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 Department of Health and Human Services Centers for Medicare & Medicaid Services [CMS-1488-CN2]
RIN 0938-A012
 AGENCY: Centers for Medicare & Medicaid Services (CMS), HHS.
 ACTION: Correction of notice.
 SUMMARY: This document corrects wage index and technical errors that appeared in the notice published in the 
                        **Federal Register**
                         on October 11, 2006 entitled “Medicare Program; Hospital Inpatient Prospective Payment Systems and Fiscal Year 2007 Rates.
 DATES: *Effective Date:*
                         Corrections listed in items 10 through 12 of section III. of this notice are effective as of October 1, 2006. The corrections to the wage index listed in items 2a, 3 through 8a, and 9a of section III. of this notice are effective as of November 3, 2006. The corrections to the wage index listed in items 1, 2b, 8b, and 9b of section III. of this notice are effective as of November 21, 2006.
 FOR FURTHER INFORMATION CONTACT: Marc Hartstein, (410) 786-4548.


SUPPLEMENTARY INFORMATION:  I. Background In FR Doc. 06-8471 of October 11, 2006 (71 FR 59886), the notice entitled “Hospital Inpatient Prospective Payment Systems and Fiscal Year 2007 Rates: Final Fiscal Year 2007 Wage Indices and Payment Rates After Application of Revised Occupational Mix Adjustment to Wage Index” (hereinafter referred to as the “FY 2007 IPPS notice”), there were a number of technical errors that are identified and corrected in the Correction of Errors section (items 10 through 12 of section III. of this notice). These technical corrections are effective October 1, 2006. In addition, in October 2006, we became aware of an error in the calculation of the FY 2007 wage index for a number of rural areas and several hospitals that are reclassified to those areas. The error also affected some hospitals in urban areas that are assigned the statewide rural wage index floor. Section 412.64(k)(1) of the regulations requires that wage index corrections made after October 1 are effective prospectively for the remainder of the fiscal year from the date the fiscal intermediaries are informed of the correction. We recalculated the wage indices for the affected hospitals, and on November 3, 2006, sent a Joint Signature Memorandum to the fiscal intermediaries informing them to pay hospitals using the corrected wage indices. Subsequent to the November 3, 2006 Joint Signature Memorandum, additional errors in the wage indices were brought to our attention and were corrected through a November 21, 2006 Joint Signature Memorandum. Therefore, the corrected FY 2007 wage indices are effective beginning November 3, 2006 or November 21, 2006. Accordingly, the wage index provisions of this correction notice are corrections to the tabulation of the rates paid to hospitals. We note that the 
                    ( print page 570)
                    corrections to the impact analysis (item 1 of section III. of this notice) are effective as of November 3, 2006 since the additional corrections made based on the November 21, 2006 Joint Signature Memorandum had no significant effect on the impact analysis. II. Summary of the Corrections to the FY 2007 IPPS Notice We made corrections to wage index values and geographic adjustment factors (GAFs) that were published in Tables 2, 4A-1, 4A-2, 4B-1, 4B-2, 4C-1, and 4C-2. In addition, we are making technical corrections to— (1) the out-migration adjustments and qualifying counties that were published in Table 4J; and (2) the list of diagnosis-related groups (DRGs), relative weighting factors, and geometric and arithmetic mean length of stay (LOS) that were published in Table 5. III. Correction of Errors In FR Doc. 06-8471 of October 11, 2006 (71 FR 59886), make the following corrections: 1. On pages 59893 and 59894, in Table I.—Impact Analysis of Changes for FY 2007, the figures in the last column (All FY 2007 changes 8
                    ) are corrected to read as follows: Impact Analysis of Final Changes for FY 2007 Operating Prospective Payment System
[Percent changes in payments per case]
All FY 2007 changes
                             (4)All Hospitals
3.5By Geographic Location:Urban hospitals
3.5Large urban areas (populations over 1 million)
3.5Other urban areas (populations of 1 million or fewer)
3.4Rural hospitals
4Bed Size (Urban):0-99 beds
3.5100-199 beds
3.8200-299 beds
3.6300-499 beds
3.4500 or more beds
3.2Bed Size (Rural):0-49 beds
4.750-99 beds
4.9100-149 beds
3.7150-199 beds
3.3200 or more beds
3.0Urban by Region:New England
3.9Middle Atlantic
3.9South Atlantic
3.2East North Central
3.4East South Central
2.7West North Central
2.8West South Central
3.4Mountain
3.7Pacific
3.7Puerto Rico
2.0Rural by Region:New England
6.3Middle Atlantic
5.2South Atlantic
3.9East North Central
3.8East South Central
3.5West North Central
4.3West South Central
4.1Mountain
2.7Pacific
3.3By Payment Classification:Urban hospitals
3.4Large urban areas (populations over 1 million)
3.5Other urban areas (populations of 1 million or fewer)
3.4Rural areas
4.0Teaching Status:Non-teaching
3.8Fewer than 100 Residents
3.4100 or more Residents
3.2Urban DSH:Non-DSH
3.6100 or more beds
3.4Less than 100 beds
3.6Rural DSH:SCH
4.6RRC
3.5Other Rural:100 or more beds
3.5Less than 100 beds
3.9Urban teaching and DSH:Both teaching and DSH
3.3Teaching and no DSH
3.3No teaching and DSH
3.7No teaching and no DSH
3.6Rural Hospital Types:RRC
3.5SCH
3.6MDH
9.0SCH and RRC
3.1MDH and RRC
14.1UnknownType of Ownership:Voluntary
3.5Proprietary
3.5Government
3.4Unknown
7.6Medicare Utilization as a Percent of Inpatient Days:0-25
3.625-50
3.350-65
3.7Over 65
3.8Unknown
4.4Hospitals Reclassified by the Medicare Geographic Classification Review Board:FY 2005 ReclassificationsUrban Hospitals Reclassified by the Medicare Geographic Classification Review Board: First Half FY 2007 Reclassifications
3.7Urban Nonreclassified, First Half FY 2007
3.4All Urban Hospitals Reclassified Second Half FY 2007
3.5Urban Nonreclassified Hospitals Second Half FY 2007
3.4All Rural Hospitals Reclassified Second Half FY 2007
3.6Rural Nonreclassified Hospitals Second Half FY 2007
4.5All Section 401 Reclassified Hospitals
5.4Other Reclassified Hospitals (Section 1886(d)(8)(B))
4.5Section 508 Hospitals
2Specialty Hospitals
—Cardiac Specialty Hospitals
1.2
 2. On pages 59903 through to 59968, in Table 2.—Hospital Case-Mix Indexes for Discharges Occurring in Federal Fiscal Year 2005; Hospital Wage Indexes for Federal Fiscal Year 2007; Hospital Average Hourly Wages for Federal Fiscal Years 2005 (2001 Wage Data), 2006 (2002 Wage Data), and 2007 (2003 Wage Data); Wage Indexes and 3-Year Average of Hospital Average Hourly Wages, for the listed providers, the wage indexes are corrected to read as follows: a. Effective November 3, 2006 Provider No.
FY 2007 wage index040039
0.8341040047
0.8431070002
1.2452070003
1.2461070004
1.2452070007
1.2452070008
1.2452070009
1.2452070011
1.2452070012
1.2452070015
1.2452070020
1.2525070021
1.2461070024
1.2452070025
1.2452070027
1.2452070029
1.2452070035
1.2452( print page 571)070038
1.2452100025
0.8847100026
0.8847100027
0.8847100048
0.8847100054
0.8847100062
0.8907100081
0.8847100093
0.8847100102
0.8972100106
0.8847100108
0.8847100118
0.9245100122
0.8847100124
0.8847100134
0.8847100142
0.8847100156
0.8972100160
0.8847100175
0.9078100212
0.8907100223
0.8847100231
0.8847100242
0.8847100266
0.8847100290
0.9429100292
0.8847230254
1.0381230257
1.0381230264
1.0381230269
1.0381230277
1.0381260004
0.8341260006
0.8341260015
0.8345260022
0.8615260024
0.8341260047
0.8348260059
0.8341260061
0.8341260070
0.8341260074
0.8499260078
0.8341260080
0.8341260097
0.8766260113
0.8341260116
0.8341260119
0.8345260142
0.8341260147
0.8341260160
0.8341260163
0.8341260195
0.8341280061
0.9048340073
0.9828380002
1.0282380040
1.0152380052
1.0152380081
1.0152390044
1.1196390096
1.1196430094
0.9048470001
1.0770470005
1.0383470012
1.0383470024
1.0383500002
1.0390500007
1.0598500012
1.0390500019
1.0603500031
1.0390500033
1.0390500036
1.0390500037
1.0390500049
1.0390500053
1.0390500058
1.0390500148
1.0390530002
0.9128530006
0.9128530008
0.9128530009
0.9128530010
0.9128530011
0.9128530014
0.9128530017
0.9128530032
0.9128530008
0.9057530009
0.9057530010
0.9057530011
0.9057530014
0.9057530017
0.9057530032
0.9057
 b. Effective November 21, 2006. Provider No.
FY 2007 wage index230013
1.0381230019
1.0381230029
1.0381230047
1.0381230071
1.0381230130
1.0381230151
1.0381230195
1.0381230204
1.0381230207
1.0381230223
1.0381230227
1.0381230254
1.0381230257
1.0381230264
1.0381230269
1.0381230277
1.0381390065
1.0977390138
1.0977490005
1.0977
 3. On page 59968 in Table 2.—Hospital Case-Mix Indexes for Discharges Occurring in Federal Fiscal Year 2005; Hospital Wage Indexes for Federal Fiscal Year 2007; Hospital Average Hourly Wages for Federal Fiscal Years 2005 (2001 Wage Data), 2006 (2002 Wage Data), and 2007 (2003 Wage Data); Wage Indexes and 3-Year Average of Hospital Average Hourly Wages, the table is corrected by adding a note to the end of the table to read as follows: Note: Due to the expiration of section 508 of the MMA, the wage index values for some hospitals will change in the second half of the fiscal year. The wage index values in this table reflect an average of the first half of FY 2007 (October 1, 2006-March 31, 2007) and second half of FY 2007 (April 1-September 30, 2007). 4. On pages 59975 through to 59998, in Table 4A-1.—Wage Index and Capital Geographic Adjustment Factor (GAF) for Urban Areas by CBSA, for the listed CBSAs, the wage indexes and GAFs are corrected to read as follows: CBSA code
Urban area (constituent counties)
Wage index
GAF15540
Burlington-South Burlington, VT
                             
                                Chittenden County, VT 2
                             
                             Franklin County, VT 
                             Grand Isle County, VT
1.0383
1.026123020
Fort Walton Beach-Crestview-Destin, FL2
                             Okaloosa County, FL
0.8847
0.919525540
Hartford-West Hartford-East Hartford, CT 1
                             2
                             Hartford County, CT 
                             Litchfield County, CT 
                             Middlesex County, CT 
                             Tolland County, CT
1.2452
1.162028420
Kennewick-Richland-Pasco, WA2
                             Benton County, WA 
                             Franklin County, WA
1.0390
1.026530300
Lewiston, ID-WA (WA Hospitals) 2
                             Nez Perce County, ID 
                             Asotin County, WA
1.0390
1.0265( print page 572)31020
Longview, WA
                             Cowlitz County, WA
1.0390
1.026534580
Mount Vernon-Anacortes, WA
                             Skagit County, WA
1.0390
1.026535300
New Haven-Milford, CT 3
                             New Haven County, CT
1.2452
1.162035980
Norwich-New London, CT
                             New London County, CT
1.2452
1.162036100
Ocala, FL2
                             Marion County, FL
0.8847
0.919537460
Panama City-Lynn Haven, FL
                             Bay County, Fl
0.8847
0.919537860
Pensacola-Ferry Pass-Brent, FL
                             Escambia County, FL 
                             Santa Rosa County, FL
0.8847
0.919548300
Wenatchee, WA
                             Chelan County, WA 
                             Douglas County, WA
1.0390
1.026549420
Yakima, WA
                             Yakima County, WA
1.0390
1.02651
                         Large urban area.2
                         Hospitals geographically located in the area are assigned the statewide rural wage index for FY 2007.3
                         For this area, the wage index and GAF on this table are only effective from October 1, 2006 through March 31, 2007. See Table 4A-2 for the values that are effective from April 1 through September 30, 2007.
 5. On page 59998, in Table 4A-2.—Wage Index and Capital Geographic Adjustment Factor (GAF) for Certain Urban Areas by CBSA for the Period April 1 Through September 30, 2007, for the listed CBSAs, the wage indexes and GAFs are corrected to read as follows: CBSA code
Urban area (constituent counties)
Wage index
GAF16940
Cheyenne, WY
0.9057
0.934435300
New Haven-Milford, CT
1.2452
1.1620
 6. On pages 59998 and 59999, in Table 4B-1.—Wage Index and Capital Geographic Adjustment Factor (GAF) for Rural Areas by CBSA—FY 2007, for the listed CBSAs, the wage indexes and GAFs are corrected to read as follows: CBSA code
Nonurban area
Wage index
GAF07
Connecticut
1.2452
1.162010
Florida
0.8847
0.919526
Missouri
0.8341
0.883238
Oregon 2
1.0152
1.010447
Vermont
1.0383
1.026150
Washington
1.0390
1.0265
 7. On page 59999, in Table 4B-2.—Wage Index and Capital Geographic Adjustment Factor (GAF) for Certain Rural Areas by CBSA for the Period April 1 Through September 30, 2007, for the listed CBSA, the wage index and GAF is corrected to read as follows: CBSA code
Nonurban area
Wage index
GAF53
Wyoming
0.9057
0.9344
 8. On pages 59999 through to 60003, in Table 4C-1.—Wage Index and Capital Geographic Adjustment Factor (GAF) for Hospitals That Are Reclassified by CBSA, for the listed CBSAs, the wage indexes and GAFs are corrected to read as follows: a. Effective November 3, 2006. CBSA code
Area
Wage index
GAF23020
Fort Walton Beach-Crestview-Destin, FL
0.8847
0.919525540
Hartford-West Hartford-East Hartford, CT (CT Hospitals)
1.2452
1.162027860
Jonesboro, AR (MO Hospitals)
0.8345
0.883528420
Kennewick-Richland-Pasco, WA
1.0390
1.026538340
Pittsfield, MA
1.0383
1.0261( print page 573)07
Connecticut
1.2452
1.162010
Florida (FL Hospitals)
0.8847
0.919514
Illinois (MO Hospitals)
0.8341
0.883216
Iowa
0.8615
0.902926
Missouri
0.8341
0.883230
New Hampshire
1.0770
1.052138
Oregon
1.0152
1.010450
Washington (WA Hospitals)
1.0390
1.026553
Wyoming
0.9048
0.9338
 b. Effective November 21, 2006. CBSA code
Area
Wage index
GAF47894
Washington-Arlington-Alexandria, DC-VA-MD-WV
1.0977
1.0659
 9. On page 60003, in Table 4C-2.—Wage Index and Capital Geographic Adjustment Factor (GAF) for Certain Hospitals That Are Reclassified by CBSA for the Period April 1 Through September 30, 2007*, CBSAs 35300 and 19804 are corrected and CBSA 47894 is added. The wage indexes and GAFs are corrected to read as follows: a. Effective November 3, 2006. CBSA code
Area
Wage index
GAF19804
Detroit-Livonia-Dearborn, MI
1.0381
1.019235300
New Haven-Milford, CT
1.2452
1.1620
 b. Effective November 21, 2006. CBSA code
Area
Wage index
GAF47894
Washington-Arlington-Alexandria, DC-VA-MD-WV
1.0977
1.0659
 10. On pages 60004 through to 60012, in Table 4J.—Out-Migration Adjustment—FY 2007, provider number 010009 is corrected and provider number 010010 is added to read as follows: a. Effective October 1, 2006. Provider No.
Reclassified 
                             between 10/1/06  
                             and 3/31/07
Reclassified 
                             between 4/1/07  
                             and 9/30/07
Out-migration 
                             adjustment
Qualifying 
                             county name010009
*
*
0.0092
MORGAN.010010
*
*
0.0259
MARSHALL.
 11. On pages 60013 through to 60025, in Table 5.—List of Diagnosis-Related Groups (DRGS), Relative Weighting Factors, and Geometric and Arithmetic Mean Length of Stay (LOS), DRGs 525, 544, and 572 are corrected to read as follows: a. Effective October 1, 2006. DRG
FY 07 final rule post-acute care DRG
FY 07 final rule special pay DRG
MDC
Type
DRG title
Weights
Geometric mean LOS
Arithmetic mean LOS525
No
No
05
SURG
Other Heart Assist System Implant
2.2268
7.7
14.3544
Yes
Yes
08
SURG
Major Joint Replacement or Reattachment of Lower Extremity
1.9878
4.0
4.4572
Yes
No
06
MED
Major Gastrointestinal Disorders and Peritoneal Infections
1.3378
5.6
7.1
 12. On page 60025 in Table 5.—List of Diagnosis-Related Groups (DRGs), Relative Weighting Factors, and Geometric and Arithmetic Mean Length of Stay (LOS), the table is corrected by adding the following notes to the end of the table: a. Effective October 1, 2006. Note: If there is an asterisk in the “Type” column this means that data is unavailable to calculate weights for these low volume DRGs. Therefore, last year's weights have been updated based on the percent change in 
                        ( print page 574)
                        normalization factors between FY 2006 and FY 2007. Note: If there is no value or dashes (that is, “----”) in either the geometric mean LOS or the arithmetic mean LOS columns, the volume of cases is insufficient to determine a meaningful computation of these statistics. IV. Discussion of Effective Date and Notice and Comment Rulemaking 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)). In addition, a final rule would ordinarily require a 30-day delay in effective date after the date of publication in the 
                    **Federal Register**
                    . This correction of the rates published in the FY 2007 IPPS notice does not constitute a rule under the Administrative Procedure Act, because, in our FY 2007 IPPS final rule (71 FR 47870, August 18, 2006), we already published the methodologies and formulas we use for determining the wage index, geographic adjustment factors, and other rates. This notice does not change our methodology or formulas, but merely ensures that our rules are implemented correctly. As this notice is not a rule under the Administrative Procedure Act, no notice of proposed rulemaking or delay in effective date is necessary. (Catalog of Federal Domestic Assistance Program No. 93.773, Medicare—Hospital Insurance; and Program No. 93.774, Medicare—Supplementary Medical Insurance Program.) Dated: December 28, 2006. Ashley Files Flory, Deputy Executive Secretary to the Department.


[FR Doc. 06-9976 Filed 12-29-06; 1:29 pm] BILLING CODE 4120-01-P