[Federal Register Volume 66, Number 10 (Tuesday, January 16, 2001)]
[Rules and Regulations]
[Pages 3497-3499]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 01-1187]
=======================================================================
-----------------------------------------------------------------------
DEPARTMENT OF HEALTH AND HUMAN SERVICES
Health Care Financing Administration
42 CFR Parts 411, 413, and 489
[HCFA-1112-CN]
RIN 0938-AJ93
Medicare Program; Prospective Payment System and Consolidated
Billing for Skilled Nursing Facilities--Update; Correction
AGENCY: Health Care Financing Administration (HCFA), HHS.
ACTION: Correction notice.
-----------------------------------------------------------------------
SUMMARY: This document corrects technical errors that appeared in the
final rule published in the Federal Register on July 31, 2000 entitled,
``Medicare Program; Prospective Payment System and Consolidated Billing
for Skilled Nursing Facilities--Update.''
EFFECTIVE DATE: This correction is effective October 1, 2000, except
for certain wage index corrections that are effective December 1, 2000.
FOR FURTHER INFORMATION CONTACT: Bill Ullman (410) 786-5667 or Susan
Burris (410) 786-6655.
SUPPLEMENTARY INFORMATION:
Background
In the July 31, 2000 final rule entitled, ``Prospective Payment
System and Consolidated Billing for Skilled Nursing Facilities'' (FR
Doc. 00-19004, July 31, 2000), there were several technical errors in
the preamble.
In the first column of Tables 3 through 6 of the preamble there was
a typographical error. We are correcting the heading of the column from
``RUG IV category'' to ``RUG III category.''
We are also correcting several SNF PPS wage index values as
published in Tables 7 and 8. Specifically, effective October 1, 2000,
in Table 7, the wage index value for the Allentown-Bethlehem-Easton, PA
MSA (area 0240) is corrected from 1.0040 to 0.9925 and the wage index
value for the Kansas City, KS-MO MSA (area 3760) is corrected from
0.9498 to 0.9509.
Effective December 1, 2000, in Table 7, the wage index value for
the Alexandria, LA MSA (area 0220) is corrected from 0.8151 to 0.8123,
the wage index value for the Kansas City, KS-MO MSA (area 3760) is
corrected again from 0.9509 (as corrected in the previous paragraph) to
0.9527, and, in Table 8, the wage index value for rural LA (area 19) is
corrected from 0.7668 to 0.7681.
In accordance with our longstanding policies, these technical and
tabulation errors are being corrected prospectively, effective on the
dates noted above. This correction notice conforms the published SNF
PPS wage index values to the prospectively revised values.
We are also taking this opportunity to provide a correction
regarding the applicable time period to which a special market basket
inflation factor is to be applied for certain providers that
participated in the Multistate Nursing Home Case-Mix and Quality
Demonstration (NHCMQD), the demonstration project that served as the
forerunner to the national skilled nursing facility (SNF) prospective
payment system (PPS). In the May 12, 1998 SNF PPS interim final rule
(63 FR 26288), we explained that for those providers that received
payment under the NHCMQD during a cost reporting period that began in
calendar year 1997, we derived a special market basket index inflation
factor of 1.031532. We used this factor to adjust the 1997 costs to the
midpoint of the rate setting period in calculating their facility-
specific rate. The May 1998 interim final rule indicated that the
initial rate setting period (which applied to those providers beginning
their first cost reporting period under the SNF PPS) encompassed the
15-month period from July 1, 1998, to September 30, 1999.
Under the statute's phased transition from facility-specific to
full Federal rates, this inflation factor was to be successively
updated for the second and third cost reporting periods under the SNF
PPS. However, for demonstration providers beginning their second cost
reporting period under the SNF PPS, the
[[Page 3498]]
July 30, 1999 SNF PPS update notice (64 FR 41697) inadvertently
included the same inflation factor of 1.031532 that had been displayed
for the first cost reporting period in the May 1998 interim final rule,
along with the same time period of July 1, 1998, to September 30, 1999.
Although a subsequent correction notice published in the Federal
Register on October 5, 1999 (64 FR 54030) provided the correct
inflation factor of 1.062244 for the second cost reporting period, it
did not make a similar correction to the applicable time period.
Further, while the July 2000 final rule (65 FR 46787) did update
both the inflation factor (1.105788) and the applicable time period
(October 1, 2000, to September 30, 2001) for these demonstration
providers, the latter change failed to reflect that it is possible for
such a provider to begin its third cost reporting period under the SNF
PPS as early as July 1, 2000. Accordingly, we are hereby correcting the
start date for the demonstration providers for the applicable time
period that was displayed in the 2000 final rule, from October 1, 2000,
to July 1, 2000.
In addition, there was an error in the Regulatory Impact Analysis,
section VI of the preamble, that resulted in two columns of incorrect
figures displayed in the impact analysis table. Based on the correct
percent changes in the two columns, some dollar figures and percentages
mentioned throughout the preamble are also in error.
Specifically, on pages 46793 and 46794, column 3, we referenced
$3.1 billion as the aggregate increase in payments associated with this
final rule; however, we made a technical error in our calculation and
the correct number is $2.6 billion. Additionally, in this section (page
46795, column 3), we made another technical error in our calculation
that the payments will increase by 21.8 percent. The correct figure is
18.3 percent.
Accordingly, we are reprinting Table 11 of the preamble (64 FR
46795), entitled ``Projected Impact of FY 2001 Update to the SNF PPS,''
with the corrected figures displayed in the last two columns of the
table and a corrected figure for the total number of facilities.
Further, we note that Table 11 presents the projected effects of the
policy changes in the SNF PPS from FY 2000 to FY 2001, as well as
statutory changes effective for FY 2001 for SNFs. As such, these
corrections do not represent any changes to the policies set forth in
the final rule.
The corrections appear in this document under the heading
``Correction of Errors.'' The provisions in this correction notice are
effective as if they had been included in the document published in the
Federal Register on July 31, 2000, that is, as of October 1, 2000,
except for those wage index value corrections that we specifically
noted to be effective as of December 1, 2000.
Correction of Errors
In FR Doc. 00-19004 of July 31, 2000 (64 FR 46770), we are making
the following corrections:
Corrections to Preamble
1. In the first column of Table 3 (on pages 46775-76), Table 4 (on
pages 46776-77), Table 5 (on pages 46777-78), and Table 6 (on page
46778), the column heading is revised to read ``RUG III category''.
2. On page 46779, in column 2, the entry of ``0.8151'' for
Alexandria, LA, under ``Wage Index for Urban Areas'' is revised by
adding ``0.8123 (effective December 1, 2000)''.
3. On page 46779, in column 3, the entry of ``1.0040'' for
Allentown-Bethlehem-Easton, PA, under ``Wage Index for Urban Areas'' is
revised to read ``0.9925''.
4. On page 46782, in column 2, the entry of ``0.9498'' for Kansas
City, KS-MO, under ``Wage Index for Urban Areas'' is revised to read
``0.9509''.
5. On page 46782, in column 2, the revised entry of ``0.9509'' for
Kansas City KS-MO, under ``Wage Index for Urban Areas'' is further
revised by adding ``0.9527 (effective December 1, 2000)''.
6. On page 46785, in column 3, the entry of ``0.7668'' for
Louisiana, under ``Wage Index for Rural Areas'' is revised by adding
``0.7681 (effective December 1, 2000)''.
7. On page 46787, in column 2, first full paragraph, the last
sentence is revised to read: ``In addition, we derive a special market
basket inflation factor, which is 1.105788, to adjust the 1997 costs to
the midpoint of the rate setting period (July 1, 2000 to September 30,
2001.)'
8. On page 46793, in column 3, section VI, Regulatory Impact
Analysis, paragraph 2, the third sentence is revised to read: ``This
final rule is a major rule as defined in Title 5, United States Code,
section 804(2), because we estimate its impact will be to increase the
payments to SNFs by approximately $2.6 billion in FY 2001.''
9. On page 46794, in column 3, first full paragraph, the first
sentence is revised to read: ``As stated previously in this rule, the
aggregate increase in payments associated with this final rule is
estimated to be $2.6 billion.''
10. On page 46795, in column 3, first full paragraph, the third
sentence is revised to read: ``It is assumed that payments will
increase by 18.3 percent in total, assuming facilities do not change
their care delivery and billing practices in response.''
11. Table 11 (Projected Impact of FY 2001 Update to the SNF PPS) is
corrected as set forth below.
Table 11.--Projected Impact of FY 2001 Update to the SNF PPS
--------------------------------------------------------------------------------------------------------------------------------------------------------
Transition Add on to
Number of to Federal Federal Update Wage index 20 Total FY
facilities rates rates change change (percent) 2001 change
(percent) (percent) (percent) (percent) add on (percent)
--------------------------------------------------------------------------------------------------------------------------------------------------------
Total........................................................ 9037 4.2 3.5 2.3 0.0 7.2 18.3
Urban........................................................ 6300 3.6 3.5 2.3 -0.1 7.1 17.4
Rural........................................................ 2737 7.1 3.7 2.2 0.8 7.7 23.2
Hospital based urban......................................... 683 -4.5 3.0 2.4 0.0 6.8 7.6
Freestanding urban........................................... 5617 5.1 3.6 2.3 -0.1 7.2 19.3
Hospital based rural......................................... 533 2.0 3.4 2.3 0.9 8.7 18.3
Freestanding rural........................................... 2204 8.2 3.7 2.2 0.7 7.5 24.1
Urban by region:
New England.................................................. 630 10.5 3.8 2.2 -0.8 7.8 25.4
Middle Atlantic.............................................. 877 14.3 3.8 2.2 -0.3 9.0 31.8
South Atlantic............................................... 959 -0.4 3.3 2.3 -0.4 6.2 11.3
East North Central........................................... 1232 6.1 3.6 2.2 0.4 7.0 20.7
[[Page 3499]]
East South Central........................................... 212 1.9 3.5 2.3 -0.7 6.9 14.5
West North Central........................................... 469 3.6 3.5 2.3 0.4 6.7 17.5
West South Central........................................... 519 -5.2 3.0 2.4 1.0 6.3 7.3
Mountain..................................................... 303 -4.0 3.1 2.4 0.0 4.8 6.2
Pacific...................................................... 1070 -2.3 3.2 2.4 -0.5 6.9 9.8
Rural by region:
New England.................................................. 88 14.4 3.9 2.2 -0.9 8.4 30.5
Middle Atlantic.............................................. 144 13.1 3.9 2.2 0.0 9.0 30.9
South Atlantic............................................... 373 5.3 3.6 2.2 1.1 8.0 21.7
East North Central........................................... 561 9.2 3.7 2.2 1.0 7.4 25.5
East South Central........................................... 255 4.2 3.6 2.3 0.6 8.8 20.9
West North Central........................................... 581 11.1 3.7 2.2 0.8 8.3 28.5
West South Central........................................... 354 1.2 3.4 2.3 1.1 6.9 15.7
Mountain..................................................... 204 3.3 3.5 2.3 0.7 6.4 17.2
Pacific...................................................... 151 3.2 3.5 2.3 0.3 6.3 16.5
--------------------------------------------------------------------------------------------------------------------------------------------------------
(Authority: Section 1888 of the Social Security Act (42 U.S.C.
1395yy))
(Catalog of Federal Domestic Assistance Program No. 93.773,
Medicare--Hospital Insurance; and Program No. 93.774, Medicare--
Supplementary Medical Insurance Program)
Dated: January 2, 2001.
Brian P. Burns,
Deputy Assistant Secretary for Information Resources Management.
[FR Doc. 01-1187 Filed 1-12-01; 8:45 am]
BILLING CODE 4120-01-P