 percent market basket increase required by section 53111 of the BBA 2018. Additionally, we found
no SNFs in rural outlying areas.
7. On page 39287, bottom of the page,
column 2, line 6 and 7 the phrase
‘‘urban rural West South Central region’’
is corrected to read ‘‘rural West South
Central region.’’
II. Summary of Errors
Final rule; correction.
[CMS–1694–CN2]
This document corrects
technical and typographical errors in
the final rule that appeared in the
August 17, 2018 issue of the Federal
Register titled ‘‘Medicare Program;
Hospital Inpatient Prospective Payment
Systems for Acute Care Hospitals and
the Long Term Care Hospital
Prospective Payment System and Policy
Changes and Fiscal Year 2019 Rates;
Quality Reporting Requirements for
Specific Providers; Medicare and
Medicaid Electronic Health Record
(EHR) Incentive Programs (Promoting
Interoperability Programs) Requirements
for Eligible Hospitals, Critical Access
Hospitals, and Eligible Professionals;
Medicare Cost Reporting Requirements;
and Physician Certification and
Recertification of Claims’’.
RIN 0938–AT27
DATES:
Dated: September 27, 2018.
Ann C. Agnew,
Executive Secretary to the Department,
Department of Health and Human Services.
[FR Doc. 2018–21499 Filed 9–28–18; 4:15 pm]
BILLING CODE 4120–01–P
DEPARTMENT OF HEALTH AND
HUMAN SERVICES
Centers for Medicare & Medicaid
Services
42 CFR Parts 412, 413, 424, and 495
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ACTION:
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 2019 Rates; Quality
Reporting Requirements for Specific
Providers; Medicare and Medicaid
Electronic Health Record (EHR)
Incentive Programs (Promoting
Interoperability Programs)
Requirements for Eligible Hospitals,
Critical Access Hospitals, and Eligible
Professionals; Medicare Cost
Reporting Requirements; and
Physician Certification and
Recertification of Claims; Correction
Centers for Medicare &
Medicaid Services (CMS), HHS.
AGENCY:
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SUMMARY:
The corrections in this document
are effective October 1, 2018.
FOR FURTHER INFORMATION CONTACT:
Donald Thompson and Michele
Hudson, (410) 786–4487.
SUPPLEMENTARY INFORMATION:
I. Background
In FR Doc. 2018–16766 of August 17,
2018 (83 FR 41144) there were a number
of technical and typographical errors
that are identified and corrected by the
Correction of Errors section of this
correcting document. The provisions in
this correcting document are effective as
if they had been included in the
document that appeared in the August
17, 2018 Federal Register. Accordingly,
the corrections are effective October 1,
2018.
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A. Summary of Errors in the Preamble
On page 41144, under FOR FURTHER
INFORMATION CONTACT section, we are
correcting the names of the contacts for
Medicare Promoting Interoperability
Program issues.
On page 41151, in our discussion
regarding Changes to the Hospital
Readmissions Reduction Program under
‘‘Summary of Cost and Benefits’’, we
made errors in the impact figures.
On pages 41200, 41219, 41236, and
41313, we made a technical error in
using the term ‘‘primary’’ rather than
‘‘principal’’ when in describing certain
diagnosis codes or conditions.
On page 41254, we inadvertently
omitted a base MS–DRG group to which
the listed thoracoscopic procedures of
pericardium and pleura may be
assigned. Specifically, we are correcting
the list of MS–DRGs on page 41254 to
include MS–DRGs 166, 167, and 168
(Other Respiratory System O.R.
Procedures with MCC, with CC, and
without CC/MCC, respectively) in MDC
4 (Diseases and Disorders of the
Respiratory System), consistent with the
MS–DRGs to which other approaches
for procedures involving drainage or
extirpation of matter from the pleura are
assigned.
On page 41299, we made a technical
error in describing which ICD–10–PCS
procedure codes will be used to identify
cases involving the use of KYMRIAH
and YESCARTA that are eligible for new
technology add-on payments in FY
2019. Specifically, cases involving the
use of KYMRIAH and YESCARTA that
are eligible for new technology add-on
payments will be identified by either of
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the ICD–10–PCS procedure codes listed
in the final rule (XW033C3 or
XW043C3) rather than requiring the
combination of both ICD–10–PCS
procedure codes.
On page 41311, we made a
typographical error in describing which
National Drug Code (NDC) will be used
to identify cases involving
VABOMERETM that are eligible for new
technology add-on payments in FY
2019. Specifically, we are correcting the
NDC code of 65293–0009–01, which
erroneously was missing an extra digit.
In addition, we were made aware after
the final rule that NDC 70842–0120–01
can also be used to identify cases of
VABOMERETM. Therefore, cases
involving the use of VABOMERETM that
are eligible for new technology add-on
payments in FY 2019 will be identified
with either of the following NDCs:
65293–0009–01 and 70842–0120–01.
On page 41320, we made a
typographical error in describing which
ICD–10–PCS procedure codes will be
used to identify cases involving the
remede¯® SystemTM that are eligible for
new technology add-on payments in FY
2019. Specifically, we are correcting the
ICD–10–PCS procedure code 05H43MZ
(Insertion of neurostimulator lead into
left innominate vein, percutaneous
approach), which had erroneously
contained an extra digit.
On page 41334, we made a technical
error in describing which ICD–10–PCS
procedure codes will be used to identify
cases involving ZEMDRITM that are
eligible for new technology add-on
payments in FY 2019. Specifically,
cases involving the use of ZEMDRITM
that are eligible for new technology addon payments will be identified by either
of the ICD–10–PCS procedure codes
listed in the final rule (XW033G4 or
XW043G4) rather than requiring the
combination of both ICD–10–PCS
procedure codes.
On page 41342, we made a technical
error in describing which ICD–10–PCS
procedure codes will be used to identify
cases involving GIAPREZATM that are
eligible for new technology add-on
payments in FY 2019. Specifically,
cases involving the use of GIAPREZATM
that are eligible for new technology addon payments will be identified by either
of the ICD–10–PCS procedure codes
listed in the final rule (XW033H4 or
XW043H4) rather than requiring the
combination of both ICD–10–PCS
procedure codes.
On page 41348, we made a
typographical error in stating the
applicant’s estimated cost of the
Sentinel® Cerebral Protection System.
Specifically, we stated that the
applicant estimated the cost is $2,400,
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when we should have stated the cost is
$2,800.
On page 41362, we made a technical
error in describing which ICD–10–PCS
procedure codes will be used to identify
cases involving AndexXaTM that are
eligible for new technology add-on
payments in FY 2019. Specifically,
cases involving the use of AndexXaTM
that are eligible for new technology addon payments will be identified by either
of the ICD–10–PCS procedure codes
listed in the final rule (XW03372 or
XW04372) rather than requiring the
combination of both ICD–10–PCS
procedure codes.
On pages 41364, 41365, 41368, and
41375, in our discussion of the wage
indexes, we are correcting the number
of hospitals with critical access hospital
(CAH) status removed from the FY 2019
wage index, the number of hospitals
used for the FY 2019 wage index, the
number of hospital occupational mix
surveys used for the FY 2019 wage
index, and the values for the FY 2019
national average hourly wage
(unadjusted for occupational mix), the
FY 2019 occupational mix adjusted
national average hourly wage, and the
FY 2019 national average hourly wages
for the occupational mix nursing
subcategories, due to inadvertent errors
related to the following:
• The inclusion of a CAH in the wage
data (CMS Certification Number (CCN)
060016).
• Wage data collected from the
Medicare cost reports of one hospital
(CCN 100044).
• Occupational Mix data collected
from one hospital (CCN 010001).
On page 41406, we are correcting a
typographical error in our reference to
the discussion of the comments received
on the proposed methodology for Factor
3.
On page 41415, in our discussion
regarding Methodology for Calculating
Factor 3 for FY 2019, we are correcting
a technical error in the calculation of
the CCR ceilings for FY 2014 and FY
2015 and the number of hospitals above
the ceiling in each of those years.
On page 41432, in our discussion
regarding Regulatory Background of
Hospital Readmissions Reduction
Program, we made a typographical error
in referencing the fiscal year in which
the calculation of the proportion of
‘‘dually eligible’’ Medicare beneficiaries
used to stratify hospitals into peer
groups will begin.
On page 41436, in our discussion
regarding Identification of Aggregate
Payments for Each Condition/Procedure
and All Discharges, we inadvertently
omitted language regarding which
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49837
MedPAR data is included in the
program calculations.
On page 41446, we made a technical
error in the heading for section IV.I.2.c.
by inadvertently stating the incorrect
number of measure removal proposals
that we were finalizing in the FY 2019
IPPS/LTCH PPS final rule for the
Hospital Value-Based Purchasing (VBP)
Program.
On page 41452, we made an error in
the date of publication of a reference.
On page 41469, in the table entitled
‘‘Previously Adopted and Newly
Displayed Performance Standards for
the FY 2021 Program Year: Safety,
Clinical Outcomes, and Efficiency and
Cost Reduction Domains,’’ we
inadvertently did not display several of
the numbers in the benchmark column
to 3 decimal places.
On page 41488, in our discussion
regarding analysis of Hospital-Acquired
Condition Reduction Program, we made
a technical error in referencing
hospital’s National Healthcare Safety
Network (NHSN) Healthcare-Associated
Infection (HAI) measures.
On pages 41528 and 41529, we
corrected the MS–LTC–DRG budget
neutrality factor due to an error in the
MS–LTC–DRG weights resulting from
the inadvertent inclusion of an allinclusive rate provider.
On pages 41536 and 41537, due to the
changes in the MS–LTC–DRG weights
resulting from the correction to the MS–
LTC–DRG budget neutrality factor
(described previously) and the
corrections in the LTCH PPS wage index
referenced above and discussed in
greater detail below, we made
conforming changes to the budget
neutrality adjustment factor for the cost
of the elimination of the 25-percent
threshold policy for FY 2019 and the
area wage budget neutrality factor.
On page 41556, in our discussion
regarding claims-based-readmission
measures, the National Quality Forum
(NQF) number for the MORT–30–CABG
measure was inadvertently listed as
NQF #2515, which is the NQF number
for the READM–30–CABG measure.
On page 41558, in our discussion
finalizing our proposals to remove the
mortality measures, we inadvertently
referenced the FY 2020 payment
determination twice.
On page 41576, in the table entitled
‘‘Summary of Hospital IQR Program
Measures Newly Finalized for
Removal,’’ an entry under ‘‘ClaimsBased Coordination of Care Measures’’
inadvertently included an ‘‘A’’ in the
short name for the Pneumonia
Readmission measure.
On page 41579, in the table entitled
‘‘Measures for the FY 2021 Payment
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Determination,’’ we inadvertently
omitted the entry for the FY 2021
payment determination for MORT–30–
CABG. In the same table, we made a
typographical error by inadvertently
including an asterisk at the end of
Hospital 30-Day, All-Cause, RiskStandardized Mortality Rate Following
Acute Ischemic Stroke (MORT–30–
STK). In the same table, we made a
typographical error by inadvertently
listing the incorrect NQF number for
STK–06, Discharged on Statin
Medication measure. In the same table,
we inadvertently excluded the word
‘‘Venous’’ from the full measure name of
VTE–2, Intensive Care Unit Venous
Thromboembolism Prophylaxis.
On page 41599, in our discussion of
Social Risk Factors in the Hospital
Inpatient Quality Reporting (IQR)
Program, we inadvertently used the
term ‘‘measures’’ instead of ‘‘methods’’.
On page 41672, in our discussion
regarding the electronic reporting of
electronic clinical quality measures
(eCQMs) for CY 2019, we incorrectly
referred to the Spring 2017 version of
the CQM electronic specifications as the
most recent version. A more recent
version of the specifications was issued
after the proposed rule was published,
which is the 2018 eCQM specifications
update (published in May 2018).
B. Summary of Errors in the Addendum
As discussed in section II.D. of this
correcting document, we made several
technical errors with regard to the
calculation of Factor 3 of the
uncompensated care payment
methodology. Factor 3 is used to
determine the total amount of the
uncompensated care payment a hospital
is eligible to receive for a fiscal year.
This amount is then used to calculate
the amount of the interim
uncompensated care payments a
hospital receives per discharge. Per
discharge uncompensated care
payments are included when
determining total payments for purposes
of all of the budget neutrality factors
and the final outlier threshold. As a
result, the revisions made to address
these technical errors regarding the
calculation of Factor 3 directly affected
the calculation of total payments and
required the recalculation of all the
budget neutrality factors and the final
outlier threshold.
Because of the errors related to the
wage data for the three hospitals (CCNs
010001, 060016 and 100044) as
discussed in section II.A. of this
correcting document, we recalculated
the FY 2019 national average hourly
wages unadjusted for occupational mix
and adjusted for occupational mix
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which resulted in the recalculation of
the final FY 2019 IPPS wage indexes
and the geographic adjustment factors
(GAFs) (which are computed from the
wage index). The final FY 2019 IPPS
wage data are used in the calculation of
the wage index budget neutrality
adjustment when comparing total
payments using the final FY 2018 IPPS
wage index data to total payments using
the final FY 2019 IPPS wage index data.
Additionally, the final FY 2019 IPPS
wage index data are used when
determining total payments for purposes
of the rest of the budget neutrality
factors (except for the MS–DRG
reclassification and recalibration budget
neutrality factor) and the final outlier
threshold. In addition, the final FY 2019
IPPS wage index data are used to
calculate the FY 2019 LTCH PPS wage
index values, certain budget neutrality
factors, and the LTCH PPS standard
Federal payment rate in the FY 2019
IPPS/LTCH PPS final rule.
We also made inadvertent errors
related to the status of four providers
reclassified from urban to rural under
section 1886(d)(8)(E) of the Act
(codified in the regulations under
§ 412.103 and hereinafter referred to as
§ 412.103). Specifically, the
reclassification status in the FY 2019
IPPS/LTCH PPS final rule did not
properly reflect the application of urban
to rural reclassification under § 412.103
for four providers (CCNs 050025,
050573, 120001 and 120002). We note,
provider 050573 was approved by the
MGCRB for reclassification (as already
reflected in the FY 2019 IPPS/LTCH
final rule) in addition to its urban to
rural reclassification under § 412.103.
Additionally, the final FY 2019 IPPS
wage index with reclassification is used
when determining total payments for
purposes of all budget neutrality factors
(except for the MS–DRG reclassification
and recalibration budget neutrality
factor and the wage index budget
neutrality adjustment factor) and the
final outlier threshold.
Due to the correction of the
combination of errors listed previously
(revisions to Factor 3 of the
uncompensated care payment
methodology, the correction to the final
FY 2019 IPPS wage index data adjusted
for occupational mix and the correction
to the geographic reclassification status
of four hospitals), we recalculated all
IPPS budget neutrality adjustment
factors, the fixed-loss cost threshold, the
final wage indexes (and GAFs), and the
national operating standardized
amounts and capital Federal rate. (We
note there was no change to the rural
community hospital demonstration
program budget neutrality adjustment or
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the operating outlier adjustment factor
resulting from the correction of this
combination of errors.) Therefore, we
made conforming changes to the
following:
• On pages 41715 and 41727, the
MS–DRG reclassification and
recalibration budget neutrality
adjustment factor.
• On page 41716, the following
budget neutrality adjustments:
++ Wage index budget neutrality
adjustment.
++ Reclassification hospital budget
neutrality adjustment.
++ Rural floor budget neutrality
adjustment.
• On page 41723, the calculation of
the outlier fixed-loss cost threshold,
total operating Federal payments, total
operating outlier payments, and the
outlier adjustment to the capital Federal
rate.
• On pages 41724 through 41725, the
table titled ‘‘Changes From FY 2018
Standardized Amounts to the FY 2019
Standardized Amounts’’.
On page 41722, we are also correcting
inadvertent technical errors in the
figures reported for the covered charges
and cases by quarter in the periods used
to calculate the charge inflation factor.
Specifically, we erroneously presented
figures based on total charges for the
applicable periods listed in the table
rather than the covered charges and the
case counts were not correctly aligned
with the corresponding quarter. We note
that although there were technical errors
in the figures as presented in the table
and the corresponding discussion on
page 41722, the correct figures were
used for the outlier calculations in the
final rule. In addition, on page 41723,
we are correcting technical errors in the
description of the formula showing total
outlier payments as a percentage of total
operating Federal payments.
On pages 41727 through 41729, in our
discussion of the determination of the
Federal hospital inpatient capitalrelated prospective payment rate
update, due to the recalculation of the
GAFs, we have made conforming
corrections to the increase in the capital
Federal rate, the GAF/DRG budget
neutrality adjustment factors, the capital
Federal rate, and the outlier threshold
(as discussed previously), along with
certain statistical figures (for example,
percent change) in the accompanying
discussions. Also, as a result of these
errors we have made conforming
corrections in the tables showing the
comparison of factors and adjustments
for the FY 2018 capital Federal rate and
FY 2019 capital Federal rate and the
proposed FY 2019 capital Federal rate
and final FY 2019 capital Federal rate.
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On pages 41730 through 41731,
41733, 41736 and 41737, due to
corrections in the LTCH PPS wage index
discussed previously, we are making
conforming corrections to the following:
• The area wage level adjustment
budget neutrality factor.
• The fixed-loss amount for FY 2019
LTCH PPS standard Federal payment
rate discharges and the high-cost outlier
(HCO) threshold.
• The budget neutrality adjustment
factor for the cost of the elimination of
the 25-percent threshold policy for FY
2019 and the FY 2019 LTCH PPS
standard Federal payment rate.
• The fixed-loss amount for FY 2019
site neutral payment rate discharges and
the high-cost outlier (HCO) threshold
(based on the corrections to the IPPS
fixed-loss amount discussed
previously).
On pages 41738 and 41739, we are
making conforming corrections to the
figures used in the example of
computing the adjusted LTCH PPS
Federal prospective payment for FY
2019.
On pages 41740 and 41741, we are
making conforming corrections to the
following:
• National adjusted operating
standardized amounts and capital
standard Federal payment rate (which
also include the rates payable to
hospitals located in Puerto Rico) in
Tables 1A, 1B, 1C, and 1D as a result of
the conforming corrections to certain
budget neutrality factors and the outlier
threshold (as described previously). We
are also correcting a typographical error
in the update factor presented in the
column heading for a hospital that
submitted quality data and is a
meaningful EHR user.
• LTCH PPS standard Federal
payment rate in Table 1E as a result of
the correction to the LTCH PPS wage
index values (as discussed previously).
C. Summary of Errors in the Appendices
On pages 41742, 41744 through
41751, and 41763 through 41765 in our
regulatory impact analyses, we made
conforming corrections to the factors,
values, and tables and accompanying
discussion of the changes in operating
and capital IPPS payments for FY 2019
and the effects of certain IPPS budget
neutrality factors as a result of the
technical errors that lead to conforming
changes in our calculation of the
operating and capital IPPS budget
neutrality factors, outlier threshold,
final wage indexes, operating
standardized amounts, and capital
Federal rate (as described in sections
II.A. and II.B. of this correcting
document).
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In particular, we made changes to the
following tables:
• On pages 41744 through 41746, the
table titled ‘‘Table I—Impact Analysis of
Changes to the IPPS for Operating Costs
for FY 2019’’.
• On pages 41748 through 41749, the
table titled ‘‘FY 2019 IPPS Estimated
Payments Due To Rural Floor With
National Budget Neutrality’’.
• On pages 41750 through 41751, the
table titled ‘‘Table II—Impact Analysis
of Changes for FY 2019 Acute Care
Hospital Operating Prospective Payment
System [Payments per discharge]’’.
• On pages 41764 through 41765, the
table titled ‘‘Table III—Comparison of
Total Payments per Case [FY 2018
payments compared to FY 2019
payments]’’.
On pages 41753 through 41755, we
are correcting the discussion of the
‘‘Effects of the Changes to Medicare
DSH and Uncompensated Care
Payments for FY 2019’’ for purposes of
the Regulatory Impact Analysis in
Appendix A of the FY 2019 IPPS/LTCH
PPS final rule, including the table titled
‘‘MODELED UNCOMPENSATED CARE
PAYMENTS FOR ESTIMATED FY 2019
DSHs BY HOSPITAL TYPE: MODEL
UCP $ (IN MILLIONS) * FROM FY 2018
to FY 2019’’ on pages 41753 and 41754,
in light of the corrections discussed in
section II.D. of this correcting
document.
On page 41756, in our discussion of
the effects of changes under the FY 2019
Hospital Value-Based Purchasing (VBP)
Program that appears in Appendix A,
we are correcting an inadvertent
reference to the word ‘‘proposed’’ in the
heading for section I.H.6.a in the first
column at the bottom of the page and in
line 1 of the last paragraph of the second
column at the bottom of the page.
On pages 41758 through 41759, in
table entitled ‘‘Estimated Proportion of
Hospitals in the Worst-Performing
Quartile (>75th Percentile) of the Total
HAC Scores for the FY 2019 HAC
Reduction Program’’, we inadvertently
included incorrect data.
On pages 41766 and 41768 through
41769, we made conforming corrections
to the LTCH PPS area wage level budget
neutrality factor, the budget neutrality
adjustment factor for the cost of the
elimination of the 25-percent threshold
policy for FY 2019, and the LTCH PPS
standard Federal payment rate as
described in section II.B. of this
correcting document.
On pages 41768 through 41770, we
are making conforming corrections to
‘‘Table IV—Impact of Payment Rate and
Policy Changes to LTCH PPS Payments
for Standard Payment Rate Cases for FY
2019’’ and the corresponding summary
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49839
text. We are also correcting the
inadvertent mislabeling of the Pacific
and Mountain rows in that table.
D. Summary of Errors in and
Corrections to Files and Tables Posted
on the CMS Website
We are correcting the errors in the
following IPPS tables that are listed on
pages 41739 through 41740 of the FY
2019 IPPS/LTCH PPS final rule and are
available on the internet on the CMS
website at https://www.cms.gov/
Medicare/Medicare-Fee-for-ServicePayment/AcuteInpatientPPS/FY2019IPPS-Final-Rule-Home-Page.html. The
tables that are available on the internet
have been updated to reflect the
revisions discussed in this correcting
document.
Table 2—Case-Mix Index and Wage
Index Table by CCN–FY 2019. The wage
data errors (as discussed in section II.A.
of this correcting document) related to
the three hospitals (CCNs 010001,
060016, and 100044) required the
recalculation of the FY 2019 national
average hourly wages unadjusted for
occupational mix and adjusted for
occupational mix which resulted in
recalculating the FY 2019 wage indexes.
Additionally, for the four providers
(CCNs 050025, 050573, 120001, and
120002) for which we are applying
urban to rural reclassification under
§ 412.103 (as discussed in section II.B.
of this correcting document), we are
correcting the values where applicable
in the columns titled ‘‘FY 2019 Wage
Index’’, ‘‘Reclassified/Redesignated
CBSA’’, ‘‘Hospital Reclassified as Rural
Under Section 1886(d)(8)(E) of the Act
(§ 412.103)’’ and ‘‘Dual Status 412.103
and MGCRB/LUGAR’’. Also, the
revisions to Factor 3 of the
uncompensated care payment
methodology and recalculation of the
FY 2019 wage index necessitated the
recalculation of the rural floor budget
neutrality factor (as discussed in section
II.B. of this correcting document).
Therefore, we are correcting the values
in the column titled ‘‘FY 2019 Wage
Index’’ for all hospitals. Additionally,
for the two hospitals (CCNs 010001 and
100044) for which we inadvertently
used the incorrect wage and
occupational mix data (as discussed in
section II.A. of this correcting
document), we are correcting the
average hourly wages in the columns
titled ‘‘Average Hourly Wage FY 2019’’
and ‘‘3-Year Average Hourly Wage
(2017, 2018, 2019)’’. Furthermore, we
are deleting provider 060016 from the
wage index and Table 2 since it is a
CAH (as discussed in section II.A. of
this correcting document).
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Table 3.—Wage Index Table by
CBSA—FY 2019. The correction of the
wage data errors (as discussed in section
II.A. of this correcting document)
related to the three hospitals (CCNs
010001, 060016, and 100044) required
the recalculation of the FY 2019
national average hourly wage adjusted
for occupational mix which resulted in
recalculating the FY 2019 wage indexes.
Also, the revisions to Factor 3 of the
uncompensated care payment
methodology, recalculation of the FY
2019 wage index, and correction of the
reclassification errors discussed in
section II.B. of this correcting document
necessitated the recalculation of the
rural floor budget neutrality factor (as
discussed in section II.B. of this
correcting document). Therefore, we are
making corresponding changes to the
wage indexes and GAFs of all CBSAs
listed in Table 3. Specifically, we are
correcting the values and flags in the
columns titled ‘‘Wage Index’’,
‘‘Reclassified Wage Index’’, ‘‘GAF’’,
‘‘Reclassified GAF’’, ‘‘Pre-Frontier and/
or Pre-Rural Floor Wage Index’’ and
‘‘Eligible for Rural Floor Wage Index’’.
Also, we are making changes to reflect
the application of urban to rural
reclassification under § 412.103 for the
four providers (CCNs 050025, 050573,
120001 and 120002) discussed in
section II.B. of this correcting document.
Specifically, we are correcting the
values and flags in the columns titled
‘‘Wage Index’’, ‘‘Reclassified Wage
Index’’, ‘‘GAF’’, ‘‘Reclassified GAF’’,
‘‘Pre-Frontier and/or Pre-Rural Floor
Wage Index’’ and ‘‘Eligible for Rural
Floor Wage Index’’. Additionally, for the
3 CBSAs (06, 20020, and 38940) where
the three hospitals (CCNs 010001,
060016, and 100044) for which there
were wage data errors are located (as
discussed in section II.A. of this
correcting document), we are correcting
the average hourly wages in the
columns titled ‘‘FY 2019 Average
Hourly Wage’’ and ‘‘3-Year Average
Hourly Wage (2017, 2018, 2019)’’.
Table 4.—List of Counties Eligible for
the Out-Migration Adjustment under
Section 1886(d)(13) of the Act—FY
2019. The correction of the wage data
errors related to the three hospitals
(CCNs 010001, 060016, and 100044), as
discussed in section II.A. of this
correcting document, required the
recalculation of the FY 2019 national
average hourly wage adjusted for
occupational mix which resulted in
recalculating the FY 2019 wage indexes.
Also, the revisions to Factor 3 of the
uncompensated care payment
methodology, recalculation of the FY
2019 wage indexes, and correction of
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the reclassification errors discussed in
section II.B. of this correcting document
necessitated the recalculation of the
rural floor budget neutrality factor (as
discussed in section II.B. of this
correcting document). Also, we are
making changes to reflect the
application of urban to rural
reclassification under § 412.103 for the
four providers (CCNs 050025, 050573,
120001 and 120002), as discussed in
section II.B. of this correcting document.
Therefore, we are making corresponding
changes to the eligible counties and out
migration values listed in Table 4.
Specifically, we are correcting the list of
counties and values in the columns
titled ‘‘FIPS County Code’’, ‘‘County
Name’’, ‘‘State’’, ‘‘State Code’’, ‘‘Fiscal
Year Begin of Adjustment’’ and ‘‘FY
2019 Out Migration’’.
Table 18.—FY 2019 Medicare DSH
Uncompensated Care Payment Factor 3.
We are correcting this table to reflect
revisions to the Factor 3 calculations for
purposes of determining
uncompensated care payments for the
FY 2019 IPPS/LTCH PPS final rule for
the following reasons:
• To reflect mergers where data for
the merged hospital were not combined
with the data for the surviving hospital.
• To correct the projected DSH
eligibility for a SCH that now has CAH
status, and therefore is no longer
included in Table 18.
• To correct a provider’s Factor 3 that
was inadvertently calculated using the
methodology for all-inclusive rate
providers.
• To correct the Factor 3s that were
computed for hospitals whose FY 2014
or FY 2015 cost report in the June 2018
extract of Healthcare Cost Report
Information System (HCRIS)
inadvertently omitted amended
uncompensated care cost data that had
been reported by the hospital on an
amended Worksheet S–10 in a timely
manner per Change Request (CR) 10378
issued on December 1, 2017, or where
the FY 2014 or FY 2015 cost report for
a DSH eligible hospital had
inadvertently been uploaded into HCRIS
without making the calculation
modifications described in Transmittal
11, and to reflect the cost-to-charge ratio
(CCR) trim changes resulting from the
inclusion of the inadvertently omitted
data.
We are revising Factor 3 for all
hospitals to correct these errors. We are
also revising the amount of the total
uncompensated care payment
calculated for each DSH-eligible
hospital. The total uncompensated care
payment that a hospital receives is used
to calculate the amount of the interim
uncompensated care payments the
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hospital receives per discharge. We also
corrected the per discharge interim
uncompensated care payment for all
hospitals to reflect the 2017 discharges
as shown on the FY 2019 IPPS Impact
File. We also corrected the per discharge
interim uncompensated care payment
calculated for a merged hospital to
reflect the discharges for the subsumed
hospital. Per discharge uncompensated
care payments are included when
determining total payments for purposes
of all of the budget neutrality factors
and the final outlier threshold. As a
result, these corrections to the
uncompensated care payments
impacted the calculation of all the
budget neutrality factors as well as the
outlier fixed-loss cost threshold. These
corrections will be reflected in Table 18
and the Medicare DSH Supplemental
Data File. In section IV.C. of this
correcting document, we have made
corresponding revisions to the
discussion of the ‘‘Effects of the Changes
to Medicare DSH and Uncompensated
Care Payments for FY 2019’’ for
purposes of the Regulatory Impact
Analysis in Appendix A of the FY 2019
IPPS/LTCH PPS final rule to reflect the
corrections discussed previously.
We are also correcting the errors in
the following LTCH PPS tables that are
listed on 41739 through 41740 of the FY
2019 IPPS/LTCH PPS final rule and are
available on the internet on the CMS
website at https://www.cms.gov/
Medicare/Medicare-Fee-for-ServicePayment/LongTermCareHospitalPPS/
index.html under the list item for
regulation number CMS–1694–F. The
tables that are available on the internet
have been updated to reflect the
revisions discussed in this correcting
document.
Table 11.—MS–LTC–DRGs, Relative
Weights, Geometric Average Length of
Stay, Short-Stay Outlier (SSO)
Threshold for Discharges Occurring
from October 1, 2018 through
September 30, 2019 under the LTCH
PPS. We are correcting this table to
reflect the revisions to the MS–LTC–
DRG relative weights, geometric average
length-of-stay, and short-stay outlier
threshold due to the inadvertent
inclusion of an all-inclusive rate
provider as discussed in section II.A. of
this correcting document.
Table 12A.—LTCH PPS Wage Index
for Urban Areas for Discharges
Occurring from October 1, 2018 through
September 30, 2019. We are correcting
this table to reflect the revisions to the
LTCH PPS wage index values discussed
in section II.A. of this correcting
document.
Table 12B.—LTCH PPS Wage Index
for Rural Areas for Discharges Occurring
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from October 1, 2018 through
September 30, 2019. We are correcting
this table to reflect the revisions to the
LTCH PPS wage index values discussed
in section II.A. of this correcting
document.
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III. Waiver of Proposed Rulemaking,
60-Day Comment Period, and Delay in
Effective Date
Under 5 U.S.C. 553(b) of the
Administrative Procedure Act (APA),
the agency is required to publish a
notice of the proposed rulemaking 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 rulemaking 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) of the Act mandate a 30day delay in effective date after issuance
or publication of a rule. Sections
553(b)(B) and 553(d)(3) of the APA
provide for exceptions from the notice
and comment and delay in effective date
APA requirements; in cases in which
these exceptions apply, sections
1871(b)(2)(C) and 1871(e)(1)(B)(ii) of the
Act provide exceptions from the notice
and 60-day comment period and delay
in effective date requirements of the Act
as well. Section 553(b)(B) of the APA
and section 1871(b)(2)(C) of the Act
authorize an agency to dispense with
normal rulemaking requirements for
good cause if the agency makes a
finding that the notice and comment
process are impracticable, unnecessary,
or contrary to the public interest. In
addition, both section 553(d)(3) of the
APA and section 1871(e)(1)(B)(ii) of the
Act allow the agency to avoid the 30day delay in effective date where such
delay is contrary to the public interest
and an agency includes a statement of
support.
We believe that this correcting
document does not constitute a rule that
would be subject to the notice and
comment or delayed effective date
requirements. The document corrects
technical and typographical errors in
the preamble, addendum, payment
rates, tables, and appendices included
or referenced in the FY 2019 IPPS/LTCH
PPS final rule, but does not make
substantive changes to the policies or
payment methodologies that were
adopted in the final rule. As a result,
this correcting document is intended to
ensure that the information in the FY
2019 IPPS/LTCH PPS final rule
accurately reflects the policies adopted
in that document.
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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 2019 IPPS/LTCH PPS final rule
accurately reflects our methodologies
and policies. Furthermore, such
procedures would be unnecessary, as
we are not making substantive changes
to our 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
2019 IPPS/LTCH PPS final rule
accurately reflects these methodologies
and policies. Therefore, we believe we
have good cause to waive the notice and
comment and effective date
requirements.
IV. Correction of Errors
In FR Rule Doc. 2018–16766 of
August 17, 2018 (83 FR 41144), we are
making the following corrections:
A. Corrections of Errors in the Preamble
1. On page 41144, third column, sixth
and seventh full paragraph, the contact
information ‘‘Elizabeth Holland, (410)
786–1309, Promoting Interoperability
Programs. Clinical Quality Measure
Related Issues. Kathleen Johnson, (410)
786–3295 and Steven Johnson (410)
786–3332, Promoting Interoperability
Programs Nonclinical Quality Measure
Related Issues.’’ is corrected to read
‘‘Jessica Wright, (410) 786–3838,
Medicare Promoting Interoperability
Program’’.
2. On page 41151, second column,
second bulleted paragraph,
a. Line 13, the figure ‘‘2,610’’ is
corrected to read ‘‘2,599’’.
b. Line 19, the figure ‘‘$566’’ is
corrected to read ‘‘$550’’.
3. On page 41200, between the
untitled tables, first column, first full
paragraph, line 27, the phrase ‘‘primary
and secondary diagnoses’’ is corrected
to read ‘‘principal and secondary
diagnoses’’.
4. On page 41219, middle of the page,
third column, partial paragraph, line 13,
the phrase ‘‘primary and secondary
diagnoses’’ is corrected to read
‘‘principal and secondary diagnoses’’.
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5. On page 41236, lower half of the
page, third column, first partial
paragraph, line 2, the phrase ‘‘primary
diagnosis’’ is corrected to read
‘‘principal diagnosis’’.
6. On page 41254, lower two-thirds of
the page, first column, partial
paragraph, lines 12 through 17, the
phrase ‘‘MS–DRGs 163, 164, and 165
(Major Chest Procedures with MCC,
with CC, and without CC/MCC,
respectively) in MDC 4 (Diseases and
Disorders of the Respiratory System);’’
to read ‘‘MS–DRGs 163, 164, and 165
(Major Chest Procedures with MCC,
with CC, and without CC/MCC,
respectively) and MS–DRGs 166, 167,
and 168 (Other Respiratory System O.R.
Procedures with MCC, with CC, and
without CC/MCC, respectively) in MDC
4 (Diseases and Disorders of the
Respiratory System);’’.
7. On page 41299, second column,
first partial paragraph, lines 2 through 7,
the sentence ‘‘Cases involving
KYMRIAH and YESCARTA that are
eligible for new technology add-on
payments will be identified by ICD–10–
PCS procedure codes XW033C3 and
XW043C3.’’ is corrected to read ‘‘Cases
involving KYMRIAH and YESCARTA
that are eligible for new technology addon payments will be identified by either
of the following ICD–10–PCS procedure
codes: XW033C3 (Introduction of
engineered autologous chimeric antigen
receptor T-cell immunotherapy into
peripheral vein, percutaneous approach,
new technology group 3) or XW043C3
(Introduction of engineered autologous
chimeric antigen receptor T-cell
immunotherapy into central vein,
percutaneous approach, new technology
group 3).’’
8. On page 41311, second column,
first partial paragraph, lines 46 through
51, the phrase ‘‘FY 2019 cases involving
the use of VABOMERETM that are
eligible for the FY 2019 new technology
add-on payments will be identified by
the NDC of 65293–009–01
(VABOMERETM MeropenemVaborbactam Vial).’’ is corrected to read
‘‘FY 2019 cases involving the use of
VABOMERETM that are eligible for the
FY 2019 new technology add-on
payments will be identified by the NDC
of 65293–0009–01 (VABOMERETM
Meropenem-Vaborbactam Vial).’’
9. On page 41313, first column, first
partial paragraph, line 8, the phrase
‘‘primary diagnosis’’ is corrected to read
‘‘principal diagnosis’’.
10. On page 41320, second column,
first partial paragraph, line 15, the code
‘‘05H043MZ’’ is corrected to read
‘‘05H43MZ’’.
11. On page 41334, second column,
first full paragraph, lines 20 through 24,
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the sentence ‘‘Cases involving
ZEMDRITM that are eligible for new
technology add-on payments will be
identified by ICD–10–PCS procedure
codes XW033G4 and XW043G4.’’ is
corrected to read ‘‘Cases involving
ZEMDRITM that are eligible for new
technology add-on payments will be
identified by either of the following
ICD–10–PCS procedure codes:
XW033G4 (Introduction of Plazomicin
anti-infective into peripheral vein,
percutaneous approach, new technology
group 4) or XW043G4 (Introduction of
Plazomicin anti-infective into central
vein, percutaneous approach, new
technology group 4).’’
12. On page 41342, second column,
first partial paragraph, lines 3 and 4, the
phrase ‘‘identified by ICD–10–PCS
procedure codes XW033H4 and
XW043H4.’’ is corrected to read
‘‘identified by either of the following
ICD–10–PCS procedure codes:
XW033H4 (Introduction of synthetic
human angiotensin II into peripheral
vein, percutaneous approach, new
technology group 4) or XW043H4
(Introduction of synthetic human
angiotensin II into central vein,
percutaneous approach, new technology
group 4).’’
13. On page 41348, second column,
first full paragraph, line 17, the figure
‘‘$2,400’’ is corrected to read ‘‘$2,800’’.
14. On page 41362, first column, first
partial paragraph, lines 4 through 7, the
phrase ‘‘eligible for new technology
add-on payments will be identified by
ICD–10–PCS procedure codes XW03372
and XW04372.’’ is corrected to read
‘‘eligible for new technology add-on
payments will be identified by either of
the following ICD–10–PCS procedure
codes: XW03372 (Introduction of
Andexanet alfa, factor Xa inhibitor
reversal agent into peripheral vein,
percutaneous approach, new technology
group 2) or XW04372 (Introduction of
Andexanet alfa, factor Xa inhibitor
reversal agent into central vein,
percutaneous approach, new technology
group 2).’’
15. On page 41364, third column, first
partial paragraph—
a. Line 10, the figure ‘‘3’’ is corrected
to read ‘‘4’’.
b. Line 18, the figure ‘‘11’’ is corrected
to read ‘‘12’’.
c. Line 21, the figure ‘‘3’’ is corrected
to read ‘‘4’’.
d. Line 23, the figure ‘‘3,283’’ is
corrected to read ‘‘3,282’’.
e. Lines 23 through 24, the figure
‘‘(3,260 + 28 ¥ 2 ¥ 3 = 3,283)’’ is
corrected to read ‘‘(3,260 + 28 ¥ 2 ¥
4 = 3,282)’’.
16. On page 41365—
a. Second column, third full
paragraph, last line, the figure
‘‘$42.997789358’’ is corrected to read
‘‘$42.998002633’’.
b. Third column, first partial
paragraph, line 32, the figure
‘‘$42.997789358’’ is corrected to read
‘‘$42.998002633’’.
17. On page 41368, third column, first
partial paragraph, line 21, the figure
‘‘3,283’’ is corrected to read ‘‘3,282’’.
18. On page 41375—
a. Second column—
i. First partial paragraph—
A. Line 2, the figure ‘‘3,283’’ is
corrected to read ‘‘3,282’’.
B. Line 3, the figure ‘‘3,114’’ is
corrected to read ‘‘3,113’’.
C. Lines 6 and 7, the parenthetical
figures ‘‘(3,114/3,283)’’ are corrected to
read ‘‘(3,113/3,282)’’.
D. Last line, the figure
‘‘$42.955567020’’ is corrected to read
‘‘$42.955981146’’.
ii. Following the first full paragraph
the untitled table is corrected to read as
follows:
Final unadjusted
national average
hourly wage
Final occupational
mix adjusted
national average
hourly wage
$42.998002633
$42.955981146
b. Third column,
i. Top of the column (before the first
full paragraph), the untitled table is
corrected to read as follows:
Occupational mix nursing
subcategory
Average
hourly wage
National RN ..........................
National LPN and Surgical
Technician .........................
National Nurse Aide, Orderly,
and Attendant ....................
National Medical Assistant ...
$41.65745883
24.73751208
16.96596364
18.13187187
Occupational mix nursing
subcategory
National Nurse Category ......
35.03615689
ii. First full paragraph, line 4, the
figure ‘‘$35.04005228’’ is corrected to
read ‘‘$35.03615689’’.
19. On page 41406, second column,
first full paragraph, line 30, the term
‘‘Facto’’ is corrected to read ‘‘Factor’’.
20. On page 41415, third column—
a. Second full paragraph,
i. Line 26, the phrase ‘‘5 hospitals’’ is
corrected to read ‘‘16 hospitals’’.
ii. Line 28, the figure ‘‘1.031’’ is
corrected to read ‘‘1.032’’.
iii. Line 30, the figure ‘‘0.93’’ is
corrected to read ‘‘0.929’’.
b. Fourth full paragraph, line 10, the
phrase ‘‘14 hospitals’’ is corrected to
read ‘‘25 hospitals’’.
21. On page 41432, first column, first
partial paragraph, lines 2 and 3, the
phrase ‘‘FY 2018’’ is corrected to read
‘‘FY 2019’’.
22. On page 41436, second column,
last bulleted paragraph, the sentence,
‘‘March 2018 update of the FY 2017
MedPAR files to identify claims within
FY 2017’’ is corrected to read ‘‘March
2018 update of the FY 2017 MedPAR
file to identify claims within FY 2017
with discharge dates that are on or
before June 30, 2017.’’
23. On page 41446, third column,
section heading ‘‘c. Removal of Ten
Measures From the Hospital VBP
Program’’ is corrected to read ‘‘c.
Removal of Four Measures From the
Hospital VBP Program’’.
24. On page 41452, third column,
footnote paragraph (footnote 241), the
date ‘‘(August 20, 2017)’’ is corrected to
read ‘‘(August 30, 2017)’’.
25. On page 41469, table titled
‘‘Previously Adopted and Newly
Displayed Performance Standards for
the FY 2021 Program Year: Safety,
Clinical Outcomes, and Efficiency and
Cost Reduction Domains’’, under
‘‘Safety Domain’’, the entries in the
‘‘Benchmark’’ column for the CAUTI,
CLABSI, MRSA Bacteremia, and Colon
and Abdominal Hysterectomy SSI
measures are corrected to read to three
decimal places as follows:
Achievement
threshold
Measure short name
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hourly wage
Benchmark
Safety Domain
CAUTI ......................................................................................................................................................................
CLABSI ....................................................................................................................................................................
CDI ...........................................................................................................................................................................
MRSA Bacteremia ...................................................................................................................................................
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Achievement
threshold
Measure short name
Colon and Abdominal Hysterectomy SSI ................................................................................................................
26. On page 41488, first column, last
paragraph, line 7, the phrase ‘‘HAI data’’
is corrected to read ‘‘HAI measure’’.
27. On page 41528, third column, last
paragraph, line 29, the figure
‘‘0.9931052’’ is corrected to read
‘‘0.9935905’’.
28. On page 41529, first column, first
full paragraph, line 7, the figure
‘‘0.9931052’’ is corrected to read
‘‘0.9935905’’.
29. On page 41536, third column—
a. First bulleted paragraph, line 2, the
figure ‘‘0.990884’’ is corrected to read
‘‘0.990878’’.
b. Second bulleted paragraph, line 2,
the figure ‘‘0.990741’’ is corrected to
read ‘‘0.990737’’.
30. On page 41537—
a. Second column, last paragraph, last
line, the figure ‘‘0.990741’’ is corrected
to read ‘‘0.990737’’.
b. Third column, second full
paragraph—
i. Line 6, the figure ‘‘0.990884’’ is
corrected to read ‘‘0.990878’’.
ii. Lines 13, the figure ‘‘0.990884’’ is
corrected to read ‘‘0.990878’’.
31. On page 41556, third column, last
bulleted paragraph, line 4, the
parenthetical phrase (NQF # 2515) is
corrected to read ‘‘(NQF # 2558)’’.
32. On page 41558, second column,
last paragraph, line 7, the phrase ‘‘FYs
2020, 2021, and 2020’’ is corrected to
read ‘‘FYs 2020, 2021, and 2022’’
33. On page 41576, in the table titled
‘‘SUMMARY OF HOSPITAL IQR
• 0.754
• 0.726
49843
Benchmark
• 0.000
• 0.000
PROGRAM MEASURES NEWLY
FINALIZED FOR REMOVAL,’’ under
the ‘‘Claims-Based Coordination of Care
Measures’’, first column (Short name),
the fifth entry ‘‘READM–30–PNA’’ is
corrected to read ‘‘READM–30–PN’’.
34. On page 41579, table titled
‘‘MEASURES FOR THE FY 2021
PAYMENT DETERMINATION,’’ under
‘‘Claims-Based Mortality Measures’’, the
following entries are corrected by:
a. Removing the inadvertently
included asterisk at the end of the full
measure name for MORT–30–STK; and
b. Adding a row to the table to
include an entry for MORT–30–CABG,
which was inadvertently omitted, such
that the table will read as follows:
Claims-Based Mortality Measures
MORT–30–CABG .....................................
MORT–30–STK ........................................
Hospital 30-Day, All-Cause, Risk-Standardized Mortality Rate Following Coronary
Artery Bypass Graft (CABG) Surgery.
Hospital 30-Day, All-Cause, Risk-Standardized Mortality Rate Following Acute
Ischemic Stroke.
35. On page 41579, table titled
‘‘MEASURES FOR THE FY 2021
PAYMENT DETERMINATION,’’ under
STK–06 .....................................................
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read ‘‘2018 eCQM specifications update
(published in May 2018)’’.
B. Correction of Errors in the Addendum
1. On page 41715, third column,
fourth full paragraph, lines 3 and 8, the
figure ‘‘0.997192’’ is corrected to read
‘‘0.997190’’.
2. On page 41716—
a. First column, fourth full paragraph,
line 9, the figure ‘‘1.000748’’ is
corrected to read ‘‘1.000746’’.
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0439
Prophylaxis’’ to reflect the complete
measure name ‘‘Intensive Care Unit
Venous Thromboembolism
Prophylaxis.’’
Intensive Care Unit Venous Thromboembolism Prophylaxis ......................................
37. On page 41599, third column,
a. Third full paragraph, lines 4 and 5,
the phrase ‘‘disparity measures’’ is
corrected to read ‘‘disparity methods’’.
b. Last paragraph, line 9, the phrase
‘‘disparity measures’’ is corrected to
read ‘‘disparity methods’’.
38. On page 41672, first column,
fourth paragraph, lines 9 through 11, the
phrase ‘‘Spring 2017 version of the CQM
electronic specifications’’ is corrected to
VerDate Sep<11>2014
Quality Measures (eCQMs))’’, second
column (Measure Name), the last line
down, the measure name for the entry
for VTE–2 is corrected from ‘‘Intensive
Care Unit Thromboembolism
N/A
column (NQF #), line 11, for the entry
for STK–06, the NQF number ‘‘0438’’ is
corrected to read ‘‘0439’’ as follows:
Discharged on Statin Medication .................................................................................
36. On page 41579, table titled
‘‘MEASURES FOR THE FY 2021
PAYMENT DETERMINATION,’’ under
‘‘EHR-Based Clinical Process of Care
Measures (that is, Electronic Clinical
VTE–2 .......................................................
‘‘EHR-Based Clinical Process of Care
Measures (that is, Electronic Clinical
Quality Measures (eCQMs))’’, third
2558
0372
b. Second column, second full
paragraph, line 11, the figure
‘‘0.985932’’ is corrected to read
‘‘0.985335’’.
c. Third column, second full
paragraph, line 3, the figure ‘‘0.993142’’
is corrected to read ‘‘0.993911’’.
3. On page 41722—
a. Middle of the page, the untitled
table is corrected to read as follows:
E:\FR\FM\03OCR1.SGM
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49844
Federal Register / Vol. 83, No. 192 / Wednesday, October 3, 2018 / Rules and Regulations
Covered charges
(April 1, 2016,
through
March 31, 2017)
Quarter
Cases
(April 1, 2016,
through
March 31, 2017)
Covered charges
(April 1, 2017,
through
March 31, 2018)
Cases
(April 1, 2017,
through
March 31, 2018)
April–June ........................................................................
July–September ...............................................................
October–December ..........................................................
January–March ................................................................
$135,512,389,540
132,339,957,018
138,602,493,305
150,230,629,335
2,415,120
2,356,775
2,413,871
2,559,371
$141,310,805,358
136,951,808,593
141,939,083,023
120,924,791,134
2,407,887
2,319,109
2,363,685
1,983,155
Total ..........................................................................
556,685,469,198
9,745,137
541,126,488,108
9,073,836
b. Bottom of the page, first column,
i. First paragraph,
ii. Lines 5, the figures ‘‘$57,448
($559,839,156,948/9,745,137)’’ are
corrected to read ‘‘$57,124
($556,685,469,198/9,745,137)’’.
iii. Lines 9 through 10, the figures
‘‘$59,939.96 ($543,885,328,430/
9,073,836)’’ are corrected to read
‘‘$59,636 ($541,126,488,108/
9,073,836)’’.
iv. Lines 13 through 14, the figures
‘‘4.3 percent (1.04338)’’ are corrected to
read ‘‘4.4 percent (1.04396)’’.
v. Line 14, the figures ‘‘8.9 percent
(1.08864)’’ are corrected to read ‘‘9.0
percent (1.08986)’’.
4. On page 41723, first column—
a. Third full paragraph—
i. Line 5, the figure ‘‘$25,769’’ is
corrected to read ‘‘$25,743’’.
ii. Line 7, the figure
‘‘$88,484,589,041’’ is corrected to read
‘‘$88,485,100,546’’.
iii. Line 8, the figure
‘‘$4,755,375,555’’ is corrected to read
‘‘$4,755,311,111’’.
iv. Lines 12 through 13, the
parenthetical phrase
‘‘(($88,484,589,041/$93,239,964,596) ×
100 = 5.1 percent)’’ is corrected to read
‘‘((1 ¥ ($88,485,100,546/
$93,240,411,657)) × 100 = 5.1 percent)’’.
v. Last line, the figure ‘‘$25,769’’ is
corrected to read ‘‘$25,743’’.
c. Following the sixth full paragraph,
the untitled table is corrected to read as
follows:
Operating
standardized
amounts
Capital
Federal
rate
0.948999
0.949417
National .............
5. On pages 41724 through 41725, the
table titled ‘‘CHANGES FROM FY 2018
STANDARDIZED AMOUNTS TO THE
FY 2019 STANDARDIZED AMOUNTS’’,
is corrected to read as follows:
CHANGES FROM FY 2018 STANDARDIZED AMOUNTS TO THE FY 2019 STANDARDIZED AMOUNTS
FY 2018 Base Rate after removing:
1. FY 2018 Geographic Reclassification
Budget Neutrality (0.987985)
2. FY 2018 Operating Outlier Offset
(0.948998)
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FY 2019 Update Factor ...................................
FY 2019 MS–DRG Recalibration Budget Neutrality Factor.
FY 2019 Wage Index Budget Neutrality Factor.
FY 2019 Reclassification Budget Neutrality
Factor.
FY 2019 Operating Outlier Factor ...................
FY 2019 Rural Demonstration Budget Neutrality Factor.
Adjustment for FY 2019 Required under Section 414 of Public Law 114–10 (MACRA).
National Standardized Amount for FY 2019 if
Wage Index is Greater Than 1.0000; Labor/
Non-Labor Share Percentage (68.3/31.7).
National Standardized Amount for FY 2019 if
Wage Index is Less Than or Equal to
1.0000; Labor/Non-Labor Share Percentage
(62/38).
6. On page 41727—
a. First column, second full
paragraph, line 13, the figure
‘‘0.997192’’ is corrected to read,
‘‘0.997190’’.
b. Second column, second full
paragraph, line 6, the figure ‘‘1.27
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Hospital submitted quality
data and is a
meaningful EHR user
Hospital submitted quality
data and is NOT a
meaningful EHR user
Hospital did NOT submit
quality data and is a
meaningful EHR user
Hospital did NOT submit
quality data and is NOT a
meaningful EHR user
If Wage Index is Greater
Than 1.0000:
Labor (68.3%): $4,059.36 ..
Nonlabor (30.4%):
$1,884.07.
If Wage Index is less Than
or Equal to 1.0000:
Labor (62%):
$3,684.92.
Nonlabor (38%):
$2,258.50.
1.0135 ................................
0.99719 ..............................
If Wage Index is Greater
Than 1.0000:
Labor (68.3%): $4,059.36 ..
Nonlabor (30.4%):
$1,884.07.
If Wage Index is less Than
or Equal to 1.0000:
Labor (62%):
$3,684.92.
Nonlabor (38%):
$2,258.50.
0.99175 ..............................
0.99719 ..............................
If Wage Index is Greater
Than 1.0000:
Labor (68.3%): $4,059.36 ..
Nonlabor (30.4%):
$1,884.07.
If Wage Index is less Than
or Equal to 1.0000:
Labor (62%):
$3,684.92.
Nonlabor (38%):
$2,258.50.
1.00625 ..............................
0.99719 ..............................
If Wage Index is Greater
Than 1.0000:
Labor (68.3%): $4,059.36.
Nonlabor (30.4%):
$1,884.07.
If Wage Index is less Than
or Equal to 1.0000:
Labor (62%):
$3,684.92.
Nonlabor (38%):
$2,258.50.
0.9845.
0.99719.
1.000746 ............................
1.000746 ............................
1.000746 ............................
1.000746.
0.985335 ............................
0.985335 ............................
0.985335 ............................
0.985335.
0.948999 ............................
0.999467 ............................
0.948999 ............................
0.999467 ............................
0.948999 ............................
0.999467 ............................
0.948999.
0.999467.
1.005 ..................................
1.005 ..................................
1.005 ..................................
1.005.
Labor: $3,856.27 ................
Nonlabor: $1,789.81 ..........
Labor: $3,773.51 ................
Nonlabor: $1,751.40 ..........
Labor: $3,828.68 ................
Nonlabor: $1,777.01 ..........
Labor: $3,745.93.
Nonlabor: $1,738.60.
Labor: $3,500.57 ................
Nonlabor: $2,145.51 ..........
Labor: $3,425.44 ................
Nonlabor: $2,099.47 ..........
Labor: $3,475.53 ................
Nonlabor: $2,130.16 ..........
Labor: $3,400.41.
Nonlabor: $2,084.12.
percent’’ is corrected to read ‘‘1.20
percent’’.
7. On page 41728, third column—
a. Second full paragraph, line 12, the
figure ‘‘0.9986’’ is corrected to read
‘‘0.9980’’.
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b. Third full paragraph, line 14, the
figure ‘‘0.9975’’ is corrected to read
‘‘0.9969’’.
8. On page 41729—
a. Top of the page—
i. First column—
A. First full paragraph—
1. Line 2, the figure ‘‘0.9975’’ is
corrected to read ‘‘0.9969’’.
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Federal Register / Vol. 83, No. 192 / Wednesday, October 3, 2018 / Rules and Regulations
2. Line 4, the figure ‘‘0.9986’’ is
corrected to read ‘‘0.9980’’.
ii. Second column—
B. First full paragraph—
1. Line 8, the figure ‘‘$459.72’’ is
corrected to read ‘‘$459.41’’.
2. Line 17, the figure ‘‘0.9975’’ is
corrected to read ‘‘0.9969’’.
3. Third column, first paragraph—
a. Line 14, the figure ‘‘0.25’’ is
corrected to read ‘‘0.31’’.
b. Line 20, the figure ‘‘1.27’’ is
corrected to read ‘‘1.20’’.
49845
b. Middle of page,
i. The table titled ‘‘COMPARISON OF
FACTORS AND ADJUSTMENTS: FY
2018 CAPITAL FEDERAL RATE AND
FY 2019 CAPITAL FEDERAL RATE’’ is
corrected to read as follows:
COMPARISON OF FACTORS AND ADJUSTMENTS: FY 2018 CAPITAL FEDERAL RATE AND FY 2019 CAPITAL FEDERAL RATE
FY 2018
Update Factor 1 ................................................................................................
GAF/DRG Adjustment Factor 1 ........................................................................
Outlier Adjustment Factor 2 ..............................................................................
Capital Federal Rate ........................................................................................
1.0130
0.9987
0.9483
$453.95
FY 2019
1.0140
0.9969
0.9494
$459.41
Change
1.014
0.9969
1.0012
1.0120
Percent
change
1.40
¥0.31
0.12
3 1.20
1 The update factor and the GAF/DRG budget neutrality adjustment factors are built permanently into the capital Federal rates. Thus, for example, the incremental change from FY 2018 to FY 2019 resulting from the application of the 0.9969 GAF/DRG budget neutrality adjustment factor
for FY 2019 is a net change of 0.9969 (or ¥0.31percent).
2 The outlier reduction factor is not built permanently into the capital Federal rate; that is, the factor is not applied cumulatively in determining
the capital Federal rate. Thus, for example, the net change resulting from the application of the FY 2019 outlier adjustment factor is 0.9494/
0.9483 or 1.0012 (or 0.12 percent).
3 Percent change may not sum due to rounding.
ii. The table titled ‘‘COMPARISON OF
FACTORS AND ADJUSTMENTS:
PROPOSED FY 2019 CAPITAL
FEDERAL RATE AND FINAL FY 2019
CAPITAL FEDERAL RATE’’ is corrected
to read as follows:
COMPARISON OF FACTORS AND ADJUSTMENTS: PROPOSED FY 2019 CAPITAL FEDERAL RATE AND FINAL FY 2019
CAPITAL FEDERAL RATE
Proposed FY
2019
Update Factor ..................................................................................................
GAF/DRG Adjustment Factor ..........................................................................
Outlier Adjustment Factor ................................................................................
Capital Federal Rate ........................................................................................
1.0120
0.9997
0.9494
$459.78
Final FY 2019
1.0140
0.9969
0.9494
$459.41
Change
1.0020
0.9972
0.0000
0.9992
Percent
change *
0.20
¥0.28
0.00
¥0.0008
* Percent change may not sum due to rounding.
daltland on DSKBBV9HB2PROD with RULES
c. Bottom of page, second column,
first partial paragraph, last line, the
figure, ‘‘$25,769’’ is corrected to read
‘‘$25,743’’.
9. On page 41730, third column, last
paragraph, line 21, the figure
‘‘0.999713.’’ is corrected to read
‘‘0.999215’’.
10. On page 41731, first column, first
partial paragraph—
a. Line 3, the figure ‘‘0.990884’’ is
corrected to read ‘‘0.990878’’.
b. Lines 10 and 11, the mathematical
phrase ‘‘$41,579.65 (calculated as
$41,415.11 × 1.0135 × 0.999713×
0.990884)’’ is corrected to read
‘‘$41,558.68 (calculated as $41,415.11 ×
1.0135 × 0.999215 × 0. 990878)’’.
c. Lines 18 through 20, ‘‘$40,759.12
(calculated as $41,415.11 × 0.9935 ×
0.999713× 0.990884)’’ is corrected to
read ‘‘$40,738.57 (calculated as
$41,415.11 × 0.9935 × 0.999215 × 0.
990878)’’.
11. On page 41733, second column,
last paragraph,
a. Line 6, the figure ‘‘0.999713’’ is
corrected to read ‘‘0.999215’’.
b. Line 11, the figure ‘‘0.999713’’ is
corrected to read ‘‘0.999215‘‘.
12. On page 41736, second column—
a. Third full paragraph—
i. Line 26, the figure, ‘‘$27,124’’ is
corrected to read ‘‘$27,121’’.
ii. Line 32, the figure, ‘‘$27,124’’ is
corrected to read ‘‘$27,121’’.
iii. Last line, the figure, ‘‘$27,124’’ is
corrected to read ‘‘$27,121’’.
b. Last partial paragraph, last line, the
figure, ‘‘$27,124’’ is corrected to read
‘‘$27,121’’.
13. On page 41737—
a. Second column, last paragraph, line
8, the figure, ‘‘$25,769’’ is corrected to
read ‘‘$25,743’’.
b. Third column—
i. First partial paragraph, last line, the
figure, ‘‘$25,769’’ is corrected to read
‘‘$25,743’’.
ii. Third full paragraph, line 3, the
figure, ‘‘$25,769’’ is corrected to read
‘‘$25,743’’.
14. On page 41738, third column, last
paragraph, line 26, the figure
‘‘$41,579.65’’ is corrected to read
‘‘$41,558.68’’.
15. On page 41739, top of page—
a. Second column, second partial
paragraph, last line, the figure
‘‘$41,579.65’’ is corrected to read
‘‘$41,558.68’’.
b. Third column, first partial
paragraph, line 13, the parenthetical
figure ‘‘($41,189.62)’’ is corrected to
read ‘‘($41,190.33)’’.
c. Untitled table, the table is corrected
to read as follows:
Unadjusted LTCH PPS Standard Federal Prospective Payment Rate .............................................................................................
Labor-Related Share ...........................................................................................................................................................................
Labor-Related Portion of the LTCH PPS Standard Federal Payment Rate .....................................................................................
Wage Index (CBSA 16974) .................................................................................................................................................................
Wage-Adjusted Labor Share of LTCH PPS Standard Federal Payment Rate ..................................................................................
Nonlabor-Related Portion of the LTCH PPS Standard Federal Payment Rate ($41,558.68 x 0.340) ............................................
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$41,558.68
× 0.660
= $27,428.73
1.0511
= $28,830.34
+ $14,129.95
49846
Federal Register / Vol. 83, No. 192 / Wednesday, October 3, 2018 / Rules and Regulations
Adjusted LTCH PPS Standard Federal Payment Amount ...............................................................................................................
MS–LTC–DRG 189 Relative Weight ..................................................................................................................................................
Total Adjusted LTCH PPS Standard Federal Prospective Payment ................................................................................................
16. On page 41740, bottom of the
page, the table titled ‘‘TABLE 1A—
NATIONAL ADJUSTED OPERATING
STANDARDIZED AMOUNTS, LABOR/
NONLABOR [(68.3 percent labor share/
31.7 percent nonlabor share if wage
= $42,960.29
× 0.9588
= $41,190.33
index is greater than 1)—FY 2019]’’ is
corrected to read as follows:
TABLE 1A—NATIONAL ADJUSTED OPERATING STANDARDIZED AMOUNTS, LABOR/NONLABOR
[(68.3 percent labor share/31.7 percent nonlabor share if wage index is greater than 1)—FY 2019]
Hospital submitted quality data
and is a meaningful
EHR user
(update = 1.35 percent)
Hospital submitted quality data
and is NOT a meaningful
EHR user
(update = ¥0.825 percent)
Hospital did NOT submit quality
data and is a meaningful
EHR user
(update = 0.625 percent)
Hospital did NOT submit quality
data and is NOT a meaningful
EHR user
(update = ¥1.55 percent)
Labor
Nonlabor
Labor
Nonlabor
Labor
Nonlabor
Labor
Nonlabor
$3,856.27
$1,789.81
$3,773.51
$1,751.40
$3,828.68
$1,777.01
$3,745.93
$1,738.60
STANDARDIZED AMOUNTS, LABOR/
NONLABOR [(62 percent labor share/38
percent nonlabor share if wage index is
17. On page 41741—
a. Top of the page—
i. The table titled ‘‘TABLE 1B—
NATIONAL ADJUSTED OPERATING
less than or equal to 1)—FY 2019]’’ is
corrected to read as follows:
TABLE 1B—NATIONAL ADJUSTED OPERATING STANDARDIZED AMOUNTS, LABOR/NONLABOR
[(62 percent labor share/38 percent nonlabor share if wage index is less than or equal to 1)—FY 2019]
Hospital submitted quality data
and is a meaningful
EHR user
(update = 1.35 percent)
Hospital submitted quality data
and is NOT a meaningful
EHR user
(update = ¥0.825 percent)
Hospital did NOT submit quality
data and is a meaningful
EHR user
(update = 0.625 percent)
Hospital did NOT submit quality
data and is NOT a meaningful
EHR user
(update = ¥1.55 percent)
Labor
Nonlabor
Labor
Nonlabor
Labor
Nonlabor
Labor
Nonlabor
$3,500.57
$2,145.51
$3,425.44
$2,099.47
$3,475.53
$3,475.53
$3,400.41
$2,084.12
ii. The table titled ‘‘Table 1C—
ADJUSTED OPERATING
STANDARDIZED AMOUNTS FOR
HOSPITALS IN PUERTO RICO,
LABOR/NONLABOR [(National: 62
percent labor share/38 percent nonlabor
share because wage index is less than or
equal to 1)—FY 2019]’’ is corrected to
read as follows:
TABLE 1C—ADJUSTED OPERATING STANDARDIZED AMOUNTS FOR HOSPITALS IN PUERTO RICO, LABOR/NONLABOR
[(National: 62 percent labor share/38 percent nonlabor share because wage index is less than or equal to 1)—FY 2019]
Rates if wage index is greater than 1
Rates if wage index is less than or equal to 1
Standardized amount
National 1 .....................................
1 For
Labor
Nonlabor
Not Applicable ..................
Not Applicable ..................
$3,500.57
Nonlabor
$2,145.51
FY 2019, there are no CBSAs in Puerto Rico with a national wage index greater than 1.
b. Middle of the page—
i. The table titled ‘‘Table 1D—
CAPITAL STANDARD FEDERAL
PAYMENT RATE [FY 2019]’’ is
corrected to read as follows:
TABLE 1D—CAPITAL STANDARD
FEDERAL PAYMENT RATE
[FY 2019]
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ii. The table titled ‘‘Table 1E—LTCH
PPS STANDARD FEDERAL PAYMENT
RATE [FY 2019]’’ is corrected to read as
follows:
Rate
National .................................
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Labor
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$459.41
E:\FR\FM\03OCR1.SGM
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Federal Register / Vol. 83, No. 192 / Wednesday, October 3, 2018 / Rules and Regulations
49847
TABLE 1E—LTCH PPS STANDARD FEDERAL PAYMENT RATE
[FY 2019]
Standard Federal Rate ................................................................................................................................
Full update
(1.35 percent)
Reduced update *
(¥0.65 Percent)
$41,558.68
$40,738.57
* For LTCHs that fail to submit quality reporting data for FY 2019 in accordance with the LTCH Quality Reporting Program (LTCH QRP), the
annual update is reduced by 2.0 percentage points as required by section 1886(m)(5) of the Act.
C. Corrections of Errors in the
Appendices
i. Line 1, the figure ‘‘3,256’’ is
corrected to read ‘‘3,255’’.
ii. Line 7, the figure ‘‘1,398’’ is
corrected to read ‘‘1,399’’.
2. On pages 41744 through 41746, the
table and table notes for the table titled
1. On page 41742—
a. Second column, second full
paragraph—
‘‘TABLE I—IMPACT ANALYSIS OF
CHANGES TO THE IPPS FOR
OPERATING COSTS FOR FY 2019’’ are
corrected to read as follows:
daltland on DSKBBV9HB2PROD with RULES
TABLE I—IMPACT ANALYSIS OF CHANGES TO THE IPPS FOR OPERATING COSTS FOR FY 2019
Number of
hospitals 1
Hospital rate
update and
adjustment
under MACRA
FY 2019
weights and
DRG changes
with
application of
recalibration
budget
neutrality
FY 2019 wage
data with
application of
wage budget
neutrality
FY 2019
MGCRB
reclassifications
Rural floor
with
application of
national rural
floor budget
neutrality
Application of
the frontier
wage index
and
outmigration
adjustment
(1) 2
(2) 3
(3) 4
(4) 5
(5) 6
(6) 7
(7) 8
All Hospitals ..................
By Geographic Location:
Urban hospitals ......
Large urban areas
Other urban areas ..
Rural hospitals .......
Bed Size (Urban):
0–99 beds ..............
100–199 beds ........
200–299 beds ........
300–499 beds ........
500 or more beds ..
Bed Size (Rural):
0–49 beds ..............
50–99 beds ............
100–149 beds ........
150–199 beds ........
200 or more beds ..
Urban by Region:
New England ..........
Middle Atlantic ........
South Atlantic .........
East North Central
East South Central
West North Central
West South Central
Mountain ................
Pacific .....................
Puerto Rico ............
Rural by Region:
New England ..........
Middle Atlantic ........
South Atlantic .........
East North Central
East South Central
West North Central
West South Central
Mountain ................
Pacific .....................
By Payment Classification:
Urban hospitals ......
Large urban areas
Other urban areas ..
Rural areas ............
Teaching Status:
Nonteaching ...........
Fewer than 100
residents .............
100 or more residents ...................
Urban DSH:
VerDate Sep<11>2014
16:40 Oct 02, 2018
All FY 2019
changes
3,255
1.8
0
0
0
0
0.1
2.4
2,483
1,302
1,181
772
1.8
1.8
1.8
1.5
0
0.1
0
¥0.3
0
0
0
¥0.1
¥0.1
¥0.8
0.6
1.2
0
0
0
¥0.1
0.1
0
0.2
0.1
2.5
2.4
2.5
1.2
644
763
433
424
219
1.7
1.8
1.8
1.8
1.8
¥0.5
0
0
0.1
0.1
0.1
0
0
0
0
¥0.8
¥0.1
0.1
0
¥0.2
0.2
0.2
0
¥0.1
0
0.2
0.2
0.1
0.1
0
1.7
2.2
2.3
2.5
2.9
305
274
108
45
40
1.4
1.3
1.6
1.7
1.7
¥0.5
¥0.4
¥0.5
¥0.1
0.1
0
0
¥0.1
¥0.2
¥0.2
0.2
0.7
0.9
2
2.3
¥0.1
¥0.1
¥0.1
¥0.2
¥0.2
0.2
0.2
0
0.3
0
0.9
1.1
1.2
1.4
1.5
113
310
401
386
147
158
379
164
374
51
1.8
1.8
1.8
1.8
1.8
1.8
1.8
1.7
1.8
1.8
0.1
0.2
0
0.1
0
¥0.1
0
¥0.1
¥0.1
0
¥0.5
0
¥0.1
¥0.2
0
0
0.2
¥0.7
0.8
¥1.2
2.7
0.2
¥0.6
¥0.5
¥0.5
¥0.9
¥0.8
0.4
0.1
¥1.3
2.4
¥0.3
¥0.3
¥0.3
¥0.3
¥0.3
¥0.3
0.6
0.2
0.1
0.1
0.1
0
0.1
0
0.6
0
0.3
0.1
0.1
4.7
2.3
2
2
2.1
2.1
2.3
2.2
3.3
0.7
20
53
122
114
150
94
145
51
23
1.5
1.5
1.6
1.5
1.7
1.3
1.5
1.3
1.4
0.1
¥0.2
¥0.2
¥0.3
¥0.1
¥0.5
¥0.3
¥1.1
¥0.4
¥0.5
¥0.1
¥0.2
0.1
¥0.2
0
0.2
¥0.4
¥0.2
1.5
0.6
1.7
0.9
2.5
0.1
1.3
¥0.1
0.8
¥0.2
¥0.1
¥0.1
¥0.1
¥0.3
0
¥0.3
¥0.1
¥0.1
0
0.1
0.1
0
0.1
0.2
0.2
0.8
0
0.9
1.4
1.2
1.1
1.8
0.9
1.5
0.8
1
2,264
1,317
947
991
1.8
1.8
1.8
1.7
0
0.1
0
¥0.1
0
0
0
0
¥0.6
¥0.7
¥0.4
2.1
0.1
0
0.2
¥0.2
0.1
0
0.2
0.1
2.3
2.4
2.1
2.7
2,156
1.7
¥0.1
0
0.1
0.1
0.1
2.1
849
1.8
0
0
¥0.2
¥0.1
0.2
2.2
250
1.8
0.2
0
0.1
¥0.1
0
3.1
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49848
Federal Register / Vol. 83, No. 192 / Wednesday, October 3, 2018 / Rules and Regulations
TABLE I—IMPACT ANALYSIS OF CHANGES TO THE IPPS FOR OPERATING COSTS FOR FY 2019—Continued
Number of
hospitals 1
Hospital rate
update and
adjustment
under MACRA
FY 2019
weights and
DRG changes
with
application of
recalibration
budget
neutrality
FY 2019 wage
data with
application of
wage budget
neutrality
FY 2019
MGCRB
reclassifications
Rural floor
with
application of
national rural
floor budget
neutrality
Application of
the frontier
wage index
and
outmigration
adjustment
(1) 2
(2) 3
(3) 4
(4) 5
(5) 6
(6) 7
(7) 8
Non–DSH ...............
100 or more beds ..
Less than 100 beds
Rural DSH:
SCH ........................
RRC .......................
100 or more beds ..
Less than 100 beds
Urban teaching and
DSH:
Both teaching and
DSH ....................
Teaching and no
DSH ....................
No teaching and
DSH ....................
No teaching and no
DSH ....................
Special Hospital Types:
RRC .......................
SCH ........................
MDH .......................
SCH and RRC .......
MDH and RRC .......
Type of Ownership:
Voluntary ................
Proprietary ..............
Government ...........
Medicare Utilization as a
Percent of Inpatient
Days:
0–25 .......................
25–50 .....................
50–65 .....................
Over 65 ..................
FY 2019 Reclassifications by the Medicare
Geographic Classification Review Board:
All Reclassified
Hospitals .............
Non-Reclassified
Hospitals .............
Urban Hospitals Reclassified .............
Urban Non-reclassified Hospitals ......
Rural Hospitals Reclassified Full
Year ....................
Rural Non-reclassified Hospitals Full
Year ....................
All Section 401 Reclassified Hospitals ...................
Other Reclassified
Hospitals (Section
1886(d)(8)(B)) .....
520
1,462
367
1.8
1.8
1.7
¥0.3
0.1
¥0.2
¥0.2
0
0.3
¥0.2
¥0.6
¥0.6
¥0.1
0.1
0.2
0.2
0.1
0.1
2
2.3
1.9
255
382
33
236
1.2
1.7
1.8
1.6
¥0.6
0
0
¥0.3
¥0.1
0.1
¥0.6
0
0
2.4
1.6
0.7
0
¥0.3
¥0.4
¥0.2
0
0.1
0.1
0.3
0.7
3.1
2.9
1.5
805
1.8
0.1
0
¥0.7
0
0.1
2.4
89
1.9
¥0.1
¥0.1
¥0.5
¥0.1
0
2.3
1,024
1.8
0
0.1
¥0.4
0.3
0.1
2.2
346
1.8
¥0.3
¥0.2
¥0.6
¥0.1
0.2
1.7
327
311
140
134
16
1.8
1.1
1.5
1.4
1.5
0
¥0.5
¥0.5
¥0.2
¥0.4
0.2
0.1
¥0.1
¥0.2
0
2.7
¥0.1
0.7
0.3
0.8
¥0.3
0
0
0
¥0.1
0.2
0
0
0.1
0
3.4
0.8
1.2
1.2
1.1
1,898
856
501
1.8
1.8
1.7
0
0
0
0
¥0.1
0.2
0.1
¥0.1
¥0.2
0
0
¥0.1
0.1
0.1
0
2.4
2.1
2.5
602
2,138
421
73
1.8
1.8
1.7
1.1
0.1
0
¥0.2
0.5
¥0.1
0
¥0.1
¥0.1
¥0.4
0
0.5
¥0.4
¥0.1
0
0.3
¥0.2
0
0.1
0.1
0.1
2.3
2.5
1.7
2.5
859
1.8
0
0.1
2.4
¥0.3
0
2.8
2,396
1.8
0
0
¥1.1
0.1
0.1
2.2
588
1.8
0
0.1
2.5
¥0.3
0
3.1
1,835
1.8
0
0
¥1.2
0.1
0.1
2.3
271
1.5
¥0.2
¥0.1
2.1
¥0.2
0.1
1.5
454
1.4
¥0.5
¥0.1
¥0.4
¥0.1
0.2
0.8
266
1.7
0
0.1
2.5
¥0.3
0.1
3.4
47
1.7
¥0.2
¥0.1
2.8
¥0.3
0
1.5
1 Because
daltland on DSKBBV9HB2PROD with RULES
All FY 2019
changes
data necessary to classify some hospitals by category were missing, the total number of hospitals in each category may not equal the national total. Discharge data are from FY 2017, and hospital cost report data are from reporting periods beginning in FY 2016 and FY 2015.
2 This column displays the payment impact of the hospital rate update and other adjustments, including the 1.35 percent adjustment to the national standardized
amount and the hospital-specific rate (the estimated 2.9 percent market basket update reduced by 0.8 percentage point for the multifactor productivity adjustment and
the 0.75 percentage point reduction under the Affordable Care Act), and the 0.5 percent adjustment to the national standardized amount required under section 414
of the MACRA.
3 This column displays the payment impact of the changes to the Version 36 GROUPER, the changes to the relative weights and the recalibration of the MS–DRG
weights based on FY 2017 MedPAR data in accordance with section 1886(d)(4)(C)(iii) of the Act. This column displays the application of the recalibration budget neutrality factor of 0.997190 in accordance with section 1886(d)(4)(C)(iii) of the Act.
4 This column displays the payment impact of the update to wage index data using FY 2015 cost report data and the OMB labor market area delineations based on
2010 Decennial Census data. This column displays the payment impact of the application of the wage budget neutrality factor, which is calculated separately from the
recalibration budget neutrality factor, and is calculated in accordance with section 1886(d)(3)(E)(i) of the Act. The wage budget neutrality factor is 1.000746.
5 Shown here are the effects of geographic reclassifications by the Medicare Geographic Classification Review Board (MGCRB). The effects demonstrate the FY
2019 payment impact of going from no reclassifications to the reclassifications scheduled to be in effect for FY 2019. Reclassification for prior years has no bearing
on the payment impacts shown here. This column reflects the geographic budget neutrality factor of 0.985335.
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49849
Federal Register / Vol. 83, No. 192 / Wednesday, October 3, 2018 / Rules and Regulations
6 This column displays the effects of the rural floor and expiration of the imputed floor. The Affordable Care Act requires the rural floor budget neutrality adjustment
to be 100 percent national level adjustment. The rural floor budget neutrality factor applied to the wage index is 0.993911.
7 This column shows the combined impact of the policy required under section 10324 of the Affordable Care Act that hospitals located in frontier States have a
wage index no less than 1.0 and of section 1886(d)(13) of the Act, as added by section 505 of Public Law 108–173, which provides for an increase in a hospital’s
wage index if a threshold percentage of residents of the county where the hospital is located commute to work at hospitals in counties with higher wage indexes.
These are not budget neutral policies.
8 This column shows the estimated change in payments from FY 2018 to FY 2019.
3. On page 41746, lower half of page,
second column, third paragraph, line 6,
the figure ‘‘0.997192’’ is corrected to
read ‘‘0.997190’’.
4. On page 41747—
a. Top half of page, second column,
first partial paragraph, line 19, the figure
‘‘1.000748’’ is corrected to read
‘‘1.000746’’.
b. Lower half of page, third column,
first partial paragraph—
i. First line, the figure ‘‘0.985932’’ is
corrected to read ‘‘0.985335’’.
ii. Line 11, ‘‘which will experience no
change’’ is corrected to read, ‘‘which
will experience a 0.1 percent decrease’’.
5. On page 41748, top of page—
a. First column, second full
paragraph—
i. Line 6, the figure ‘‘0.993142’’ is
corrected to read ‘‘0.993911’’.
ii. Line 7, the figure ‘‘0.69 percent’’ is
corrected to read ‘‘0.61 percent’’.
b. Second column, first full
paragraph—
i. Line 1, the figure ‘‘263’’ is corrected
to read ‘‘253’’.
ii. Line 5, the figure ‘‘0.993142’’ is
corrected to read ‘‘0.993911’’.
iii. Line 7, the figure ‘‘0.2’’ is
corrected to read ‘‘0.1’’.
iv. Line 22, the figure ‘‘2.5’’ is
corrected to read ‘‘2.4’’.
v. Line 30, the figure ‘‘$121 million’’
is corrected to read ‘‘$123 million’’.
6. On pages 41748 and 41749, the
table titled ‘‘FY 2019 IPPS ESTIMATED
PAYMENTS DUE TO RURAL FLOOR
WITH NATIONAL BUDGET
NEUTRALITY’’ is corrected to read as
follows:
FY 2019 IPPS ESTIMATED PAYMENTS DUE TO RURAL FLOOR WITH NATIONAL BUDGET NEUTRALITY
daltland on DSKBBV9HB2PROD with RULES
State
Number of
hospitals
Number of
hospitals that
would receive
the rural floor
Percent
change
in payments
due to
application of
rural floor
with budget
neutrality
(1)
(2)
(3)
Alabama ...........................................................................................................
Alaska ..............................................................................................................
Arizona .............................................................................................................
Arkansas ..........................................................................................................
California ..........................................................................................................
Colorado ..........................................................................................................
Connecticut ......................................................................................................
Delaware ..........................................................................................................
Washington, DC ...............................................................................................
Florida ..............................................................................................................
Georgia ............................................................................................................
Hawaii ..............................................................................................................
Idaho ................................................................................................................
Illinois ...............................................................................................................
Indiana .............................................................................................................
Iowa .................................................................................................................
Kansas .............................................................................................................
Kentucky ..........................................................................................................
Louisiana ..........................................................................................................
Maine ...............................................................................................................
Massachusetts .................................................................................................
Michigan ...........................................................................................................
Minnesota ........................................................................................................
Mississippi ........................................................................................................
Missouri ............................................................................................................
Montana ...........................................................................................................
Nebraska ..........................................................................................................
Nevada .............................................................................................................
New Hampshire ...............................................................................................
New Jersey ......................................................................................................
New Mexico .....................................................................................................
New York .........................................................................................................
North Carolina ..................................................................................................
North Dakota ....................................................................................................
Ohio .................................................................................................................
Oklahoma .........................................................................................................
Oregon .............................................................................................................
Pennsylvania ....................................................................................................
Puerto Rico ......................................................................................................
Rhode Island ....................................................................................................
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84
6
56
45
297
45
30
6
7
168
101
12
14
125
85
34
51
64
90
17
56
94
49
59
72
13
23
22
13
64
24
149
84
6
130
79
34
150
51
11
E:\FR\FM\03OCR1.SGM
2
3
33
0
59
9
8
0
0
7
0
6
0
2
0
0
0
0
0
0
29
0
0
0
0
1
0
3
8
0
2
16
0
3
7
2
1
3
11
0
03OCR1
¥0.3
0.1
1.3
¥0.3
0.4
0.7
1.3
¥0.3
¥0.3
¥0.3
¥0.3
¥0.1
¥0.3
¥0.3
¥0.3
¥0.3
¥0.2
¥0.3
¥0.3
¥0.3
3.3
¥0.3
¥0.2
¥0.3
¥0.2
¥0.2
¥0.3
0.4
2.4
¥0.4
¥0.2
¥0.3
¥0.3
0.4
¥0.3
¥0.3
¥0.2
¥0.3
0.1
¥0.4
Difference
(in $ millions)
(4)
$¥5
0
26
¥3
42
9
21
¥2
¥2
¥20
¥8
0
¥1
¥14
¥7
¥3
¥2
¥5
¥5
¥2
123
¥14
¥6
¥3
¥6
¥1
¥2
3
14
¥16
¥1
¥21
¥9
1
¥11
¥4
¥2
¥17
0
¥1
49850
Federal Register / Vol. 83, No. 192 / Wednesday, October 3, 2018 / Rules and Regulations
FY 2019 IPPS ESTIMATED PAYMENTS DUE TO RURAL FLOOR WITH NATIONAL BUDGET NEUTRALITY—Continued
State
Number of
hospitals
Number of
hospitals that
would receive
the rural floor
Percent
change
in payments
due to
application of
rural floor
with budget
neutrality
(1)
(2)
(3)
South Carolina .................................................................................................
South Dakota ...................................................................................................
Tennessee .......................................................................................................
Texas ...............................................................................................................
Utah .................................................................................................................
Vermont ...........................................................................................................
Virginia .............................................................................................................
Washington ......................................................................................................
West Virginia ....................................................................................................
Wisconsin .........................................................................................................
Wyoming ..........................................................................................................
7. On pages 41750 and 41751, the
table titled ‘‘TABLE II—IMPACT
ANALYSIS OF CHANGES FOR FY 2019
54
17
90
310
31
6
74
48
29
66
10
ACUTE CARE HOSPITAL OPERATING
PROSPECTIVE PAYMENT SYSTEM
Difference
(in $ millions)
(4)
¥0.1
¥0.2
¥0.3
¥0.3
¥0.3
¥0.2
¥0.2
¥0.3
¥0.2
¥0.3
0
6
0
6
13
0
0
1
3
2
5
2
¥1
¥1
¥7
¥18
¥2
0
¥6
¥7
¥1
¥5
0
[Payments per discharge]’’ is corrected
to read as follows:
TABLE II—IMPACT ANALYSIS OF CHANGES FOR FY 2019 ACUTE CARE HOSPITAL OPERATING PROSPECTIVE PAYMENT
SYSTEM
daltland on DSKBBV9HB2PROD with RULES
[Payments per discharge]
Number of
hospitals
Estimated
average
FY 2018
payment per
discharge
Estimated
average
FY 2019
payment per
discharge
FY 2019
changes
(1)
(2)
(3)
(4)
All Hospitals .....................................................................................................
By Geographic Location:
Urban hospitals .........................................................................................
Large urban areas ....................................................................................
Other urban areas ....................................................................................
Rural hospitals ..........................................................................................
Bed Size (Urban):
0–99 beds .................................................................................................
100–199 beds ...........................................................................................
200–299 beds ...........................................................................................
300–499 beds ...........................................................................................
500 or more beds .....................................................................................
Bed Size (Rural):
0–49 beds .................................................................................................
50–99 beds ...............................................................................................
100–149 beds ...........................................................................................
150–199 beds ...........................................................................................
200 or more beds .....................................................................................
Urban by Region:
New England ............................................................................................
Middle Atlantic ..........................................................................................
South Atlantic ...........................................................................................
East North Central ....................................................................................
East South Central ...................................................................................
West North Central ...................................................................................
West South Central ..................................................................................
Mountain ...................................................................................................
Pacific .......................................................................................................
Puerto Rico ...............................................................................................
Rural by Region:
New England ............................................................................................
Middle Atlantic ..........................................................................................
South Atlantic ...........................................................................................
East North Central ....................................................................................
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3,255
12,172
12,463
2.4
2,483
1,302
1,181
772
12,508
12,986
12,049
9,193
12,819
13,302
12,355
9,307
2.5
2.4
2.5
1.2
644
763
433
424
219
9,945
10,399
11,384
12,606
15,449
10,113
10,623
11,650
12,917
15,893
1.7
2.2
2.3
2.5
2.9
305
274
108
45
40
7,826
8,746
9,150
9,667
10,734
7,897
8,843
9,256
9,805
10,899
0.9
1.1
1.2
1.4
1.5
113
310
401
386
147
158
379
164
374
51
13,491
14,099
11,145
11,830
10,517
12,266
11,310
12,938
15,773
9,117
14,131
14,429
11,372
12,072
10,742
12,524
11,574
13,218
16,289
9,185
4.7
2.3
2
2
2.1
2.1
2.3
2.2
3.3
0.7
20
53
122
114
12,613
9,137
8,497
9,444
12,728
9,265
8,598
9,551
0.9
1.4
1.2
1.1
E:\FR\FM\03OCR1.SGM
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Federal Register / Vol. 83, No. 192 / Wednesday, October 3, 2018 / Rules and Regulations
49851
TABLE II—IMPACT ANALYSIS OF CHANGES FOR FY 2019 ACUTE CARE HOSPITAL OPERATING PROSPECTIVE PAYMENT
SYSTEM—Continued
[Payments per discharge]
Number of
hospitals
Estimated
average
FY 2018
payment per
discharge
Estimated
average
FY 2019
payment per
discharge
FY 2019
changes
(1)
(2)
(3)
(4)
daltland on DSKBBV9HB2PROD with RULES
East South Central ...................................................................................
West North Central ...................................................................................
West South Central ..................................................................................
Mountain ...................................................................................................
Pacific .......................................................................................................
By Payment Classification:
Urban hospitals .........................................................................................
Large urban areas ....................................................................................
Other urban areas ....................................................................................
Rural areas ...............................................................................................
Teaching Status:
Nonteaching ..............................................................................................
Fewer than 100 residents .........................................................................
100 or more residents ..............................................................................
Urban DSH:
Non-DSH ..................................................................................................
100 or more beds .....................................................................................
Less than 100 beds ..................................................................................
Rural DSH:
SCH ..........................................................................................................
RRC ..........................................................................................................
100 or more beds .....................................................................................
Less than 100 beds ..................................................................................
Urban teaching and DSH:
Both teaching and DSH ............................................................................
Teaching and no DSH ..............................................................................
No teaching and DSH ..............................................................................
No teaching and no DSH .........................................................................
Special Hospital Types:
RRC ..........................................................................................................
SCH ..........................................................................................................
MDH ..........................................................................................................
SCH and RRC ..........................................................................................
MDH and RRC ..........................................................................................
Type of Ownership:
Voluntary ...................................................................................................
Proprietary ................................................................................................
Government ..............................................................................................
Medicare Utilization as a Percent of Inpatient Days:
0–25 ..........................................................................................................
25–50 ........................................................................................................
50–65 ........................................................................................................
Over 65 .....................................................................................................
FY 2019 Reclassifications by the Medicare Geographic Classification Review Board:
All Reclassified Hospitals .........................................................................
Non-Reclassified Hospitals .......................................................................
Urban Hospitals Reclassified ....................................................................
Urban Nonreclassified Hospitals ..............................................................
Rural Hospitals Reclassified Full Year .....................................................
Rural Nonreclassified Hospitals Full Year ................................................
All Section 401 Reclassified Hospitals .....................................................
Other Reclassified Hospitals (Section 1886(d)(8)(B)) ..............................
8. On pages 41753 through 41754 the
table titled ‘‘MODELED
UNCOMPENSATED CARE PAYMENTS
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94
145
51
23
8,142
10,019
7,844
11,139
12,734
8,285
10,112
7,958
11,226
12,858
1.8
0.9
1.5
0.8
1
2,264
1,317
947
991
12,276
12,974
11,325
11,833
12,557
13,290
11,559
12,155
2.3
2.4
2.1
2.7
2,156
849
250
10,059
11,616
17,680
10,267
11,866
18,220
2.1
2.2
3.1
520
1,462
367
10,533
12,643
9,220
10,748
12,939
9,397
2
2.3
1.9
255
382
33
236
10,239
12,516
13,322
7,300
10,313
12,901
13,711
7,410
0.7
3.1
2.9
1.5
805
89
1,024
346
13,783
11,402
10,322
9,951
14,112
11,664
10,549
10,125
2.4
2.3
2.2
1.7
327
311
140
134
16
12,440
11,126
7,958
11,502
10,039
12,863
11,219
8,056
11,640
10,149
3.4
0.8
1.2
1.2
1.1
1,898
856
501
12,323
10,658
13,378
12,624
10,879
13,708
2.4
2.1
2.5
602
2,138
421
73
14,927
11,996
9,817
7,271
15,266
12,294
9,985
7,450
2.3
2.5
1.7
2.5
859
2,396
588
1,835
271
454
266
47
12,226
12,148
12,821
12,349
9,566
8,750
13,625
8,609
12,572
12,415
13,212
12,629
9,710
8,821
14,091
8,736
2.8
2.2
3.1
2.3
1.5
0.8
3.4
1.5
FOR ESTIMATED FY 2019 DSHs BY
HOSPITAL TYPE: MODEL UCP $ (IN
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MILLIONS) * FROM FY 2018 to FY
2019’’ is corrected to read as follows:
E:\FR\FM\03OCR1.SGM
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Federal Register / Vol. 83, No. 192 / Wednesday, October 3, 2018 / Rules and Regulations
MODELED UNCOMPENSATED CARE PAYMENTS FOR ESTIMATED FY 2019 DSHS BY HOSPITAL TYPE: MODEL UCP $ (IN
MILLIONS) * FROM FY 2018 TO FY 2019
daltland on DSKBBV9HB2PROD with RULES
Total .....................................................................................
By Geographic Location:
Urban Hospitals ............................................................
Large Urban Areas .......................................................
Other Urban Areas .......................................................
Rural Hospitals .............................................................
Bed Size (Urban):
0 to 99 Beds .................................................................
100 to 249 Beds ...........................................................
250+ Beds ....................................................................
Bed Size (Rural):.
0 to 99 Beds .................................................................
100 to 249 Beds ...........................................................
250+ Beds ....................................................................
Urban by Region:
New England ................................................................
Middle Atlantic ..............................................................
South Atlantic ................................................................
East North Central ........................................................
East South Central .......................................................
West North Central .......................................................
West South Central ......................................................
Mountain .......................................................................
Pacific ...........................................................................
Puerto Rico ...................................................................
Rural by Region:
New England ................................................................
Middle Atlantic ..............................................................
South Atlantic ................................................................
East North Central ........................................................
East South Central .......................................................
West North Central .......................................................
West South Central ......................................................
Mountain .......................................................................
Pacific ...........................................................................
By Payment Classification:
Urban Hospitals ............................................................
Large Urban Areas .......................................................
Other Urban Areas .......................................................
Rural Hospitals .............................................................
Teaching Status:
Nonteaching ..................................................................
Fewer than 100 residents .............................................
100 or more residents ..................................................
Type of Ownership:
Voluntary .......................................................................
Proprietary ....................................................................
Government ..................................................................
Medicare Utilization Percent: ***
0 to 25 ...........................................................................
25 to 50 .........................................................................
50 to 65 .........................................................................
Greater than 65 ............................................................
Number of
estimated
DSHs
FY 2018
final rule
CN estimated
UCP $
(in millions)
FY 2019
final rule
estimated
UCP $
(in millions)
Dollar
difference:
FY 2019–
FY 2018
(in millions)
Percent
change **
(1)
(2)
(3)
(4)
(5)
2,447
$6,767
$8,273
$1,506
22.26
1,953
1,046
907
494
6,422
3,847
2,575
345
7,802
4,706
3,096
471
1,380
859
521
126
21.49
22.33
20.22
36.64
342
860
751
177
1,519
4,726
257
1,903
5,642
79
384
916
44.80
25.28
19.39
365
116
13
164
146
34
229
200
43
64
54
8
39.19
36.66
24.33
91
244
320
323
133
104
254
125
318
41
259
1,004
1,343
864
389
312
981
313
874
82
279
1,058
1,769
1,010
477
386
1,423
397
899
102
20
55
426
146
88
74
442
84
25
20
7.76
5.45
31.69
16.92
22.71
23.68
45.03
26.78
2.88
24.47
9
26
88
69
135
29
106
27
5
14
19
79
40
93
16
66
14
4
17
22
116
56
106
22
102
26
5
3
2
37
16
13
6
36
12
1
19.24
12.43
47.54
41.12
13.78
40.28
53.62
84.16
24.85
1,866
1,058
808
581
5,917
3,855
2,062
850
7,257
4,717
2,540
1,016
1,340
862
478
166
22.65
22.37
23.16
19.54
1,509
694
244
2,020
2,246
2,501
2,597
2,744
2,931
578
498
430
28.62
22.17
17.20
1,447
561
439
4,137
1,015
1,615
4,895
1,259
2,119
758
244
504
18.32
24.05
31.24
472
1,674
262
36
2,255
4,290
215
7
2,720
5,266
276
11
464
977
61
4
20.60
22.77
28.34
56.55
Source: Dobson | DaVanzo analysis of 2013–2015 Hospital Cost Reports.
* Dollar UCP calculated by [0.75 * estimated section 1886(d)(5)(F) payments * Factor 2 * Factor 3]. When summed across all hospitals projected to receive DSH payments, uncompensated care payments are estimated to be $6,767 million in FY 2018 and $8,273 million in FY 2019.
** Percentage change is determined as the difference between Medicare UCP payments modeled for the FY 2019 IPPS/LTCH PPS proposed
rule (column 3) and Medicare UCP payments modeled for the FY 2018 IPPS/LTCH PPS final rule correction notice (column 2) divided by Medicare UCP payments modeled for the FY 2018 final rule correction notice (column 2) times 100 percent.
*** Hospitals with Missing or Unknown Medicare Utilization are not shown in table.
9. On page 41754,
a. Second column, first full paragraph,
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ii. Line 8, the figure ‘‘21.48’’ is
corrected to read ‘‘21.49’’.
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b. Third column, first partial
paragraph,
i. Line 2, the figure ‘‘39.52’’ is
corrected to read ‘‘39.19’’.
ii. Line 5, the figure ‘‘36.35’’ is
corrected to read ‘‘36.66’’
iii. Line 7, the figure ‘‘24.35’’ is
corrected to read ‘‘24.33’’.
iv. Line 13, the figure ‘‘44.83’’ is
corrected to read ‘‘44.80’’.
v. Line 16, the figure ‘‘25.23’’ is
corrected to read ‘‘25.28’’.
vi. Line 19, the figure ‘‘19.40’’ is
corrected to read ‘‘19.39’’.
10. On page 41755, first column,
second paragraph—
a. Line 5, the figure ‘‘22.14’’ is
corrected to read ‘‘22.17’’.
b. Line 9, the figure ‘‘17.23’’ is
corrected to read ‘‘17.20’’.
c. Line 12, the figure ‘‘31.26’’ is
corrected to read ‘‘31.24’’.
d. Line 12, the figure ‘‘24.06’’ is
corrected to read ‘‘24.05’’.
e. Line 15, the figure ‘‘18.30’’ is
corrected to read ‘‘18.32’’.
11. On page 41756, bottom of the
page—
a. First column, before the first
paragraph, the section heading ‘‘a.
Effects of Proposed Changes for FY
49853
2019’’ is corrected to read ‘‘a. Effects of
Changes for FY 2019’’.
b. Second column, last paragraph, line
1, the phrase ‘‘The proposed estimated
impacts’’ is corrected to read ‘‘The
estimated impacts’’.
12. On pages 41758 through 41759,
the table titled ‘‘ESTIMATED
PROPORTION OF HOSPITALS IN THE
WORST-PERFORMING QUARTILE
(>75th PERCENTILE) OF THE TOTAL
HAC SCORES FOR THE FY 2019 HAC
REDUCTION PROGRAM’’ is corrected
to read as follows:
ESTIMATED PROPORTION OF HOSPITALS IN THE WORST-PERFORMING QUARTILE (>75TH PERCENTILE) OF THE TOTAL HAC
SCORES FOR THE FY 2019 HAC REDUCTION PROGRAM
[By hospital characteristic]
Number of
hospitals
daltland on DSKBBV9HB2PROD with RULES
Hospital characteristic
Total c ...........................................................................................................................................
By Geographic Location (n = 3,201): d
Urban hospitals .....................................................................................................................
1–99 beds ......................................................................................................................
100–199 beds ................................................................................................................
200–299 beds ................................................................................................................
300–399 beds ................................................................................................................
400–499 beds ................................................................................................................
500 or more beds ..........................................................................................................
Rural hospitals ......................................................................................................................
1–49 beds ......................................................................................................................
50–99 beds ....................................................................................................................
100–149 beds ................................................................................................................
150–199 beds ................................................................................................................
200 or more beds ..........................................................................................................
By Safety-Net Status (n = 3,201): e
Non-safety net ......................................................................................................................
Safety-net .............................................................................................................................
By DSH Percent (n = 3,201): f
0–24 ......................................................................................................................................
25–49 ....................................................................................................................................
50–64 ....................................................................................................................................
65 and over ..........................................................................................................................
By Teaching Status (n = 3,201): g
Non-teaching ........................................................................................................................
Fewer than 100 residents .....................................................................................................
100 or more residents ..........................................................................................................
By Ownership (n = 3,173):
Voluntary ...............................................................................................................................
Proprietary ............................................................................................................................
Government ..........................................................................................................................
By MCR Percent (n = 3,175): h
0–24 ......................................................................................................................................
25–49 ....................................................................................................................................
50–64 ....................................................................................................................................
65 and over ..........................................................................................................................
By Region (n = 3,217): i
New England ........................................................................................................................
Mid-Atlantic ...........................................................................................................................
South Atlantic .......................................................................................................................
East North Central ................................................................................................................
East South Central ...............................................................................................................
West North Central ...............................................................................................................
West South Central ..............................................................................................................
Mountain ...............................................................................................................................
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Number of
hospitals in
the worstperforming
quartile a
Percent of
hospitals in
the worstperforming
quartile b
3,219
804
25.0
2,416
622
728
430
278
145
213
785
304
282
116
44
39
628
133
182
119
80
39
75
165
68
56
22
10
9
26.0
21.4
25.0
27.7
28.8
26.9
35.2
21.0
22.4
19.9
19.0
22.7
23.1
2,555
646
576
217
22.5
33.6
1,313
1,507
198
183
292
366
75
60
22.2
24.3
37.9
32.8
2,121
832
248
484
196
113
22.8
23.6
45.6
1,868
813
492
466
175
145
24.9
21.5
29.5
511
2,118
473
73
144
505
117
15
28.2
23.8
24.7
20.5
133
364
522
498
299
256
519
229
43
101
133
108
68
57
114
60
32.3
27.7
25.5
21.7
22.7
22.3
22.0
26.2
03OCR1
49854
Federal Register / Vol. 83, No. 192 / Wednesday, October 3, 2018 / Rules and Regulations
ESTIMATED PROPORTION OF HOSPITALS IN THE WORST-PERFORMING QUARTILE (>75TH PERCENTILE) OF THE TOTAL HAC
SCORES FOR THE FY 2019 HAC REDUCTION PROGRAM—Continued
[By hospital characteristic]
Number of
hospitals
Hospital characteristic
Pacific ...................................................................................................................................
397
Number of
hospitals in
the worstperforming
quartile a
118
Percent of
hospitals in
the worstperforming
quartile b
29.7
Source: FY 2019 HAC Reduction Program Final Rule Results are based on CMS PSI 90 Composite data from October 2015 through June
2017 and CDC CLABSI, CAUTI, SSI, CDI, and MRSA results from January 2016 through December 2017. Hospital Characteristics are based on
the FY 2019 Hospital Inpatient Prospective Payment System (IPPS) Proposed Rule Impact File.
a This column is the number of non-Maryland hospitals with a Total HAC Score within the corresponding characteristic that are estimated to be
in the worst-performing quartile.
b This column is the percent of non-Maryland hospitals within each characteristic that are estimated to be in the worst-performing quartile. The
percentages are calculated by dividing the number of non-Maryland hospitals with a Total HAC Score in the worst-performing quartile by the total
number of non-Maryland hospitals with a Total HAC Score within that characteristic.
c The number of non-Maryland hospitals with a FY 2019 Total HAC Score (N=3,219). Note that not all hospitals have data for all hospital characteristics.
d The number of hospitals that had information for geographic location with bed size, Safety-net status, Disproportionate Share Hospital (DSH)
percent, teaching status, and ownership status (n=3,201).
e A hospital is considered a Safety-net hospital if it is in the top quintile for DSH percent.
f The DSH patient percentage is equal to the sum of (1) the percentage of Medicare inpatient days attributable to patients eligible for both
Medicare Part A and Supplemental Security Income and (2) the percentage of total inpatient days attributable to patients eligible for Medicaid but
not Medicare Part A.
g A hospital is considered a teaching hospital if it has an Indirect Medical Education adjustment factor for Operation PPS (TCHOP) greater
than zero.
h Not all hospitals had data for MCR percent (n=3,175).
i Not all hospitals had data for Region (n=3,217).
13. On page 41763—
a. Second column, fourth bullet, the
figure ‘‘0.9975’’ is corrected to read
‘‘0.9969’’.
b. Third column, first full paragraph,
line 5, the figure ‘‘3,256’’ is corrected to
read ‘‘3,255’’.
14. On page 41764, third column—
a. Line 12, the figure ‘‘1.0’’ is
corrected to read ‘‘1.1’’.
b. Line 14, the figure ‘‘3.0’’ is
corrected to read ‘‘2.9’’.
15. On pages 41764 through 41765,
the table titled ‘‘TABLE III—
COMPARISON OF TOTAL PAYMENTS
PER CASE [FY 2018 payments
compared to FY 2019 payments]’’ is
corrected to read as follows:
TABLE III—COMPARISON OF TOTAL PAYMENTS PER CASE
[FY 2018 payments compared to FY 2019 payments]
Average
FY 2018
payments/case
Average
FY 2019
payments/case
3,255
2,483
1,302
1,181
644
763
433
424
219
772
305
274
108
45
40
$943
974
1,011
939
789
835
902
981
1,170
666
541
606
677
729
808
$963
997
1,042
952
812
854
922
1,003
1,197
659
556
621
654
706
781
2.1
2.3
3.2
1.4
3.0
2.4
2.2
2.2
2.3
¥0.9
2.6
2.3
¥3.3
¥3.2
¥3.3
2,483
113
310
401
386
147
158
379
164
374
51
974
1,068
1,069
866
938
821
959
881
1,011
1,238
447
997
1,108
1,090
883
951
838
977
908
1,028
1,281
455
2.3
3.8
2.0
2.0
1.4
2.1
1.9
3.1
1.5
3.4
1.7
daltland on DSKBBV9HB2PROD with RULES
Number of
hospitals
By Geographic Location:
All hospitals ..............................................................................................
Large urban areas (populations over 1 million) .......................................
Other urban areas (populations of 1 million of fewer) .............................
Urban hospitals .........................................................................................
0–99 beds ..........................................................................................
100–199 beds ....................................................................................
200–299 beds ....................................................................................
300–499 beds ....................................................................................
500 or more beds ..............................................................................
Rural hospitals ..........................................................................................
0–49 beds ..........................................................................................
50–99 beds ........................................................................................
100–149 beds ....................................................................................
150–199 beds ....................................................................................
200 or more beds ..............................................................................
By Region:
Urban by Region ......................................................................................
New England .....................................................................................
Middle Atlantic ...................................................................................
South Atlantic ....................................................................................
East North Central .............................................................................
East South Central ............................................................................
West North Central ............................................................................
West South Central ...........................................................................
Mountain ............................................................................................
Pacific ................................................................................................
Puerto Rico ........................................................................................
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Federal Register / Vol. 83, No. 192 / Wednesday, October 3, 2018 / Rules and Regulations
49855
TABLE III—COMPARISON OF TOTAL PAYMENTS PER CASE—Continued
[FY 2018 payments compared to FY 2019 payments]
Average
FY 2018
payments/case
Average
FY 2019
payments/case
772
20
53
122
114
150
94
145
51
23
666
922
639
619
675
623
706
590
742
865
660
918
638
610
671
606
704
588
752
864
¥0.9
¥0.5
¥0.3
¥1.4
¥0.6
¥2.6
¥0.2
¥0.3
1.2
¥0.5
3,255
1,317
947
991
943
1,010
895
884
963
1,042
919
875
2.1
3.2
2.6
¥1.1
2,156
849
250
800
909
1,308
816
925
1,342
1.9
1.8
2.7
520
1,462
367
867
984
720
890
1,013
743
2.6
3.0
3.1
255
382
680
947
681
931
0.1
¥1.6
33
236
1,068
530
1,053
543
¥1.4
2.4
805
89
1,024
346
1,055
912
833
847
1,087
934
856
871
3.1
2.4
2.8
2.8
178
327
312
134
831
968
749
807
831
960
752
797
0.0
¥0.7
0.5
¥1.3
588
1,835
271
454
266
47
995
966
704
613
1,033
651
1,006
996
690
615
1,022
661
1.1
2.9
¥1.8
0.2
¥1.1
1.6
1,898
856
501
959
851
981
976
871
1,011
1.8
2.3
3.1
601
2,139
421
73
1,076
942
774
567
1,104
961
784
582
2.6
2.1
1.3
2.7
Number of
hospitals
daltland on DSKBBV9HB2PROD with RULES
Rural by Region ........................................................................................
New England .....................................................................................
Middle Atlantic ...................................................................................
South Atlantic ....................................................................................
East North Central .............................................................................
East South Central ............................................................................
West North Central ............................................................................
West South Central ...........................................................................
Mountain ............................................................................................
Pacific ................................................................................................
By Payment Classification:
All hospitals ..............................................................................................
Large urban areas (populations over 1 million) .......................................
Other urban areas (populations of 1 million of fewer) .............................
Rural areas ...............................................................................................
Teaching Status:
Non-teaching ............................................................................................
Fewer than 100 Residents .......................................................................
100 or more Residents .............................................................................
Urban DSH:
Non-DSH ...........................................................................................
100 or more beds ..............................................................................
Less than 100 beds ...........................................................................
Rural DSH:
Sole Community (SCH/EACH) ..........................................................
Referral Center (RRC/EACH) ............................................................
Other Rural:
100 or more beds .......................................................................
Less than 100 beds ...................................................................
Urban teaching and DSH:
Both teaching and DSH ....................................................................
Teaching and no DSH .......................................................................
No teaching and DSH .......................................................................
No teaching and no DSH ..................................................................
Rural Hospital Types:
Plain Rural ................................................................................................
RRC/EACH ...............................................................................................
SCH/EACH ...............................................................................................
SCH, RRC and EACH ..............................................................................
Hospitals Reclassified by the Medicare Geographic Classification Review
Board:
FY2018 Reclassifications:
All Urban Reclassified .......................................................................
All Urban Non-Reclassified ...............................................................
All Rural Reclassified ........................................................................
All Rural Non-Reclassified .................................................................
All Section 401 Reclassified Hospitals ..............................................
Other Reclassified Hospitals (Section 1886(d)(8)(B)) .......................
Type of Ownership:
Voluntary ...........................................................................................
Proprietary .........................................................................................
Government .......................................................................................
Medicare Utilization as a Percent of Inpatient Days:
0–25 ...................................................................................................
25–50 .................................................................................................
50–65 .................................................................................................
Over 65 ..............................................................................................
16. On page 41766,
a. First column, last paragraph,
i. Line 4, the figure ‘‘41,579.65’’ is
corrected to read ‘‘$41,558.68’’.
ii. Line 8, the figure ‘‘0.999713’’ is
corrected to read ‘‘0.999215’’.
b. Second column,
i. First partial paragraph,
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A. Line 4, the figure ‘‘0.990884’’ is
corrected to read ‘‘0.990878’’.
B. Line 12, the figure ‘‘$40,759.12’’ is
corrected to read ‘‘$40,738.57’’.
ii. Second full paragraph, line 14, the
figure ‘‘0.999713’’ is corrected to read
‘‘0.999215’’.
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iii. Last paragraph, line 7, the figure
‘‘0.990884’’ is corrected to read
‘‘0.990878’’.
17. On page 41768, first column,
a. Line 8, the figure ‘‘41,579.65’’ is
corrected to read ‘‘$41,558.68’’.
b. Line 9, the figure ‘‘40,759.12’’ is
corrected to read ‘‘$40,738.57’’.
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Federal Register / Vol. 83, No. 192 / Wednesday, October 3, 2018 / Rules and Regulations
18. On pages 41768 and 41769, the
table entitled ‘‘TABLE IV—IMPACT OF
PAYMENT RATE AND POLICY
CHANGES TO LTCH PPS PAYMENTS
FOR LTCH PPS STANDARD FEDERAL
PAYMENT RATE CASES FOR FY
2019’’, is corrected to read as follows:
TABLE IV—IMPACT OF PAYMENT RATE AND POLICY CHANGES TO LTCH PPS PAYMENTS FOR LTCH PPS STANDARD
FEDERAL PAYMENT RATE CASES FOR FY 2019
[Estimated FY 2018 payments compared to estimated FY 2019 payments]
LTCH classification
Number of
LTCHS
Number of
LTCH PPS
standard
payment rate
cases
(1)
(2)
(3)
All Providers ..................................................
By Location:
Rural .......................................................
Urban .....................................................
Large ...............................................
Other ...............................................
By Participation Date:
Before Oct. 1983 ....................................
Oct. 1983–Sept. 1993 ............................
Oct. 1993–Sept. 2002 ............................
After October 2002 ................................
By Ownership Type:
Voluntary ................................................
Proprietary ..............................................
Government ...........................................
By Region:
New England ..........................................
Middle Atlantic ........................................
South Atlantic .........................................
East North Central .................................
East South Central .................................
West North Central ................................
West South Central ................................
Mountain ................................................
Pacific .....................................................
By Bed Size:
Beds: 0–24 .............................................
Beds: 25–49 ...........................................
Beds: 50–74 ...........................................
Beds: 75–124 .........................................
Beds: 125–199 .......................................
Beds: 200+ .............................................
Average FY
2018 LTCH
PPS payment
per standard
payment rate
Average FY
2019 LTCH
PPS payment
per standard
payment rate 1
Percent
change due to
change to the
annual update
to the
standard
federal rate 2
Percent
change due to
changes to
area wage
adjustment
with wage
budget
neutrality 3
Percent
change due to
all standard
payment rate
changes 4
(4)
(5)
(6)
(7)
(8)
409
75,416
$46,852
$47,334
1.3
0
1.0
21
388
195
193
2,457
72,959
40,491
32,468
39,339
47,105
50,164
43,291
39,714
47,591
50,740
43,664
1.3
1.3
1.3
1.3
¥0.1
0
0
0
1.0
1.0
1.1
0.9
11
42
169
187
1,923
9,632
31,338
32,523
43,083
51,709
45,565
46,877
43,225
52,481
45,991
47,347
1.3
1.3
1.3
1.3
¥0.5
0.2
0
0
0.3
1.5
0.9
1.0
77
319
13
10,614
63,040
1,762
48,824
46,378
51,945
49,614
46,799
52,739
1.3
1.3
1.3
0.3
¥0.1
0.0
1.6
0.9
1.5
12
24
66
68
36
28
120
29
26
2,707
5,959
13,792
11,843
6,385
4,412
18,361
4,070
7,887
43,164
50,920
47,641
46,386
45,490
45,951
41,402
47,897
58,121
43,275
51,553
48,127
46,711
45,978
46,428
41,785
48,125
59,205
1.3
1.3
1.3
1.3
1.3
1.3
1.3
1.4
1.3
¥0.4
¥0.1
¥0.1
¥0.3
0
¥0.3
0.2
¥0.5
0.7
0.3
1.2
1.0
0.7
1.1
1.0
0.9
0.5
1.9
43
185
107
43
22
9
4,206
26,270
20,178
12,086
7,709
4,967
44,740
44,623
47,733
50,145
47,404
47,988
45,008
45,044
48,246
50,770
47,768
48,682
1.3
1.3
1.3
1.3
1.3
1.3
¥0.4
0
0
0.1
¥0.3
0.5
0.6
0.9
1.1
1.2
0.8
1.4
daltland on DSKBBV9HB2PROD with RULES
1 Estimated FY 2019 LTCH PPS payments for LTCH PPS standard Federal payment rate criteria based on the payment rate and factor changes applicable to such
cases presented in the preamble of and the Addendum to this final rule.
2 Percent change in estimated payments per discharge for LTCH PPS standard Federal payment rate cases from FY 2018 to FY 2019 for the annual update to the
LTCH PPS standard Federal payment rate.
3 Percent change in estimated payments per discharge for LTCH PPS standard Federal payment rate cases from FY 2018 to FY 2019 for changes to the area
wage level adjustment under § 412.525(c) (as discussed in section V.B. of the Addendum to this final rule).
4 Percent change in estimated payments per discharge for LTCH PPS standard Federal payment rate cases from FY 2018 (shown in Column 4) to FY 2019 (shown
in Column 5), including all of the changes to the rates and factors applicable to such cases presented in the preamble and the Addendum to this final rule. We note
that this column, which shows the percent change in estimated payments per discharge for all changes, does not equal the sum of the percent changes in estimated
payments per discharge for the annual update to the LTCH PPS standard Federal payment rate (Column 6) and the changes to the area wage level adjustment with
budget neutrality (Column 7) due to the effect of estimated changes in estimated payments to aggregate HCO payments for LTCH PPS standard Federal payment
rate cases (as discussed in this impact analysis), as well as other interactive effects that cannot be isolated.
19. On page 41769, lower two-thirds
of the page—
a. First column, last paragraph, line
13, the figure ‘‘0.999713’’ is corrected to
read ‘‘0.999215’’.
b. Second column,
i. First partial paragraph, line 1, the
figure ‘‘0.999713’’ is corrected to read
‘‘0.999215’’.
ii. Last paragraph, line 16, the figure
‘‘0.9’’ is corrected to read ‘‘1.0’’.
VerDate Sep<11>2014
16:40 Oct 02, 2018
Jkt 247001
c. Third column, second full
paragraph, line 5, the figure ‘‘0.4’’ is
corrected to read ‘‘0.3’’.
20. On page 41770, first column,
a. First full paragraph, line 5, the
word ‘‘Pacific’’ is corrected to read
‘‘Mountain’’,
b. First full paragraph, line 7, the
word ‘‘Mountain’’ is corrected to read
‘‘Pacific’’,
c. First full paragraph, line 9, the
figure ‘‘0.4’’ is corrected to read ‘‘0.5’’,
PO 00000
Frm 00088
Fmt 4700
Sfmt 9990
d. Second full paragraph, line 9, the
figure ‘‘1.5’’ is corrected to read ‘‘1.4’’.
Dated: September 27, 2018.
Wilma M. Robinson,
Deputy Executive Secretary to the
Department, Department of Health and
Human Services.
[FR Doc. 2018–21500 Filed 9–28–18; 4:15 pm]
BILLING CODE 4120–01–P
E:\FR\FM\03OCR1.SGM
03OCR1
]]>Agencies
[Federal Register Volume 83, Number 192 (Wednesday, October 3, 2018)]
[Rules and Regulations]
[Pages 49836-49856]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2018-21500]
-----------------------------------------------------------------------
DEPARTMENT OF HEALTH AND HUMAN SERVICES
Centers for Medicare & Medicaid Services
42 CFR Parts 412, 413, 424, and 495
[CMS-1694-CN2]
RIN 0938-AT27
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 2019 Rates; Quality
Reporting Requirements for Specific Providers; Medicare and Medicaid
Electronic Health Record (EHR) Incentive Programs (Promoting
Interoperability Programs) Requirements for Eligible Hospitals,
Critical Access Hospitals, and Eligible Professionals; Medicare Cost
Reporting Requirements; and Physician Certification and Recertification
of Claims; Correction
AGENCY: Centers for Medicare & Medicaid Services (CMS), HHS.
ACTION: Final rule; correction.
-----------------------------------------------------------------------
SUMMARY: This document corrects technical and typographical errors in
the final rule that appeared in the August 17, 2018 issue of the
Federal Register titled ``Medicare Program; Hospital Inpatient
Prospective Payment Systems for Acute Care Hospitals and the Long Term
Care Hospital Prospective Payment System and Policy Changes and Fiscal
Year 2019 Rates; Quality Reporting Requirements for Specific Providers;
Medicare and Medicaid Electronic Health Record (EHR) Incentive Programs
(Promoting Interoperability Programs) Requirements for Eligible
Hospitals, Critical Access Hospitals, and Eligible Professionals;
Medicare Cost Reporting Requirements; and Physician Certification and
Recertification of Claims''.
DATES: The corrections in this document are effective October 1, 2018.
FOR FURTHER INFORMATION CONTACT: Donald Thompson and Michele Hudson,
(410) 786-4487.
SUPPLEMENTARY INFORMATION:
I. Background
In FR Doc. 2018-16766 of August 17, 2018 (83 FR 41144) there were a
number of technical and typographical errors that are identified and
corrected by the Correction of Errors section of this correcting
document. The provisions in this correcting document are effective as
if they had been included in the document that appeared in the August
17, 2018 Federal Register. Accordingly, the corrections are effective
October 1, 2018.
II. Summary of Errors
A. Summary of Errors in the Preamble
On page 41144, under FOR FURTHER INFORMATION CONTACT section, we
are correcting the names of the contacts for Medicare Promoting
Interoperability Program issues.
On page 41151, in our discussion regarding Changes to the Hospital
Readmissions Reduction Program under ``Summary of Cost and Benefits'',
we made errors in the impact figures.
On pages 41200, 41219, 41236, and 41313, we made a technical error
in using the term ``primary'' rather than ``principal'' when in
describing certain diagnosis codes or conditions.
On page 41254, we inadvertently omitted a base MS-DRG group to
which the listed thoracoscopic procedures of pericardium and pleura may
be assigned. Specifically, we are correcting the list of MS-DRGs on
page 41254 to include MS-DRGs 166, 167, and 168 (Other Respiratory
System O.R. Procedures with MCC, with CC, and without CC/MCC,
respectively) in MDC 4 (Diseases and Disorders of the Respiratory
System), consistent with the MS-DRGs to which other approaches for
procedures involving drainage or extirpation of matter from the pleura
are assigned.
On page 41299, we made a technical error in describing which ICD-
10-PCS procedure codes will be used to identify cases involving the use
of KYMRIAH and YESCARTA that are eligible for new technology add-on
payments in FY 2019. Specifically, cases involving the use of KYMRIAH
and YESCARTA that are eligible for new technology add-on payments will
be identified by either of
[[Page 49837]]
the ICD-10-PCS procedure codes listed in the final rule (XW033C3 or
XW043C3) rather than requiring the combination of both ICD-10-PCS
procedure codes.
On page 41311, we made a typographical error in describing which
National Drug Code (NDC) will be used to identify cases involving
VABOMERETM that are eligible for new technology add-on
payments in FY 2019. Specifically, we are correcting the NDC code of
65293-0009-01, which erroneously was missing an extra digit. In
addition, we were made aware after the final rule that NDC 70842-0120-
01 can also be used to identify cases of VABOMERETM.
Therefore, cases involving the use of VABOMERETM that are
eligible for new technology add-on payments in FY 2019 will be
identified with either of the following NDCs: 65293-0009-01 and 70842-
0120-01.
On page 41320, we made a typographical error in describing which
ICD-10-PCS procedure codes will be used to identify cases involving the
remed[emacr][reg] SystemTM that are eligible for new
technology add-on payments in FY 2019. Specifically, we are correcting
the ICD-10-PCS procedure code 05H43MZ (Insertion of neurostimulator
lead into left innominate vein, percutaneous approach), which had
erroneously contained an extra digit.
On page 41334, we made a technical error in describing which ICD-
10-PCS procedure codes will be used to identify cases involving
ZEMDRITM that are eligible for new technology add-on
payments in FY 2019. Specifically, cases involving the use of
ZEMDRITM that are eligible for new technology add-on
payments will be identified by either of the ICD-10-PCS procedure codes
listed in the final rule (XW033G4 or XW043G4) rather than requiring the
combination of both ICD-10-PCS procedure codes.
On page 41342, we made a technical error in describing which ICD-
10-PCS procedure codes will be used to identify cases involving
GIAPREZATM that are eligible for new technology add-on
payments in FY 2019. Specifically, cases involving the use of
GIAPREZATM that are eligible for new technology add-on
payments will be identified by either of the ICD-10-PCS procedure codes
listed in the final rule (XW033H4 or XW043H4) rather than requiring the
combination of both ICD-10-PCS procedure codes.
On page 41348, we made a typographical error in stating the
applicant's estimated cost of the Sentinel[reg] Cerebral Protection
System. Specifically, we stated that the applicant estimated the cost
is $2,400, when we should have stated the cost is $2,800.
On page 41362, we made a technical error in describing which ICD-
10-PCS procedure codes will be used to identify cases involving
AndexXaTM that are eligible for new technology add-on
payments in FY 2019. Specifically, cases involving the use of
AndexXaTM that are eligible for new technology add-on
payments will be identified by either of the ICD-10-PCS procedure codes
listed in the final rule (XW03372 or XW04372) rather than requiring the
combination of both ICD-10-PCS procedure codes.
On pages 41364, 41365, 41368, and 41375, in our discussion of the
wage indexes, we are correcting the number of hospitals with critical
access hospital (CAH) status removed from the FY 2019 wage index, the
number of hospitals used for the FY 2019 wage index, the number of
hospital occupational mix surveys used for the FY 2019 wage index, and
the values for the FY 2019 national average hourly wage (unadjusted for
occupational mix), the FY 2019 occupational mix adjusted national
average hourly wage, and the FY 2019 national average hourly wages for
the occupational mix nursing subcategories, due to inadvertent errors
related to the following:
The inclusion of a CAH in the wage data (CMS Certification
Number (CCN) 060016).
Wage data collected from the Medicare cost reports of one
hospital (CCN 100044).
Occupational Mix data collected from one hospital (CCN
010001).
On page 41406, we are correcting a typographical error in our
reference to the discussion of the comments received on the proposed
methodology for Factor 3.
On page 41415, in our discussion regarding Methodology for
Calculating Factor 3 for FY 2019, we are correcting a technical error
in the calculation of the CCR ceilings for FY 2014 and FY 2015 and the
number of hospitals above the ceiling in each of those years.
On page 41432, in our discussion regarding Regulatory Background of
Hospital Readmissions Reduction Program, we made a typographical error
in referencing the fiscal year in which the calculation of the
proportion of ``dually eligible'' Medicare beneficiaries used to
stratify hospitals into peer groups will begin.
On page 41436, in our discussion regarding Identification of
Aggregate Payments for Each Condition/Procedure and All Discharges, we
inadvertently omitted language regarding which MedPAR data is included
in the program calculations.
On page 41446, we made a technical error in the heading for section
IV.I.2.c. by inadvertently stating the incorrect number of measure
removal proposals that we were finalizing in the FY 2019 IPPS/LTCH PPS
final rule for the Hospital Value-Based Purchasing (VBP) Program.
On page 41452, we made an error in the date of publication of a
reference.
On page 41469, in the table entitled ``Previously Adopted and Newly
Displayed Performance Standards for the FY 2021 Program Year: Safety,
Clinical Outcomes, and Efficiency and Cost Reduction Domains,'' we
inadvertently did not display several of the numbers in the benchmark
column to 3 decimal places.
On page 41488, in our discussion regarding analysis of Hospital-
Acquired Condition Reduction Program, we made a technical error in
referencing hospital's National Healthcare Safety Network (NHSN)
Healthcare-Associated Infection (HAI) measures.
On pages 41528 and 41529, we corrected the MS-LTC-DRG budget
neutrality factor due to an error in the MS-LTC-DRG weights resulting
from the inadvertent inclusion of an all-inclusive rate provider.
On pages 41536 and 41537, due to the changes in the MS-LTC-DRG
weights resulting from the correction to the MS-LTC-DRG budget
neutrality factor (described previously) and the corrections in the
LTCH PPS wage index referenced above and discussed in greater detail
below, we made conforming changes to the budget neutrality adjustment
factor for the cost of the elimination of the 25-percent threshold
policy for FY 2019 and the area wage budget neutrality factor.
On page 41556, in our discussion regarding claims-based-readmission
measures, the National Quality Forum (NQF) number for the MORT-30-CABG
measure was inadvertently listed as NQF #2515, which is the NQF number
for the READM-30-CABG measure.
On page 41558, in our discussion finalizing our proposals to remove
the mortality measures, we inadvertently referenced the FY 2020 payment
determination twice.
On page 41576, in the table entitled ``Summary of Hospital IQR
Program Measures Newly Finalized for Removal,'' an entry under
``Claims-Based Coordination of Care Measures'' inadvertently included
an ``A'' in the short name for the Pneumonia Readmission measure.
On page 41579, in the table entitled ``Measures for the FY 2021
Payment
[[Page 49838]]
Determination,'' we inadvertently omitted the entry for the FY 2021
payment determination for MORT-30-CABG. In the same table, we made a
typographical error by inadvertently including an asterisk at the end
of Hospital 30-Day, All-Cause, Risk-Standardized Mortality Rate
Following Acute Ischemic Stroke (MORT-30-STK). In the same table, we
made a typographical error by inadvertently listing the incorrect NQF
number for STK-06, Discharged on Statin Medication measure. In the same
table, we inadvertently excluded the word ``Venous'' from the full
measure name of VTE-2, Intensive Care Unit Venous Thromboembolism
Prophylaxis.
On page 41599, in our discussion of Social Risk Factors in the
Hospital Inpatient Quality Reporting (IQR) Program, we inadvertently
used the term ``measures'' instead of ``methods''.
On page 41672, in our discussion regarding the electronic reporting
of electronic clinical quality measures (eCQMs) for CY 2019, we
incorrectly referred to the Spring 2017 version of the CQM electronic
specifications as the most recent version. A more recent version of the
specifications was issued after the proposed rule was published, which
is the 2018 eCQM specifications update (published in May 2018).
B. Summary of Errors in the Addendum
As discussed in section II.D. of this correcting document, we made
several technical errors with regard to the calculation of Factor 3 of
the uncompensated care payment methodology. Factor 3 is used to
determine the total amount of the uncompensated care payment a hospital
is eligible to receive for a fiscal year. This amount is then used to
calculate the amount of the interim uncompensated care payments a
hospital receives per discharge. Per discharge uncompensated care
payments are included when determining total payments for purposes of
all of the budget neutrality factors and the final outlier threshold.
As a result, the revisions made to address these technical errors
regarding the calculation of Factor 3 directly affected the calculation
of total payments and required the recalculation of all the budget
neutrality factors and the final outlier threshold.
Because of the errors related to the wage data for the three
hospitals (CCNs 010001, 060016 and 100044) as discussed in section
II.A. of this correcting document, we recalculated the FY 2019 national
average hourly wages unadjusted for occupational mix and adjusted for
occupational mix which resulted in the recalculation of the final FY
2019 IPPS wage indexes and the geographic adjustment factors (GAFs)
(which are computed from the wage index). The final FY 2019 IPPS wage
data are used in the calculation of the wage index budget neutrality
adjustment when comparing total payments using the final FY 2018 IPPS
wage index data to total payments using the final FY 2019 IPPS wage
index data. Additionally, the final FY 2019 IPPS wage index data are
used when determining total payments for purposes of the rest of the
budget neutrality factors (except for the MS-DRG reclassification and
recalibration budget neutrality factor) and the final outlier
threshold. In addition, the final FY 2019 IPPS wage index data are used
to calculate the FY 2019 LTCH PPS wage index values, certain budget
neutrality factors, and the LTCH PPS standard Federal payment rate in
the FY 2019 IPPS/LTCH PPS final rule.
We also made inadvertent errors related to the status of four
providers reclassified from urban to rural under section 1886(d)(8)(E)
of the Act (codified in the regulations under Sec. 412.103 and
hereinafter referred to as Sec. 412.103). Specifically, the
reclassification status in the FY 2019 IPPS/LTCH PPS final rule did not
properly reflect the application of urban to rural reclassification
under Sec. 412.103 for four providers (CCNs 050025, 050573, 120001 and
120002). We note, provider 050573 was approved by the MGCRB for
reclassification (as already reflected in the FY 2019 IPPS/LTCH final
rule) in addition to its urban to rural reclassification under Sec.
412.103. Additionally, the final FY 2019 IPPS wage index with
reclassification is used when determining total payments for purposes
of all budget neutrality factors (except for the MS-DRG
reclassification and recalibration budget neutrality factor and the
wage index budget neutrality adjustment factor) and the final outlier
threshold.
Due to the correction of the combination of errors listed
previously (revisions to Factor 3 of the uncompensated care payment
methodology, the correction to the final FY 2019 IPPS wage index data
adjusted for occupational mix and the correction to the geographic
reclassification status of four hospitals), we recalculated all IPPS
budget neutrality adjustment factors, the fixed-loss cost threshold,
the final wage indexes (and GAFs), and the national operating
standardized amounts and capital Federal rate. (We note there was no
change to the rural community hospital demonstration program budget
neutrality adjustment or the operating outlier adjustment factor
resulting from the correction of this combination of errors.)
Therefore, we made conforming changes to the following:
On pages 41715 and 41727, the MS-DRG reclassification and
recalibration budget neutrality adjustment factor.
On page 41716, the following budget neutrality
adjustments:
++ Wage index budget neutrality adjustment.
++ Reclassification hospital budget neutrality adjustment.
++ Rural floor budget neutrality adjustment.
On page 41723, the calculation of the outlier fixed-loss
cost threshold, total operating Federal payments, total operating
outlier payments, and the outlier adjustment to the capital Federal
rate.
On pages 41724 through 41725, the table titled ``Changes
From FY 2018 Standardized Amounts to the FY 2019 Standardized
Amounts''.
On page 41722, we are also correcting inadvertent technical errors
in the figures reported for the covered charges and cases by quarter in
the periods used to calculate the charge inflation factor.
Specifically, we erroneously presented figures based on total charges
for the applicable periods listed in the table rather than the covered
charges and the case counts were not correctly aligned with the
corresponding quarter. We note that although there were technical
errors in the figures as presented in the table and the corresponding
discussion on page 41722, the correct figures were used for the outlier
calculations in the final rule. In addition, on page 41723, we are
correcting technical errors in the description of the formula showing
total outlier payments as a percentage of total operating Federal
payments.
On pages 41727 through 41729, in our discussion of the
determination of the Federal hospital inpatient capital-related
prospective payment rate update, due to the recalculation of the GAFs,
we have made conforming corrections to the increase in the capital
Federal rate, the GAF/DRG budget neutrality adjustment factors, the
capital Federal rate, and the outlier threshold (as discussed
previously), along with certain statistical figures (for example,
percent change) in the accompanying discussions. Also, as a result of
these errors we have made conforming corrections in the tables showing
the comparison of factors and adjustments for the FY 2018 capital
Federal rate and FY 2019 capital Federal rate and the proposed FY 2019
capital Federal rate and final FY 2019 capital Federal rate.
[[Page 49839]]
On pages 41730 through 41731, 41733, 41736 and 41737, due to
corrections in the LTCH PPS wage index discussed previously, we are
making conforming corrections to the following:
The area wage level adjustment budget neutrality factor.
The fixed-loss amount for FY 2019 LTCH PPS standard
Federal payment rate discharges and the high-cost outlier (HCO)
threshold.
The budget neutrality adjustment factor for the cost of
the elimination of the 25-percent threshold policy for FY 2019 and the
FY 2019 LTCH PPS standard Federal payment rate.
The fixed-loss amount for FY 2019 site neutral payment
rate discharges and the high-cost outlier (HCO) threshold (based on the
corrections to the IPPS fixed-loss amount discussed previously).
On pages 41738 and 41739, we are making conforming corrections to
the figures used in the example of computing the adjusted LTCH PPS
Federal prospective payment for FY 2019.
On pages 41740 and 41741, we are making conforming corrections to
the following:
National adjusted operating standardized amounts and
capital standard Federal payment rate (which also include the rates
payable to hospitals located in Puerto Rico) in Tables 1A, 1B, 1C, and
1D as a result of the conforming corrections to certain budget
neutrality factors and the outlier threshold (as described previously).
We are also correcting a typographical error in the update factor
presented in the column heading for a hospital that submitted quality
data and is a meaningful EHR user.
LTCH PPS standard Federal payment rate in Table 1E as a
result of the correction to the LTCH PPS wage index values (as
discussed previously).
C. Summary of Errors in the Appendices
On pages 41742, 41744 through 41751, and 41763 through 41765 in our
regulatory impact analyses, we made conforming corrections to the
factors, values, and tables and accompanying discussion of the changes
in operating and capital IPPS payments for FY 2019 and the effects of
certain IPPS budget neutrality factors as a result of the technical
errors that lead to conforming changes in our calculation of the
operating and capital IPPS budget neutrality factors, outlier
threshold, final wage indexes, operating standardized amounts, and
capital Federal rate (as described in sections II.A. and II.B. of this
correcting document).
In particular, we made changes to the following tables:
On pages 41744 through 41746, the table titled ``Table I--
Impact Analysis of Changes to the IPPS for Operating Costs for FY
2019''.
On pages 41748 through 41749, the table titled ``FY 2019
IPPS Estimated Payments Due To Rural Floor With National Budget
Neutrality''.
On pages 41750 through 41751, the table titled ``Table
II--Impact Analysis of Changes for FY 2019 Acute Care Hospital
Operating Prospective Payment System [Payments per discharge]''.
On pages 41764 through 41765, the table titled ``Table
III--Comparison of Total Payments per Case [FY 2018 payments compared
to FY 2019 payments]''.
On pages 41753 through 41755, we are correcting the discussion of
the ``Effects of the Changes to Medicare DSH and Uncompensated Care
Payments for FY 2019'' for purposes of the Regulatory Impact Analysis
in Appendix A of the FY 2019 IPPS/LTCH PPS final rule, including the
table titled ``MODELED UNCOMPENSATED CARE PAYMENTS FOR ESTIMATED FY
2019 DSHs BY HOSPITAL TYPE: MODEL UCP $ (IN MILLIONS) * FROM FY 2018 to
FY 2019'' on pages 41753 and 41754, in light of the corrections
discussed in section II.D. of this correcting document.
On page 41756, in our discussion of the effects of changes under
the FY 2019 Hospital Value-Based Purchasing (VBP) Program that appears
in Appendix A, we are correcting an inadvertent reference to the word
``proposed'' in the heading for section I.H.6.a in the first column at
the bottom of the page and in line 1 of the last paragraph of the
second column at the bottom of the page.
On pages 41758 through 41759, in table entitled ``Estimated
Proportion of Hospitals in the Worst-Performing Quartile (>75th
Percentile) of the Total HAC Scores for the FY 2019 HAC Reduction
Program'', we inadvertently included incorrect data.
On pages 41766 and 41768 through 41769, we made conforming
corrections to the LTCH PPS area wage level budget neutrality factor,
the budget neutrality adjustment factor for the cost of the elimination
of the 25-percent threshold policy for FY 2019, and the LTCH PPS
standard Federal payment rate as described in section II.B. of this
correcting document.
On pages 41768 through 41770, we are making conforming corrections
to ``Table IV--Impact of Payment Rate and Policy Changes to LTCH PPS
Payments for Standard Payment Rate Cases for FY 2019'' and the
corresponding summary text. We are also correcting the inadvertent
mislabeling of the Pacific and Mountain rows in that table.
D. Summary of Errors in and Corrections to Files and Tables Posted on
the CMS Website
We are correcting the errors in the following IPPS tables that are
listed on pages 41739 through 41740 of the FY 2019 IPPS/LTCH PPS final
rule and are available on the internet on the CMS website at https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/AcuteInpatientPPS/FY2019-IPPS-Final-Rule-Home-Page.html. The tables
that are available on the internet have been updated to reflect the
revisions discussed in this correcting document.
Table 2--Case-Mix Index and Wage Index Table by CCN-FY 2019. The
wage data errors (as discussed in section II.A. of this correcting
document) related to the three hospitals (CCNs 010001, 060016, and
100044) required the recalculation of the FY 2019 national average
hourly wages unadjusted for occupational mix and adjusted for
occupational mix which resulted in recalculating the FY 2019 wage
indexes. Additionally, for the four providers (CCNs 050025, 050573,
120001, and 120002) for which we are applying urban to rural
reclassification under Sec. 412.103 (as discussed in section II.B. of
this correcting document), we are correcting the values where
applicable in the columns titled ``FY 2019 Wage Index'',
``Reclassified/Redesignated CBSA'', ``Hospital Reclassified as Rural
Under Section 1886(d)(8)(E) of the Act (Sec. 412.103)'' and ``Dual
Status 412.103 and MGCRB/LUGAR''. Also, the revisions to Factor 3 of
the uncompensated care payment methodology and recalculation of the FY
2019 wage index necessitated the recalculation of the rural floor
budget neutrality factor (as discussed in section II.B. of this
correcting document). Therefore, we are correcting the values in the
column titled ``FY 2019 Wage Index'' for all hospitals. Additionally,
for the two hospitals (CCNs 010001 and 100044) for which we
inadvertently used the incorrect wage and occupational mix data (as
discussed in section II.A. of this correcting document), we are
correcting the average hourly wages in the columns titled ``Average
Hourly Wage FY 2019'' and ``3-Year Average Hourly Wage (2017, 2018,
2019)''. Furthermore, we are deleting provider 060016 from the wage
index and Table 2 since it is a CAH (as discussed in section II.A. of
this correcting document).
[[Page 49840]]
Table 3.--Wage Index Table by CBSA--FY 2019. The correction of the
wage data errors (as discussed in section II.A. of this correcting
document) related to the three hospitals (CCNs 010001, 060016, and
100044) required the recalculation of the FY 2019 national average
hourly wage adjusted for occupational mix which resulted in
recalculating the FY 2019 wage indexes. Also, the revisions to Factor 3
of the uncompensated care payment methodology, recalculation of the FY
2019 wage index, and correction of the reclassification errors
discussed in section II.B. of this correcting document necessitated the
recalculation of the rural floor budget neutrality factor (as discussed
in section II.B. of this correcting document). Therefore, we are making
corresponding changes to the wage indexes and GAFs of all CBSAs listed
in Table 3. Specifically, we are correcting the values and flags in the
columns titled ``Wage Index'', ``Reclassified Wage Index'', ``GAF'',
``Reclassified GAF'', ``Pre-Frontier and/or Pre-Rural Floor Wage
Index'' and ``Eligible for Rural Floor Wage Index''. Also, we are
making changes to reflect the application of urban to rural
reclassification under Sec. 412.103 for the four providers (CCNs
050025, 050573, 120001 and 120002) discussed in section II.B. of this
correcting document. Specifically, we are correcting the values and
flags in the columns titled ``Wage Index'', ``Reclassified Wage
Index'', ``GAF'', ``Reclassified GAF'', ``Pre-Frontier and/or Pre-Rural
Floor Wage Index'' and ``Eligible for Rural Floor Wage Index''.
Additionally, for the 3 CBSAs (06, 20020, and 38940) where the three
hospitals (CCNs 010001, 060016, and 100044) for which there were wage
data errors are located (as discussed in section II.A. of this
correcting document), we are correcting the average hourly wages in the
columns titled ``FY 2019 Average Hourly Wage'' and ``3-Year Average
Hourly Wage (2017, 2018, 2019)''.
Table 4.--List of Counties Eligible for the Out-Migration
Adjustment under Section 1886(d)(13) of the Act--FY 2019. The
correction of the wage data errors related to the three hospitals (CCNs
010001, 060016, and 100044), as discussed in section II.A. of this
correcting document, required the recalculation of the FY 2019 national
average hourly wage adjusted for occupational mix which resulted in
recalculating the FY 2019 wage indexes. Also, the revisions to Factor 3
of the uncompensated care payment methodology, recalculation of the FY
2019 wage indexes, and correction of the reclassification errors
discussed in section II.B. of this correcting document necessitated the
recalculation of the rural floor budget neutrality factor (as discussed
in section II.B. of this correcting document). Also, we are making
changes to reflect the application of urban to rural reclassification
under Sec. 412.103 for the four providers (CCNs 050025, 050573, 120001
and 120002), as discussed in section II.B. of this correcting document.
Therefore, we are making corresponding changes to the eligible counties
and out migration values listed in Table 4. Specifically, we are
correcting the list of counties and values in the columns titled ``FIPS
County Code'', ``County Name'', ``State'', ``State Code'', ``Fiscal
Year Begin of Adjustment'' and ``FY 2019 Out Migration''.
Table 18.--FY 2019 Medicare DSH Uncompensated Care Payment Factor
3. We are correcting this table to reflect revisions to the Factor 3
calculations for purposes of determining uncompensated care payments
for the FY 2019 IPPS/LTCH PPS final rule for the following reasons:
To reflect mergers where data for the merged hospital were
not combined with the data for the surviving hospital.
To correct the projected DSH eligibility for a SCH that
now has CAH status, and therefore is no longer included in Table 18.
To correct a provider's Factor 3 that was inadvertently
calculated using the methodology for all-inclusive rate providers.
To correct the Factor 3s that were computed for hospitals
whose FY 2014 or FY 2015 cost report in the June 2018 extract of
Healthcare Cost Report Information System (HCRIS) inadvertently omitted
amended uncompensated care cost data that had been reported by the
hospital on an amended Worksheet S-10 in a timely manner per Change
Request (CR) 10378 issued on December 1, 2017, or where the FY 2014 or
FY 2015 cost report for a DSH eligible hospital had inadvertently been
uploaded into HCRIS without making the calculation modifications
described in Transmittal 11, and to reflect the cost-to-charge ratio
(CCR) trim changes resulting from the inclusion of the inadvertently
omitted data.
We are revising Factor 3 for all hospitals to correct these errors.
We are also revising the amount of the total uncompensated care payment
calculated for each DSH-eligible hospital. The total uncompensated care
payment that a hospital receives is used to calculate the amount of the
interim uncompensated care payments the hospital receives per
discharge. We also corrected the per discharge interim uncompensated
care payment for all hospitals to reflect the 2017 discharges as shown
on the FY 2019 IPPS Impact File. We also corrected the per discharge
interim uncompensated care payment calculated for a merged hospital to
reflect the discharges for the subsumed hospital. Per discharge
uncompensated care payments are included when determining total
payments for purposes of all of the budget neutrality factors and the
final outlier threshold. As a result, these corrections to the
uncompensated care payments impacted the calculation of all the budget
neutrality factors as well as the outlier fixed-loss cost threshold.
These corrections will be reflected in Table 18 and the Medicare DSH
Supplemental Data File. In section IV.C. of this correcting document,
we have made corresponding revisions to the discussion of the ``Effects
of the Changes to Medicare DSH and Uncompensated Care Payments for FY
2019'' for purposes of the Regulatory Impact Analysis in Appendix A of
the FY 2019 IPPS/LTCH PPS final rule to reflect the corrections
discussed previously.
We are also correcting the errors in the following LTCH PPS tables
that are listed on 41739 through 41740 of the FY 2019 IPPS/LTCH PPS
final rule and are available on the internet on the CMS website at
https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/LongTermCareHospitalPPS/ under the list item for regulation
number CMS-1694-F. The tables that are available on the internet have
been updated to reflect the revisions discussed in this correcting
document.
Table 11.--MS-LTC-DRGs, Relative Weights, Geometric Average Length
of Stay, Short-Stay Outlier (SSO) Threshold for Discharges Occurring
from October 1, 2018 through September 30, 2019 under the LTCH PPS. We
are correcting this table to reflect the revisions to the MS-LTC-DRG
relative weights, geometric average length-of-stay, and short-stay
outlier threshold due to the inadvertent inclusion of an all-inclusive
rate provider as discussed in section II.A. of this correcting
document.
Table 12A.--LTCH PPS Wage Index for Urban Areas for Discharges
Occurring from October 1, 2018 through September 30, 2019. We are
correcting this table to reflect the revisions to the LTCH PPS wage
index values discussed in section II.A. of this correcting document.
Table 12B.--LTCH PPS Wage Index for Rural Areas for Discharges
Occurring
[[Page 49841]]
from October 1, 2018 through September 30, 2019. We are correcting this
table to reflect the revisions to the LTCH PPS wage index values
discussed in section II.A. of this correcting document.
III. Waiver of Proposed Rulemaking, 60-Day Comment Period, and Delay in
Effective Date
Under 5 U.S.C. 553(b) of the Administrative Procedure Act (APA),
the agency is required to publish a notice of the proposed rulemaking
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 rulemaking 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) of
the Act mandate a 30-day delay in effective date after issuance or
publication of a rule. Sections 553(b)(B) and 553(d)(3) of the APA
provide for exceptions from the notice and comment and delay in
effective date APA requirements; in cases in which these exceptions
apply, sections 1871(b)(2)(C) and 1871(e)(1)(B)(ii) of the Act provide
exceptions from the notice and 60-day comment period and delay in
effective date requirements of the Act as well. Section 553(b)(B) of
the APA and section 1871(b)(2)(C) of the Act authorize an agency to
dispense with normal rulemaking requirements for good cause if the
agency makes a finding that the notice and comment process are
impracticable, unnecessary, or contrary to the public interest. In
addition, both section 553(d)(3) of the APA and section
1871(e)(1)(B)(ii) of the Act allow the agency to avoid the 30-day delay
in effective date where such delay is contrary to the public interest
and an agency includes a statement of support.
We believe that this correcting document does not constitute a rule
that would be subject to the notice and comment or delayed effective
date requirements. The document corrects technical and typographical
errors in the preamble, addendum, payment rates, tables, and appendices
included or referenced in the FY 2019 IPPS/LTCH PPS final rule, but
does not make substantive changes to the policies or payment
methodologies that were adopted in the final rule. As a result, this
correcting document is intended to ensure that the information in the
FY 2019 IPPS/LTCH PPS final rule accurately reflects the policies
adopted in that document.
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 2019 IPPS/LTCH PPS final
rule accurately reflects our methodologies and policies. Furthermore,
such procedures would be unnecessary, as we are not making substantive
changes to our 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 2019
IPPS/LTCH PPS final rule accurately reflects these methodologies and
policies. Therefore, we believe we have good cause to waive the notice
and comment and effective date requirements.
IV. Correction of Errors
In FR Rule Doc. 2018-16766 of August 17, 2018 (83 FR 41144), we are
making the following corrections:
A. Corrections of Errors in the Preamble
1. On page 41144, third column, sixth and seventh full paragraph,
the contact information ``Elizabeth Holland, (410) 786-1309, Promoting
Interoperability Programs. Clinical Quality Measure Related Issues.
Kathleen Johnson, (410) 786-3295 and Steven Johnson (410) 786-3332,
Promoting Interoperability Programs Nonclinical Quality Measure Related
Issues.'' is corrected to read ``Jessica Wright, (410) 786-3838,
Medicare Promoting Interoperability Program''.
2. On page 41151, second column, second bulleted paragraph,
a. Line 13, the figure ``2,610'' is corrected to read ``2,599''.
b. Line 19, the figure ``$566'' is corrected to read ``$550''.
3. On page 41200, between the untitled tables, first column, first
full paragraph, line 27, the phrase ``primary and secondary diagnoses''
is corrected to read ``principal and secondary diagnoses''.
4. On page 41219, middle of the page, third column, partial
paragraph, line 13, the phrase ``primary and secondary diagnoses'' is
corrected to read ``principal and secondary diagnoses''.
5. On page 41236, lower half of the page, third column, first
partial paragraph, line 2, the phrase ``primary diagnosis'' is
corrected to read ``principal diagnosis''.
6. On page 41254, lower two-thirds of the page, first column,
partial paragraph, lines 12 through 17, the phrase ``MS-DRGs 163, 164,
and 165 (Major Chest Procedures with MCC, with CC, and without CC/MCC,
respectively) in MDC 4 (Diseases and Disorders of the Respiratory
System);'' to read ``MS-DRGs 163, 164, and 165 (Major Chest Procedures
with MCC, with CC, and without CC/MCC, respectively) and MS-DRGs 166,
167, and 168 (Other Respiratory System O.R. Procedures with MCC, with
CC, and without CC/MCC, respectively) in MDC 4 (Diseases and Disorders
of the Respiratory System);''.
7. On page 41299, second column, first partial paragraph, lines 2
through 7, the sentence ``Cases involving KYMRIAH and YESCARTA that are
eligible for new technology add-on payments will be identified by ICD-
10-PCS procedure codes XW033C3 and XW043C3.'' is corrected to read
``Cases involving KYMRIAH and YESCARTA that are eligible for new
technology add-on payments will be identified by either of the
following ICD-10-PCS procedure codes: XW033C3 (Introduction of
engineered autologous chimeric antigen receptor T-cell immunotherapy
into peripheral vein, percutaneous approach, new technology group 3) or
XW043C3 (Introduction of engineered autologous chimeric antigen
receptor T-cell immunotherapy into central vein, percutaneous approach,
new technology group 3).''
8. On page 41311, second column, first partial paragraph, lines 46
through 51, the phrase ``FY 2019 cases involving the use of
VABOMERE\TM\ that are eligible for the FY 2019 new technology add-on
payments will be identified by the NDC of 65293-009-01 (VABOMERE\TM\
Meropenem-Vaborbactam Vial).'' is corrected to read ``FY 2019 cases
involving the use of VABOMERE\TM\ that are eligible for the FY 2019 new
technology add-on payments will be identified by the NDC of 65293-0009-
01 (VABOMERE\TM\ Meropenem-Vaborbactam Vial).''
9. On page 41313, first column, first partial paragraph, line 8,
the phrase ``primary diagnosis'' is corrected to read ``principal
diagnosis''.
10. On page 41320, second column, first partial paragraph, line 15,
the code ``05H043MZ'' is corrected to read ``05H43MZ''.
11. On page 41334, second column, first full paragraph, lines 20
through 24,
[[Page 49842]]
the sentence ``Cases involving ZEMDRITM that are eligible
for new technology add-on payments will be identified by ICD-10-PCS
procedure codes XW033G4 and XW043G4.'' is corrected to read ``Cases
involving ZEMDRITM that are eligible for new technology add-
on payments will be identified by either of the following ICD-10-PCS
procedure codes: XW033G4 (Introduction of Plazomicin anti-infective
into peripheral vein, percutaneous approach, new technology group 4) or
XW043G4 (Introduction of Plazomicin anti-infective into central vein,
percutaneous approach, new technology group 4).''
12. On page 41342, second column, first partial paragraph, lines 3
and 4, the phrase ``identified by ICD-10-PCS procedure codes XW033H4
and XW043H4.'' is corrected to read ``identified by either of the
following ICD-10-PCS procedure codes: XW033H4 (Introduction of
synthetic human angiotensin II into peripheral vein, percutaneous
approach, new technology group 4) or XW043H4 (Introduction of synthetic
human angiotensin II into central vein, percutaneous approach, new
technology group 4).''
13. On page 41348, second column, first full paragraph, line 17,
the figure ``$2,400'' is corrected to read ``$2,800''.
14. On page 41362, first column, first partial paragraph, lines 4
through 7, the phrase ``eligible for new technology add-on payments
will be identified by ICD-10-PCS procedure codes XW03372 and XW04372.''
is corrected to read ``eligible for new technology add-on payments will
be identified by either of the following ICD-10-PCS procedure codes:
XW03372 (Introduction of Andexanet alfa, factor Xa inhibitor reversal
agent into peripheral vein, percutaneous approach, new technology group
2) or XW04372 (Introduction of Andexanet alfa, factor Xa inhibitor
reversal agent into central vein, percutaneous approach, new technology
group 2).''
15. On page 41364, third column, first partial paragraph--
a. Line 10, the figure ``3'' is corrected to read ``4''.
b. Line 18, the figure ``11'' is corrected to read ``12''.
c. Line 21, the figure ``3'' is corrected to read ``4''.
d. Line 23, the figure ``3,283'' is corrected to read ``3,282''.
e. Lines 23 through 24, the figure ``(3,260 + 28 - 2 - 3 = 3,283)''
is corrected to read ``(3,260 + 28 - 2 - 4 = 3,282)''.
16. On page 41365--
a. Second column, third full paragraph, last line, the figure
``$42.997789358'' is corrected to read ``$42.998002633''.
b. Third column, first partial paragraph, line 32, the figure
``$42.997789358'' is corrected to read ``$42.998002633''.
17. On page 41368, third column, first partial paragraph, line 21,
the figure ``3,283'' is corrected to read ``3,282''.
18. On page 41375--
a. Second column--
i. First partial paragraph--
A. Line 2, the figure ``3,283'' is corrected to read ``3,282''.
B. Line 3, the figure ``3,114'' is corrected to read ``3,113''.
C. Lines 6 and 7, the parenthetical figures ``(3,114/3,283)'' are
corrected to read ``(3,113/3,282)''.
D. Last line, the figure ``$42.955567020'' is corrected to read
``$42.955981146''.
ii. Following the first full paragraph the untitled table is
corrected to read as follows:
------------------------------------------------------------------------
Final unadjusted national average Final occupational mix adjusted
hourly wage national average hourly wage
------------------------------------------------------------------------
$42.998002633 $42.955981146
------------------------------------------------------------------------
b. Third column,
i. Top of the column (before the first full paragraph), the
untitled table is corrected to read as follows:
------------------------------------------------------------------------
Average hourly
Occupational mix nursing subcategory wage
------------------------------------------------------------------------
National RN............................................. $41.65745883
National LPN and Surgical Technician.................... 24.73751208
National Nurse Aide, Orderly, and Attendant............. 16.96596364
National Medical Assistant.............................. 18.13187187
National Nurse Category................................. 35.03615689
------------------------------------------------------------------------
ii. First full paragraph, line 4, the figure ``$35.04005228'' is
corrected to read ``$35.03615689''.
19. On page 41406, second column, first full paragraph, line 30,
the term ``Facto'' is corrected to read ``Factor''.
20. On page 41415, third column--
a. Second full paragraph,
i. Line 26, the phrase ``5 hospitals'' is corrected to read ``16
hospitals''.
ii. Line 28, the figure ``1.031'' is corrected to read ``1.032''.
iii. Line 30, the figure ``0.93'' is corrected to read ``0.929''.
b. Fourth full paragraph, line 10, the phrase ``14 hospitals'' is
corrected to read ``25 hospitals''.
21. On page 41432, first column, first partial paragraph, lines 2
and 3, the phrase ``FY 2018'' is corrected to read ``FY 2019''.
22. On page 41436, second column, last bulleted paragraph, the
sentence, ``March 2018 update of the FY 2017 MedPAR files to identify
claims within FY 2017'' is corrected to read ``March 2018 update of the
FY 2017 MedPAR file to identify claims within FY 2017 with discharge
dates that are on or before June 30, 2017.''
23. On page 41446, third column, section heading ``c. Removal of
Ten Measures From the Hospital VBP Program'' is corrected to read ``c.
Removal of Four Measures From the Hospital VBP Program''.
24. On page 41452, third column, footnote paragraph (footnote 241),
the date ``(August 20, 2017)'' is corrected to read ``(August 30,
2017)''.
25. On page 41469, table titled ``Previously Adopted and Newly
Displayed Performance Standards for the FY 2021 Program Year: Safety,
Clinical Outcomes, and Efficiency and Cost Reduction Domains'', under
``Safety Domain'', the entries in the ``Benchmark'' column for the
CAUTI, CLABSI, MRSA Bacteremia, and Colon and Abdominal Hysterectomy
SSI measures are corrected to read to three decimal places as follows:
------------------------------------------------------------------------
Achievement
Measure short name threshold Benchmark
------------------------------------------------------------------------
Safety Domain
------------------------------------------------------------------------
CAUTI................................... 0.774 0.000
CLABSI.................................. 0.687 0.000
CDI..................................... 0.748 0.067
MRSA Bacteremia......................... 0.763 0.000
[[Page 49843]]
Colon and Abdominal Hysterectomy SSI.... 0.754 0.000
0.726 0.000
------------------------------------------------------------------------
26. On page 41488, first column, last paragraph, line 7, the phrase
``HAI data'' is corrected to read ``HAI measure''.
27. On page 41528, third column, last paragraph, line 29, the
figure ``0.9931052'' is corrected to read ``0.9935905''.
28. On page 41529, first column, first full paragraph, line 7, the
figure ``0.9931052'' is corrected to read ``0.9935905''.
29. On page 41536, third column--
a. First bulleted paragraph, line 2, the figure ``0.990884'' is
corrected to read ``0.990878''.
b. Second bulleted paragraph, line 2, the figure ``0.990741'' is
corrected to read ``0.990737''.
30. On page 41537--
a. Second column, last paragraph, last line, the figure
``0.990741'' is corrected to read ``0.990737''.
b. Third column, second full paragraph--
i. Line 6, the figure ``0.990884'' is corrected to read
``0.990878''.
ii. Lines 13, the figure ``0.990884'' is corrected to read
``0.990878''.
31. On page 41556, third column, last bulleted paragraph, line 4,
the parenthetical phrase (NQF # 2515) is corrected to read ``(NQF #
2558)''.
32. On page 41558, second column, last paragraph, line 7, the
phrase ``FYs 2020, 2021, and 2020'' is corrected to read ``FYs 2020,
2021, and 2022''
33. On page 41576, in the table titled ``SUMMARY OF HOSPITAL IQR
PROGRAM MEASURES NEWLY FINALIZED FOR REMOVAL,'' under the ``Claims-
Based Coordination of Care Measures'', first column (Short name), the
fifth entry ``READM-30-PNA'' is corrected to read ``READM-30-PN''.
34. On page 41579, table titled ``MEASURES FOR THE FY 2021 PAYMENT
DETERMINATION,'' under ``Claims-Based Mortality Measures'', the
following entries are corrected by:
a. Removing the inadvertently included asterisk at the end of the
full measure name for MORT-30-STK; and
b. Adding a row to the table to include an entry for MORT-30-CABG,
which was inadvertently omitted, such that the table will read as
follows:
------------------------------------------------------------------------
------------------------------------------------------------------------
Claims-Based Mortality Measures
------------------------------------------------------------------------
MORT-30-CABG................... Hospital 30-Day, All- 2558
Cause,
Risk[dash]Standardized
Mortality Rate
Following Coronary
Artery Bypass Graft
(CABG) Surgery.
MORT-30-STK.................... Hospital 30-Day, All- N/A
Cause,
Risk[dash]Standardized
Mortality Rate
Following Acute
Ischemic Stroke.
------------------------------------------------------------------------
35. On page 41579, table titled ``MEASURES FOR THE FY 2021 PAYMENT
DETERMINATION,'' under ``EHR-Based Clinical Process of Care Measures
(that is, Electronic Clinical Quality Measures (eCQMs))'', third column
(NQF #), line 11, for the entry for STK-06, the NQF number ``0438'' is
corrected to read ``0439'' as follows:
------------------------------------------------------------------------
------------------------------------------------------------------------
STK-06......................... Discharged on Statin 0439
Medication.
------------------------------------------------------------------------
36. On page 41579, table titled ``MEASURES FOR THE FY 2021 PAYMENT
DETERMINATION,'' under ``EHR-Based Clinical Process of Care Measures
(that is, Electronic Clinical Quality Measures (eCQMs))'', second
column (Measure Name), the last line down, the measure name for the
entry for VTE-2 is corrected from ``Intensive Care Unit Thromboembolism
Prophylaxis'' to reflect the complete measure name ``Intensive Care
Unit Venous Thromboembolism Prophylaxis.''
------------------------------------------------------------------------
------------------------------------------------------------------------
VTE-2.......................... Intensive Care Unit 0372
Venous Thromboembolism
Prophylaxis.
------------------------------------------------------------------------
37. On page 41599, third column,
a. Third full paragraph, lines 4 and 5, the phrase ``disparity
measures'' is corrected to read ``disparity methods''.
b. Last paragraph, line 9, the phrase ``disparity measures'' is
corrected to read ``disparity methods''.
38. On page 41672, first column, fourth paragraph, lines 9 through
11, the phrase ``Spring 2017 version of the CQM electronic
specifications'' is corrected to read ``2018 eCQM specifications update
(published in May 2018)''.
B. Correction of Errors in the Addendum
1. On page 41715, third column, fourth full paragraph, lines 3 and
8, the figure ``0.997192'' is corrected to read ``0.997190''.
2. On page 41716--
a. First column, fourth full paragraph, line 9, the figure
``1.000748'' is corrected to read ``1.000746''.
b. Second column, second full paragraph, line 11, the figure
``0.985932'' is corrected to read ``0.985335''.
c. Third column, second full paragraph, line 3, the figure
``0.993142'' is corrected to read ``0.993911''.
3. On page 41722--
a. Middle of the page, the untitled table is corrected to read as
follows:
[[Page 49844]]
----------------------------------------------------------------------------------------------------------------
Covered charges Covered charges
(April 1, 2016, Cases (April 1, (April 1, 2017, Cases (April 1,
Quarter through March 31, 2016, through through March 31, 2017, through
2017) March 31, 2017) 2018) March 31, 2018)
----------------------------------------------------------------------------------------------------------------
April-June...................... $135,512,389,540 2,415,120 $141,310,805,358 2,407,887
July-September.................. 132,339,957,018 2,356,775 136,951,808,593 2,319,109
October-December................ 138,602,493,305 2,413,871 141,939,083,023 2,363,685
January-March................... 150,230,629,335 2,559,371 120,924,791,134 1,983,155
-------------------------------------------------------------------------------
Total....................... 556,685,469,198 9,745,137 541,126,488,108 9,073,836
----------------------------------------------------------------------------------------------------------------
b. Bottom of the page, first column,
i. First paragraph,
ii. Lines 5, the figures ``$57,448 ($559,839,156,948/9,745,137)''
are corrected to read ``$57,124 ($556,685,469,198/9,745,137)''.
iii. Lines 9 through 10, the figures ``$59,939.96
($543,885,328,430/9,073,836)'' are corrected to read ``$59,636
($541,126,488,108/9,073,836)''.
iv. Lines 13 through 14, the figures ``4.3 percent (1.04338)'' are
corrected to read ``4.4 percent (1.04396)''.
v. Line 14, the figures ``8.9 percent (1.08864)'' are corrected to
read ``9.0 percent (1.08986)''.
4. On page 41723, first column--
a. Third full paragraph--
i. Line 5, the figure ``$25,769'' is corrected to read ``$25,743''.
ii. Line 7, the figure ``$88,484,589,041'' is corrected to read
``$88,485,100,546''.
iii. Line 8, the figure ``$4,755,375,555'' is corrected to read
``$4,755,311,111''.
iv. Lines 12 through 13, the parenthetical phrase
``(($88,484,589,041/$93,239,964,596) x 100 = 5.1 percent)'' is
corrected to read ``((1 - ($88,485,100,546/$93,240,411,657)) x 100 =
5.1 percent)''.
v. Last line, the figure ``$25,769'' is corrected to read
``$25,743''.
c. Following the sixth full paragraph, the untitled table is
corrected to read as follows:
------------------------------------------------------------------------
Operating Capital
standardized Federal
amounts rate
------------------------------------------------------------------------
National................................... 0.948999 0.949417
------------------------------------------------------------------------
5. On pages 41724 through 41725, the table titled ``CHANGES FROM FY
2018 STANDARDIZED AMOUNTS TO THE FY 2019 STANDARDIZED AMOUNTS'', is
corrected to read as follows:
Changes From FY 2018 Standardized Amounts to the FY 2019 Standardized Amounts
----------------------------------------------------------------------------------------------------------------
Hospital submitted Hospital did NOT Hospital did NOT
Hospital submitted quality data and submit quality submit quality
quality data and is NOT a data and is a data and is NOT a
is a meaningful meaningful EHR meaningful EHR meaningful EHR
EHR user user user user
----------------------------------------------------------------------------------------------------------------
FY 2018 Base Rate after If Wage Index is If Wage Index is If Wage Index is If Wage Index is
removing: Greater Than Greater Than Greater Than Greater Than
1. FY 2018 Geographic 1.0000: 1.0000: 1.0000: 1.0000:
Reclassification Budget Labor (68.3%): Labor (68.3%): Labor (68.3%): Labor (68.3%):
Neutrality (0.987985) $4,059.36. $4,059.36. $4,059.36. $4,059.36.
2. FY 2018 Operating Outlier Nonlabor (30.4%): Nonlabor (30.4%): Nonlabor (30.4%): Nonlabor (30.4%):
Offset (0.948998) $1,884.07. $1,884.07. $1,884.07. $1,884.07.
If Wage Index is If Wage Index is If Wage Index is If Wage Index is
less Than or less Than or less Than or less Than or
Equal to 1.0000: Equal to 1.0000: Equal to 1.0000: Equal to 1.0000:
Labor (62%): Labor (62%): Labor (62%): Labor (62%):
$3,684.92. $3,684.92. $3,684.92. $3,684.92.
Nonlabor (38%): Nonlabor (38%): Nonlabor (38%): Nonlabor (38%):
$2,258.50. $2,258.50. $2,258.50. $2,258.50.
FY 2019 Update Factor........... 1.0135............ 0.99175........... 1.00625........... 0.9845.
FY 2019 MS-DRG Recalibration 0.99719........... 0.99719........... 0.99719........... 0.99719.
Budget Neutrality Factor.
FY 2019 Wage Index Budget 1.000746.......... 1.000746.......... 1.000746.......... 1.000746.
Neutrality Factor.
FY 2019 Reclassification Budget 0.985335.......... 0.985335.......... 0.985335.......... 0.985335.
Neutrality Factor.
FY 2019 Operating Outlier Factor 0.948999.......... 0.948999.......... 0.948999.......... 0.948999.
FY 2019 Rural Demonstration 0.999467.......... 0.999467.......... 0.999467.......... 0.999467.
Budget Neutrality Factor.
Adjustment for FY 2019 Required 1.005............. 1.005............. 1.005............. 1.005.
under Section 414 of Public Law
114-10 (MACRA).
National Standardized Amount for Labor: $3,856.27.. Labor: $3,773.51.. Labor: $3,828.68.. Labor: $3,745.93.
FY 2019 if Wage Index is Nonlabor: Nonlabor: Nonlabor: Nonlabor:
Greater Than 1.0000; Labor/Non- $1,789.81. $1,751.40. $1,777.01. $1,738.60.
Labor Share Percentage (68.3/
31.7).
National Standardized Amount for Labor: $3,500.57.. Labor: $3,425.44.. Labor: $3,475.53.. Labor: $3,400.41.
FY 2019 if Wage Index is Less Nonlabor: Nonlabor: Nonlabor: Nonlabor:
Than or Equal to 1.0000; Labor/ $2,145.51. $2,099.47. $2,130.16. $2,084.12.
Non-Labor Share Percentage (62/
38).
----------------------------------------------------------------------------------------------------------------
6. On page 41727--
a. First column, second full paragraph, line 13, the figure
``0.997192'' is corrected to read, ``0.997190''.
b. Second column, second full paragraph, line 6, the figure ``1.27
percent'' is corrected to read ``1.20 percent''.
7. On page 41728, third column--
a. Second full paragraph, line 12, the figure ``0.9986'' is
corrected to read ``0.9980''.
b. Third full paragraph, line 14, the figure ``0.9975'' is
corrected to read ``0.9969''.
8. On page 41729--
a. Top of the page--
i. First column--
A. First full paragraph--
1. Line 2, the figure ``0.9975'' is corrected to read ``0.9969''.
[[Page 49845]]
2. Line 4, the figure ``0.9986'' is corrected to read ``0.9980''.
ii. Second column--
B. First full paragraph--
1. Line 8, the figure ``$459.72'' is corrected to read ``$459.41''.
2. Line 17, the figure ``0.9975'' is corrected to read ``0.9969''.
3. Third column, first paragraph--
a. Line 14, the figure ``0.25'' is corrected to read ``0.31''.
b. Line 20, the figure ``1.27'' is corrected to read ``1.20''.
b. Middle of page,
i. The table titled ``COMPARISON OF FACTORS AND ADJUSTMENTS: FY
2018 CAPITAL FEDERAL RATE AND FY 2019 CAPITAL FEDERAL RATE'' is
corrected to read as follows:
Comparison of Factors and Adjustments: FY 2018 Capital Federal Rate and FY 2019 Capital Federal Rate
----------------------------------------------------------------------------------------------------------------
FY 2018 FY 2019 Change Percent change
----------------------------------------------------------------------------------------------------------------
Update Factor \1\............................... 1.0130 1.0140 1.014 1.40
GAF/DRG Adjustment Factor \1\................... 0.9987 0.9969 0.9969 -0.31
Outlier Adjustment Factor \2\................... 0.9483 0.9494 1.0012 0.12
Capital Federal Rate............................ $453.95 $459.41 1.0120 \3\ 1.20
----------------------------------------------------------------------------------------------------------------
\1\ The update factor and the GAF/DRG budget neutrality adjustment factors are built permanently into the
capital Federal rates. Thus, for example, the incremental change from FY 2018 to FY 2019 resulting from the
application of the 0.9969 GAF/DRG budget neutrality adjustment factor for FY 2019 is a net change of 0.9969
(or -0.31percent).
\2\ The outlier reduction factor is not built permanently into the capital Federal rate; that is, the factor is
not applied cumulatively in determining the capital Federal rate. Thus, for example, the net change resulting
from the application of the FY 2019 outlier adjustment factor is 0.9494/0.9483 or 1.0012 (or 0.12 percent).
\3\ Percent change may not sum due to rounding.
ii. The table titled ``COMPARISON OF FACTORS AND ADJUSTMENTS:
PROPOSED FY 2019 CAPITAL FEDERAL RATE AND FINAL FY 2019 CAPITAL FEDERAL
RATE'' is corrected to read as follows:
Comparison of Factors and Adjustments: Proposed FY 2019 Capital Federal Rate and Final FY 2019 Capital Federal
Rate
----------------------------------------------------------------------------------------------------------------
Proposed FY Percent change
2019 Final FY 2019 Change *
----------------------------------------------------------------------------------------------------------------
Update Factor................................... 1.0120 1.0140 1.0020 0.20
GAF/DRG Adjustment Factor....................... 0.9997 0.9969 0.9972 -0.28
Outlier Adjustment Factor....................... 0.9494 0.9494 0.0000 0.00
Capital Federal Rate............................ $459.78 $459.41 0.9992 -0.0008
----------------------------------------------------------------------------------------------------------------
* Percent change may not sum due to rounding.
c. Bottom of page, second column, first partial paragraph, last
line, the figure, ``$25,769'' is corrected to read ``$25,743''.
9. On page 41730, third column, last paragraph, line 21, the figure
``0.999713.'' is corrected to read ``0.999215''.
10. On page 41731, first column, first partial paragraph--
a. Line 3, the figure ``0.990884'' is corrected to read
``0.990878''.
b. Lines 10 and 11, the mathematical phrase ``$41,579.65
(calculated as $41,415.11 x 1.0135 x 0.999713x 0.990884)'' is corrected
to read ``$41,558.68 (calculated as $41,415.11 x 1.0135 x 0.999215 x 0.
990878)''.
c. Lines 18 through 20, ``$40,759.12 (calculated as $41,415.11 x
0.9935 x 0.999713x 0.990884)'' is corrected to read ``$40,738.57
(calculated as $41,415.11 x 0.9935 x 0.999215 x 0. 990878)''.
11. On page 41733, second column, last paragraph,
a. Line 6, the figure ``0.999713'' is corrected to read
``0.999215''.
b. Line 11, the figure ``0.999713'' is corrected to read
``0.999215``.
12. On page 41736, second column--
a. Third full paragraph--
i. Line 26, the figure, ``$27,124'' is corrected to read
``$27,121''.
ii. Line 32, the figure, ``$27,124'' is corrected to read
``$27,121''.
iii. Last line, the figure, ``$27,124'' is corrected to read
``$27,121''.
b. Last partial paragraph, last line, the figure, ``$27,124'' is
corrected to read ``$27,121''.
13. On page 41737--
a. Second column, last paragraph, line 8, the figure, ``$25,769''
is corrected to read ``$25,743''.
b. Third column--
i. First partial paragraph, last line, the figure, ``$25,769'' is
corrected to read ``$25,743''.
ii. Third full paragraph, line 3, the figure, ``$25,769'' is
corrected to read ``$25,743''.
14. On page 41738, third column, last paragraph, line 26, the
figure ``$41,579.65'' is corrected to read ``$41,558.68''.
15. On page 41739, top of page--
a. Second column, second partial paragraph, last line, the figure
``$41,579.65'' is corrected to read ``$41,558.68''.
b. Third column, first partial paragraph, line 13, the
parenthetical figure ``($41,189.62)'' is corrected to read
``($41,190.33)''.
c. Untitled table, the table is corrected to read as follows:
------------------------------------------------------------------------
------------------------------------------------------------------------
Unadjusted LTCH PPS Standard Federal Prospective Payment $41,558.68
Rate...................................................
Labor-Related Share..................................... x 0.660
Labor-Related Portion of the LTCH PPS Standard Federal = $27,428.73
Payment Rate...........................................
Wage Index (CBSA 16974)................................. 1.0511
Wage-Adjusted Labor Share of LTCH PPS Standard Federal = $28,830.34
Payment Rate...........................................
Nonlabor-Related Portion of the LTCH PPS Standard + $14,129.95
Federal Payment Rate ($41,558.68 x 0.340)..............
[[Page 49846]]
Adjusted LTCH PPS Standard Federal Payment Amount....... = $42,960.29
MS-LTC-DRG 189 Relative Weight.......................... x 0.9588
Total Adjusted LTCH PPS Standard Federal Prospective = $41,190.33
Payment................................................
------------------------------------------------------------------------
16. On page 41740, bottom of the page, the table titled ``TABLE
1A-- NATIONAL ADJUSTED OPERATING STANDARDIZED AMOUNTS, LABOR/NONLABOR
[(68.3 percent labor share/31.7 percent nonlabor share if wage index is
greater than 1)--FY 2019]'' is corrected to read as follows:
Table 1A--National Adjusted Operating Standardized Amounts, Labor/Nonlabor
[(68.3 percent labor share/31.7 percent nonlabor share if wage index is greater than 1)--FY 2019]
--------------------------------------------------------------------------------------------------------------------------------------------------------
Hospital submitted quality data and is Hospital submitted quality data and Hospital did NOT submit quality data Hospital did NOT submit quality data
a meaningful EHR user (update = 1.35 is NOT a meaningful EHR user (update and is a meaningful EHR user (update and is NOT a meaningful EHR user
percent) = -0.825 percent) = 0.625 percent) (update = -1.55 percent)
--------------------------------------------------------------------------------------------------------------------------------------------------------
Labor Nonlabor Labor Nonlabor Labor Nonlabor Labor Nonlabor
--------------------------------------------------------------------------------------------------------------------------------------------------------
$3,856.27 $1,789.81 $3,773.51 $1,751.40 $3,828.68 $1,777.01 $3,745.93 $1,738.60
--------------------------------------------------------------------------------------------------------------------------------------------------------
17. On page 41741--
a. Top of the page--
i. The table titled ``TABLE 1B--NATIONAL ADJUSTED OPERATING
STANDARDIZED AMOUNTS, LABOR/NONLABOR [(62 percent labor share/38
percent nonlabor share if wage index is less than or equal to 1)--FY
2019]'' is corrected to read as follows:
Table 1B--National Adjusted Operating Standardized Amounts, Labor/Nonlabor
[(62 percent labor share/38 percent nonlabor share if wage index is less than or equal to 1)--FY 2019]
--------------------------------------------------------------------------------------------------------------------------------------------------------
Hospital submitted quality data and is Hospital submitted quality data and Hospital did NOT submit quality data Hospital did NOT submit quality data
a meaningful EHR user (update = 1.35 is NOT a meaningful EHR user (update and is a meaningful EHR user (update and is NOT a meaningful EHR user
percent) = -0.825 percent) = 0.625 percent) (update = -1.55 percent)
--------------------------------------------------------------------------------------------------------------------------------------------------------
Labor Nonlabor Labor Nonlabor Labor Nonlabor Labor Nonlabor
--------------------------------------------------------------------------------------------------------------------------------------------------------
$3,500.57 $2,145.51 $3,425.44 $2,099.47 $3,475.53 $3,475.53 $3,400.41 $2,084.12
--------------------------------------------------------------------------------------------------------------------------------------------------------
ii. The table titled ``Table 1C--ADJUSTED OPERATING STANDARDIZED
AMOUNTS FOR HOSPITALS IN PUERTO RICO, LABOR/NONLABOR [(National: 62
percent labor share/38 percent nonlabor share because wage index is
less than or equal to 1)--FY 2019]'' is corrected to read as follows:
Table 1C--Adjusted Operating Standardized Amounts for Hospitals in Puerto Rico, Labor/Nonlabor
[(National: 62 percent labor share/38 percent nonlabor share because wage index is less than or equal to 1)--FY
2019]
----------------------------------------------------------------------------------------------------------------
Rates if wage index is greater Rates if wage index is less than or equal to 1
than 1 -------------------------------------------------
Standardized amount ----------------------------------
Labor Nonlabor Labor Nonlabor
----------------------------------------------------------------------------------------------------------------
National \1\................ Not Applicable. Not Applicable. $3,500.57 $2,145.51
----------------------------------------------------------------------------------------------------------------
\1\ For FY 2019, there are no CBSAs in Puerto Rico with a national wage index greater than 1.
b. Middle of the page--
i. The table titled ``Table 1D--CAPITAL STANDARD FEDERAL PAYMENT
RATE [FY 2019]'' is corrected to read as follows:
Table 1D--Capital Standard Federal Payment Rate
[FY 2019]
------------------------------------------------------------------------
Rate
------------------------------------------------------------------------
National............................................... $459.41
------------------------------------------------------------------------
ii. The table titled ``Table 1E--LTCH PPS STANDARD FEDERAL PAYMENT
RATE [FY 2019]'' is corrected to read as follows:
[[Page 49847]]
Table 1E--LTCH PPS Standard Federal Payment Rate
[FY 2019]
------------------------------------------------------------------------
Full update (1.35 Reduced update * (-
percent) 0.65 Percent)
------------------------------------------------------------------------
Standard Federal Rate........... $41,558.68 $40,738.57
------------------------------------------------------------------------
* For LTCHs that fail to submit quality reporting data for FY 2019 in
accordance with the LTCH Quality Reporting Program (LTCH QRP), the
annual update is reduced by 2.0 percentage points as required by
section 1886(m)(5) of the Act.
C. Corrections of Errors in the Appendices
1. On page 41742--
a. Second column, second full paragraph--
i. Line 1, the figure ``3,256'' is corrected to read ``3,255''.
ii. Line 7, the figure ``1,398'' is corrected to read ``1,399''.
2. On pages 41744 through 41746, the table and table notes for the
table titled ``TABLE I--IMPACT ANALYSIS OF CHANGES TO THE IPPS FOR
OPERATING COSTS FOR FY 2019'' are corrected to read as follows:
TABLE I--Impact Analysis of Changes to the IPPS for Operating Costs for FY 2019
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
FY 2019
weights and Rural floor
Hospital rate DRG changes FY 2019 wage with Application of
Number of update and with data with FY 2019 MGCRB application of the frontier All FY 2019
hospitals \1\ adjustment application of application of reclassifications national rural wage index and changes
under MACRA recalibration wage budget floor budget outmigration
budget neutrality neutrality adjustment
neutrality
(1) \2\ (2) \3\ (3) \4\ (4) \5\ (5) \6\ (6) \7\ (7) \8\
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
All Hospitals................................................ 3,255 1.8 0 0 0 0 0.1 2.4
By Geographic Location:
Urban hospitals.......................................... 2,483 1.8 0 0 -0.1 0 0.1 2.5
Large urban areas........................................ 1,302 1.8 0.1 0 -0.8 0 0 2.4
Other urban areas........................................ 1,181 1.8 0 0 0.6 0 0.2 2.5
Rural hospitals.......................................... 772 1.5 -0.3 -0.1 1.2 -0.1 0.1 1.2
Bed Size (Urban):
0-99 beds................................................ 644 1.7 -0.5 0.1 -0.8 0.2 0.2 1.7
100-199 beds............................................. 763 1.8 0 0 -0.1 0.2 0.2 2.2
200-299 beds............................................. 433 1.8 0 0 0.1 0 0.1 2.3
300-499 beds............................................. 424 1.8 0.1 0 0 -0.1 0.1 2.5
500 or more beds......................................... 219 1.8 0.1 0 -0.2 0 0 2.9
Bed Size (Rural):
0-49 beds................................................ 305 1.4 -0.5 0 0.2 -0.1 0.2 0.9
50-99 beds............................................... 274 1.3 -0.4 0 0.7 -0.1 0.2 1.1
100-149 beds............................................. 108 1.6 -0.5 -0.1 0.9 -0.1 0 1.2
150-199 beds............................................. 45 1.7 -0.1 -0.2 2 -0.2 0.3 1.4
200 or more beds......................................... 40 1.7 0.1 -0.2 2.3 -0.2 0 1.5
Urban by Region:
New England.............................................. 113 1.8 0.1 -0.5 2.7 2.4 0.1 4.7
Middle Atlantic.......................................... 310 1.8 0.2 0 0.2 -0.3 0.1 2.3
South Atlantic........................................... 401 1.8 0 -0.1 -0.6 -0.3 0 2
East North Central....................................... 386 1.8 0.1 -0.2 -0.5 -0.3 0.1 2
East South Central....................................... 147 1.8 0 0 -0.5 -0.3 0 2.1
West North Central....................................... 158 1.8 -0.1 0 -0.9 -0.3 0.6 2.1
West South Central....................................... 379 1.8 0 0.2 -0.8 -0.3 0 2.3
Mountain................................................. 164 1.7 -0.1 -0.7 0.4 0.6 0.3 2.2
Pacific.................................................. 374 1.8 -0.1 0.8 0.1 0.2 0.1 3.3
Puerto Rico.............................................. 51 1.8 0 -1.2 -1.3 0.1 0.1 0.7
Rural by Region:
New England.............................................. 20 1.5 0.1 -0.5 1.5 -0.2 0 0.9
Middle Atlantic.......................................... 53 1.5 -0.2 -0.1 0.6 -0.1 0.1 1.4
South Atlantic........................................... 122 1.6 -0.2 -0.2 1.7 -0.1 0.1 1.2
East North Central....................................... 114 1.5 -0.3 0.1 0.9 -0.1 0 1.1
East South Central....................................... 150 1.7 -0.1 -0.2 2.5 -0.3 0.1 1.8
West North Central....................................... 94 1.3 -0.5 0 0.1 0 0.2 0.9
West South Central....................................... 145 1.5 -0.3 0.2 1.3 -0.3 0.2 1.5
Mountain................................................. 51 1.3 -1.1 -0.4 -0.1 -0.1 0.8 0.8
Pacific.................................................. 23 1.4 -0.4 -0.2 0.8 -0.1 0 1
By Payment Classification:
Urban hospitals.......................................... 2,264 1.8 0 0 -0.6 0.1 0.1 2.3
Large urban areas........................................ 1,317 1.8 0.1 0 -0.7 0 0 2.4
Other urban areas........................................ 947 1.8 0 0 -0.4 0.2 0.2 2.1
Rural areas.............................................. 991 1.7 -0.1 0 2.1 -0.2 0.1 2.7
Teaching Status:
Nonteaching.............................................. 2,156 1.7 -0.1 0 0.1 0.1 0.1 2.1
Fewer than 100 residents................................. 849 1.8 0 0 -0.2 -0.1 0.2 2.2
100 or more residents.................................... 250 1.8 0.2 0 0.1 -0.1 0 3.1
Urban DSH:
[[Page 49848]]
Non-DSH.................................................. 520 1.8 -0.3 -0.2 -0.2 -0.1 0.2 2
100 or more beds......................................... 1,462 1.8 0.1 0 -0.6 0.1 0.1 2.3
Less than 100 beds....................................... 367 1.7 -0.2 0.3 -0.6 0.2 0.1 1.9
Rural DSH:
SCH...................................................... 255 1.2 -0.6 -0.1 0 0 0 0.7
RRC...................................................... 382 1.7 0 0.1 2.4 -0.3 0.1 3.1
100 or more beds......................................... 33 1.8 0 -0.6 1.6 -0.4 0.1 2.9
Less than 100 beds....................................... 236 1.6 -0.3 0 0.7 -0.2 0.3 1.5
Urban teaching and DSH:
Both teaching and DSH.................................... 805 1.8 0.1 0 -0.7 0 0.1 2.4
Teaching and no DSH...................................... 89 1.9 -0.1 -0.1 -0.5 -0.1 0 2.3
No teaching and DSH...................................... 1,024 1.8 0 0.1 -0.4 0.3 0.1 2.2
No teaching and no DSH................................... 346 1.8 -0.3 -0.2 -0.6 -0.1 0.2 1.7
Special Hospital Types:
RRC...................................................... 327 1.8 0 0.2 2.7 -0.3 0.2 3.4
SCH...................................................... 311 1.1 -0.5 0.1 -0.1 0 0 0.8
MDH...................................................... 140 1.5 -0.5 -0.1 0.7 0 0 1.2
SCH and RRC.............................................. 134 1.4 -0.2 -0.2 0.3 0 0.1 1.2
MDH and RRC.............................................. 16 1.5 -0.4 0 0.8 -0.1 0 1.1
Type of Ownership:
Voluntary................................................ 1,898 1.8 0 0 0.1 0 0.1 2.4
Proprietary.............................................. 856 1.8 0 -0.1 -0.1 0 0.1 2.1
Government............................................... 501 1.7 0 0.2 -0.2 -0.1 0 2.5
Medicare Utilization as a Percent of Inpatient Days:
0-25..................................................... 602 1.8 0.1 -0.1 -0.4 -0.1 0 2.3
25-50.................................................... 2,138 1.8 0 0 0 0 0.1 2.5
50-65.................................................... 421 1.7 -0.2 -0.1 0.5 0.3 0.1 1.7
Over 65.................................................. 73 1.1 0.5 -0.1 -0.4 -0.2 0.1 2.5
FY 2019 Reclassifications by the Medicare Geographic
Classification Review Board:
All Reclassified Hospitals............................... 859 1.8 0 0.1 2.4 -0.3 0 2.8
Non-Reclassified Hospitals............................... 2,396 1.8 0 0 -1.1 0.1 0.1 2.2
Urban Hospitals Reclassified............................. 588 1.8 0 0.1 2.5 -0.3 0 3.1
Urban Non-reclassified Hospitals......................... 1,835 1.8 0 0 -1.2 0.1 0.1 2.3
Rural Hospitals Reclassified Full Year................... 271 1.5 -0.2 -0.1 2.1 -0.2 0.1 1.5
Rural Non-reclassified Hospitals Full Year............... 454 1.4 -0.5 -0.1 -0.4 -0.1 0.2 0.8
All Section 401 Reclassified Hospitals................... 266 1.7 0 0.1 2.5 -0.3 0.1 3.4
Other Reclassified Hospitals (Section 1886(d)(8)(B))..... 47 1.7 -0.2 -0.1 2.8 -0.3 0 1.5
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
\1\ Because data necessary to classify some hospitals by category were missing, the total number of hospitals in each category may not equal the national total. Discharge data are from FY
2017, and hospital cost report data are from reporting periods beginning in FY 2016 and FY 2015.
\2\ This column displays the payment impact of the hospital rate update and other adjustments, including the 1.35 percent adjustment to the national standardized amount and the hospital-
specific rate (the estimated 2.9 percent market basket update reduced by 0.8 percentage point for the multifactor productivity adjustment and the 0.75 percentage point reduction under the
Affordable Care Act), and the 0.5 percent adjustment to the national standardized amount required under section 414 of the MACRA.
\3\ This column displays the payment impact of the changes to the Version 36 GROUPER, the changes to the relative weights and the recalibration of the MS-DRG weights based on FY 2017 MedPAR
data in accordance with section 1886(d)(4)(C)(iii) of the Act. This column displays the application of the recalibration budget neutrality factor of 0.997190 in accordance with section
1886(d)(4)(C)(iii) of the Act.
\4\ This column displays the payment impact of the update to wage index data using FY 2015 cost report data and the OMB labor market area delineations based on 2010 Decennial Census data. This
column displays the payment impact of the application of the wage budget neutrality factor, which is calculated separately from the recalibration budget neutrality factor, and is calculated
in accordance with section 1886(d)(3)(E)(i) of the Act. The wage budget neutrality factor is 1.000746.
\5\ Shown here are the effects of geographic reclassifications by the Medicare Geographic Classification Review Board (MGCRB). The effects demonstrate the FY 2019 payment impact of going from
no reclassifications to the reclassifications scheduled to be in effect for FY 2019. Reclassification for prior years has no bearing on the payment impacts shown here. This column reflects
the geographic budget neutrality factor of 0.985335.
[[Page 49849]]
\6\ This column displays the effects of the rural floor and expiration of the imputed floor. The Affordable Care Act requires the rural floor budget neutrality adjustment to be 100 percent
national level adjustment. The rural floor budget neutrality factor applied to the wage index is 0.993911.
\7\ This column shows the combined impact of the policy required under section 10324 of the Affordable Care Act that hospitals located in frontier States have a wage index no less than 1.0 and
of section 1886(d)(13) of the Act, as added by section 505 of Public Law 108-173, which provides for an increase in a hospital's wage index if a threshold percentage of residents of the
county where the hospital is located commute to work at hospitals in counties with higher wage indexes. These are not budget neutral policies.
\8\ This column shows the estimated change in payments from FY 2018 to FY 2019.
3. On page 41746, lower half of page, second column, third
paragraph, line 6, the figure ``0.997192'' is corrected to read
``0.997190''.
4. On page 41747--
a. Top half of page, second column, first partial paragraph, line
19, the figure ``1.000748'' is corrected to read ``1.000746''.
b. Lower half of page, third column, first partial paragraph--
i. First line, the figure ``0.985932'' is corrected to read
``0.985335''.
ii. Line 11, ``which will experience no change'' is corrected to
read, ``which will experience a 0.1 percent decrease''.
5. On page 41748, top of page--
a. First column, second full paragraph--
i. Line 6, the figure ``0.993142'' is corrected to read
``0.993911''.
ii. Line 7, the figure ``0.69 percent'' is corrected to read ``0.61
percent''.
b. Second column, first full paragraph--
i. Line 1, the figure ``263'' is corrected to read ``253''.
ii. Line 5, the figure ``0.993142'' is corrected to read
``0.993911''.
iii. Line 7, the figure ``0.2'' is corrected to read ``0.1''.
iv. Line 22, the figure ``2.5'' is corrected to read ``2.4''.
v. Line 30, the figure ``$121 million'' is corrected to read ``$123
million''.
6. On pages 41748 and 41749, the table titled ``FY 2019 IPPS
ESTIMATED PAYMENTS DUE TO RURAL FLOOR WITH NATIONAL BUDGET NEUTRALITY''
is corrected to read as follows:
FY 2019 IPPS Estimated Payments Due to Rural Floor With National Budget Neutrality
----------------------------------------------------------------------------------------------------------------
Percent change
Number of in payments
hospitals that due to
State Number of would receive application of Difference (in
hospitals the rural rural floor $ millions)
floor with budget
neutrality
(1) (2) (3) (4)
----------------------------------------------------------------------------------------------------------------
Alabama......................................... 84 2 -0.3 $-5
Alaska.......................................... 6 3 0.1 0
Arizona......................................... 56 33 1.3 26
Arkansas........................................ 45 0 -0.3 -3
California...................................... 297 59 0.4 42
Colorado........................................ 45 9 0.7 9
Connecticut..................................... 30 8 1.3 21
Delaware........................................ 6 0 -0.3 -2
Washington, DC.................................. 7 0 -0.3 -2
Florida......................................... 168 7 -0.3 -20
Georgia......................................... 101 0 -0.3 -8
Hawaii.......................................... 12 6 -0.1 0
Idaho........................................... 14 0 -0.3 -1
Illinois........................................ 125 2 -0.3 -14
Indiana......................................... 85 0 -0.3 -7
Iowa............................................ 34 0 -0.3 -3
Kansas.......................................... 51 0 -0.2 -2
Kentucky........................................ 64 0 -0.3 -5
Louisiana....................................... 90 0 -0.3 -5
Maine........................................... 17 0 -0.3 -2
Massachusetts................................... 56 29 3.3 123
Michigan........................................ 94 0 -0.3 -14
Minnesota....................................... 49 0 -0.2 -6
Mississippi..................................... 59 0 -0.3 -3
Missouri........................................ 72 0 -0.2 -6
Montana......................................... 13 1 -0.2 -1
Nebraska........................................ 23 0 -0.3 -2
Nevada.......................................... 22 3 0.4 3
New Hampshire................................... 13 8 2.4 14
New Jersey...................................... 64 0 -0.4 -16
New Mexico...................................... 24 2 -0.2 -1
New York........................................ 149 16 -0.3 -21
North Carolina.................................. 84 0 -0.3 -9
North Dakota.................................... 6 3 0.4 1
Ohio............................................ 130 7 -0.3 -11
Oklahoma........................................ 79 2 -0.3 -4
Oregon.......................................... 34 1 -0.2 -2
Pennsylvania.................................... 150 3 -0.3 -17
Puerto Rico..................................... 51 11 0.1 0
Rhode Island.................................... 11 0 -0.4 -1
[[Page 49850]]
South Carolina.................................. 54 6 -0.1 -1
South Dakota.................................... 17 0 -0.2 -1
Tennessee....................................... 90 6 -0.3 -7
Texas........................................... 310 13 -0.3 -18
Utah............................................ 31 0 -0.3 -2
Vermont......................................... 6 0 -0.2 0
Virginia........................................ 74 1 -0.2 -6
Washington...................................... 48 3 -0.3 -7
West Virginia................................... 29 2 -0.2 -1
Wisconsin....................................... 66 5 -0.3 -5
Wyoming......................................... 10 2 0 0
----------------------------------------------------------------------------------------------------------------
7. On pages 41750 and 41751, the table titled ``TABLE II--IMPACT
ANALYSIS OF CHANGES FOR FY 2019 ACUTE CARE HOSPITAL OPERATING
PROSPECTIVE PAYMENT SYSTEM [Payments per discharge]'' is corrected to
read as follows:
Table II--Impact Analysis of Changes for FY 2019 Acute Care Hospital Operating Prospective Payment System
[Payments per discharge]
----------------------------------------------------------------------------------------------------------------
Estimated Estimated
Number of average FY average FY FY 2019
hospitals 2018 payment 2019 payment changes
per discharge per discharge
(1) (2) (3) (4)
----------------------------------------------------------------------------------------------------------------
All Hospitals................................... 3,255 12,172 12,463 2.4
By Geographic Location:
Urban hospitals............................. 2,483 12,508 12,819 2.5
Large urban areas........................... 1,302 12,986 13,302 2.4
Other urban areas........................... 1,181 12,049 12,355 2.5
Rural hospitals............................. 772 9,193 9,307 1.2
Bed Size (Urban):
0-99 beds................................... 644 9,945 10,113 1.7
100-199 beds................................ 763 10,399 10,623 2.2
200-299 beds................................ 433 11,384 11,650 2.3
300-499 beds................................ 424 12,606 12,917 2.5
500 or more beds............................ 219 15,449 15,893 2.9
Bed Size (Rural):
0-49 beds................................... 305 7,826 7,897 0.9
50-99 beds.................................. 274 8,746 8,843 1.1
100-149 beds................................ 108 9,150 9,256 1.2
150-199 beds................................ 45 9,667 9,805 1.4
200 or more beds............................ 40 10,734 10,899 1.5
Urban by Region:
New England................................. 113 13,491 14,131 4.7
Middle Atlantic............................. 310 14,099 14,429 2.3
South Atlantic.............................. 401 11,145 11,372 2
East North Central.......................... 386 11,830 12,072 2
East South Central.......................... 147 10,517 10,742 2.1
West North Central.......................... 158 12,266 12,524 2.1
West South Central.......................... 379 11,310 11,574 2.3
Mountain.................................... 164 12,938 13,218 2.2
Pacific..................................... 374 15,773 16,289 3.3
Puerto Rico................................. 51 9,117 9,185 0.7
Rural by Region:
New England................................. 20 12,613 12,728 0.9
Middle Atlantic............................. 53 9,137 9,265 1.4
South Atlantic.............................. 122 8,497 8,598 1.2
East North Central.......................... 114 9,444 9,551 1.1
[[Page 49851]]
East South Central.......................... 150 8,142 8,285 1.8
West North Central.......................... 94 10,019 10,112 0.9
West South Central.......................... 145 7,844 7,958 1.5
Mountain.................................... 51 11,139 11,226 0.8
Pacific..................................... 23 12,734 12,858 1
By Payment Classification:
Urban hospitals............................. 2,264 12,276 12,557 2.3
Large urban areas........................... 1,317 12,974 13,290 2.4
Other urban areas........................... 947 11,325 11,559 2.1
Rural areas................................. 991 11,833 12,155 2.7
Teaching Status:
Nonteaching................................. 2,156 10,059 10,267 2.1
Fewer than 100 residents.................... 849 11,616 11,866 2.2
100 or more residents....................... 250 17,680 18,220 3.1
Urban DSH:
Non-DSH..................................... 520 10,533 10,748 2
100 or more beds............................ 1,462 12,643 12,939 2.3
Less than 100 beds.......................... 367 9,220 9,397 1.9
Rural DSH:
SCH......................................... 255 10,239 10,313 0.7
RRC......................................... 382 12,516 12,901 3.1
100 or more beds............................ 33 13,322 13,711 2.9
Less than 100 beds.......................... 236 7,300 7,410 1.5
Urban teaching and DSH:
Both teaching and DSH....................... 805 13,783 14,112 2.4
Teaching and no DSH......................... 89 11,402 11,664 2.3
No teaching and DSH......................... 1,024 10,322 10,549 2.2
No teaching and no DSH...................... 346 9,951 10,125 1.7
Special Hospital Types:
RRC......................................... 327 12,440 12,863 3.4
SCH......................................... 311 11,126 11,219 0.8
MDH......................................... 140 7,958 8,056 1.2
SCH and RRC................................. 134 11,502 11,640 1.2
MDH and RRC................................. 16 10,039 10,149 1.1
Type of Ownership:
Voluntary................................... 1,898 12,323 12,624 2.4
Proprietary................................. 856 10,658 10,879 2.1
Government.................................. 501 13,378 13,708 2.5
Medicare Utilization as a Percent of Inpatient
Days:
0-25........................................ 602 14,927 15,266 2.3
25-50....................................... 2,138 11,996 12,294 2.5
50-65....................................... 421 9,817 9,985 1.7
Over 65..................................... 73 7,271 7,450 2.5
FY 2019 Reclassifications by the Medicare
Geographic Classification Review Board:
All Reclassified Hospitals.................. 859 12,226 12,572 2.8
Non-Reclassified Hospitals.................. 2,396 12,148 12,415 2.2
Urban Hospitals Reclassified................ 588 12,821 13,212 3.1
Urban Nonreclassified Hospitals............. 1,835 12,349 12,629 2.3
Rural Hospitals Reclassified Full Year...... 271 9,566 9,710 1.5
Rural Nonreclassified Hospitals Full Year... 454 8,750 8,821 0.8
All Section 401 Reclassified Hospitals...... 266 13,625 14,091 3.4
Other Reclassified Hospitals (Section 47 8,609 8,736 1.5
1886(d)(8)(B)).............................
----------------------------------------------------------------------------------------------------------------
8. On pages 41753 through 41754 the table titled ``MODELED
UNCOMPENSATED CARE PAYMENTS FOR ESTIMATED FY 2019 DSHs BY HOSPITAL
TYPE: MODEL UCP $ (IN MILLIONS) * FROM FY 2018 to FY 2019'' is
corrected to read as follows:
[[Page 49852]]
Modeled Uncompensated Care Payments for Estimated FY 2019 DSHs by Hospital Type: Model UCP $ (in Millions) *
From FY 2018 to FY 2019
----------------------------------------------------------------------------------------------------------------
FY 2018 final
rule CN FY 2019 final Dollar
Number of estimated UCP rule estimated difference: FY Percent change
estimated DSHs $ (in UCP $ (in 2019- FY 2018 **
millions) millions) (in millions)
(1) (2) (3) (4) (5)
----------------------------------------------------------------------------------------------------------------
Total........................... 2,447 $6,767 $8,273 $1,506 22.26
By Geographic Location:
Urban Hospitals............. 1,953 6,422 7,802 1,380 21.49
Large Urban Areas........... 1,046 3,847 4,706 859 22.33
Other Urban Areas........... 907 2,575 3,096 521 20.22
Rural Hospitals............. 494 345 471 126 36.64
Bed Size (Urban):
0 to 99 Beds................ 342 177 257 79 44.80
100 to 249 Beds............. 860 1,519 1,903 384 25.28
250+ Beds................... 751 4,726 5,642 916 19.39
Bed Size (Rural):...........
0 to 99 Beds................ 365 164 229 64 39.19
100 to 249 Beds............. 116 146 200 54 36.66
250+ Beds................... 13 34 43 8 24.33
Urban by Region:
New England................. 91 259 279 20 7.76
Middle Atlantic............. 244 1,004 1,058 55 5.45
South Atlantic.............. 320 1,343 1,769 426 31.69
East North Central.......... 323 864 1,010 146 16.92
East South Central.......... 133 389 477 88 22.71
West North Central.......... 104 312 386 74 23.68
West South Central.......... 254 981 1,423 442 45.03
Mountain.................... 125 313 397 84 26.78
Pacific..................... 318 874 899 25 2.88
Puerto Rico................. 41 82 102 20 24.47
Rural by Region:
New England................. 9 14 17 3 19.24
Middle Atlantic............. 26 19 22 2 12.43
South Atlantic.............. 88 79 116 37 47.54
East North Central.......... 69 40 56 16 41.12
East South Central.......... 135 93 106 13 13.78
West North Central.......... 29 16 22 6 40.28
West South Central.......... 106 66 102 36 53.62
Mountain.................... 27 14 26 12 84.16
Pacific..................... 5 4 5 1 24.85
By Payment Classification:
Urban Hospitals............. 1,866 5,917 7,257 1,340 22.65
Large Urban Areas........... 1,058 3,855 4,717 862 22.37
Other Urban Areas........... 808 2,062 2,540 478 23.16
Rural Hospitals............. 581 850 1,016 166 19.54
Teaching Status:
Nonteaching................. 1,509 2,020 2,597 578 28.62
Fewer than 100 residents.... 694 2,246 2,744 498 22.17
100 or more residents....... 244 2,501 2,931 430 17.20
Type of Ownership:
Voluntary................... 1,447 4,137 4,895 758 18.32
Proprietary................. 561 1,015 1,259 244 24.05
Government.................. 439 1,615 2,119 504 31.24
Medicare Utilization Percent:
***
0 to 25..................... 472 2,255 2,720 464 20.60
25 to 50.................... 1,674 4,290 5,266 977 22.77
50 to 65.................... 262 215 276 61 28.34
Greater than 65............. 36 7 11 4 56.55
----------------------------------------------------------------------------------------------------------------
Source: Dobson [verbar] DaVanzo analysis of 2013-2015 Hospital Cost Reports.
* Dollar UCP calculated by [0.75 * estimated section 1886(d)(5)(F) payments * Factor 2 * Factor 3]. When summed
across all hospitals projected to receive DSH payments, uncompensated care payments are estimated to be $6,767
million in FY 2018 and $8,273 million in FY 2019.
** Percentage change is determined as the difference between Medicare UCP payments modeled for the FY 2019 IPPS/
LTCH PPS proposed rule (column 3) and Medicare UCP payments modeled for the FY 2018 IPPS/LTCH PPS final rule
correction notice (column 2) divided by Medicare UCP payments modeled for the FY 2018 final rule correction
notice (column 2) times 100 percent.
*** Hospitals with Missing or Unknown Medicare Utilization are not shown in table.
9. On page 41754,
a. Second column, first full paragraph,
i. Line 5, the figure ``36.66'' is corrected to read ``36.64''.
ii. Line 8, the figure ``21.48'' is corrected to read ``21.49''.
[[Page 49853]]
b. Third column, first partial paragraph,
i. Line 2, the figure ``39.52'' is corrected to read ``39.19''.
ii. Line 5, the figure ``36.35'' is corrected to read ``36.66''
iii. Line 7, the figure ``24.35'' is corrected to read ``24.33''.
iv. Line 13, the figure ``44.83'' is corrected to read ``44.80''.
v. Line 16, the figure ``25.23'' is corrected to read ``25.28''.
vi. Line 19, the figure ``19.40'' is corrected to read ``19.39''.
10. On page 41755, first column, second paragraph--
a. Line 5, the figure ``22.14'' is corrected to read ``22.17''.
b. Line 9, the figure ``17.23'' is corrected to read ``17.20''.
c. Line 12, the figure ``31.26'' is corrected to read ``31.24''.
d. Line 12, the figure ``24.06'' is corrected to read ``24.05''.
e. Line 15, the figure ``18.30'' is corrected to read ``18.32''.
11. On page 41756, bottom of the page--
a. First column, before the first paragraph, the section heading
``a. Effects of Proposed Changes for FY 2019'' is corrected to read
``a. Effects of Changes for FY 2019''.
b. Second column, last paragraph, line 1, the phrase ``The proposed
estimated impacts'' is corrected to read ``The estimated impacts''.
12. On pages 41758 through 41759, the table titled ``ESTIMATED
PROPORTION OF HOSPITALS IN THE WORST-PERFORMING QUARTILE (>75th
PERCENTILE) OF THE TOTAL HAC SCORES FOR THE FY 2019 HAC REDUCTION
PROGRAM'' is corrected to read as follows:
Estimated Proportion of Hospitals in the Worst-Performing Quartile (>75th Percentile) of the Total HAC Scores
for the FY 2019 HAC Reduction Program
[By hospital characteristic]
----------------------------------------------------------------------------------------------------------------
Number of Percent of
hospitals in hospitals in
Hospital characteristic Number of the worst- the worst-
hospitals performing performing
quartile \a\ quartile \b\
----------------------------------------------------------------------------------------------------------------
Total \c\....................................................... 3,219 804 25.0
By Geographic Location (n = 3,201): \d\
Urban hospitals............................................. 2,416 628 26.0
1-99 beds............................................... 622 133 21.4
100-199 beds............................................ 728 182 25.0
200-299 beds............................................ 430 119 27.7
300-399 beds............................................ 278 80 28.8
400-499 beds............................................ 145 39 26.9
500 or more beds........................................ 213 75 35.2
Rural hospitals............................................. 785 165 21.0
1-49 beds............................................... 304 68 22.4
50-99 beds.............................................. 282 56 19.9
100-149 beds............................................ 116 22 19.0
150-199 beds............................................ 44 10 22.7
200 or more beds........................................ 39 9 23.1
By Safety-Net Status (n = 3,201): \e\
Non-safety net.............................................. 2,555 576 22.5
Safety-net.................................................. 646 217 33.6
By DSH Percent (n = 3,201): \f\
0-24........................................................ 1,313 292 22.2
25-49....................................................... 1,507 366 24.3
50-64....................................................... 198 75 37.9
65 and over................................................. 183 60 32.8
By Teaching Status (n = 3,201): \g\
Non-teaching................................................ 2,121 484 22.8
Fewer than 100 residents.................................... 832 196 23.6
100 or more residents....................................... 248 113 45.6
By Ownership (n = 3,173):
Voluntary................................................... 1,868 466 24.9
Proprietary................................................. 813 175 21.5
Government.................................................. 492 145 29.5
By MCR Percent (n = 3,175): \h\
0-24........................................................ 511 144 28.2
25-49....................................................... 2,118 505 23.8
50-64....................................................... 473 117 24.7
65 and over................................................. 73 15 20.5
By Region (n = 3,217): \i\
New England................................................. 133 43 32.3
Mid-Atlantic................................................ 364 101 27.7
South Atlantic.............................................. 522 133 25.5
East North Central.......................................... 498 108 21.7
East South Central.......................................... 299 68 22.7
West North Central.......................................... 256 57 22.3
West South Central.......................................... 519 114 22.0
Mountain.................................................... 229 60 26.2
[[Page 49854]]
Pacific..................................................... 397 118 29.7
----------------------------------------------------------------------------------------------------------------
Source: FY 2019 HAC Reduction Program Final Rule Results are based on CMS PSI 90 Composite data from October
2015 through June 2017 and CDC CLABSI, CAUTI, SSI, CDI, and MRSA results from January 2016 through December
2017. Hospital Characteristics are based on the FY 2019 Hospital Inpatient Prospective Payment System (IPPS)
Proposed Rule Impact File.
\a\ This column is the number of non-Maryland hospitals with a Total HAC Score within the corresponding
characteristic that are estimated to be in the worst-performing quartile.
\b\ This column is the percent of non-Maryland hospitals within each characteristic that are estimated to be in
the worst-performing quartile. The percentages are calculated by dividing the number of non-Maryland hospitals
with a Total HAC Score in the worst-performing quartile by the total number of non-Maryland hospitals with a
Total HAC Score within that characteristic.
\c\ The number of non-Maryland hospitals with a FY 2019 Total HAC Score (N=3,219). Note that not all hospitals
have data for all hospital characteristics.
\d\ The number of hospitals that had information for geographic location with bed size, Safety-net status,
Disproportionate Share Hospital (DSH) percent, teaching status, and ownership status (n=3,201).
\e\ A hospital is considered a Safety-net hospital if it is in the top quintile for DSH percent.
\f\ The DSH patient percentage is equal to the sum of (1) the percentage of Medicare inpatient days attributable
to patients eligible for both Medicare Part A and Supplemental Security Income and (2) the percentage of total
inpatient days attributable to patients eligible for Medicaid but not Medicare Part A.
\g\ A hospital is considered a teaching hospital if it has an Indirect Medical Education adjustment factor for
Operation PPS (TCHOP) greater than zero.
\h\ Not all hospitals had data for MCR percent (n=3,175).
\i\ Not all hospitals had data for Region (n=3,217).
13. On page 41763--
a. Second column, fourth bullet, the figure ``0.9975'' is corrected
to read ``0.9969''.
b. Third column, first full paragraph, line 5, the figure ``3,256''
is corrected to read ``3,255''.
14. On page 41764, third column--
a. Line 12, the figure ``1.0'' is corrected to read ``1.1''.
b. Line 14, the figure ``3.0'' is corrected to read ``2.9''.
15. On pages 41764 through 41765, the table titled ``TABLE III--
COMPARISON OF TOTAL PAYMENTS PER CASE [FY 2018 payments compared to FY
2019 payments]'' is corrected to read as follows:
Table III--Comparison of Total Payments per Case
[FY 2018 payments compared to FY 2019 payments]
----------------------------------------------------------------------------------------------------------------
Average FY Average FY
Number of 2018 payments/ 2019 payments/ Percent change
hospitals case case
----------------------------------------------------------------------------------------------------------------
By Geographic Location:
All hospitals............................... 3,255 $943 $963 2.1
Large urban areas (populations over 1 2,483 974 997 2.3
million)...................................
Other urban areas (populations of 1 million 1,302 1,011 1,042 3.2
of fewer)..................................
Urban hospitals............................. 1,181 939 952 1.4
0-99 beds............................... 644 789 812 3.0
100-199 beds............................ 763 835 854 2.4
200-299 beds............................ 433 902 922 2.2
300-499 beds............................ 424 981 1,003 2.2
500 or more beds........................ 219 1,170 1,197 2.3
Rural hospitals............................. 772 666 659 -0.9
0-49 beds............................... 305 541 556 2.6
50-99 beds.............................. 274 606 621 2.3
100-149 beds............................ 108 677 654 -3.3
150-199 beds............................ 45 729 706 -3.2
200 or more beds........................ 40 808 781 -3.3
By Region:
Urban by Region............................. 2,483 974 997 2.3
New England............................. 113 1,068 1,108 3.8
Middle Atlantic......................... 310 1,069 1,090 2.0
South Atlantic.......................... 401 866 883 2.0
East North Central...................... 386 938 951 1.4
East South Central...................... 147 821 838 2.1
West North Central...................... 158 959 977 1.9
West South Central...................... 379 881 908 3.1
Mountain................................ 164 1,011 1,028 1.5
Pacific................................. 374 1,238 1,281 3.4
Puerto Rico............................. 51 447 455 1.7
[[Page 49855]]
Rural by Region............................. 772 666 660 -0.9
New England............................. 20 922 918 -0.5
Middle Atlantic......................... 53 639 638 -0.3
South Atlantic.......................... 122 619 610 -1.4
East North Central...................... 114 675 671 -0.6
East South Central...................... 150 623 606 -2.6
West North Central...................... 94 706 704 -0.2
West South Central...................... 145 590 588 -0.3
Mountain................................ 51 742 752 1.2
Pacific................................. 23 865 864 -0.5
By Payment Classification:
All hospitals............................... 3,255 943 963 2.1
Large urban areas (populations over 1 1,317 1,010 1,042 3.2
million)...................................
Other urban areas (populations of 1 million 947 895 919 2.6
of fewer)..................................
Rural areas................................. 991 884 875 -1.1
Teaching Status:
Non-teaching................................ 2,156 800 816 1.9
Fewer than 100 Residents.................... 849 909 925 1.8
100 or more Residents....................... 250 1,308 1,342 2.7
Urban DSH:
Non-DSH................................. 520 867 890 2.6
100 or more beds........................ 1,462 984 1,013 3.0
Less than 100 beds...................... 367 720 743 3.1
Rural DSH:
Sole Community (SCH/EACH)............... 255 680 681 0.1
Referral Center (RRC/EACH).............. 382 947 931 -1.6
Other Rural:
100 or more beds.................... 33 1,068 1,053 -1.4
Less than 100 beds.................. 236 530 543 2.4
Urban teaching and DSH:
Both teaching and DSH................... 805 1,055 1,087 3.1
Teaching and no DSH..................... 89 912 934 2.4
No teaching and DSH..................... 1,024 833 856 2.8
No teaching and no DSH.................. 346 847 871 2.8
Rural Hospital Types:
Plain Rural................................. 178 831 831 0.0
RRC/EACH.................................... 327 968 960 -0.7
SCH/EACH.................................... 312 749 752 0.5
SCH, RRC and EACH........................... 134 807 797 -1.3
Hospitals Reclassified by the Medicare
Geographic Classification Review Board:
FY2018 Reclassifications:
All Urban Reclassified.................. 588 995 1,006 1.1
All Urban Non-Reclassified.............. 1,835 966 996 2.9
All Rural Reclassified.................. 271 704 690 -1.8
All Rural Non-Reclassified.............. 454 613 615 0.2
All Section 401 Reclassified Hospitals.. 266 1,033 1,022 -1.1
Other Reclassified Hospitals (Section 47 651 661 1.6
1886(d)(8)(B)).........................
Type of Ownership:
Voluntary............................... 1,898 959 976 1.8
Proprietary............................. 856 851 871 2.3
Government.............................. 501 981 1,011 3.1
Medicare Utilization as a Percent of
Inpatient Days:
0-25.................................... 601 1,076 1,104 2.6
25-50................................... 2,139 942 961 2.1
50-65................................... 421 774 784 1.3
Over 65................................. 73 567 582 2.7
----------------------------------------------------------------------------------------------------------------
16. On page 41766,
a. First column, last paragraph,
i. Line 4, the figure ``41,579.65'' is corrected to read
``$41,558.68''.
ii. Line 8, the figure ``0.999713'' is corrected to read
``0.999215''.
b. Second column,
i. First partial paragraph,
A. Line 4, the figure ``0.990884'' is corrected to read
``0.990878''.
B. Line 12, the figure ``$40,759.12'' is corrected to read
``$40,738.57''.
ii. Second full paragraph, line 14, the figure ``0.999713'' is
corrected to read ``0.999215''.
iii. Last paragraph, line 7, the figure ``0.990884'' is corrected
to read ``0.990878''.
17. On page 41768, first column,
a. Line 8, the figure ``41,579.65'' is corrected to read
``$41,558.68''.
b. Line 9, the figure ``40,759.12'' is corrected to read
``$40,738.57''.
[[Page 49856]]
18. On pages 41768 and 41769, the table entitled ``TABLE IV--IMPACT
OF PAYMENT RATE AND POLICY CHANGES TO LTCH PPS PAYMENTS FOR LTCH PPS
STANDARD FEDERAL PAYMENT RATE CASES FOR FY 2019'', is corrected to read
as follows:
Table IV--Impact of Payment Rate and Policy Changes to LTCH PPS Payments for LTCH PPS Standard Federal Payment Rate Cases for FY 2019
[Estimated FY 2018 payments compared to estimated FY 2019 payments]
--------------------------------------------------------------------------------------------------------------------------------------------------------
Percent change Percent change
Average FY Average FY due to change due to changes Percent change
Number of LTCH 2018 LTCH PPS 2019 LTCH PPS to the annual to area wage due to all
LTCH classification Number of PPS standard payment per payment per update to the adjustment standard
LTCHS payment rate standard standard standard with wage payment rate
cases payment rate payment rate federal rate budget changes \4\
\1\ \2\ neutrality \3\
(1) (2) (3) (4) (5) (6) (7) (8)
--------------------------------------------------------------------------------------------------------------------------------------------------------
All Providers........................... 409 75,416 $46,852 $47,334 1.3 0 1.0
By Location:
Rural............................... 21 2,457 39,339 39,714 1.3 -0.1 1.0
Urban............................... 388 72,959 47,105 47,591 1.3 0 1.0
Large........................... 195 40,491 50,164 50,740 1.3 0 1.1
Other........................... 193 32,468 43,291 43,664 1.3 0 0.9
By Participation Date:
Before Oct. 1983.................... 11 1,923 43,083 43,225 1.3 -0.5 0.3
Oct. 1983-Sept. 1993................ 42 9,632 51,709 52,481 1.3 0.2 1.5
Oct. 1993-Sept. 2002................ 169 31,338 45,565 45,991 1.3 0 0.9
After October 2002.................. 187 32,523 46,877 47,347 1.3 0 1.0
By Ownership Type:
Voluntary........................... 77 10,614 48,824 49,614 1.3 0.3 1.6
Proprietary......................... 319 63,040 46,378 46,799 1.3 -0.1 0.9
Government.......................... 13 1,762 51,945 52,739 1.3 0.0 1.5
By Region:
New England......................... 12 2,707 43,164 43,275 1.3 -0.4 0.3
Middle Atlantic..................... 24 5,959 50,920 51,553 1.3 -0.1 1.2
South Atlantic...................... 66 13,792 47,641 48,127 1.3 -0.1 1.0
East North Central.................. 68 11,843 46,386 46,711 1.3 -0.3 0.7
East South Central.................. 36 6,385 45,490 45,978 1.3 0 1.1
West North Central.................. 28 4,412 45,951 46,428 1.3 -0.3 1.0
West South Central.................. 120 18,361 41,402 41,785 1.3 0.2 0.9
Mountain............................ 29 4,070 47,897 48,125 1.4 -0.5 0.5
Pacific............................. 26 7,887 58,121 59,205 1.3 0.7 1.9
By Bed Size:
Beds: 0-24.......................... 43 4,206 44,740 45,008 1.3 -0.4 0.6
Beds: 25-49......................... 185 26,270 44,623 45,044 1.3 0 0.9
Beds: 50-74......................... 107 20,178 47,733 48,246 1.3 0 1.1
Beds: 75-124........................ 43 12,086 50,145 50,770 1.3 0.1 1.2
Beds: 125-199....................... 22 7,709 47,404 47,768 1.3 -0.3 0.8
Beds: 200+.......................... 9 4,967 47,988 48,682 1.3 0.5 1.4
--------------------------------------------------------------------------------------------------------------------------------------------------------
\1\ Estimated FY 2019 LTCH PPS payments for LTCH PPS standard Federal payment rate criteria based on the payment rate and factor changes applicable to
such cases presented in the preamble of and the Addendum to this final rule.
\2\ Percent change in estimated payments per discharge for LTCH PPS standard Federal payment rate cases from FY 2018 to FY 2019 for the annual update to
the LTCH PPS standard Federal payment rate.
\3\ Percent change in estimated payments per discharge for LTCH PPS standard Federal payment rate cases from FY 2018 to FY 2019 for changes to the area
wage level adjustment under Sec. 412.525(c) (as discussed in section V.B. of the Addendum to this final rule).
\4\ Percent change in estimated payments per discharge for LTCH PPS standard Federal payment rate cases from FY 2018 (shown in Column 4) to FY 2019
(shown in Column 5), including all of the changes to the rates and factors applicable to such cases presented in the preamble and the Addendum to this
final rule. We note that this column, which shows the percent change in estimated payments per discharge for all changes, does not equal the sum of
the percent changes in estimated payments per discharge for the annual update to the LTCH PPS standard Federal payment rate (Column 6) and the changes
to the area wage level adjustment with budget neutrality (Column 7) due to the effect of estimated changes in estimated payments to aggregate HCO
payments for LTCH PPS standard Federal payment rate cases (as discussed in this impact analysis), as well as other interactive effects that cannot be
isolated.
19. On page 41769, lower two-thirds of the page--
a. First column, last paragraph, line 13, the figure ``0.999713''
is corrected to read ``0.999215''.
b. Second column,
i. First partial paragraph, line 1, the figure ``0.999713'' is
corrected to read ``0.999215''.
ii. Last paragraph, line 16, the figure ``0.9'' is corrected to
read ``1.0''.
c. Third column, second full paragraph, line 5, the figure ``0.4''
is corrected to read ``0.3''.
20. On page 41770, first column,
a. First full paragraph, line 5, the word ``Pacific'' is corrected
to read ``Mountain'',
b. First full paragraph, line 7, the word ``Mountain'' is corrected
to read ``Pacific'',
c. First full paragraph, line 9, the figure ``0.4'' is corrected to
read ``0.5'',
d. Second full paragraph, line 9, the figure ``1.5'' is corrected
to read ``1.4''.
Dated: September 27, 2018.
Wilma M. Robinson,
Deputy Executive Secretary to the Department, Department of Health and
Human Services.
[FR Doc. 2018-21500 Filed 9-28-18; 4:15 pm]
BILLING CODE 4120-01-P
