[Federal Register Volume 69, Number 194 (Thursday, October 7, 2004)]
[Notices]
[Pages 60158-60159]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 04-22399]


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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.

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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

[[Page 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, pre-reclassification 
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 add-on 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-and-comment 
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