[Federal Register: October 7, 2004 (Volume 69, Number 194)]
[Notices]
[Page 60158-60159]
From the Federal Register Online via GPO Access [wais.access.gpo.gov]
[DOCID:fr07oc04-47]
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DEPARTMENT OF HEALTH AND HUMAN SERVICES
Centers for Medicare & Medicaid Services
[CMS-1249-CN]
RIN 0938-AM46
Medicare Program; Prospective Payment System and Consolidated
Billing for Skilled Nursing Facilities; Corrections
AGENCY: Centers for Medicare & Medicaid Services (CMS), HHS.
ACTION: Correction notice.
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SUMMARY: This document corrects technical errors that appeared in the
July 30, 2004 Federal Register, entitled ``Medicare Program;
Prospective Payment System and Consolidated Billing for Skilled Nursing
Facilities--Update--Notice.''
DATES: This correction is effective October 1, 2004.
FOR FURTHER INFORMATION CONTACT: Jeanette Kranacs, (410) 786-9385, Bill
Ullman, (410) 786-5667, or Sheila Lambowitz, (410) 786-7605.
SUPPLEMENTARY INFORMATION:
I. Background
In FR Doc. 04-17443 of July 30, 2004 (69 FR 45775), there were a
number of technical errors that are identified in this notice. It was
recently determined that technical errors occurred in the hospital wage
index calculation process
[[Page 60159]]
for FY 2005, necessitating adjustments to the hospital wage index
relating to a number of specific Metropolitan Statistical Areas (MSAs).
A description of those technical errors will be included in a Federal
Register notice specific to the hospital inpatient prospective payment
systems (IPPS). As we explained in the July 30, 2004, update notice,
the SNF wage index values reflect the pre-floor, pre-reclassification
wage data used in the FY 2005 IPPS rates, and therefore, we believe it
would be appropriate to incorporate corrections made to the inpatient
hospital wage indexes in our SNF PPS wage index tables. Further, we
note that correcting these technical errors is a purely administrative
function that does not result in any change of policy or payment
methodology.
We are correcting Table 10 (which serves to illustrate the payment
rate computations for a fictitious ``XYZ'' SNF located in State
College, PA), in order to reflect the application of the corrected wage
index. In section II of this notice we are correcting the figure for
the PPS total payment in the ``XYZ'' example and restoring a footnote
that was inadvertently omitted from the published table. This footnote
corresponds to the triple asterisk displayed in the table's ``Percent
Adjustment'' column for Resource Utilization Group (RUG) SSC, and
refers to the application of the 20 percent add-on under section 101(a)
of the Medicare, Medicaid and SCHIP Balanced Budget Refinement Act of
1999.
We are also correcting Table 12, which displays the projected
impact of the FY 2005 SNF PPS payment update, including the variation
in impact by region and by certain other facility characteristics. We
note that the effect on the corrected table is solely distributional in
nature and, accordingly, there is no change in the estimated aggregate
expenditures for FY 2005 as set forth in the July 30, 2004, update
notice. A further discussion of the projected impact of the FY 2005 SNF
PPS payment update can be found in the July 30, 2004, update notice (69
FR 45820).
In addition, we have identified a labeling error in the wage index
tables used in the SNF PPS. That labeling error is the listing of
Stanly County, NC as one of the areas under Metropolitan Statistical
Area (MSA) 1520 when, in fact, we consider Stanly County, NC to be a
rural area in North Carolina. Stanly County wage data have always been
correctly treated as rural in the actual creation of the SNF wage index
values, and it has only been the listing of Stanly County under MSA
1520 that was in error. Consequently, we have corrected the wage index
table in the update notice to remove Stanly County from the list of
areas that fall under the MSA 1520 wage index. Since this is strictly a
labeling correction that does not affect the actual computation of the
wage index values, SNFs in Stanly County, NC will fall under, and use,
the wage index for rural North Carolina effective October 1, 2004.
We also wish to clarify that the adjustment amount ($463.96)
displayed for RUG CC2 in the ``Percent Adjustment'' column of the
corrected Table 10, as indicated by the double asterisk and
accompanying footnote, assumes that the days shown in the table for RUG
CC2 are for treatment of a patient with acquired immune deficiency
syndrome (AIDS). Therefore, this adjustment amount reflected the
application of section 511 of the Medicare Prescription Drug,
Improvement, and Modernization Act of 2003 (MMA). As explained in the
July 30, 2004, update notice (69 FR 45777), section 511 of the MMA
provides for a temporary 128 percent increase in payment for any SNF
resident with AIDS. We further note that this special 128 percent add-
on is applicable regardless of the particular RUG to which an AIDS
patient is assigned, and is made in lieu of any other add-on (either 20
percent or 6.7 percent) that might otherwise apply to that RUG.
We have corrected the errors in the wage tables and other tables as
noted above. These corrected tables are posted and available on the CMS
Web site at: http://www.cms.hhs.gov/providers/snfpps. These corrected
tables are effective October 1, 2004. We note the corrected tables will
be included in a forthcoming Federal Register notice.
II. Correction of Errors
In FR Doc. 04-17443 (69 FR 45775), make the following corrections:
1. On page 45817,
a. Third column, line 12, the figure ``$25,161'' is corrected to
read ``$25,117''.
b. At the end of the table and after the last sentence, add the
following sentence ``*-*-*Reflects a 20 percent adjustment from section
101(a) of the BBRA.''.
III. Waiver of Proposed Rulemaking and Delayed Effective Date
We ordinarily publish a notice of proposed rulemaking in the
Federal Register to provide a period for public comment before the
provisions of a rule take effect in accordance with section 553(b) of
the Administrative Procedure Act (APA) (5 U.S.C. 553(b)). We also
ordinarily provide a 30-day delay in the effective date of the
provisions of a notice in accordance with section 553(d) of the APA (5
U.S.C. 553(d)). However, we can waive both the notice and comment
procedure and the 30-day delay in effective date if the Secretary
finds, for good cause, that a 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.
We find it unnecessary to undertake notice-and-comment rulemaking
because this notice merely provides technical corrections to the
regulations. We are not changing our payment methodology, but rather,
are simply implementing correctly the payment methodology that we
previously proposed, received comment on, and subsequently finalized.
Thus, because the public has already had the opportunity to comment on
the payment methodology being used to calculate wage indexes,
additional comment would be unnecessary.
Further, we believe a delayed effective date is unnecessary because
this correction notice merely corrects inadvertent technical mistakes
(that is, a labeling error with respect to Stanley County and the
insertion of incorrect numbers in the wage indexes for certain MSAs).
Further, we believe imposing a 30-day delay in the effective date would
be contrary to the public interest with respect to SNF providers in the
affected MSAs. As a matter of good public policy, the rates used in the
SNF PPS should not be based on wage indexes that contain inadvertent
errors that, if not corrected, would have very real impacts on the
payments received by providers in the affected MSAs. We believe that it
is imperative that these providers receive appropriate SNF PPS payments
and that failure to do so would be contrary to the public interest.
Furthermore, the changes noted above do not make any substantive
changes to the SNF PPS payment methodology or underlying payment
policies. Therefore, we find good cause to waive notice-and-comment
procedures, as well as the 30-day delay in effective date.
(Catalog of Federal Domestic Assistance Program No. 93.773,
Medicare--Hospital Insurance; and Program No. 93.774, Medicare--
Supplementary Medical Insurance Program.)
Dated: September 30, 2004.
Ann Agnew,
Executive Secretary to the Department.
[FR Doc. 04-22399 Filed 10-1-04; 11:46 am]
BILLING CODE 4120-01-P