Medicare Program; FY 2025 Inpatient Psychiatric Facilities Prospective Payment System-Rate Update; Correction, 80095-80098 [2024-22496]
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Federal Register / Vol. 89, No. 191 / Wednesday, October 2, 2024 / Rules and Regulations
tribes, on the relationship between the
Federal Government and Indian tribes,
or on the distribution of power and
responsibilities between the Federal
Government and Indian tribes.
E. Unfunded Mandates Reform Act
F. Environment
We have analyzed this rule under
Department of Homeland Security
Directive 023–01, Rev. 1, associated
implementing instructions, and
Environmental Planning COMDTINST
5090.1 (series), which guide the Coast
Guard in complying with the National
Environmental Policy Act of 1969 (42
U.S.C. 4321–4370f), and have
determined that this action is one of a
category of actions that do not
individually or cumulatively have a
significant effect on the human
environment. This rule involves a 1500foot safety zone around the M/V SSI
DEFIANT for less than 7 days. It is
categorically excluded from further
review under paragraph L60(c) of
appendix A, table 1 of DHS Instruction
Manual 023–01–001–01, Rev. 1.
G. Protest Activities
The Coast Guard respects the First
Amendment rights of protesters.
Protesters are asked to call or email the
person listed in the FOR FURTHER
INFORMATION CONTACT section to
coordinate protest activities so that your
message can be received without
jeopardizing the safety or security of
people, places, or vessels.
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List of Subjects in 33 CFR Part 165
Harbors, Marine safety, Navigation
(water), Reporting and recordkeeping
requirements, Security measures,
Waterways.
For the reasons discussed in the
preamble, the Coast Guard amends 33
CFR part 165 as follows:
PART 165—REGULATED NAVIGATION
AREAS AND LIMITED ACCESS AREAS
1. The authority citation for part 165
continues to read as follows:
VerDate Sep<11>2014
16:46 Oct 01, 2024
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2. Add § 165.T05–0171 to read as
follows:
■
Dated: September 27, 2024.
Patrick C. Burkett,
Captain, U.S. Coast Guard, Captain of the
Port, Sector Maryland-National Capital
Region.
[FR Doc. 2024–22720 Filed 10–1–24; 8:45 am]
BILLING CODE 9110–04–P
The Unfunded Mandates Reform Act
of 1995 (2 U.S.C. 1531–1538) requires
Federal agencies to assess the effects of
their discretionary regulatory actions. In
particular, the Act addresses actions
that may result in the expenditure by a
State, local, or tribal government, in the
aggregate, or by the private sector of
$100,000,000 (adjusted for inflation) or
more in any one year. Though this rule
will not result in such an expenditure,
we do discuss the effects of this rule
elsewhere in this preamble.
■
Authority: 46 U.S.C. 70034, 70051, 70124;
33 CFR 1.05–1; 6.04–1, 6.04–6, and 160.5;
Department of Homeland Security Delegation
No. 0170.1, Revision No. 01.3.
80095
§ 165.T05–0171
Harbor, MD
Safety Zone; Baltimore
(a) Location. The following area is a
safety zone: all navigable waters within
1500-feet of the location of the vessel
SSI DEFIANT located at position 39°
13.18N, 076° 31.78W.
(b) Enforcement period. This section
is effective from September 27, 2024,
through October 3, 2024.
(c) Regulations. (1) In accordance with
the general regulations in § 165.23 of
this part, entry into, transiting through,
or exiting from this area is prohibited
unless authorized by the COTP
Maryland-NCR or a designated
representative.
(2) Vessels desiring to transit the
regulated area may do so only with prior
approval of the COTP Maryland-NCR or
a designated representative and when so
directed will be operated at a minimum
safe navigation speed in a manner that
will not endanger pollution response
operations in the zone or any other
vessels.
(3) The COTP Maryland-NCR or a
designated representative may forbid
and control the movement of all vessels
in the regulated area. When hailed or
signaled by an official patrol vessel, a
vessel shall come to an immediate stop
and comply with the directions given.
Failure to do so may result in expulsion
from the area, citation for failure to
comply, or both.
(4) Entry into this zone is prohibited
unless authorized by the COTP
Maryland-NCR or a designated
representative.
(5) Persons or vessels seeking to enter
or transit through the zone must request
permission from the COTP MarylandNCR or a designated representative.
They may be contacted on VHF–FM
channel 16 or by telephone at 410–576–
2693.
(6) If permission is granted, all
persons and vessels must comply with
the instructions of the COTP MarylandNCR or designated representative.
(d) Informational broadcasts. The
COTP Maryland-NCR or a designated
representative will inform the public
through Broadcast Notices to Mariners
of the enforcement period for the
temporary safety zone as well as any
changes in the planned schedule.
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DEPARTMENT OF HEALTH AND
HUMAN SERVICES
Centers for Medicare & Medicaid
Services
42 CFR Part 412
[CMS–1806–CN]
RIN 0938–AV32
Medicare Program; FY 2025 Inpatient
Psychiatric Facilities Prospective
Payment System—Rate Update;
Correction
Centers for Medicare &
Medicaid Services (CMS), HHS.
ACTION: Final action; correction.
AGENCY:
This document corrects
technical errors in the final action that
appeared in the August 7, 2024 Federal
Register titled ‘‘Medicare Program; FY
2025 Inpatient Psychiatric Facilities
Prospective Payment System—Rate
Update’’.
SUMMARY:
This correction is effective
October 1, 2024.
DATES:
FOR FURTHER INFORMATION CONTACT:
The IPF Payment Policy mailbox at
IPFPaymentPolicy@cms.hhs.gov for
information regarding the IPF wage
index.
Nick Brock (410) 786–5148, for
general information regarding the
inpatient psychiatric facilities
prospective payment system (IPF PPS).
SUPPLEMENTARY INFORMATION:
I. Background
In FR Doc. 2024–16909 of August 7,
2024, the fiscal year (FY) 2025 Inpatient
Psychiatric Facilities Prospective
Payment System (IPF PPS) final rule (89
FR 64582), there were technical errors
that are identified and corrected in this
correcting document. These corrections
are effective as if they had been
included in the FY 2025 IPF PPS final
rule. Accordingly, the corrections are
effective October 1, 2024.
II. Summary of Errors
A. Summary of Errors in the Preamble
There was a technical error in the
calculation of the final FY 2025 IPF PPS
wage indexes, which impacted several
calculations. There is an impact to the
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Federal Register / Vol. 89, No. 191 / Wednesday, October 2, 2024 / Rules and Regulations
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wage index for twelve providers in
Core-Based Statistical Area (CBSA) 26
for rural Missouri due to the
recalculated wage indexes, and thus we
recalculated the impact analysis
provided in Table 24 of the FY 2025 IPF
PPS final rule (89 FR 64670 through
64671). Therefore, changes are needed
to the published values in Table 24. We
also recalculated the wage index budget
neutrality factor; however, after
recalculating, there are no changes
needed to the published wage index
budget neutrality factor because the
difference between the previously
published factor and the newly
calculated factor is within the margin of
error for rounding. This means that the
recalculated wage index budget
neutrality factor remained 0.9996 and
the IPF federal per diem base rate
remained $876.53.
On pages 64670 and 64671, Table 24
reflects the impact to providers based on
the inaccurate calculation of the FY
2025 IPF PPS wage index; therefore,
Table 24 should be updated to reflect
the correct calculations.
On page 64672, the payment percent
increase for rural areas of ‘‘3.8 percent’’
is incorrect; therefore, ‘‘3.8 percent’’
should be replaced with ‘‘3.9 percent’’.
B. Summary of Errors in and Corrections
to the Tables Posted on the CMS website
for the IPF PPS Wage Index
As discussed in the FY 2025 IPF PPS
final rule (89 FR 64582), we used the
concurrent pre-floor, pre-reclassified
Inpatient Prospective Payment System
(IPPS) hospital wage index as the basis
for the IPF wage index. For FY 2025,
concurrent pre-floor, pre-reclassified
IPPS hospital wage data used under the
IPF PPS are for cost reporting periods
beginning on or after October 1, 2020
and before October 1, 2021 (FY 2021
cost report data), as discussed in the
final rule titled, ‘‘Medicare and
Medicaid Programs and the Children’s
Health Insurance Program; Hospital
Inpatient Prospective Payment Systems
for Acute Care Hospitals and the LongTerm Care Hospital Prospective
Payment System and Policy Changes
and Fiscal Year 2025 Rates; Quality
Programs Requirements; and Other
Policy Changes’’ (89 FR 68986)
(hereinafter referred to as the FY 2025
IPPS final rule). In calculating the wage
index under the FY 2025 IPPS final rule,
we made an inadvertent error related to
the calculation of the wage index. This
error is identified, discussed, and
corrected in the correction notice titled,
‘‘Medicare and Medicaid Programs and
the Children’s Health Insurance
Program; Hospital Inpatient Prospective
Payment Systems for Acute Care
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Hospitals and the Long-Term Care
Hospital Prospective Payment System
and Policy Changes and Fiscal Year
2025 Rates; Quality Programs
Requirements; and Other Policy
Changes; Correction’’, published
elsewhere in this issue of the Federal
Register.
In the FY 2025 Hospital Inpatient
Prospective Payment Systems and LongTerm Care Hospital Prospective
Payment System (IPPS/LTCH PPS) final
rule (89 FR 68986), we finalized a policy
to exclude hospitals that have
subsequently converted to rural
emergency hospitals (REHs) from the
wage index. Specifically, we stated that
any hospital that is designated as a REH
by 7 days prior to the publication of the
preliminary wage index public use file
(PUF) is excluded from the calculation
of the wage index. We inadvertently
treated a current IPPS hospital as a
hospital that had converted to REH
status, thereby erroneously excluding its
data from the wage index (CMS
Certification Number (CCN) 26–0163).
Therefore, we restored the wage data for
this hospital to be included in the wage
index.
This error affects the unadjusted, prereclassified, pre-rural floor IPPS wage
data and thereby affects the IPF PPS
wage data for CBSA 26 for rural
Missouri.
We are correcting the wage index for
CBSA 26 rural Missouri in Table B
setting forth the wage indexes for rural
areas based on CBSA labor market areas
and Table C setting forth the wage
indexes for urban and rural areas
without counties, which are available
exclusively on the CMS website at
https://www.cms.gov/medicare/
medicare-fee-for-service-payment/
inpatientpsychfacilpps/wageindex.
The omitted wage data for the one
hospital in CBSA 26 required the
recalculation of the final FY 2025 IPF
PPS wage indexes. Additionally, as
discussed in the FY 2025 IPF PPS final
rule (89 FR 64582), changes to the wage
index are made in a budget neutral
manner so that updates do not increase
expenditures. Due to the recalculation
and subsequent revision of the final FY
2025 IPF PPS wage indexes, it was
necessary to recalculate the FY 2025 IPF
PPS wage index budget neutrality factor.
However, as discussed above, no
changes are needed to the published
wage index budget neutrality factor
since the difference between the
previously published factor and the
newly calculated factor is within the
margin of error for rounding. This
means that the recalculated wage index
budget neutrality factor remained
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0.9996 and the IPF federal per diem
base rate remained $876.53.
III. Waiver of Proposed Rulemaking
We ordinarily publish a notice of
proposed rulemaking in the Federal
Register to provide a period for public
comment before the provisions of a rule
take effect in accordance with section
553(b) of the Administrative Procedure
Act (APA) (5 U.S.C. 553(b)). However,
we can waive this notice and comment
procedure if the Secretary finds, for
good cause, that the notice and
comment process is impracticable,
unnecessary, or contrary to the public
interest, and incorporates a statement of
the finding and the reasons therefore in
the notice.
Section 553(d) of the APA ordinarily
requires a 30-day delay in effective date
of final rules after the date of their
publication in the Federal Register.
This 30-day delay in effective date can
be waived, however, if an agency finds
for good cause that the delay is
impracticable, unnecessary, or contrary
to the public interest, and the agency
incorporates a statement of the findings
and its reasons in the rule issued.
We believe that this correcting
document does not constitute a rule that
would be subject to the notice and
comment or delayed effective date
requirements. This document corrects
technical errors in the preamble of the
FY 2025 IPF PPS final rule, as well as
two tables on the Centers for Medicare
& Medicaid Services (CMS) website, 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 2025 IPF 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 IPFs to receive
appropriate payments in a timely
manner to ensure that the FY 2025 IPF
PPS final rule accurately reflects our
policies as of the date they take effect
and are applicable. Furthermore, such
procedures would be unnecessary, as
we are not altering our payment
methodologies or policies, but rather,
we are simply correctly implementing
the policies that we previously
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Federal Register / Vol. 89, No. 191 / Wednesday, October 2, 2024 / Rules and Regulations
proposed, received comment on, and
subsequently finalized. This correcting
document is intended solely to ensure
that the FY 2025 IPF PPS final rule
accurately reflects these payment
methodologies and policies. For these
reasons, we believe we have good cause
to waive the notice and comment and
effective date requirements.
IV. Correction of Errors in the Preamble
In FR Doc. 2024–16909 of August 7,
2024 (89 FR 64582), make the following
corrections:
80097
1. On pages 64670 and 64671, TABLE
24: FY 2025 IPF PPS PAYMENT
IMPACTS is corrected to read as
follows:
TABLE 24—FY 2025 IPF PPS PAYMENT SYSTEMS
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[Percent change in columns 3 through 6]
Facility by type
Number of
facilities
Outlier
Refinement of
patient-level
adjustments
and ECT
Wage index
FY25, LRS,
and 5% Cap
Total percent
change 1
(1)
(2)
(3)
(4)
(5)
(6)
All Facilities ..........................................................................
Total Urban ...................................................................
Urban unit ..............................................................
Urban hospital .......................................................
Total Rural ....................................................................
Rural unit ...............................................................
Rural hospital .........................................................
By Type of Ownership:
Freestanding IPFs:
Urban Psychiatric Hospitals:
Government ....................................................
Non-Profit .......................................................
For-Profit .........................................................
Rural Psychiatric Hospitals:
Government ....................................................
Non-Profit .......................................................
For-Profit .........................................................
IPF Units:
Urban:
Government ....................................................
Non-Profit .......................................................
For-Profit .........................................................
Rural:
Government ....................................................
Non-Profit .......................................................
For-Profit .........................................................
By Teaching Status:
Non-teaching .................................................................
Less than 10% interns and residents to beds ..............
10% to 30% interns and residents to beds ..................
More than 30% interns and residents to beds .............
By Region:
New England ................................................................
Mid-Atlantic ...................................................................
South Atlantic ................................................................
East North Central ........................................................
East South Central .......................................................
West North Central .......................................................
West South Central ......................................................
Mountain .......................................................................
Pacific ...........................................................................
By Bed Size:
Psychiatric Hospitals:
Beds: 0–24 ............................................................
Beds: 25–49 ..........................................................
Beds: 50–75 ..........................................................
Beds: 76 + .............................................................
Psychiatric Units:
Beds: 0–24 ............................................................
Beds: 25–49 ..........................................................
Beds: 50–75 ..........................................................
Beds: 76 + .............................................................
1,419
1,162
645
517
257
197
60
¥0.3
¥0.3
¥0.4
¥0.1
¥0.1
¥0.1
¥0.2
0.0
0.0
0.5
¥0.5
¥0.3
0.1
¥1.1
0.0
¥0.2
¥0.6
0.2
1.4
1.1
2.1
2.5
2.3
2.3
2.5
3.9
4.0
3.6
119
97
301
¥0.5
¥0.1
0.0
1.1
¥0.1
¥0.9
¥0.6
¥0.3
0.6
2.7
2.3
2.5
30
12
18
¥0.3
¥0.5
0.0
1.6
¥1.5
¥2.3
¥0.3
0.3
3.7
3.9
1.0
4.2
93
430
122
¥0.8
¥0.4
¥0.2
0.8
0.7
¥0.5
¥0.1
¥0.9
0.1
2.7
2.1
2.3
44
113
40
¥0.1
¥0.2
¥0.1
¥0.1
0.4
¥0.1
0.7
1.2
1.3
3.4
4.3
4.0
1,217
100
76
26
¥0.2
¥0.5
¥0.6
¥0.7
¥0.2
0.6
1.2
1.2
0.3
¥1.1
¥1.2
¥0.1
2.7
1.9
2.2
3.2
99
191
228
225
140
95
213
102
126
¥0.4
¥0.4
¥0.2
¥0.2
¥0.1
¥0.5
¥0.1
¥0.2
¥0.3
0.9
0.3
0.4
0.0
¥0.2
1.1
¥1.2
¥0.3
¥0.5
¥1.5
¥1.7
1.3
0.5
2.6
0.0
1.6
0.8
¥1.8
1.8
0.9
4.4
3.2
5.0
3.4
3.2
3.1
0.1
87
86
91
313
¥0.1
0.0
¥0.1
¥0.1
¥0.9
¥1.3
¥0.4
¥0.3
0.8
1.3
0.9
0.0
2.5
2.7
3.2
2.3
440
229
103
70
¥0.2
¥0.3
¥0.4
¥0.7
0.0
0.5
0.7
0.6
0.3
¥0.7
0.1
¥1.2
2.9
2.3
3.2
1.5
1 This column includes the impact of the updates in columns (3) through (6) above, and of the IPF market basket percentage for FY 2025 of
3.3 percent, reduced by 0.5 percentage point for the productivity adjustment as required by section 1886(s)(2)(A)(i) of the Act.
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Federal Register / Vol. 89, No. 191 / Wednesday, October 2, 2024 / Rules and Regulations
2. On page 64672, in the first column,
in the first full paragraph, in line 6,
‘‘3.8’’ is corrected to read ‘‘3.9’’.
Elizabeth J. Gramling,
Executive Secretary to the Department,
Department of Health and Human Services.
[FR Doc. 2024–22496 Filed 9–27–24; 4:15 pm]
BILLING CODE 4120–01–P
DEPARTMENT OF HEALTH AND
HUMAN SERVICES
Centers for Medicare & Medicaid
Services
42 CFR Parts 405, 412, 413, 431, 482,
485, 495, and 512
[CMS–1808–CN2]
RIN 0938–AV34
Medicare and Medicaid Programs and
the Children’s Health Insurance
Program; Hospital Inpatient
Prospective Payment Systems for
Acute Care Hospitals and the LongTerm Care Hospital Prospective
Payment System and Policy Changes
and Fiscal Year 2025 Rates; Quality
Programs Requirements; and Other
Policy Changes; Correction
Centers for Medicare &
Medicaid Services (CMS), Department
of Health and Human Services HHS.
ACTION: Final rule; correction
AGENCY:
This document corrects
technical and typographical errors in
the final rule that appeared in the
August 28, 2024 Federal Register titled
‘‘Medicare and Medicaid Programs and
the Children’s Health Insurance
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
2025 Rates; Quality Programs
Requirements; and Other Policy
Changes’’ (referred to hereafter as the
‘‘FY 2025 IPPS/LTCH PPS final rule’’).
DATES: The corrections in this document
are effective October 1, 2024.
FOR FURTHER INFORMATION CONTACT:
Donald Thompson and Michele
Hudson, DAC@cms.hhs.gov, (410) 786–
4487, IPPS Payment Rate Issues.
Lily Yuan, NewTech@cms.hhs.gov,
New Technology Add-On Payments
Issues.
Benjamin Cohen, benjamin.cohen@
cms.hhs.gov, Provider Reimbursement
Review Board.
Mady Hue, marilu.hue@cms.hhs.gov,
and Andrea Hazeley, andrea.hazeley@
cms.hhs.gov, MS–DRG Classifications
Issues.
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SUMMARY:
VerDate Sep<11>2014
16:46 Oct 01, 2024
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Jennifer Tate, jennifer.tate@
cms.hhs.gov, Hospital-Acquired
Condition Reduction Program—
Administration Issues.
Julia Venanzi, julia.venanzi@
cms.hhs.gov, Hospital Inpatient Quality
Reporting Program and Hospital ValueBased Purchasing Program—
Administration Issues.
Jennifer Tate, jennifer.tate@
cms.hhs.gov, PPS-Exempt Cancer
Hospital Quality Reporting—
Administration Issues.
Ariel Cress, ariel.cress@cms.hhs.gov
or Lorraine Wickiser, lorraine.wickiser@
cms.hhs.gov, Long-Term Care Hospital
Quality Reporting Program—
Administration Issues.
Jessica Warren, jessica.warren@
cms.hhs.gov and Elizabeth Holland,
elizabeth.holland@cms.hhs.gov,
Medicare Promoting Interoperability
Program.
SUPPLEMENTARY INFORMATION:
I. Background
In FR Doc. 2024–07567 of August 28,
2024 (89 FR 68986), there were a
number of typographical and technical
errors that are identified and corrected
in this correcting document. The
corrections in this correcting document
are applicable to discharges occurring
on or after October 1, 2024, as if they
had been included in the document that
appeared in the August 28, 2024
Federal Register.
II. Summary of Errors
A. Summary of Error in the Dates
Section
On page 68986, we are correcting
technical errors in our discussion of the
regulatory provisions that are effective
November 1, 2024.
B. Summary of Errors in the Preamble
On pages 69060 and 69095, in our
discussion of the Change to Specific
Medicare Severity Diagnosis-Related
Group (MS–DRG) Classifications, we are
correcting several inadvertent
typographical errors.
Under our methodologies as finalized
in the FY 2025 IPPS/LTCH PPS final
rule, we exclude hospitals that have
subsequently converted to rural
emergency hospitals (REHs) from
certain data and calculations used in the
IPPS ratesetting. Specifically, we stated
that we exclude REHs, including
hospitals that subsequently became
REHs after the period from which the
data were taken for purposes of
developing the MS–DRG relative
weights for FY 2025 (89 FR 69109) and
from the calculation of the standardized
amount (89 FR 69942). In addition, we
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stated that any hospital that is
designated as a REH by 7 days prior to
the publication of the preliminary wage
index public use file (PUF) is excluded
from the calculation of the wage index.
We inadvertently treated a current IPPS
hospital as a hospital that had converted
to REH status, thereby erroneously
excluding its data from the MS–DRG
relative weight calculation and the wage
index (CMS Certification Number (CCN)
260163). Therefore, we restored the
applicable data for this hospital for
these and other ratesetting calculations,
as discussed further in section II.D. of
this correcting document.
We are correcting an error in the
version 42 MS–DRG assignment for
some cases in the historical claims data
in the FY 2023 MedPAR files used in
the ratesetting for the FY 2025 IPPS/
LTCH PPS final rule, which resulted in
inadvertent errors in the MS–DRG
relative weights. (We note this error did
not change the associated average
length-of-stay (LOS) for the impacted
DRGs.) Additionally, the version 42
MS–DRG assignment and relative
weights are used when determining
total payments for purposes of all of the
budget neutrality factors and the final
outlier threshold. Therefore, the
corrections to the MS–DRG assignment
under the version 42 GROUPER for
some cases in the historical claims data
in the FY 2023 MedPAR files (along
with the restoration of the data for CCN
260163 as discussed previously) and the
conforming recalculation of the relative
weights directly affected the calculation
of total payments and required the
recalculation of all the budget neutrality
factors and the final outlier threshold.
On page 69109, we are correcting the
number of Medicare discharges from
IPPS providers in the FY 2023 MedPAR
file used in calculating the relative
weights for FY 2025 due to the
correction of the number of hospitals
with REH status.
On page 69113, we are correcting the
normalization adjustment factor used in
calculating the relative weights for FY
2025 due to the correction of the
number of hospitals with REH status,
the error in the version 42 MS–DRG
assignment for some cases in the
historical claims data, and the
conforming changes to the relative
weights.
On page 69268, we are correcting the
total number of hospitals that were
removed from the FY 2025 IPPS wage
index due to conversion to REH status
and making a corresponding correction
to the number of hospitals’ wage data
used to calculate the FY 2025 wage
index.
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Agencies
[Federal Register Volume 89, Number 191 (Wednesday, October 2, 2024)]
[Rules and Regulations]
[Pages 80095-80098]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2024-22496]
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DEPARTMENT OF HEALTH AND HUMAN SERVICES
Centers for Medicare & Medicaid Services
42 CFR Part 412
[CMS-1806-CN]
RIN 0938-AV32
Medicare Program; FY 2025 Inpatient Psychiatric Facilities
Prospective Payment System--Rate Update; Correction
AGENCY: Centers for Medicare & Medicaid Services (CMS), HHS.
ACTION: Final action; correction.
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SUMMARY: This document corrects technical errors in the final action
that appeared in the August 7, 2024 Federal Register titled ``Medicare
Program; FY 2025 Inpatient Psychiatric Facilities Prospective Payment
System--Rate Update''.
DATES: This correction is effective October 1, 2024.
FOR FURTHER INFORMATION CONTACT:
The IPF Payment Policy mailbox at [email protected] for
information regarding the IPF wage index.
Nick Brock (410) 786-5148, for general information regarding the
inpatient psychiatric facilities prospective payment system (IPF PPS).
SUPPLEMENTARY INFORMATION:
I. Background
In FR Doc. 2024-16909 of August 7, 2024, the fiscal year (FY) 2025
Inpatient Psychiatric Facilities Prospective Payment System (IPF PPS)
final rule (89 FR 64582), there were technical errors that are
identified and corrected in this correcting document. These corrections
are effective as if they had been included in the FY 2025 IPF PPS final
rule. Accordingly, the corrections are effective October 1, 2024.
II. Summary of Errors
A. Summary of Errors in the Preamble
There was a technical error in the calculation of the final FY 2025
IPF PPS wage indexes, which impacted several calculations. There is an
impact to the
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wage index for twelve providers in Core-Based Statistical Area (CBSA)
26 for rural Missouri due to the recalculated wage indexes, and thus we
recalculated the impact analysis provided in Table 24 of the FY 2025
IPF PPS final rule (89 FR 64670 through 64671). Therefore, changes are
needed to the published values in Table 24. We also recalculated the
wage index budget neutrality factor; however, after recalculating,
there are no changes needed to the published wage index budget
neutrality factor because the difference between the previously
published factor and the newly calculated factor is within the margin
of error for rounding. This means that the recalculated wage index
budget neutrality factor remained 0.9996 and the IPF federal per diem
base rate remained $876.53.
On pages 64670 and 64671, Table 24 reflects the impact to providers
based on the inaccurate calculation of the FY 2025 IPF PPS wage index;
therefore, Table 24 should be updated to reflect the correct
calculations.
On page 64672, the payment percent increase for rural areas of
``3.8 percent'' is incorrect; therefore, ``3.8 percent'' should be
replaced with ``3.9 percent''.
B. Summary of Errors in and Corrections to the Tables Posted on the CMS
website for the IPF PPS Wage Index
As discussed in the FY 2025 IPF PPS final rule (89 FR 64582), we
used the concurrent pre-floor, pre-reclassified Inpatient Prospective
Payment System (IPPS) hospital wage index as the basis for the IPF wage
index. For FY 2025, concurrent pre-floor, pre-reclassified IPPS
hospital wage data used under the IPF PPS are for cost reporting
periods beginning on or after October 1, 2020 and before October 1,
2021 (FY 2021 cost report data), as discussed in the final rule titled,
``Medicare and Medicaid Programs and the Children's Health Insurance
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 2025 Rates; Quality Programs
Requirements; and Other Policy Changes'' (89 FR 68986) (hereinafter
referred to as the FY 2025 IPPS final rule). In calculating the wage
index under the FY 2025 IPPS final rule, we made an inadvertent error
related to the calculation of the wage index. This error is identified,
discussed, and corrected in the correction notice titled, ``Medicare
and Medicaid Programs and the Children's Health Insurance 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 2025 Rates; Quality Programs Requirements; and
Other Policy Changes; Correction'', published elsewhere in this issue
of the Federal Register.
In the FY 2025 Hospital Inpatient Prospective Payment Systems and
Long-Term Care Hospital Prospective Payment System (IPPS/LTCH PPS)
final rule (89 FR 68986), we finalized a policy to exclude hospitals
that have subsequently converted to rural emergency hospitals (REHs)
from the wage index. Specifically, we stated that any hospital that is
designated as a REH by 7 days prior to the publication of the
preliminary wage index public use file (PUF) is excluded from the
calculation of the wage index. We inadvertently treated a current IPPS
hospital as a hospital that had converted to REH status, thereby
erroneously excluding its data from the wage index (CMS Certification
Number (CCN) 26-0163). Therefore, we restored the wage data for this
hospital to be included in the wage index.
This error affects the unadjusted, pre-reclassified, pre-rural
floor IPPS wage data and thereby affects the IPF PPS wage data for CBSA
26 for rural Missouri.
We are correcting the wage index for CBSA 26 rural Missouri in
Table B setting forth the wage indexes for rural areas based on CBSA
labor market areas and Table C setting forth the wage indexes for urban
and rural areas without counties, which are available exclusively on
the CMS website at https://www.cms.gov/medicare/medicare-fee-for-service-payment/inpatientpsychfacilpps/wageindex.
The omitted wage data for the one hospital in CBSA 26 required the
recalculation of the final FY 2025 IPF PPS wage indexes. Additionally,
as discussed in the FY 2025 IPF PPS final rule (89 FR 64582), changes
to the wage index are made in a budget neutral manner so that updates
do not increase expenditures. Due to the recalculation and subsequent
revision of the final FY 2025 IPF PPS wage indexes, it was necessary to
recalculate the FY 2025 IPF PPS wage index budget neutrality factor.
However, as discussed above, no changes are needed to the published
wage index budget neutrality factor since the difference between the
previously published factor and the newly calculated factor is within
the margin of error for rounding. This means that the recalculated wage
index budget neutrality factor remained 0.9996 and the IPF federal per
diem base rate remained $876.53.
III. Waiver of Proposed Rulemaking
We ordinarily publish a notice of proposed rulemaking in the
Federal Register to provide a period for public comment before the
provisions of a rule take effect in accordance with section 553(b) of
the Administrative Procedure Act (APA) (5 U.S.C. 553(b)). However, we
can waive this notice and comment procedure if the Secretary finds, for
good cause, that the notice and comment process is impracticable,
unnecessary, or contrary to the public interest, and incorporates a
statement of the finding and the reasons therefore in the notice.
Section 553(d) of the APA ordinarily requires a 30-day delay in
effective date of final rules after the date of their publication in
the Federal Register. This 30-day delay in effective date can be
waived, however, if an agency finds for good cause that the delay is
impracticable, unnecessary, or contrary to the public interest, and the
agency incorporates a statement of the findings and its reasons in the
rule issued.
We believe that this correcting document does not constitute a rule
that would be subject to the notice and comment or delayed effective
date requirements. This document corrects technical errors in the
preamble of the FY 2025 IPF PPS final rule, as well as two tables on
the Centers for Medicare & Medicaid Services (CMS) website, 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 2025 IPF
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 IPFs to receive appropriate payments in a timely manner to
ensure that the FY 2025 IPF PPS final rule accurately reflects our
policies as of the date they take effect and are applicable.
Furthermore, such procedures would be unnecessary, as we are not
altering our payment methodologies or policies, but rather, we are
simply correctly implementing the policies that we previously
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proposed, received comment on, and subsequently finalized. This
correcting document is intended solely to ensure that the FY 2025 IPF
PPS final rule accurately reflects these payment methodologies and
policies. For these reasons, we believe we have good cause to waive the
notice and comment and effective date requirements.
IV. Correction of Errors in the Preamble
In FR Doc. 2024-16909 of August 7, 2024 (89 FR 64582), make the
following corrections:
1. On pages 64670 and 64671, TABLE 24: FY 2025 IPF PPS PAYMENT
IMPACTS is corrected to read as follows:
Table 24--FY 2025 IPF PPS Payment Systems
[Percent change in columns 3 through 6]
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Refinement of
Number of patient-level Wage index Total percent
Facility by type facilities Outlier adjustments FY25, LRS, and change \1\
and ECT 5% Cap
(1) (2) (3) (4) (5) (6)
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All Facilities.................. 1,419 -0.3 0.0 0.0 2.5
Total Urban................. 1,162 -0.3 0.0 -0.2 2.3
Urban unit.............. 645 -0.4 0.5 -0.6 2.3
Urban hospital.......... 517 -0.1 -0.5 0.2 2.5
Total Rural................. 257 -0.1 -0.3 1.4 3.9
Rural unit.............. 197 -0.1 0.1 1.1 4.0
Rural hospital.......... 60 -0.2 -1.1 2.1 3.6
By Type of Ownership:
Freestanding IPFs:
Urban Psychiatric Hospitals:
Government.......... 119 -0.5 1.1 -0.6 2.7
Non-Profit.......... 97 -0.1 -0.1 -0.3 2.3
For-Profit.......... 301 0.0 -0.9 0.6 2.5
Rural Psychiatric Hospitals:
Government.......... 30 -0.3 1.6 -0.3 3.9
Non-Profit.......... 12 -0.5 -1.5 0.3 1.0
For-Profit.......... 18 0.0 -2.3 3.7 4.2
IPF Units:
Urban:
Government.......... 93 -0.8 0.8 -0.1 2.7
Non-Profit.......... 430 -0.4 0.7 -0.9 2.1
For-Profit.......... 122 -0.2 -0.5 0.1 2.3
Rural:
Government.......... 44 -0.1 -0.1 0.7 3.4
Non-Profit.......... 113 -0.2 0.4 1.2 4.3
For-Profit.......... 40 -0.1 -0.1 1.3 4.0
By Teaching Status:
Non-teaching................ 1,217 -0.2 -0.2 0.3 2.7
Less than 10% interns and 100 -0.5 0.6 -1.1 1.9
residents to beds..........
10% to 30% interns and 76 -0.6 1.2 -1.2 2.2
residents to beds..........
More than 30% interns and 26 -0.7 1.2 -0.1 3.2
residents to beds..........
By Region:
New England................. 99 -0.4 0.9 -1.5 1.8
Mid-Atlantic................ 191 -0.4 0.3 -1.7 0.9
South Atlantic.............. 228 -0.2 0.4 1.3 4.4
East North Central.......... 225 -0.2 0.0 0.5 3.2
East South Central.......... 140 -0.1 -0.2 2.6 5.0
West North Central.......... 95 -0.5 1.1 0.0 3.4
West South Central.......... 213 -0.1 -1.2 1.6 3.2
Mountain.................... 102 -0.2 -0.3 0.8 3.1
Pacific..................... 126 -0.3 -0.5 -1.8 0.1
By Bed Size:
Psychiatric Hospitals:
Beds: 0-24.............. 87 -0.1 -0.9 0.8 2.5
Beds: 25-49............. 86 0.0 -1.3 1.3 2.7
Beds: 50-75............. 91 -0.1 -0.4 0.9 3.2
Beds: 76 +.............. 313 -0.1 -0.3 0.0 2.3
Psychiatric Units:
Beds: 0-24.............. 440 -0.2 0.0 0.3 2.9
Beds: 25-49............. 229 -0.3 0.5 -0.7 2.3
Beds: 50-75............. 103 -0.4 0.7 0.1 3.2
Beds: 76 +.............. 70 -0.7 0.6 -1.2 1.5
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\1\ This column includes the impact of the updates in columns (3) through (6) above, and of the IPF market
basket percentage for FY 2025 of 3.3 percent, reduced by 0.5 percentage point for the productivity adjustment
as required by section 1886(s)(2)(A)(i) of the Act.
[[Page 80098]]
2. On page 64672, in the first column, in the first full paragraph,
in line 6, ``3.8'' is corrected to read ``3.9''.
Elizabeth J. Gramling,
Executive Secretary to the Department, Department of Health and Human
Services.
[FR Doc. 2024-22496 Filed 9-27-24; 4:15 pm]
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