[Federal Register: October 1, 2009 (Volume 74, Number 189)]
[Rules and Regulations]
[Page 50712-50713]
From the Federal Register Online via GPO Access [wais.access.gpo.gov]
[DOCID:fr01oc09-15]
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DEPARTMENT OF HEALTH AND HUMAN SERVICES
Centers for Medicare & Medicaid Services
42 CFR Part 412
[CMS-1538-CN]
RIN 0938-AP56
Medicare Program; Inpatient Rehabilitation Facility Prospective
Payment System for Federal Fiscal Year 2010; Correction
AGENCY: Centers for Medicare & Medicaid Services (CMS), HHS.
ACTION: Correction of final rule.
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SUMMARY: This document corrects technical errors that appeared in the
final rule published in the Federal Register on August 7, 2009 entitled
``Inpatient Rehabilitation Facility Prospective Payment System for
Federal Fiscal Year 2010'' (74 FR 39762).
DATES: Effective Date. The correction to the average length of stay
value for CMG 0501, tier 2, in Table 1 on page 39768 of the final rule
(74 FR 39762) is effective October 1, 2009. The correction to the
preamble text at the top of the middle column of page 39791 of the
final rule (74 FR 39762) is effective January 1, 2010.
FOR FURTHER INFORMATION CONTACT: Susanne Seagrave, (410) 786-0044.
SUPPLEMENTARY INFORMATION:
I. Background
In FR Doc. E9-18616 of August 7, 2009 (74 FR 39762), there are
technical errors that we are identifying and correcting in the
Correction of Errors section below. The corrections in this notice are
effective as if they were included in the final rule published on
August 7, 2009. Accordingly, the correction to the average length of
stay value for CMG 0501, tier 2, in Table 1 on page 39768 of the final
rule (74 FR 39762) is effective October 1, 2009. This change is
applicable for IRF discharges occurring on or after October 1, 2009 and
on or before September 30, 2010 (FY 2010). The correction to the
preamble text at the top of the middle column of page 39791 of the
final rule is effective January 1, 2010.
II. Summary of Errors
In the August 7, 2009 final rule (74 FR 39762), the average length
of stay value for CMG 0501, tier 2, in Table 1 on page 39768 should
have been listed as 10, but was inadvertently listed as 0. In the FY
2010 IRF PPS proposed rule (74 FR 21052 at 21057), we proposed the
average length of stay value for CMG 0501, tier 2, as 10. The proposal
was based on FY 2007 IRF claims data, which was the most recent
available data we had at the time. The updated FY 2008 data that we
used for the final rule contained no IRF cases for CMG 0501, tier 2.
When there are not enough cases in a particular CMG and tier (referred
to herein as a ``payment group'') to calculate an average length of
stay, we combine the cases in that payment group with the next highest-
paying payment group to calculate an average length of stay value.
Accordingly, for the final rule, we used the average length of stay
value of 10 from CMG 0501, tier 1 for CMG 0501, tier 2, but in Table 1
we inadvertently indicated a value of 0 instead of 10. Thus, we are
correcting Table 1 to show the average length of stay value for CMG
0501, tier 2, is 10.
In addition, we are correcting certain language in the preamble
that could be misread, resulting in confusion with the regulatory
requirements that must be met with respect to the preadmission
screening required under Sec. 412.622(a)(4)(A). Section
412.622(a)(4)(A) requires that the comprehensive preadmission screening
be conducted by a licensed or certified clinician(s) designated by the
rehabilitation physician described in Sec. 412.622(a)(3(iv) within 48
hours immediately preceding the IRF admission. Our policy is that the
IRF personnel conducting the screening must be a clinician or group of
clinicians who are appropriately trained and qualified to assess the
patient's medical and functional status, assess the risk for clinical
and rehabilitation complications, and assess other aspects of the
patient's condition both medically and functionally. As we stated in
the final rule, we do not believe that non-clinical personnel can
adequately perform these assessments. In the final rule (74 FR 39791),
we stated that, ``* * * we believe that the IRF personnel involved in
collecting the information for the preadmission screening must be
appropriately trained and qualified to assess the patient's medical and
functional status, assess the risk for clinical and rehabilitation
complications, and assess other aspects of the patient's condition both
medically and functionally'' (emphasis added). As the discussion in
which this sentence was embedded only pertained to clinical staff
assessments under Sec. 412.622(a)(4)(A), we should have utilized
terminology that referenced ``clinical staff'' and ``assessment,'' not
``IRF personnel'' and ``collecting.'' Consistent with the discussion in
which the statement appears, we meant to convey that the IRF clinical
staff conducting the preadmission screening must be trained and
qualified to make the appropriate assessments. The appropriate use of
non-clinical staff in the collection of the information that is used in
the Sec. 412.622(a)(4)(A) assessment is beyond the scope of the
preamble discussion. Therefore, to eliminate any confusion, we are
revising the sentence in the middle column at the top of page 39791 of
the final rule to read, ``* * * we believe that the clinician(s)
conducting the preadmission screening must be appropriately trained and
qualified to assess the patient's medical and functional status, assess
the risk for clinical and rehabilitation
[[Page 50713]]
complications, and assess other aspects of the patient's condition both
medically and functionally.''
III. Correction of Errors
In FR Doc. E9-18616 of August 7, 2009 (74 FR 39762), make the
following corrections:
0
1. On page 39768, in Table 1, in CMG 0501, under ``Average length of
stay,'' tier 2, the value ``0'' is corrected to read ``10.''
0
2. On page 39791, in column 2, in line 7 from the top, the phrase ``IRF
personnel involved in collecting the information for,'' is corrected to
read, ``clinician(s) conducting.''
IV. 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 rule in accordance with section 553(d) of the APA (5
U.S.C. 553(d)). However, we can waive both notice and comment
procedures and the 30-day delay in effective date if the Secretary
finds, for good cause, that such procedures are impracticable,
unnecessary, or contrary to the public interest, and incorporates a
statement of the finding and the reasons into the notice.
The policies and payment methodology expressed in the FY 2010 IRF
PPS final rule (74 FR 39762) have previously been subjected to notice
and comment procedures. This correction notice provides technical
corrections to the FY 2010 final rule that was promulgated through
notice and comment rulemaking, and does not make substantive changes to
the policies or payment methodologies that were expressed in the final
rule. Therefore, we find it unnecessary to undertake further notice and
comment procedures with respect to this correction notice. We also
believe that it is in the public interest (and would be contrary to the
public interest to do otherwise) to waive notice and comment procedures
and the 30-day delay in effective date for this notice. This correction
notice is intended to ensure that the FY 2010 final rule accurately
reflects the policies expressed in the final rule, and that the correct
information is made available to the public prior to the effective
dates of the final rule. Therefore, we find good cause to waive notice
and comment procedures and the 30-day delay in the effective date for
this correction notice.
(Catalog of Federal Domestic Assistance Program No. 93.773,
Medicare--Hospital Insurance; and Program No. 93.774, Medicare--
Supplementary Medical Insurance Program)
Dated: September 25, 2009.
Dawn L. Smalls,
Executive Secretary to the Department.
[FR Doc. E9-23708 Filed 9-30-09; 8:45 am]
BILLING CODE 4120-01-P