60158 Federal Register / Vol. 69, No. 194 / Thursday, October 7, 2004 / Notices 

FOR FURTHER INFORMATION CONTACT:

August Nemec, (410) 786–0612; or 

Jeannette Kranacs, (410) 786–9385.

SUPPLEMENTARY INFORMATION: 

I. Background 

In CMS–1360–N, FR Doc. 04–17444 of 

July 30, 2004 (69 FR 45721), there were 

three technical errors that are identified 

and corrected in the Correction of Errors 

section below. The provisions in this 

correction notice are effective as if they 

had been included in the document 

published July 30, 2004. Accordingly, 

the corrections are effective for 

discharges occurring on or after October 

1, 2004, and on or before September 30, 

2005. 

We recently determined that several 

technical errors occurred in the 

publication of the wage index values for 

a number of specific Metropolitan 

Statistical Areas (MSAs). A description 

of those technical errors is included in 

the ‘‘Correction of Errors’’ section 

below. We note that correcting these 

technical errors is a purely 

administrative function that does not 

result in any change of policy or 

payment methodology. 

II. Correction of Errors 

In CMS–1360–N, FR Doc. 04–17444 of 

July 30, 2004 (69 FR 45721), make the 

following corrections: 

A. On page 45734, remove Stanly, NC 

from Urban Area 1520 CharlotteGastonia-Rock Hill, NC-SC, because it 

has a rural designation instead of an 

urban designation. We note an error in 

the labeling of the wage index tables 

within the Inpatient Rehabilitation 

Facility Prospective Payment System 

(IRF PPS). That labeling error is the 

listing of Stanly County, NC as one of 

the urban areas under MSA 1520 when, 

in fact, we consider Stanly County, NC 

to be a rural area in North Carolina. 

Stanly County wage data have always 

been correctly treated as rural in the 

actual creation of the IRF wage index 

values, and it has only been the listing 

of Stanly County under MSA 1520 that 

was in error. Consequently, we are 

correcting our labeling error in the IRF 

PPS notice (CMS–1360–N), and have 

removed Stanly County from the list of 

areas that fall under the MSA 1520 wage 

index. Since this is strictly a labeling 

correction that does not affect the actual 

computation of the wage index values, 

IRFs in Stanly County, NC will continue 

to fall under, and use, the wage index 

for rural North Carolina. 

B. On page 45746, remove the wage 

index of 0.0000 for Urban Area 4150 

and in its place, add a wage index of 

0.8677. This change is made due the 

inadvertent insertion of 0.0000 for MSA 

4150 when it should have been 0.8677. 

C. On page 45757, remove the wage 

index of 0.0000 for Urban Area 7000 

and in its place, add a wage index of 

0.9757. This change is made due to the 

inadvertent insertion of 0.0000 for MSA 

7000 when it should have been 0.9757.

III. Waiver of Proposed Rulemaking 

and Delayed Effective Date 

We ordinarily publish a notice of 

proposed rulemaking in the Federal 

Register to provide a period for public 

comment before the provisions of a 

regulation take effect. We can waive this 

procedure, however, if we find good 

cause that notice-and-comment 

procedure is impracticable, 

unnecessary, or contrary to the public 

interest and incorporate a statement of 

the finding and the reasons for it into 

the notice issued. 5 U.S.C. 553(b)(B). We 

can also waive the 30-day delayed 

effective date of the Administrative 

Procedure Act (5 U.S.C. 553(d)) when 

there is good cause to do so and we 

publish in the rule an explanation of our 

good cause. 

We find it unnecessary to undertake 

notice-and-comment rulemaking 

because this correction notice merely 

provides technical corrections to the 

July 30, 2004 notice. This correction 

notice corrects inadvertent drafting 

errors (that is, a labeling error with 

respect to Stanley County and the 

insertion of incorrect wage indexes for 

MSA 4150 and MSA 7000). We are not 

making substantive changes in policy, 

but rather, are simply implementing 

correctly the payment methodology that 

we long ago proposed, received 

comment on, and subsequently 

finalized. Thus, because the public has 

already had the opportunity to comment 

on the payment methodology used to 

calculate the wage indexes, additional 

comment would be unnecessary. 

In addition, publication of a 

substantive rule shall be made not less 

than 30 days before its effective date. 

We can waive this procedure, however, 

if we find good cause that a delayed 

effective date is impracticable, 

unnecessary, or contrary to the public 

interest. 5 U.S.C. 553(d)(3). We believe 

a delayed effective date is unnecessary 

because this correction notice merely 

corrects inadvertent technical mistakes 

(that is, a labeling error with respect to 

Stanley County and the insertion of 

incorrect numbers in the wage indexes 

for MSA 4150 and MSA 7000). Further, 

we believe imposing a 30-day delay in 

the effective date would be contrary to 

the public interest with respect to IRF 

providers in MSA 4150 and MSA 7000. 

As a matter of good public policy, the 

rates used in the IRF PPS should not be 

based on wage indexes that contain 

inadvertent errors that, if not corrected, 

would have very real impacts on the 

payments received by providers in MSA 

4150 and MSA 7000. We believe that it 

is imperative that these providers 

receive appropriate IRF PPS payments 

and that failure to do so would be 

contrary to the public interest. 

Furthermore, the changes noted above 

do not make any substantive changes to 

the IRF PPS payment methodology or 

underlying payment policies. Therefore, 

we find good cause to waive the 30-day 

delayed effective date.

(Catalog of Federal Domestic Assistance 

Program No. 93.773, Medicare—Hospital 

Insurance; and Program No. 93.774, 

Medicare—Supplementary Medical 

Insurance Program.)

Dated: September 30, 2004. 

Ann C. Agnew, 

Executive Secretary to the Department.

[FR Doc. 04–22400 Filed 10–1–04; 11:46 am] 

BILLING CODE 4120–01–P

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Centers for Medicare & Medicaid 

Services 

[CMS–1249–CN] 

RIN 0938–AM46

Medicare Program; Prospective 

Payment System and Consolidated 

Billing for Skilled Nursing Facilities; 

Corrections

AGENCY: Centers for Medicare & 

Medicaid Services (CMS), HHS.

ACTION: Correction notice.

SUMMARY: This document corrects 

technical errors that appeared in the 

July 30, 2004 Federal Register, entitled 

‘‘Medicare Program; Prospective 

Payment System and Consolidated 

Billing for Skilled Nursing Facilities—

Update—Notice.’’

DATES: This correction is effective 

October 1, 2004.

FOR FURTHER INFORMATION CONTACT:

Jeanette Kranacs, (410) 786–9385, Bill 

Ullman, (410) 786–5667, or Sheila 

Lambowitz, (410) 786–7605.

SUPPLEMENTARY INFORMATION:

I. Background 

In FR Doc. 04–17443 of July 30, 2004 

(69 FR 45775), there were a number of 

technical errors that are identified in 

this notice. It was recently determined 

that technical errors occurred in the 

hospital wage index calculation process 

Federal Register / Vol. 69, No. 194 / Thursday, October 7, 2004 / Notices 60159

for FY 2005, necessitating adjustments 

to the hospital wage index relating to a 

number of specific Metropolitan 

Statistical Areas (MSAs). A description 

of those technical errors will be 

included in a Federal Register notice 

specific to the hospital inpatient 

prospective payment systems (IPPS). As 

we explained in the July 30, 2004, 

update notice, the SNF wage index 

values reflect the pre-floor, prereclassification wage data used in the 

FY 2005 IPPS rates, and therefore, we 

believe it would be appropriate to 

incorporate corrections made to the 

inpatient hospital wage indexes in our 

SNF PPS wage index tables. Further, we 

note that correcting these technical 

errors is a purely administrative 

function that does not result in any 

change of policy or payment 

methodology. 

We are correcting Table 10 (which 

serves to illustrate the payment rate 

computations for a fictitious ‘‘XYZ’’

SNF located in State College, PA), in 

order to reflect the application of the 

corrected wage index. In section II of 

this notice we are correcting the figure 

for the PPS total payment in the ‘‘XYZ’’

example and restoring a footnote that 

was inadvertently omitted from the 

published table. This footnote 

corresponds to the triple asterisk 

displayed in the table’s ‘‘Percent 

Adjustment’’ column for Resource 

Utilization Group (RUG) SSC, and refers 

to the application of the 20 percent addon under section 101(a) of the Medicare, 

Medicaid and SCHIP Balanced Budget 

Refinement Act of 1999. 

We are also correcting Table 12, 

which displays the projected impact of 

the FY 2005 SNF PPS payment update, 

including the variation in impact by 

region and by certain other facility 

characteristics. We note that the effect 

on the corrected table is solely 

distributional in nature and, 

accordingly, there is no change in the 

estimated aggregate expenditures for FY 

2005 as set forth in the July 30, 2004, 

update notice. A further discussion of 

the projected impact of the FY 2005 

SNF PPS payment update can be found 

in the July 30, 2004, update notice (69 

FR 45820). 

In addition, we have identified a 

labeling error in the wage index tables 

used in the SNF PPS. That labeling error 

is the listing of Stanly County, NC as 

one of the areas under Metropolitan 

Statistical Area (MSA) 1520 when, in 

fact, we consider Stanly County, NC to 

be a rural area in North Carolina. Stanly 

County wage data have always been 

correctly treated as rural in the actual 

creation of the SNF wage index values, 

and it has only been the listing of Stanly 

County under MSA 1520 that was in 

error. Consequently, we have corrected 

the wage index table in the update 

notice to remove Stanly County from the 

list of areas that fall under the MSA 

1520 wage index. Since this is strictly 

a labeling correction that does not affect 

the actual computation of the wage 

index values, SNFs in Stanly County, 

NC will fall under, and use, the wage 

index for rural North Carolina effective 

October 1, 2004. 

We also wish to clarify that the 

adjustment amount ($463.96) displayed 

for RUG CC2 in the ‘‘Percent 

Adjustment’’ column of the corrected 

Table 10, as indicated by the double 

asterisk and accompanying footnote, 

assumes that the days shown in the 

table for RUG CC2 are for treatment of 

a patient with acquired immune 

deficiency syndrome (AIDS). Therefore, 

this adjustment amount reflected the 

application of section 511 of the 

Medicare Prescription Drug, 

Improvement, and Modernization Act of 

2003 (MMA). As explained in the July 

30, 2004, update notice (69 FR 45777), 

section 511 of the MMA provides for a 

temporary 128 percent increase in 

payment for any SNF resident with 

AIDS. We further note that this special 

128 percent add-on is applicable 

regardless of the particular RUG to 

which an AIDS patient is assigned, and 

is made in lieu of any other add-on 

(either 20 percent or 6.7 percent) that 

might otherwise apply to that RUG. 

We have corrected the errors in the 

wage tables and other tables as noted 

above. These corrected tables are posted 

and available on the CMS Web site at: 

http://www.cms.hhs.gov/providers/

snfpps. These corrected tables are 

effective October 1, 2004. We note the 

corrected tables will be included in a 

forthcoming Federal Register notice. 

II. Correction of Errors 

In FR Doc. 04–17443 (69 FR 45775), 

make the following corrections: 

1. On page 45817, 

a. Third column, line 12, the figure 

‘‘$25,161’’ is corrected to read 

‘‘$25,117’’. 

b. At the end of the table and after the 

last sentence, add the following 

sentence ‘‘*–*–*Reflects a 20 percent 

adjustment from section 101(a) of the 

BBRA.’’. 

III. Waiver of Proposed Rulemaking 

and Delayed Effective Date 

We ordinarily publish a notice of 

proposed rulemaking in the Federal 

Register to provide a period for public 

comment before the provisions of a rule 

take effect in accordance with section 

553(b) of the Administrative Procedure 

Act (APA) (5 U.S.C. 553(b)). We also 

ordinarily provide a 30-day delay in the 

effective date of the provisions of a 

notice in accordance with section 553(d) 

of the APA (5 U.S.C. 553(d)). However, 

we can waive both the notice and 

comment procedure and the 30-day 

delay in effective date if the Secretary 

finds, for good cause, that a notice and 

comment process is impracticable, 

unnecessary or contrary to the public 

interest, and incorporates a statement of 

the finding and the reasons therefore in 

the notice. 

We find it unnecessary to undertake 

notice-and-comment rulemaking 

because this notice merely provides 

technical corrections to the regulations. 

We are not changing our payment 

methodology, but rather, are simply 

implementing correctly the payment 

methodology that we previously 

proposed, received comment on, and 

subsequently finalized. Thus, because 

the public has already had the 

opportunity to comment on the payment 

methodology being used to calculate 

wage indexes, additional comment 

would be unnecessary. 

Further, we believe a delayed 

effective date is unnecessary because 

this correction notice merely corrects 

inadvertent technical mistakes (that is, a 

labeling error with respect to Stanley 

County and the insertion of incorrect 

numbers in the wage indexes for certain 

MSAs). Further, we believe imposing a 

30-day delay in the effective date would 

be contrary to the public interest with 

respect to SNF providers in the affected 

MSAs. As a matter of good public 

policy, the rates used in the SNF PPS 

should not be based on wage indexes 

that contain inadvertent errors that, if 

not corrected, would have very real 

impacts on the payments received by 

providers in the affected MSAs. We 

believe that it is imperative that these 

providers receive appropriate SNF PPS 

payments and that failure to do so 

would be contrary to the public interest. 

Furthermore, the changes noted above 

do not make any substantive changes to 

the SNF PPS payment methodology or 

underlying payment policies. Therefore, 

we find good cause to waive notice-andcomment procedures, as well as the 30-

day delay in effective date.

(Catalog of Federal Domestic Assistance 

Program No. 93.773, Medicare—Hospital 

Insurance; and Program No. 93.774, 

Medicare—Supplementary Medical 

Insurance Program.)

Dated: September 30, 2004. 

Ann Agnew, 

Executive Secretary to the Department.

[FR Doc. 04–22399 Filed 10–1–04; 11:46 am] 

BILLING CODE 4120–01–P