## 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 tothe 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


## 59257 Federal Register / Vol. 76, No. 186 / Monday, September 26, 2011 / Rules and Regulations

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:



### T ABLE 

### 1—R ELATIVE 

### W EIGHTS AND 

### A VERAGE 

### L ENGTH OF 

### S TAY 

### V ALUES FOR 

### C ASE 

### -M IX 

### G ROUPS

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


## 59258 Federal Register / Vol. 76, No. 186 / Monday, September 26, 2011 / Rules and Regulations

T ABLE 

### 1—R ELATIVE 

### W EIGHTS AND 

### A VERAGE 

### L ENGTH OF 

### S TAY 

### V ALUES FOR 

### C ASE 

### -M IX 

### G ROUPS 

### —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


## 59259 Federal Register / Vol. 76, No. 186 / Monday, September 26, 2011 / Rules and Regulations

T ABLE 

### 1—R ELATIVE 

### W EIGHTS AND 

### A VERAGE 

### L ENGTH OF 

### S TAY 

### V ALUES FOR 

### C ASE 

### -M IX 

### G ROUPS 

### —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:



### T ABLE 

### 11—FY 2012 P AYMENT 

### R ATES

CMG Payment rate tier 1 Payment rate tier 2 Payment rate tier 3 Payment rate no comorbidity

0101 ................................................................................................. $10,797.70 $10,102.35 $9,0 74.80 $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 7,990.9 5 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


## 59260 Federal Register / Vol. 76, No. 186 / Monday, September 26, 2011 / Rules and Regulations

T ABLE 

### 11—FY 2012 P AYMENT 

### R ATES 

### —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:



### T ABLE 

### 12—E XAMPLE OF 

### C OMPUTING THE 

### IRF PPS FY 2012 F EDERAL 

### P ROSPECTIVE 

### P AYMENT

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 ................................................................ $3 1,753 .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


## 59261 Federal Register / Vol. 76, No. 186 / Monday, September 26, 2011 / Rules and Regulations

‘‘$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:


## 59262 Federal Register / Vol. 76, No. 186 / Monday, September 26, 2011 / Rules and RegulationsTABLE14—IRF IMPACTTABLE FORFY 2012Facility classificationNumber ofIRFsNumberof casesOutlierFY 2012adjustedmarketbasketincreasefactor1FY 2012CBSA wageindex andlabor-shareCMGTotal percentchange(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 ............................................................................................752 200,5870.61.8¥0.1 0.0 2.3Ruralunit .............................................................................................175 27,997 0.5 1.8 0.8 0.1 3.2Urbanhospital .....................................................................................205 162,171 0.2 1.8 0.0 0.01.9Ruralhospital .......................................................................................20 6,633 0.2 1.8 1.6¥0.1 3.5UrbanFor-Profit ...................................................................................317 151,821 0.2 1.8 0.1¥0.1 2.1RuralFor-Profit ....................................................................................63 12,437 0.4 1.8 1.1 0.1 3.4Urban Non-Profit ..................................................................................596 199,3130.51.8¥0.3 0.0 2.1RuralNon-Profit ...................................................................................122 20,442 0.5 1.8 0.7 0.1 3.1UrbanGovernment ..............................................................................44 11,624 0.7 1.8 0.2 0.0 2.8RuralGovernment ...............................................................................10 1,751 0.9 1.8 1.3 0.1 4.1Urban ...................................................................................................957 362,758 0.4 1.8¥0.1 0.0 2.1Rural ....................................................................................................195 34,630 0.5 1.8 0.90.1 3.2Urban by region:2Urban New England .....................................................................32 16,3930.41.8¥1.2 0.0 1.0Urban Middle Atlantic ...................................................................142 66,3630.31.8¥0.7 0.0 1.4UrbanSouthAtlantic ....................................................................132 63,793 0.4 1.8 0.0 0.0 2.2UrbanEastNorthCentral .............................................................188 57,269 0.5 1.8 0.0 0.0 2.4Urban East South Central ............................................................49 26,3750.21.80.4¥0.1 2.2UrbanWestNorthCentral ............................................................73 18,118 0.6 1.8 0.0 0.0 2.3UrbanWestSouthCentral ...........................................................169 66,313 0.4 1.8 0.5 0.0 2.7UrbanMountain ............................................................................70 23,834 0.4 1.8 0.2¥0.1 2.3Urban Pacific ................................................................................102 24,3000.71.8¥0.3 0.0 2.2Rural by region:2RuralNewEngland ......................................................................6 1,354 1.0 1.9 0.7 0.1 3.7RuralMiddleAtlantic ....................................................................16 3,232 0.2 1.8 1.8 0.1 4.0RuralSouthAtlantic .....................................................................25 5,988 0.3 1.8 0.8 0.0 2.9RuralEastNorthCentral ..............................................................33 5,776 0.4 1.8 0.1 0.1 2.4RuralEastSouthCentral .............................................................23 4,017 0.2 1.8 1.4 0.0 3.4Rural West North Central .............................................................31 3,9450.71.8¥0.2 0.1 2.5RuralWestSouthCentral ............................................................50 9,261 0.5 1.8 1.6 0.1 4.0RuralMountain .............................................................................7 670 0.6 1.8 0.3 0.2 2.9Rural Pacific .................................................................................43871.41.8¥0.4¥0.1 2.7Teaching status:Non-teaching ................................................................................1,036 345,500 0.4 1.8 0.1 0.0 2.3Resident to ADC less than 10% ..................................................69 36,8780.51.8¥0.4 0.0 2.0Resident to ADC 10%–19% .........................................................33 12,4970.61.8¥0.3 0.1 2.2Resident to ADC greater than 19% .............................................14 2,5130.71.8¥0.7¥0.1 1.8Disproportionate Share Patient Percentage (DSH):DSH=0% ....................................................................................39 10,534 0.4 1.8 0.4 0.0 2.7DSH <5% .....................................................................................208 62,4340.41.8¥0.2 0.0 2.0DSH5%–10% ..............................................................................342 134,694 0.3 1.8 0.0 0.0 2.2DSH10%–20% ............................................................................330 123,398 0.4 1.8 0.0 0.0 2.2DSH>20% ...................................................................................233 66,328 0.5 1.8 0.0 0.0 2.31This 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 percentagepoint 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 section1886(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.


## 59263 Federal Register / Vol. 76, No. 186 / Monday, September 26, 2011 / Rules and Regulations

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 Long**  **Term 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 Systemsfor 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