[Federal Register Volume 76, Number 7 (Tuesday, January 11, 2011)]
[Rules and Regulations]
[Pages 1670-1859]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2010-33264]



[[Page 1669]]

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Part II





Department of Health and Human Services





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Centers for Medicare & Medicaid Services



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42 CFR Parts 405, 409, 410, et al.



Medicare Program; Payment Policies Under the Physician Fee Schedule and 
Other Revisions to Part B for CY 2011; Corrections; Final Rule

Federal Register / Vol. 76 , No. 7 / Tuesday, January 11, 2011 / 
Rules and Regulations

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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare & Medicaid Services

42 CFR Parts 405, 409, 410, 411, 413, 414, 415, and 424

[CMS-1503-CN2]
RIN 0938-AP79


Medicare Program; Payment Policies Under the Physician Fee 
Schedule and Other Revisions to Part B for CY 2011; Corrections

AGENCY: Centers for Medicare & Medicaid Services (CMS), HHS.

ACTION: Correction of final rule with comment period.

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SUMMARY: This document corrects several technical and typographical 
errors in the final rule with comment period that appeared in the 
November 29, 2010 Federal Register entitled ``Medicare Program; Payment 
Policies Under the Physician Fee Schedule and Other Revisions to Part B 
for CY 2011; Final Rule'' (75 FR 73170).

DATES: Effective Date: This correction is effective January 1, 2011.

FOR FURTHER INFORMATION CONTACT: Rebecca Cole or Erin Smith, (410) 786-
4497.

SUPPLEMENTARY INFORMATION:

I. Background

    In FR Doc. 2010-27969 of November 29, 2010 (75 FR 73170) 
(hereinafter referred to as the Calendar Year (CY) 2011 Physician Fee 
Schedule (PFS) final rule with comment period), there were a number of 
technical and typographical errors that are identified and corrected in 
the Correction of Errors section of this notice. The provisions of this 
notice are effective as if they had been included in the CY 2011 PFS 
final rule with comment period. Accordingly, the corrections are 
effective January 1, 2011.
    On November 30, 2010, the Physician Payment and Therapy Relief Act 
of 2010 (Pub. L. 111-286) was signed into law. Section 3 of Public Law 
111-286 changed the policy finalized in the CY 2011 PFS final rule with 
comment period regarding payment reductions applied to multiple therapy 
services provided to the same patient on the same day and paid for 
under the PFS effective January 1, 2011.
    Further, on December 15, 2010, the Medicare and Medicaid Extenders 
Act of 2010 (Pub. L. 111-309) was signed into law. Section 101 of 
Public Law 111-309 provides for a 1-year zero-percent update to the 
Medicare physician fee schedule (PFS) for CY 2011.
    As this correction notice corrects the CY 2011 physician fee 
schedule final rule with comment period that was released prior to 
enactment of the statutory changes contained in the two laws noted 
above, the statutory changes to PFS payments for CY 2011 are not 
reflected in this correction notice. Payment files reflecting current 
law as of January 1, 2011 will be made available through usual CMS 
notices and data files.

II. Summary of Errors

A. Errors in the Preamble

1. Errors in the Budget Neutrality, Conversion, Anesthesia, and Other 
Factors
    On page 73276, we are correcting the adjustments to the PE and 
malpractice RVUs to match the proportions of the RVU shares to the 
rebased and revised Medicare Economic Index (MEI), resulting from the 
corrections of work, PE, and malpractice RVUs discussed in this 
section. We are making the corresponding changes to Table 45--
Calculation of the CY 2011 PFS CF.
    On pages 73283 and 73284, we are correcting the figures for the CY 
2011 budget neutrality factors, conversion factor (CF), and anesthesia 
CF to reflect the updated values resulting from the corrections to the 
work, PE, and malpractice RVUs discussed in this section.
    On page 73388, we are correcting Table 60--CY 2011 RVUs for CPT 
code 77080 to reflect the corrected CF.
2. Errors in Work RVUs
    On page 73328, we are correcting the count of AMA RUC work RVU 
recommendations with which we agreed or disagreed. Due to a 
typographical error, the published count was incorrect.
    On page 73340, we are correcting the CY 2011 Interim Final Work RVU 
value for CPT code 52332 that was listed incorrectly due to a 
typographical error.
    On page 73341, we are correcting the CY 2011 Interim Final Work RVU 
value for CPT code 77427 that was incorrect due to a technical error.
    On pages 73342 through 73349, we are correcting Table 53: AMA RUC 
Recommendations and Interim Final Work RVUs for CY 2011 New, Revised, 
and Potentially Misvalued Codes to reflect the corrections previously 
listed for CPT codes 52332 and 77427, and to make these additional 
corrections:
    <bullet> The AMA RUC-Recommended Work RVU value for CPT code 77427 
was incorrect due to a typographical error.
    <bullet> The CMS Decision and CY 2011 Interim Final Work RVU fields 
for CPT code 64483 were incorrect due to typographical errors.
3. Errors in the PE RVUs
    On pages 73352 and 73353, in Table 54--CPT Codes With Accepted AMA 
RUC Direct PE Recommendations for CY 2011 Codes, we listed codes for 
which we accepted on an interim final basis the AMA RUC direct PE 
recommendations. However, due to technical errors, we did not apply the 
correct inputs when calculating the PE values for the following CPT 
codes: 31296, 31297, 37223, 90945, 95800, and 95801. Similar technical 
errors in the creation of the direct practice expense database resulted 
in incorrect direct PE inputs for five other CPT codes: 77750, 92506, 
93224, 93225, and 93226. The corrections to these direct PE inputs are 
included in the corrected final CY 2011 direct PE database available 
under downloads for the CY 2011 PFS final rule with comment period on 
the CMS Web site at: http://www.cms.gov/PhysicianFeeSched/PFSFRN/list.asp#TopOfPage.
    Changes to the PE RVUs resulting from the corrections to the direct 
PE inputs and the work RVU corrections previously noted are reflected 
in changes to Addendum B and Addendum C. We also note that because work 
RVUs factor into the calculation for both the malpractice (MP) and 
practice expense (PE) RVUs, those values for these CPT codes may have 
also changed, and these subsequent changes are reflected in Addenda B 
and C. In addition, on page 73188, we are correcting errors in Table 
2--Calculation of PE RVUs Under Methodology for Selected Codes (we are 
correcting the table in its entirety) as a result of changed values for 
PE RVUs that indirectly resulted from the changes to work RVUs.
    Finally, we note that changes in the RVUs for these codes affect 
additional codes due to various factors related to the relativity of 
the system including budget neutrality and adjustments to maintain PE 
RVU shares.
4. Errors in the Malpractice RVUs
    In section II.B.2 of the preamble to the CY 2011 PFS final rule 
with comment period, we discussed malpractice RVUs for new and revised 
services. These codes are listed on pages 73209 through 73213 in Table 
8: Source Codes for CY 2011 New/Revised Codes Used to Set the 
Malpractice RVUs, and their MP RVU values are listed in Addendum B

[[Page 1671]]

and Addendum C. Due to a technical error in the application of the 
methodology used to calculate the MP RVUs as described in the CY 2011 
PFS final rule with comment period, the MP RVU values listed for the 
following CPT codes were incorrect: 92606, 92607, 92608, 92609, 93452, 
93452TC, 93453, 93453TC, 93454, 93454TC, 93457, 93457TC, 93458, 
93458TC, 93459, 93459TC, 93460, 93460TC, 93461, 93461TC.
    Additionally, changes to the MP RVUs resulting from the correction 
to the work RVUs for CPT codes 77427 and 52332 as previously described 
are also reflected in Addendum B and Addendum C. Finally, we note that 
changes in RVUs previously described affect MP RVUs for additional 
codes due to various factors related to the relativity of the system.
    Due to the changes previously noted, we are correcting errors on 
pages 73595 through 73596 in Table 101: CY 2011 PFS Final Rule Total 
Allowed Charge Estimated Impact for RVU, MPPR, and MEI Rebasing Changes 
and on pages 73598 through 73600 in Table 102: Impact of Final Rule 
with Comment Period and Estimated Physician Update on CY 2011 Payment 
for Selected Procedures by replacing the tables in their entirety.

B. Errors in the Addenda

    On pages 73630 through 73809 and 73810 through 73815, in Addendum 
B: CY 2011--Relative Value Units and Related Information Used in 
Determining Medicare Payments and Addendum C: Codes with Interim RVUs, 
respectively, we need to correct errors in the work, PE, or MP RVUs (or 
combinations of these RVUs) for certain existing new and revised CY 
2011 CPT codes. These errors are a result of the technical and 
typographical errors identified and summarized in section II.A. of this 
correction notice. We note that we are providing these addenda in their 
entirety.
    On page 73831 in Addendum J: List of CPT \1\/HCPCS Codes Used to 
Define Certain Designated Health Service Categories \2\ under Section 
1877 of the Social Security Act Effective January 1, 2011 we are 
correcting a technical error in the short descriptor for HCPCS code 
G0431.
    On pages 73841 through 73859, in Addendum K: CY 2011 ESRD Wage 
Index for Urban Areas Based on CBSA Labor Market Areas, we made 
technical and typographical errors in the composite rate wage index for 
CBSA codes 11540, 12060, 19060, 27740, and 35380, and in the ESRD PPS 
wage index for CBSA codes 40980 and 43780. On page 73848, we also made 
a typographical error in the CBSA code for Houston-Sugar Land-Baytown, 
TX.
    On page 73859, in Addendum L: CY 2011 ESRD Wage Index for Rural 
Areas Based on CBSA Labor Market Areas, we made a technical error in 
the composite wage index for the nonurban area of Alaska.

III. Correction of Errors

    In FR Doc. 2010-27969 of November 29, 2010 make the following 
corrections:

A. Corrections to the Preamble

    1. On page 73188, in Table 2--Calculation of PE RVUs Under 
Methodology for Selected Codes, the table is corrected to read as 
follows:

[[Page 1672]]



                                                                                  Table 2--Calculation of PE RVUS Under Methodology for Selected Codes
----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
                                                                                                                                         33533 CABG,
                                                                                                                          99213 Office    arterial,    71020 Chest                  71020-26     93000 ECG,    93005 ECG,    93010 ECG,
                                                       Step                         Source                  Formula        visit, est      single         x-ray       71020-TC     Chest xray     complete       tracing       report
                                                                                                                           nonfacility    facility     nonfacility                 nonfacility   nonfacility   nonfacility   nonfacility
----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
(1) Labor cost (Lab).....................  Step 1......................  AMA........................  ..................         13.32         77.52          5.74          5.74          0.00          6.12          6.12          0.00
(2) Supply cost (Sup)....................  Step 1......................  AMA........................  ..................          2.98          7.34          3.39          3.39          0.00          1.19          1.19          0.00
(3) Equipment cost (Eqp.)................  Step 1......................  AMA........................  ..................          0.19          0.65          8.17          8.17          0.00          0.12          0.12          0.00
(4) Direct cost (Dir)....................  Step 1......................  ...........................        =(1)+(2)+(3)         16.50         85.51         17.31         17.31          0.00          7.43          7.43          0.00
(5) Direct adjustment (Dir. Adj).........  Steps 2-4...................  See footnote*..............  ..................          0.50          0.50          0.50          0.50          0.50          0.50          0.50          0.50
(6) Adjusted Labor.......................  Steps 2-4...................  =Lab * Dir Adj.............            =(1)*(5)          6.65         38.68          2.86          2.86          0.00          3.05          3.05          0.00
(7) Adjusted Supplies....................  Steps 2-4...................  = Sup * Dir Adj............            =(2)*(5)          1.49          3.66          1.69          1.69          0.00          0.60          0.60          0.00
(8) Adjusted Equipment...................  Steps 2-4...................  = Eqp * Dir Adj............            =(3)*(5)          0.10          0.33          4.08          4.08          0.00          0.06          0.06          0.00
(9) Adjusted direct......................  Steps 2-4...................  ...........................        =(6)+(7)+(8)          8.23         42.67          8.64          8.64          0.00          3.71          3.71          0.00
(10) Conversion Factor (CF)..............  Step 5......................  PFS........................  ..................         36.87         36.87         36.87         36.87         36.87         36.87         36.87         36.87
(11) Adj. labor cost converted...........  Step 5......................  =(Lab * Dir Adj)/CF........           =(6)/(10)          0.18          1.05          0.08          0.08          0.00          0.08          0.08          0.00
(12) Adj. supply cost converted..........  Step 5......................  =(Sup * Dir Adj)/CF........           =(7)/(10)          0.04          0.10          0.05          0.05          0.00          0.02          0.02          0.00
(13) Adj. equipment cost converted.......  Step 5......................  =(Eqp * Dir Adj)/CF........           =(8)/(10)          0.00          0.01          0.11          0.11          0.00          0.00          0.00          0.00
(14) Adj. direct cost converted..........  Step 5......................  ...........................     =(11)+(12)+(13)          0.22          1.16          0.23          0.23          0.00          0.10          0.10          0.00
(15) Work RVU............................  Setup File..................  PFS........................  ..................          0.97         33.75          0.22          0.00          0.22          0.17          0.00          0.17
(16) Dir--pct............................  Steps 6, 7..................  Surveys....................  ..................          0.26          0.18          0.29          0.29          0.29          0.29          0.29          0.29
(17) Ind--pct............................  Steps 6, 7..................  Surveys....................  ..................          0.74          0.82          0.71          0.71          0.71          0.71          0.71          0.71
(18) Ind. Alloc. Formula (1st part)......  Step 8......................  See Step 8.................  ..................   ((14)/(16))   ((14)/(16))   ((14)/(16))   ((14)/(16))   ((14)/(16))   ((14)/(16))   ((14)/(16))   ((14)/(16))
                                                                                                                                * (17)        * (17)        * (17)        * (17)        * (17)        * (17)        * (17)        * (17)
(19) Ind. Alloc. (1st part)..............  Step 8......................  ...........................            See (18)          0.65          5.27          0.58          0.58          0.00          0.25          0.25          0.00
(20) Ind. Alloc. Formulas (2nd part).....  Step 8......................  See Step 8.................  ..................          (15)          (15)     (15)+(11)          (11)          (15)     (15)+(11)          (11)          (15)
(21) Ind. Alloc. (2nd part)..............  Step 8......................  ...........................            See (20)          0.97         33.75          0.30          0.08          0.22          0.25          0.08          0.17
(22) Indirect Allocator (1st + 2nd)......  Step 8......................  ...........................          =(19)+(21)          1.62         39.02          0.88          0.66          0.22          0.50          0.33          0.17
(23) Indirect Adjustment (Ind. Adj.).....  Steps 9-11..................  See footnote**.............  ..................          0.37          0.37          0.37          0.37          0.37          0.37          0.37          0.37
(24) Adjusted indirect allocator.........  Steps 9-11..................  =Ind Alloc * Ind Adj.......  ..................          0.60         14.46          0.32          0.24          0.08          0.19          0.12          0.06
(25) Ind. Practice Cost Index (IPCI).....  Steps 12-16.................  See Steps 12-16............  ..................          1.11          0.83          0.89          0.89          0.89          0.92          0.92          0.92
(26) Adjusted Indirect...................  Step 17.....................  = Adj.Ind Alloc * PCI......        =(24) * (25)          0.67         12.05          0.29          0.22          0.07          0.17          0.11          0.06
(27) MEI Rebasing Adjustment.............  Step 18.....................  PFS........................  ..................          1.18          1.18          1.18          1.18          1.18          1.18          1.18          1.18
(28) MPPR Adjustment.....................  Step 18.....................  PFS........................  ..................          1.01          1.01          1.01          1.01          1.01          1.01          1.01          1.01
(29) PE RVU..............................  Step 18.....................  =(Adj Dir + Adj Ind) * budn      =((14)+(26)) *          1.06         15.69          0.62          0.53          0.09          0.32          0.25          0.07
                                                                          * MEI Adj * MPPR Adj.       budn * (27) * (28)
----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
Note: PE RVUs in table 2, row 29, may not match Addendum B due to rounding.
* The direct adj = [current pe rvus * CF * avg dir pct]/[sum direct inputs] = [Step 2]/[Step 3].
** The indirect adj = [current pe rvus * avg ind pct]/[sum of ind allocators] = [Step 9]/[Step 10].


[[Page 1673]]

    2. On page 73276, third column,
    a. Second full paragraph,
    (1) Line 23, the figure ``1.181'' is corrected to read ``1.182.''
    (2) Line 24, the figure ``1.358'' is corrected to read ``1.361.''
    (3) Line 28, the figure ``1.358'' is corrected to read ``1.361.''
    b. Last partial paragraph,
    (1) Line 10, the figure ``0.9181'' is corrected to read ``0.9175.''
    (2) Line 11, the figure ``1.181'' is corrected to read ``1.182.''
    (3) Line 12, the figure ``1.358'' is corrected to read ``1.361.''
    3. On page 73283,
    a. Top half of the page,
    (1) First column, first full paragraph,
    (a) Line 1, the figure ``$25.5217'' is corrected to read 
``$25.4999.''
    (b) Line 3, the figure ``$15.8085'' is corrected to read 
``$15.7999.''
    (2) Second column, second partial paragraph, last line, the figure 
``1.0045'' is corrected to read ``1.0043.''
    (3) Third column, first partial paragraph,
    (a) Line 6, the figure ``0.9181'' is corrected to read ``0.9175.''
    (b) Line 15, the figure ``$25.5217'' is corrected to read 
``$25.4999''
    b. Bottom half of the page, in Table 45--Calculation of the CY 2011 
PFS CF, the listed entries are corrected to read as follows:

------------------------------------------------------------------------
 
------------------------------------------------------------------------
CY 2011 RVU Budget Neutrality       0.4 percent
 Adjustment.                         (1.0043).
CY 2011 Rescaling to Match MEI      -8.3 percent
 Weights Budget Neutrality           (0.9175).
 Adjustment.
CY 2011 Conversion Factor.........  ....................        $25.4999
------------------------------------------------------------------------

    4. On pages 73283 and 73284, top of the page, in Table 46--
Calculation of the CY 2011 Anesthesia Conversion Factor, the listed 
entries are corrected to read as follows:

------------------------------------------------------------------------
 
------------------------------------------------------------------------
CY 2011 Anesthesia Adjustment.....  -2.4 percent
                                     (0.9760).
CY 2011 Anesthesia Conversion       ....................        $15.7999
 Factor.
------------------------------------------------------------------------

    5. On page 73328, first column, last paragraph,
    a. Line 4, the figure ``207'' is corrected to read ``206.''
    b. Line 7, the figure ``84'' is corrected to read ``85.''
    6. On page 73340, first column, first full paragraph,
    a. Line 9, the number ``1.47'' is corrected to read ``2.60.''
    b. Line 10, the phrase ``25th percentile'' is corrected to read 
``low value.''
    c. Line 14, the number ``1.47'' is corrected to read ``2.60.''
    7. On page 73341, third column, last paragraph, line 12, the figure 
``2.92'' is corrected to read ``3.37.''
    8. On pages 73342 through 73349, in Table 53--AMA RUC 
Recommendations and Interim Final Work RVUs for CY 2011 New, Revised, 
and Potentially Misvalued Codes the listed entries are corrected to 
read as follows:

----------------------------------------------------------------------------------------------------------------
                                          Valued in relation
                                           to a potentially      AMA RUC-                             CY 2011
     CPT code         Short descriptor      misvalued code      recommended      CMS decision      interim final
                                                screen           work RVUs                           work RVUs
----------------------------------------------------------------------------------------------------------------
52332.............  Cystoscopy and                        x             2.83  Disagree..........            2.60
                     treatment.
64483.............  Inj foramen epidural                  x             1.90  Disagree..........            1.75
                     l/s.
77427.............  Radiation tx                          x             3.45  Disagree..........            3.37
                     management x5.
----------------------------------------------------------------------------------------------------------------

    9. On page 73388, lower third of the page,
    a. First column, first paragraph, last line, the figure 
``$25.5217'' is corrected to read ``$25.4999.''
    b. Table 60--CY 2011 RVUs for CPT Code 77080, the table is 
corrected to read as follows:

                                                        Table 60--CY 2011 RVUs for CPT Code 77080
                                             [Note: Calculated using the current law CY 2011 CF of $25.4999]
--------------------------------------------------------------------------------------------------------------------------------------------------------
                                                                                       CY 2011           CY 2011
                CY 2011 CPT code                               Mod                 physician work    nonfacility PE   CY 2011 facility       CY 2011
                                                                                        RVUs              RVUs             PE RVUs      malpractice RVUs
--------------------------------------------------------------------------------------------------------------------------------------------------------
77080..........................................  26.............................              0.31              0.10              0.10              0.01
77080..........................................  TC.............................              0.00              3.23                NA              0.18
77080..........................................  ...............................              0.31              3.33                NA              0.19
--------------------------------------------------------------------------------------------------------------------------------------------------------

    10. On pages 73595 and 73596, in Table 101--CY 2011 PFS Final Rule 
Total Allowed Charge Estimate Impact for RVU, MPPR, and MEI Rebasing 
Changes, the table is corrected to read as follows:
BILLING CODE 4120-01-P

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    11. On pages 73598 through 73600, in Table 102--Impact of Final 
Rule with Comment Period and Estimated Physician Update on CY 2011 
Payment for Selected Procedures, the table is corrected to read as 
follows:

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B. Corrections to the Addenda

    1. On pages 73630 through 73809, in Addendum B: CY 2011-Relative 
Value Units and Related Information Used in Determining Medicare 
Payments, the addendum is corrected to read as follows:

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    3. On page 73831, in Addendum J: List of CPT \1\/HCPCS Codes Used 
to Define Certain Designated Health Service Categories \2\ under 
Section 1877 of the Social Security Act Effective January 1, 2011, the 
listed entry is corrected to read as follows:
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    4. On pages 73841 through 73859, in Addendum K: CY 2011 ESRD Wage 
Index for Urban Areas Based on CBSA Labor Market Areas, the listed 
entries are corrected to read as follows:

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    4. On page 73859, in Addendum L: CY 2011 ESRD Wage Index for Rural 
Areas Based on CBSA Labor Market Areas, the listed entry is corrected 
to read as follows:
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III. Waiver of Proposed Rulemaking and Delay in 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)). However, we 
can waive the notice and comment procedure if the Secretary finds, for 
good cause, that the notice and comment process is impracticable, 
unnecessary, or contrary to the public interest, and incorporates a 
statement of the finding and the reasons for it in the rule.
    Section 553(d) of the APA ordinarily requires a 30-day delay in the 
effective date of final rules after the date of their publication. This 
30-day delay in effective date can be waived, however, if an agency 
finds for good cause that the delay is impracticable, unnecessary, or 
contrary to the public interest, and the agency incorporates a 
statement of the findings and its reasons in the rule issued.
    This document merely corrects typographical and technical errors 
made in the CY 2011 PFS final rule with comment period, which appeared 
in the November 29, 2010 Federal Register (75 FR 73170), and is (with 
limited exceptions not relevant to these corrections, but noted in the 
rule), effective January 1, 2011. The provisions of the final rule with 
comment period have been subjected previously to notice and comment 
procedures. The corrections contained in this document are consistent 
with, and do not make substantive changes to, the payment methodologies 
and policies adopted in the CY 2011 PFS final rule with comment period. 
As such, these corrections are being made to ensure the CY 2011 PFS 
final rule with comment period accurately reflects the policies adopted 
in that rule. Therefore, we find for good cause that it is unnecessary 
and would be contrary to the public interest to undertake further 
notice and comment procedures to incorporate these corrections into the 
CY 2011 PFS final rule with comment period.
    For the same reasons, we are also waiving the 30-day delay in 
effective date for these corrections. We believe that it is in the 
public interest to ensure that the CY 2011 PFS final rule with comment 
period accurately states our policies as of the date they take effect. 
Therefore, we find that delaying the effective date of these 
corrections beyond the effective date of the final rule with comment 
period would be contrary to the public interest. In so doing, we find 
good cause to waive the 30-day delay in the effective date.

    Authority: (Catalog of Federal Domestic Assistance Program No. 
93.774, Medicare--Supplementary Medical Insurance Program)

    Dated: December 29, 2010.
Dawn L. Smalls,
Executive Secretary to the Department.
[FR Doc. 2010-33264 Filed 12-30-10; 4:15 pm]
BILLING CODE 4120-01-C