59256 Federal Register / Vol. 76, No. 186 / Monday, September 26, 2011 / Rules and Regulations 

This rule does not impose an 

information collection burden under the 

provisions of the Paperwork Reduction 

Act of 1995 (44 U.S.C. 3501 et seq.). 

The Congressional Review Act, 5 

U.S.C. 801 et seq., as added by the Small 

Business Regulatory Enforcement 

Fairness Act of 1996, generally provides 

that before a rule may take effect, the 

agency promulgating the rule must 

submit a rule report to Congress and the 

Comptroller General. However, section 

808 provides that any rule for which the 

issuing agency for good cause finds that 

notice and public procedure thereon are 

impracticable, unnecessary, or contrary 

to the public interest, shall take effect at 

such time as the agency promulgating 

the rule determines. 5 U.S.C. 808(2). 

EPA has made such a good cause 

finding, including the reasons therefor, 

and established an effective date of 

September 26, 2011. EPA will submit a 

report containing this rule and other 

required information to the U.S. Senate, 

the U.S. House of Representatives, and 

the Comptroller General of the United 

States prior to publication of the rule in 

the Federal Register. A major rule 

cannot take effect until 60 days after it 

is published in the Federal Register. 

This rule is not a ‘‘major rule’’ as 

defined by 5 U.S.C. 804(2). 

Under section 307(b)(1) of the CAA, 

petitions for judicial review of this 

action must be filed in the United States 

Court of Appeals for the appropriate 

circuit by November 25, 2011. Filing a 

petition for reconsideration by the 

Administrator of this final rule does not 

affect the finality of this rule for the 

purpose of judicial review nor does it 

extend the time within which petition 

for judicial review may be filed, and 

shall not postpone the effectiveness of 

such rule or action. This action may not 

be challenged later in proceedings to 

enforce its requirements (see section 

307(b)(2)). 

List of Subjects in 40 CFR Part 52 

Environmental protection, Air 

pollution control, Incorporation by 

reference, Intergovernmental 

regulations, Ozone, Reporting and 

recordkeeping requirements, Volatile 

organic compounds. 

Dated: September 16, 2011. 

Thomas J. McCullough, 

Acting Regional Administrator, Region IX. 

[FR Doc. 2011–24516 Filed 9–23–11; 8:45 am] 

BILLING CODE 6560–50–P 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Centers for Medicare & Medicaid 

Services 

42 CFR Part 412 

[CMS–1349–CN] 

RIN 0938–AQ28 

Medicare Program; Inpatient 

Rehabilitation Facility Prospective 

Payment System for Federal Fiscal 

Year 2012; Changes in Size and Square 

Footage of Inpatient Rehabilitation 

Units and Inpatient Psychiatric Units; 

Correction 

AGENCY: Centers for Medicare & 

Medicaid Services (CMS), HHS. 

ACTION: Final rule; correction. 

SUMMARY: This document corrects 

technical errors that appeared in the 

final rule published in the Federal 

Register on August 5, 2011 entitled 

‘‘Medicare Program; Inpatient 

Rehabilitation Facility Prospective 

Payment System for Federal Fiscal Year 

2012; Changes in Size and Square 

Footage of Inpatient Rehabilitation 

Units and Inpatient Psychiatric Units,’’ 

(hereinafter FY 2012 IRF PPS final rule 

(76 FR 47836)). 

DATES: Effective Date. The corrections 

are effective October 1, 2011. 

FOR FURTHER INFORMATION CONTACT: 

Susanne Seagrave, (410) 786–0044. 

SUPPLEMENTARY INFORMATION: 

I. Background 

There were technical errors in the 

August 5, 2011 FY 2012 IRF PPS final 

rule (76 FR 47836). These technical 

errors are identified and corrected in the 

‘‘Summary of Errors’’ and ‘‘Correction of 

Errors’’ sections below. The provisions 

in this correction document are effective 

as if they were included in the final rule 

published on August 5, 2011. 

Accordingly, the corrections are 

effective October 1, 2011. 

II. Summary of Errors 

In the August 5, 2011 final rule (76 FR 

47836), we applied our established 

formula for calculating the relative 

weight values for case-mix groups 

(CMG). The CMG relative weight values 

for CMGs 1201, 1202, 1203, 1301, 1302, 

and 1303 in Table 1 on pages 47842 

through 47844 of the final rule did not 

reflect our policy that the relative 

weight values for higher-paying tiers 

must always be greater than or equal to 

the relative weight values for lowerpaying tiers. That is, a tier 1 payment for 

a given CMG must always be at least as 

high as a tier 2 payment for that same 

CMG, the tier 2 payment must always be 

at least as high as the tier 3 payment, 

and the tier 3 payment must always be 

at least as high as the ‘‘no-comorbidity’’ 

tier payment. We have used this policy 

in calculating the CMG relative weights 

since the inception of the IRF PPS. 

However, we inadvertently did not 

apply this policy correctly for CMGs 

1201, 1202, 1203, 1301, 1302, and 1303 

in Table 1 on pages 47842 through 

47844 of the FY 2012 IRF PPS final rule. 

Further, as discussed in ‘‘Step 4’’ in 

the CMG relative weights discussion, 

column 1, on page 47841 of the FY 2012 

IRF PPS final rule, we normalized the 

FY 2012 CMG relative weights to the 

same average CMG relative weight 

values from the FY 2011 IRF PPS notice 

(75 FR 42836). As this process utilized 

the incorrect values that had been listed 

for the relative weight values for CMGs 

1201, 1202, 1203, 1301, 1302, and 1303, 

upon correction we also needed to 

reapply the normalization process to the 

other CMGs using the corrected relative 

weight values. This process corrects the 

relative weight values for all CMGs so 

that we are appropriately applying the 

policy of normalizing the FY 2012 CMG 

relative weights to the same average 

CMG relative weight values from the FY 

2011 IRF PPS notice. 

Since the FY 2012 payment rates 

listed in Table 11 on pages 47865 

through 47866 of the final rule are based 

on the CMG relative weights in Table 1 

(the payment rates are equal to the CMG 

relative weights multiplied by the FY 

2012 Standard Payment Conversion 

Factor), we are also providing 

corrections to Table 11 in the final rule 

to reflect the corrections to the CMG 

relative weights in Table 1. In addition, 

we are correcting the example of 

computing the IRF FY 2012 Federal 

prospective payment in Table 12 on 

page 47867 of the final rule to reflect the 

correction to the unadjusted Federal 

prospective payment rate for CMG 0110 

(without comorbidities) from Table 11. 

Finally, we utilized the CMG payment 

rates reflected in Table 11 of the IRF 

PPS final rule to determine the FY 2012 

outlier threshold. As described in the 

final rule, the outlier threshold is to be 

set so that the estimated total outlier 

payments in FY 2012 will equal 3 

percent of total estimated payments. 

Since corrections to the FY 2012 

payment rates result in slight 

differences in the amount of outlier 

payments we estimate for FY 2012, the 

use of the corrected data results in an 

outlier threshold for FY 2012 IRF PPS 

of $10,713. Therefore, we are correcting 

the outlier threshold amount for FY 

2012 from $10,660 to $10,713 to ensure 


bjneal on DSK5VPTVN1PROD with RULES
Federal Register / Vol. 76, No. 186 / Monday, September 26, 2011 / Rules and Regulations 59257 

that estimated outlier payments for FY 

2012 continue to equal 3 percent of total 

estimated payments. 

We note that the corrections to the 

CMG relative weight values in Table 1 

of the FY 2012 IRF PPS final rule do not 

affect the average length of stay values, 

which we have republished here for 

simplicity. The average length of stay 

values are the same values that were 

published correctly in Table 1 of the 

August 5, 2011 final rule (76 FR 47836). 

As a result of the corrections to Table 

1 and Table 11 of the final rule, as well 

as the correction to the FY 2012 outlier 

threshold amount, some of the numbers 

in Table 14 on page 47887 of the final 

rule (the IRF Impact Table for FY 2012), 

also need to be corrected. We are 

correcting these numbers both in Table 

14 and in the preamble text that 

references Table 14. 

III. Waiver of Proposed Rulemaking 

and Delayed Effective Date 

In accordance with the 

Administrative Procedure Act (APA) (5 

U.S.C. 553(b)), 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. 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 corrections that are laid out in 

this document were necessitated by an 

inadvertent error to accurately apply our 

stated policies as we calculated and laid 

out the CMG relative weight values in 

Table 1 of the FY 2012 IRF PPS final 

rule. As a result of those calculation 

errors, corrections were needed in 

Tables 1, 11, 12 and 14. Corrections 

were also needed as a result of these 

calculation errors in the places 

indicated above in the preamble 

discussion. 

Upon recognition of these calculation 

errors, we reviewed the comments that 

were submitted in response to our FY 

2012 IRF PPS proposed rule. We found 

that the necessary corrections would not 

have altered the substantive content of 

those comments. 

As the corrections necessitated by the 

calculation errors outlined above do not 

change the stated policies in the FY 

2012 IRF PPS final rule, as the policies 

and payment methodology expressed in 

the FY 2012 IRF PPS final rule (76 FR 

47836) have previously been subjected 

to notice and comment procedures, and 

as the public’s comments would not 

have been affected if we had published 

the correctly calculated data elements, 

we find it unnecessary to undertake 

further notice and comment procedures 

with respect to this correction 

document. Further, the corrections 

made in this document will not 

significantly affect anticipated overall 

reimbursements to IRF providers and, as 

such, will only result in negligible 

changes to anticipated revenues and 

will not necessitate any actions on the 

part of individual providers. Therefore, 

we find good cause to waive notice and 

comment procedures and the 30-day 

delay in the effective date for this 

correction document. 

IV. Correction of Errors 

In the August 5, 2011 FY 2012 IRF 

PPS final rule (76 FR 47836), make the 

following corrections: 

1. On pages 47842 through 47844, 

Table 1, ‘‘Relative Weights and Average 

Length of Stay Values for Case-Mix 

Groups,’’ is corrected as follows: 

TABLE 1—RELATIVE WEIGHTS AND AVERAGE LENGTH OF STAY VALUES FOR CASE-MIX GROUPS

CMG CMG Description (M = motor, C = cognitive, A = age) 

Relative weight Average length of stay 

Tier 1 Tier 2 Tier 3 None Tier 1 Tier 2 Tier 3 None 

0101 Stroke M>51.05 .................................................................. 0.7671 0.7177 0.6447 0.6098 10 10 9 8 

0102 Stroke M>44.45 and M<51.05 and C>18.5 ....................... 0.9521 0.8908 0.8002 0.7568 12 13 10 10 

0103 Stroke M>44.45 and M<51.05 and C<18.5 ....................... 1.1369 1.0637 0.9555 0.9037 14 14 12 12 

0104 Stroke M>38.85 and M<44.45 ........................................... 1.1812 1.1052 0.9928 0.9389 15 14 13 12 

0105 Stroke M>34.25 and M<38.85 ........................................... 1.3725 1.2841 1.1535 1.0910 16 17 14 14 

0106 Stroke M>30.05 and M<34.25 ........................................... 1.5805 1.4788 1.3284 1.2564 20 18 16 16 

0107 Stroke M>26.15 and M<30.05 ........................................... 1.7895 1.6743 1.5040 1.4225 20 20 18 18 

0108 Stroke M<26.15 and A>84.5 .............................................. 2.2165 2.0738 1.8629 1.7619 31 25 23 22 

0109 Stroke M>22.35 and M<26.15 and A<84.5 ........................ 2.0496 1.9177 1.7226 1.6292 24 23 20 20 

0110 Stroke M<22.35 and A<84.5 .............................................. 2.6418 2.4717 2.2203 2.1000 33 29 26 25 

0201 Traumatic brain injury M>53.35 and C>23.5 ..................... 0.7466 0.6128 0.5677 0.5154 8 8 7 8 

0202 Traumatic brain injury M>44.25 and M<53.35 and C>23.5 1.0607 0.8707 0.8065 0.7323 12 12 10 10 

0203 Traumatic brain injury M>44.25 and C<23.5 ..................... 1.2074 0.9911 0.9181 0.8336 16 11 13 12 

0204 Traumatic brain injury M>40.65 and M<44.25 ................... 1.2649 1.0383 0.9618 0.8733 16 12 12 12 

0205 Traumatic brain injury M>28.75 and M<40.65 ................... 1.5974 1.3113 1.2146 1.1029 17 18 15 14 

0206 Traumatic brain injury M>22.05 and M<28.75 ................... 1.9887 1.6325 1.5122 1.3731 23 19 19 18 

0207 Traumatic brain injury M<22.05 ......................................... 2.6902 2.2084 2.0455 1.8574 35 27 25 22 

0301 Non-traumatic brain injury M>41.05 ................................... 1.0568 0.9507 0.8434 0.7725 12 12 11 10 

0302 Non-traumatic brain injury M>35.05 and M<41.05 ............ 1.3383 1.2039 1.0681 0.9782 12 15 13 13 

0303 Non-traumatic brain injury M>26.15 and M<35.05 ............ 1.5912 1.4315 1.2699 1.1631 21 17 15 14 

0304 Non-traumatic brain injury M<26.15 ................................... 2.2032 1.9820 1.7583 1.6104 29 23 20 19 

0401 Traumatic spinal cord injury M>48.45 ................................ 1.0564 0.8795 0.8001 0.7020 14 14 11 10 

0402 Traumatic spinal cord injury M>30.35 and M<48.45 ......... 1.3772 1.1465 1.0430 0.9151 17 14 13 12 

0403 Traumatic spinal cord injury M>16.05 and M<30.35 ......... 2.4588 2.0470 1.8622 1.6339 29 26 23 20 

0404 Traumatic spinal cord injury M<16.05 and A>63.5 ............ 4.3666 3.6353 3.3070 2.9016 52 39 38 35 

0405 Traumatic spinal cord injury M<16.05 and A<63.5 ............ 3.8573 3.2113 2.9213 2.5632 52 39 36 29 

0501 Non-traumatic spinal cord injury M>51.35 ......................... 0.6555 0.6294 0.5613 0.4975 10 10 7 7 

0502 Non-traumatic spinal cord injury M>40.15 and M<51.35 ... 0.9809 0.9418 0.8399 0.7444 13 13 11 10 

0503 Non-traumatic spinal cord injury M>31.25 and M<40.15 ... 1.2453 1.1956 1.0663 0.9450 16 14 13 12 

0504 Non-traumatic spinal cord injury M>29.25 and M<31.25 ... 1.5015 1.4416 1.2856 1.1394 18 16 16 14 

0505 Non-traumatic spinal cord injury M>23.75 and M<29.25 ... 1.7549 1.6848 1.5026 1.3317 20 21 18 17 

0506 Non-traumatic spinal cord injury M<23.75 ......................... 2.4598 2.3616 2.1062 1.8667 34 28 24 23 

0601 Neurological M>47.75 ........................................................ 0.9452 0.7987 0.7286 0.6586 10 11 9 9 


bjneal on DSK5VPTVN1PROD with RULES
59258 Federal Register / Vol. 76, No. 186 / Monday, September 26, 2011 / Rules and Regulations 

TABLE 1—RELATIVE WEIGHTS AND AVERAGE LENGTH OF STAY VALUES FOR CASE-MIX GROUPS—Continued 

CMG CMG Description (M = motor, C = cognitive, A = age) 

Relative weight Average length of stay 

Tier 1 Tier 2 Tier 3 None Tier 1 Tier 2 Tier 3 None 

0602 Neurological M>37.35 and M<47.75 .................................. 1.2511 1.0572 0.9644 0.8717 12 13 12 11 

0603 Neurological M>25.85 and M<37.35 .................................. 1.6157 1.3654 1.2455 1.1258 17 16 14 14 

0604 Neurological M<25.85 ........................................................ 2.1425 1.8106 1.6515 1.4929 24 21 19 18 

0701 Fracture of lower extremity M>42.15 ................................. 0.7996 0.7871 0.7581 0.6767 10 12 10 9 

0702 Fracture of lower extremity M>34.15 and M<42.15 ........... 1.0462 1.0299 0.9919 0.8854 12 13 12 12 

0703 Fracture of lower extremity M>28.15 and M<34.15 ........... 1.2589 1.2393 1.1937 1.0654 15 15 14 14 

0704 Fracture of lower extremity M<28.15 ................................. 1.6270 1.6017 1.5426 1.3769 18 19 18 17 

0801 Replacement of lower extremity joint M>49.55 .................. 0.5777 0.5777 0.5383 0.4915 7 8 7 7 

0802 Replacement of lower extremity joint M>37.05 and 

M<49.55.

0.7792 0.7792 0.7262 0.6630 8 11 9 9 

0803 Replacement of lower extremity joint M>28.65 and 

M<37.05 and A>83.5.

1.0718 1.0718 0.9988 0.9119 11 14 13 12 

0804 Replacement of lower extremity joint M>28.65 and 

M<37.05 and A<83.5.

0.9510 0.9510 0.8863 0.8092 10 12 11 10 

0805 Replacement of lower extremity joint M>22.05 and 

M<28.65.

1.1734 1.1734 1.0936 0.9984 11 14 13 13 

0806 Replacement of lower extremity joint M<22.05 .................. 1.4368 1.4368 1.3390 1.2225 13 18 16 15 

0901 Other orthopedic M>44.75 ................................................. 0.8460 0.7455 0.6746 0.6112 10 10 9 8 

0902 Other orthopedic M>34.35 and M<44.75 ........................... 1.1316 0.9971 0.9023 0.8175 12 13 12 11 

0903 Other orthopedic M>24.15 and M<34.35 ........................... 1.4493 1.2770 1.1556 1.0470 16 16 14 13 

0904 Other orthopedic M<24.15 ................................................. 1.8779 1.6547 1.4973 1.3566 21 20 18 17 

1001 Amputation, lower extremity M>47.65 ................................ 1.0321 0.9074 0.8107 0.7246 13 12 10 10 

1002 Amputation, lower extremity M>36.25 and M<47.65 ......... 1.3551 1.1914 1.0645 0.9514 16 14 13 12 

1003 Amputation, lower extremity M<36.25 ................................ 2.0018 1.7600 1.5725 1.4055 21 21 18 17 

1101 Amputation, non-lower extremity M>36.35 ........................ 1.0375 1.0375 0.9841 0.9236 11 11 12 11 

1102 Amputation, non-lower extremity M<36.35 ........................ 1.5611 1.5611 1.4808 1.3897 14 18 16 16 

1201 Osteoarthritis M>37.65 ....................................................... 0.8554 0.8554 0.8088 0.7645 13 13 11 10 

1202 Osteoarthritis M>30.75 and M<37.65 ................................ 1.1152 1.1152 1.0544 0.9966 16 16 14 13 

1203 Osteoarthritis M<30.75 ....................................................... 1.3737 1.3737 1.2989 1.2277 13 19 15 15 

1301 Rheumatoid, other arthritis M>36.35 .................................. 0.8929 0.8929 0.8833 0.7875 11 10 11 10 

1302 Rheumatoid, other arthritis M>26.15 and M<36.35 ........... 1.1759 1.1759 1.1632 1.0370 17 17 14 13 

1303 Rheumatoid, other arthritis M<26.15 .................................. 1.5198 1.5198 1.5035 1.3403 15 19 18 16 

1401 Cardiac M>48.85 ................................................................ 0.9405 0.7530 0.6659 0.6022 10 10 9 8 

1402 Cardiac M>38.55 and M<48.85 ......................................... 1.2630 1.0112 0.8941 0.8087 13 12 11 10 

1403 Cardiac M>31.15 and M<38.55 ......................................... 1.5254 1.2213 1.0799 0.9767 18 14 13 12 

1404 Cardiac M<31.15 ................................................................ 1.9757 1.5818 1.3987 1.2651 24 19 16 15 

1501 Pulmonary M>49.25 ........................................................... 0.9606 0.8970 0.7731 0.7308 10 11 8 9 

1502 Pulmonary M>39.05 and M<49.25 ..................................... 1.2091 1.1290 0.9732 0.9198 13 13 11 11 

1503 Pulmonary M>29.15 and M<39.05 ..................................... 1.4911 1.3923 1.2001 1.1343 16 16 13 13 

1504 Pulmonary M<29.15 ........................................................... 1.8836 1.7589 1.5160 1.4330 22 18 17 16 

1601 Pain syndrome M>37.15 .................................................... 1.1167 0.8790 0.7713 0.7211 12 12 10 10 

1602 Pain syndrome M>26.75 and M<37.15 .............................. 1.4957 1.1773 1.0331 0.9658 19 13 13 13 

1603 Pain syndrome M<26.75 .................................................... 1.9322 1.5210 1.3347 1.2477 22 18 16 15 

1701 Major multiple trauma without brain or spinal cord injury 

M>39.25.

1.0424 0.9277 0.8419 0.7360 10 11 11 10 

1702 Major multiple trauma without brain or spinal cord injury 

M>31.05 and M<39.25.

1.3755 1.2242 1.1110 0.9712 13 15 14 13 

1703 Major multiple trauma without brain or spinal cord injury 

M>25.55 and M<31.05.

1.6223 1.4439 1.3104 1.1455 15 16 15 15 

1704 Major multiple trauma without brain or spinal cord injury 

M<25.55.

2.0766 1.8482 1.6773 1.4663 26 22 20 18 

1801 Major multiple trauma with brain or spinal cord injury 

M>40.85.

1.1991 0.9837 0.9497 0.8687 14 15 12 11 

1802 Major multiple trauma with brain or spinal cord injury 

M>23.05 and M<40.85.

1.6464 1.3507 1.3040 1.1927 18 20 15 15 

1803 Major multiple trauma with brain or spinal cord injury 

M<23.05.

2.8188 2.3124 2.2325 2.0420 34 32 26 24 

1901 Guillian Barre M>35.95 ...................................................... 1.1440 1.0078 0.9143 0.8879 13 14 12 12 

1902 Guillian Barre M>18.05 and M<35.95 ................................ 2.1760 1.9170 1.7390 1.6888 22 22 21 21 

1903 Guillian Barre M<18.05 ...................................................... 3.6334 3.2009 2.9037 2.8199 48 29 34 32 

2001 Miscellaneous M>49.15 ...................................................... 0.8533 0.7540 0.6760 0.6073 9 10 9 8 

2002 Miscellaneous M>38.75 and M<49.15 ............................... 1.1420 1.0091 0.9047 0.8128 12 12 11 10 

2003 Miscellaneous M>27.85 and M<38.75 ............................... 1.4421 1.2742 1.1425 1.0264 15 15 13 13 

2004 Miscellaneous M<27.85 ...................................................... 1.9337 1.7086 1.5319 1.3763 24 20 18 16 

2101 Burns M>0 .......................................................................... 2.4686 2.1368 1.7017 1.3793 34 23 19 18

5001 Short-stay cases, length of stay is 3 days or fewer .......... ............ ............ ............ 0.1474 ............ ............ ............ 3 

5101 Expired, orthopedic, length of stay is 13 days or fewer .... ............ ............ ............ 0.5851 ............ ............ ............ 7 

5102 Expired, orthopedic, length of stay is 14 days or more ..... ............ ............ ............ 1.4705 ............ ............ ............ 18 

5103 Expired, not orthopedic, length of stay is 15 days or 

fewer.

............ ............ ............ 0.6965 ............ ............ ............ 8 


bjneal on DSK5VPTVN1PROD with RULES
Federal Register / Vol. 76, No. 186 / Monday, September 26, 2011 / Rules and Regulations 59259 

TABLE 1—RELATIVE WEIGHTS AND AVERAGE LENGTH OF STAY VALUES FOR CASE-MIX GROUPS—Continued 

CMG CMG Description (M = motor, C = cognitive, A = age) 

Relative weight Average length of stay 

Tier 1 Tier 2 Tier 3 None Tier 1 Tier 2 Tier 3 None 

5104 Expired, not orthopedic, length of stay is 16 days or more ............ ............ ............ 1.8764 ............ ............ ............ 23 

2. On pages 47865 through 47866, 

Table 11, ‘‘FY 2012 Payment Rates,’’ is 

corrected as follows: 

TABLE 11—FY 2012 PAYMENT RATES

CMG Payment rate 

tier 1 

Payment rate 

tier 2 

Payment rate 

tier 3 

Payment rate 

no comorbidity 

0101 ................................................................................................. $10,797.70 $10,102.35 $9,074.80 $8,583.54 

0102 ................................................................................................. 13,401.76 12,538.90 11,263.62 10,652.72 

0103 ................................................................................................. 16,003.00 14,972.64 13,449.62 12,720.48 

0104 ................................................................................................. 16,626.57 15,556.80 13,974.65 13,215.96 

0105 ................................................................................................. 19,319.31 18,074.99 16,236.67 15,356.92 

0106 ................................................................................................. 22,247.12 20,815.59 18,698.56 17,685.09 

0107 ................................................................................................. 25,189.00 23,567.45 21,170.30 20,023.11 

0108 ................................................................................................. 31,199.45 29,190.81 26,222.18 24,800.50 

0109 ................................................................................................. 28,850.17 26,993.55 24,247.32 22,932.62 

0110 ................................................................................................. 37,185.98 34,791.65 31,252.94 29,559.60 

0201 ................................................................................................. 10,509.14 8,625.77 7,990.95 7,254.77 

0202 ................................................................................................. 14,930.41 12,255.97 11,352.29 10,307.85 

0203 ................................................................................................. 16,995.36 13,950.72 12,923.18 11,733.75 

0204 ................................................................................................. 17,804.73 14,615.11 13,538.30 12,292.57 

0205 ................................................................................................. 22,485.00 18,457.86 17,096.71 15,524.42 

0206 ................................................................................................. 27,992.94 22,979.07 21,285.73 19,327.76 

0207 ................................................................................................. 37,867.26 31,085.44 28,792.46 26,144.76 

0301 ................................................................................................. 14,875.52 13,382.05 11,871.70 10,873.71 

0302 ................................................................................................. 18,837.91 16,946.10 15,034.58 13,769.14 

0303 ................................................................................................. 22,397.73 20,149.79 17,875.11 16,371.80 

0304 ................................................................................................. 31,012.24 27,898.63 24,749.83 22,667.99 

0401 ................................................................................................. 14,869.89 12,379.84 11,262.21 9,881.35 

0402 ................................................................................................. 19,385.47 16,138.13 14,681.27 12,880.95 

0403 ................................................................................................. 34,610.07 28,813.57 26,212.33 22,998.78 

0404 ................................................................................................. 61,464.26 51,170.48 46,549.33 40,842.92 

0405 ................................................................................................. 54,295.35 45,202.26 41,120.22 36,079.60 

0501 ................................................................................................. 9,226.82 8,859.43 7,900.86 7,002.81 

0502 ................................................................................................. 13,807.15 13,256.78 11,822.43 10,478.17 

0503 ................................................................................................. 17,528.84 16,829.27 15,009.24 13,301.82 

0504 ................................................................................................. 21,135.11 20,291.96 18,096.11 16,038.19 

0505 ................................................................................................. 24,701.97 23,715.24 21,150.60 18,745.01 

0506 ................................................................................................. 34,624.14 33,241.88 29,646.87 26,275.67 

0601 ................................................................................................. 13,304.64 11,242.50 10,255.77 9,270.45 

0602 ................................................................................................. 17,610.48 14,881.15 13,574.89 12,270.05 

0603 ................................................................................................. 22,742.59 19,219.37 17,531.66 15,846.76 

0604 ................................................................................................. 30,157.83 25,486.01 23,246.51 21,014.06 

0701 ................................................................................................. 11,255.17 11,079.22 10,671.02 9,525.23 

0702 ................................................................................................. 14,726.31 14,496.87 13,961.98 12,462.89 

0703 ................................................................................................. 17,720.28 17,444.39 16,802.52 14,996.57 

0704 ................................................................................................. 22,901.65 22,545.53 21,713.64 19,381.24 

0801 ................................................................................................. 8,131.71 8,131.71 7,577.11 6,918.35 

0802 ................................................................................................. 10,968.02 10,968.02 10,221.99 9,332.39 

0803 ................................................................................................. 15,086.66 15,086.66 14,059.11 12,835.90 

0804 ................................................................................................. 13,386.28 13,386.28 12,475.56 11,390.30 

0805 ................................................................................................. 16,516.78 16,516.78 15,393.51 14,053.48 

0806 ................................................................................................. 20,224.40 20,224.40 18,847.76 17,207.91 

0901 ................................................................................................. 11,908.30 10,493.66 9,495.67 8,603.25 

0902 ................................................................................................. 15,928.40 14,035.18 12,700.77 11,507.13 

0903 ................................................................................................. 20,400.35 17,975.05 16,266.23 14,737.57 

0904 ................................................................................................. 26,433.32 23,291.56 21,075.99 19,095.50 

1001 ................................................................................................. 14,527.84 12,772.56 11,411.41 10,199.47 

1002 ................................................................................................. 19,074.39 16,770.15 14,983.90 13,391.91 

1003 ................................................................................................. 28,177.34 24,773.76 22,134.51 19,783.82 

1101 ................................................................................................. 14,603.85 14,603.85 13,852.19 13,000.59 

1102 ................................................................................................. 21,974.04 21,974.04 20,843.74 19,561.42 

1201 ................................................................................................. 12,040.61 12,040.61 11,384.67 10,761.10 

1202 ................................................................................................. 15,697.56 15,697.56 14,841.73 14,028.14 


bjneal on DSK5VPTVN1PROD with RULES
59260 Federal Register / Vol. 76, No. 186 / Monday, September 26, 2011 / Rules and Regulations 

TABLE 11—FY 2012 PAYMENT RATES—Continued 

CMG Payment rate 

tier 1 

Payment rate 

tier 2 

Payment rate 

tier 3 

Payment rate 

no comorbidity 

1203 ................................................................................................. 19,336.20 19,336.20 18,283.32 17,281.11 

1301 ................................................................................................. 12,568.46 12,568.46 12,433.33 11,084.85 

1302 ................................................................................................. 16,551.97 16,551.97 16,373.20 14,596.81 

1303 ................................................................................................. 21,392.70 21,392.70 21,163.27 18,866.06 

1401 ................................................................................................. 13,238.48 10,599.23 9,373.21 8,476.57 

1402 ................................................................................................. 17,777.99 14,233.65 12,585.35 11,383.26 

1403 ................................................................................................. 21,471.53 17,191.02 15,200.67 13,748.03 

1404 ................................................................................................. 27,809.95 22,265.42 19,688.10 17,807.55 

1501 ................................................................................................. 13,521.41 12,626.17 10,882.16 10,286.74 

1502 ................................................................................................. 17,019.29 15,891.80 13,698.76 12,947.10 

1503 ................................................................................................. 20,988.72 19,598.01 16,892.61 15,966.41 

1504 ................................................................................................. 26,513.55 24,758.28 21,339.22 20,170.91 

1601 ................................................................................................. 15,718.67 12,372.80 10,856.82 10,150.20 

1602 ................................................................................................. 21,053.47 16,571.67 14,541.92 13,594.60 

1603 ................................................................................................. 27,197.65 21,409.60 18,787.24 17,562.63 

1701 ................................................................................................. 14,672.82 13,058.31 11,850.58 10,359.94 

1702 ................................................................................................. 19,361.54 17,231.84 15,638.44 13,670.61 

1703 ................................................................................................. 22,835.49 20,324.34 18,445.19 16,124.06 

1704 ................................................................................................. 29,230.22 26,015.26 23,609.67 20,639.64 

1801 ................................................................................................. 16,878.53 13,846.56 13,367.98 12,227.82 

1802 ................................................................................................. 23,174.73 19,012.45 18,355.10 16,788.45 

1803 ................................................................................................. 39,677.43 32,549.34 31,424.67 28,743.19 

1901 ................................................................................................. 16,102.94 14,185.79 12,869.69 12,498.08 

1902 ................................................................................................. 30,629.38 26,983.69 24,478.16 23,771.55 

1903 ................................................................................................. 51,143.74 45,055.87 40,872.48 39,692.91 

2001 ................................................................................................. 12,011.05 10,613.30 9,515.38 8,548.35 

2002 ................................................................................................. 16,074.79 14,204.09 12,734.56 11,440.97 

2003 ................................................................................................. 20,299.00 17,935.64 16,081.83 14,447.61 

2004 ................................................................................................. 27,218.76 24,050.25 21,563.02 19,372.80 

2101 ................................................................................................. 34,748.01 30,077.60 23,953.13 19,415.03 

5001 ................................................................................................. ............................ ............................ ............................ 2,074.80 

5101 ................................................................................................. ............................ ............................ ............................ 8,235.87 

5102 ................................................................................................. ............................ ............................ ............................ 20,698.76 

5103 ................................................................................................. ............................ ............................ ............................ 9,803.93 

5104 ................................................................................................. ............................ ............................ ............................ 26,412.21 

3. On page 47867: 

a. In table 12, ‘‘Example of Computing 

the IRF FY 2012 Federal Prospective 

Payment,’’ correct the entire table to 

read as follows: 

TABLE 12—EXAMPLE OF COMPUTING THE IRF PPS FY 2012 FEDERAL PROSPECTIVE PAYMENT

Steps 

Rural 

Facility A 

(Spencer 

Co., IN) 

Urban 

Facility B 

(Harrison 

Co., IN) 

1 ........... Unadjusted Federal Prospective Payment .................................................................................... 29,559 .60 29,559 .60 

2 ........... Labor Share ................................................................................................................................... 0 .70199 0 .70199 

3 ........... Labor Portion of Federal Payment ................................................................................................ $20,750 .54 $20,750 .54 

4 ........... CBSA Based Wage Index (shown in the Addendum , Tables 1 and 2) ....................................... 0 .8391 0 .8896 

5 ........... Wage-Adjusted Amount ................................................................................................................. $17,411 .78 $18,459 .68 

6 ........... Nonlabor Amount ........................................................................................................................... $8,809 .06 $8,809 .06 

7 ........... Wage-Adjusted Federal Payment .................................................................................................. $26,220 .84 $27,268 .74 

8 ........... Rural Adjustment ........................................................................................................................... 1 .184 1 .0000 

9 ........... Wage- and Rural-Adjusted Federal Payment ............................................................................... $31,045 .47 $27,268 .74 

10 ......... LIP Adjustment .............................................................................................................................. 1 .0228 1 .0666 

11 ......... FY 2012 Wage-, Rural- and LIP-Adjusted Federal Prospective Payment Rate ........................... $31,753 .31 $29,084 .84 

12 ......... FY 2012 Wage- and Rural-Adjusted Federal Prospective Payment ............................................ $31,045 .47 $27,268 .74 

13 ......... Teaching Status Adjustment .......................................................................................................... 0 .0000 0 .0610 

14 ......... Teaching Status Adjustment Amount ............................................................................................ $0 .00 $1,663 .39 

15 ......... FY2012 Wage-, Rural-, and LIP-Adjusted Federal Prospective Payment Rate ........................... $31,753 .31 $29,084 .84 

16 ......... Total FY 2012 Adjusted Federal Prospective Payment ................................................................ $31,753 .31 $30,748 .23 

b. In the 1st column, the 4th 

paragraph, in line 2, the amount 

‘‘$31,771.45’’ is corrected to read 

‘‘$31,753.31.’’ 

c. In the 1st column, the 2nd 

paragraph, in line 4, the amount 


bjneal on DSK5VPTVN1PROD with RULES
Federal Register / Vol. 76, No. 186 / Monday, September 26, 2011 / Rules and Regulations 59261 

‘‘$30,765.80’’ is corrected to read 

‘‘$30,748.23.’’ 

4. On page 47868, in the 3rd column, 

in the 1st full paragraph, in line 6, the 

amount ‘‘$10,660’’ is corrected to read 

‘‘$10,713.’’ 

5. On page 47887, Table 14, ‘‘IRF 

Impact Table for FY 2012,’’ is corrected 

as follows: 


bjneal on DSK5VPTVN1PROD with RULES
59262 Federal Register / Vol. 76, No. 186 / Monday, September 26, 2011 / Rules and Regulations 

TABLE 14—IRF IMPACT

TABLE FOR FY 2012 

Facility classification Number of IRFs Number of cases Outlier 

FY 2012 

adjusted 

market 

basket 

increase 

factor 1

FY 2012 

CBSA wage 

index and 

labor-share 

CMG Total percent change 

(1) (2) (3) (4) (5) (6) (7) (8) 

Total ..................................................................................................... 1,152 397,388 0.4% 1.8% 0.0% 0.0% 2.2% Urban unit ............................................................................................ 752 200,587 0.6 1.8 

¥0.1 0.0 2.3 

Rural unit ............................................................................................. 175 27,997 0.5 1.8 0.8 0.1 3.2 Urban hospital ..................................................................................... 205 162,171 0.2 1.8 0.0 0.0 1.9 Rural hospital ....................................................................................... 20 6,633 0.2 1.8 1.6 

¥0.1 3.5 

Urban For-Profit ................................................................................... 317 151,821 0.2 1.8 0.1 

¥0.1 2.1 

Rural For-Profit .................................................................................... 63 12,437 0.4 1.8 1.1 0.1 3.4 Urban Non-Profit .................................................................................. 596 199,313 0.5 1.8 

¥0.3 0.0 2.1 

Rural Non-Profit ................................................................................... 122 20,442 0.5 1.8 0.7 0.1 3.1 Urban Government .............................................................................. 44 11,624 0.7 1.8 0.2 0.0 2.8 Rural Government ............................................................................... 10 1,751 0.9 1.8 1.3 0.1 4.1 Urban ................................................................................................... 957 362,758 0.4 1.8 

¥0.1 0.0 2.1 

Rural .................................................................................................... 195 34,630 0.5 1.8 0.9 0.1 3.2 Urban by region: 2

Urban New England ..................................................................... 32 16,393 0.4 1.8 

¥1.2 0.0 1.0 

Urban Middle Atlantic ................................................................... 142 66,363 0.3 1.8 

¥0.7 0.0 1.4 

Urban South Atlantic .................................................................... 132 63,793 0.4 1.8 0.0 0.0 2.2 Urban East North Central ............................................................. 188 57,269 0.5 1.8 0.0 0.0 2.4 Urban East South Central ............................................................ 49 26,375 0.2 1.8 0.4 

¥0.1 2.2 

Urban West North Central ............................................................ 73 18,118 0.6 1.8 0.0 0.0 2.3 Urban West South Central ........................................................... 169 66,313 0.4 1.8 0.5 0.0 2.7 Urban Mountain ............................................................................ 70 23,834 0.4 1.8 0.2 

¥0.1 2.3 

Urban Pacific ................................................................................ 102 24,300 0.7 1.8 

¥0.3 0.0 2.2 

Rural by region: 2

Rural New England ...................................................................... 6 1,354 1.0 1.9 0.7 0.1 3.7 Rural Middle Atlantic .................................................................... 16 3,232 0.2 1.8 1.8 0.1 4.0 Rural South Atlantic ..................................................................... 25 5,988 0.3 1.8 0.8 0.0 2.9 Rural East North Central .............................................................. 33 5,776 0.4 1.8 0.1 0.1 2.4 Rural East South Central ............................................................. 23 4,017 0.2 1.8 1.4 0.0 3.4 Rural West North Central ............................................................. 31 3,945 0.7 1.8 

¥0.2 0.1 2.5 

Rural West South Central ............................................................ 50 9,261 0.5 1.8 1.6 0.1 4.0 Rural Mountain ............................................................................. 7 670 0.6 1.8 0.3 0.2 2.9 Rural Pacific ................................................................................. 4 387 1.4 1.8 

¥0.4 

¥0.1 2.7 

Teaching status: 

Non-teaching ................................................................................ 1,036 345,500 0.4 1.8 0.1 0.0 2.3 Resident to ADC less than 10% .................................................. 69 36,878 0.5 1.8 

¥0.4 0.0 2.0 

Resident to ADC 10%–19% ......................................................... 33 12,497 0.6 1.8 

¥0.3 0.1 2.2 

Resident to ADC greater than 19% ............................................. 14 2,513 0.7 1.8 

¥0.7 

¥0.1 1.8 

Disproportionate Share Patient Percentage (DSH): 

DSH = 0% .................................................................................... 39 10,534 0.4 1.8 0.4 0.0 2.7 DSH <5% ..................................................................................... 208 62,434 0.4 1.8 

¥0.2 0.0 2.0 

DSH 5%–10% .............................................................................. 342 134,694 0.3 1.8 0.0 0.0 2.2 DSH 10%–20% ............................................................................ 330 123,398 0.4 1.8 0.0 0.0 2.2 DSH >20% ................................................................................... 233 66,328 0.5 1.8 0.0 0.0 2.3 

1This column reflects the impact of the rebased RPL market basket increase factor for FY 2012 of 1.8 percent, which includes a market basket update of 2.9 percent, a 0.1 percentage 

point reduction in accordance with sections 1886(j)(3)(C)(ii)(II) and 1886(j)(3)(D)(ii) of the Act and a 1.0 percent reduction for the productivity adjustment as required by section 1886(j)(3)(C)(ii)(I) of the Act, as finalized in 76 FR 47860. 2A map of States that comprise the 9 geographic regions can be found at: http://www.census.gov/geo/www/us_regdiv.pdf. 


bjneal on DSK5VPTVN1PROD with RULES
Federal Register / Vol. 76, No. 186 / Monday, September 26, 2011 / Rules and Regulations 59263 

6. On page 47888: 

a. In the 1st column, in the 1st full 

paragraph, in line 18, the amount 

‘‘$10,660’’ is corrected to read 

‘‘$10,713.’’ 

b. In the 1st column, in the 2nd full 

paragraph, in line 9, the value ‘‘1.5’’ is 

corrected to read ‘‘1.4.’’ 

c. In the 2nd column, the 2nd full 

paragraph, lines 9 through 14, the 

sentence: ‘‘The largest decrease in 

payments as a result of these updates is 

a 0.1 percent decrease to rural 

freestanding IRFs, urban IRFs in the East 

South Central and Mountain regions, 

and rural IRFs in the Pacific region.’’ is 

corrected to read, ‘‘The largest decrease 

in payments as a result of these updates 

is a 0.1 percent decrease to rural IRF 

hospitals, urban for-profit IRFs, urban 

IRFs in the East South Central and 

Mountain regions, rural IRFs in the 

Pacific region, and teaching IRFs with 

resident to ADC ratios greater than 19 

percent.’’ 

7. On page 47890, in the 1st column, 

the 2nd full paragraph, lines 1 through 

4, the sentence, ‘‘Overall the largest 

payment increase is estimated at 4.1 

percent for rural government-owned 

IRFs and rural IRFs in the West South 

Central region.’’ is corrected to read, 

‘‘Overall, the largest payment increases 

are estimated at 4.1 percent for rural 

government-owned IRFs, and 4.0 

percent for rural IRFs in the Middle 

Atlantic and West South Central 

regions.’’ 

(Catalog of Federal Domestic Assistance 

Program No. 93.773, Medicare—Hospital 

Insurance; and Program No. 93.774, 

Medicare—Supplementary Medical 

Insurance Program) 

Dated: September 19, 2011. 

Barbara J. Holland, 

Deputy Executive Secretary to the 

Department. 

[FR Doc. 2011–24671 Filed 9–23–11; 8:45 am] 

BILLING CODE 4120–01–P 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Centers for Medicare & Medicaid 

Services 

42 CFR Parts 412, 413, and 476 

[CMS–1518–CN3] 

RIN 0938–AQ24; 0938–AQ92 

Medicare Program; Hospital Inpatient 

Prospective Payment Systems for 

Acute Care Hospitals and the LongTerm Care Hospital Prospective 

Payment System and Fiscal Year 2012 

Rates; Hospitals’ FTE Resident Caps 

for Graduate Medical Education 

Payment; Corrections 

AGENCY: Centers for Medicare & 

Medicaid Services (CMS), HHS. 

ACTION: Correction of final rule. 

SUMMARY: This document corrects 

technical errors and typographical 

errors in the final rule entitled 

‘‘Medicare Program; Hospital Inpatient 

Prospective Payment Systems for Acute 

Care Hospitals and the Long-Term Care 

Hospital Prospective Payment System 

and FY 2012 Rates; Hospitals’ FTE 

Resident Caps for Graduate Medical 

Education Payment; Corrections’’ which 

appeared in the August 18, 2011 

Federal Register. 

DATES: This correction document is 

effective October 1, 2011. 

FOR FURTHER INFORMATION CONTACT:

Brian Slater, (410) 786–5229, Hospital 

inpatient wage data. 

Michele Hudson, (410) 786–4487, Longterm care hospital wage data. 

Caroline Gallaher, (410) 786–8705, 

Long-term care hospital quality 

measures. 

SUPPLEMENTARY INFORMATION:

I. Background 

In FR Doc. 2011–19719 of August 18, 

2011 (76 FR 51476), the final rule 

entitled ‘‘Medicare Program; Hospital 

Inpatient Prospective Payment Systems 

for Acute Care Hospitals and the LongTerm Care Hospital Prospective 

Payment System and FY 2012 Rates; 

Hospitals’ FTE Resident Caps for 

Graduate Medical Education Payment; 

Corrections’’ (hereinafter referred to as 

the FY 2012 IPPS/FY 2012 LTCH PPS 

final rule) there were a number of 

technical errors that are identified and 

corrected in the Correction of Errors 

section. We have already made changes 

to our rates through PRICER and joint 

signature memoranda. Accordingly, the 

corrections are effective October 1, 

2011. 

II. Summary of Errors and Corrections 

Posted on the CMS Web Site 

A. Errors in the Preamble 

On page 51745, in our discussion of 

quality reporting for long-term care 

hospitals (LTCHs) for FY 2014 payment 

determinations, Measure #1, we 

inadvertently miscounted and omitted a 

footnote. 

On pages 51746 and 51747, in our 

discussion of the technical expert panel 

(TEP) we made typographical errors and 

made a technical error in a footnote. 

On page 51747, in our discussion of 

the TEP, the acronym for Center Line 

Catheter-Associated Bloodstream 

Infection (CLABSI) was inadvertently 

misspelled. 

On page 51748, in our discussion of 

quality reporting for LTCHs for FY 2014 

payment determinations, Measure #2, 

we inadvertently included an incorrect 

Web site link for detailed information 

on the Standardized Infection Ratio 

(SIR). 

On page 51752, in our discussion of 

quality reporting for LTCHs data 

submission, we made an error in 

referencing the number of States in 

which healthcare associated infections 

(HAIs) reporting is already or soon will 

be mandated. 

On page 51754, in our discussion of 

the method of data collection and 

submission for the pressure ulcer 

measure, we made typographical and 

technical errors. 

On page 51755, in our discussion of 

Continuity Assessment Record & 

Evaluation (CARE), we made a 

grammatical error. 

On page 51780, in our discussion of 

the information collection requirements 

(ICRs) for the quality reporting program 

for LTCHs, we made an error in the 

number of States that already submitted 

HAI data to National Healthcare Safety 

Network (NHSN). 

On page 51813, in our discussion of 

the Web site location for the LTCH PPS 

tables for the FY 2012 IPPS/FY 2012 

LTCH PPS final rule, we made a 

typographical error in the regulation 

number. 

B. Corrections Posted on the CMS Web 

Site 

On pages 51812 and 51813, we list 

tables 2, 3A, 3B, 3C, 4A, 4B, 4C, 4J, 9A, 

9C, 12A, and 12B as tables that are 

available only through the Internet. 

In Table 2.—Acute Care Hospitals 

Case-Mix Indexes for Discharges 

Occurring in Federal Fiscal Year 2010; 

Hospital Wage Indexes for Federal 

Fiscal Year 2012; Hospital Average 

Hourly Wages for Federal Fiscal Years 

2010 (2006 Wage Data), 2011 (2007 


bjneal on DSK5VPTVN1PROD with RULES