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 Department of Health and Human Services Centers for Medicare & Medicaid Services 42 CFR Part 484
[CMS-1541-CN]
RIN 0938-AO32
 AGENCY: Centers for Medicare & Medicaid Services (CMS), HHS.
 ACTION: Proposed rule; correction notice.
 SUMMARY: This document corrects technical errors that appeared in the proposed rule published in the 
                        **Federal Register**
                         on May 4, 2007, entitled “Medicare Program; Home Health Prospective Payment System Refinement and Rate Update for Calendar Year 2008” (72 FR 25356).
 FOR FURTHER INFORMATION CONTACT: Randy Throndset, (410) 786-0131.


SUPPLEMENTARY INFORMATION: I. Background In FR Doc. 07-2167 of May 4, 2007 (72 FR 25356), there were a number of technical errors that we identified and corrected in the Correction of Errors section below. II. Summary of Errors In the May 4, 2007 published proposed rule, on page 25388, we 
                    ( print page 33426)
                    provided a Table 4 “Regression Coefficients for Calculating Case-Mix Relative Weights” that illustrated payment regression coefficients, which represent the average addition to resource cost due to each severity level. We inadvertently miscalculated the payment for the case-mix groups in the second column of Table 4 and have corrected these errors. We are republishing Table 4 in its entirety with the corrected information. The text on page 25388 describing Table 4 has also been changed to reflect the corrected data in the table as well as a typographical error. We are also correcting the language on page 25388 which describes how coefficients are scaled. A phrase was inadvertently omitted which notes that the calculation also adjusts for budget neutrality in the weights. We are correcting text on page 25389, which incorrectly stated that we are proposing to adjust for nominal change in case-mix through a reduction in the weights. The adjustment for nominal change in case-mix is made through a rate reduction in the national standardized 60-day episode payment. We are also correcting some typographic errors. On pages 25389-25392, Table 5 “Case-Mix Groups, Average Cost, and Case-Mix Weight” includes the predicted average resource cost for the 153 case-mix groups of the proposed model. We inadvertently miscalculated the “Average Cost” in the fourth column. We are republishing Table 5 in its entirety with the corrected information. On pages 25430-25431, Table 12a “NRS Case-Mix Adjustment Variables and Scores” sets forth the NRS scores for the five-group model. We inadvertently included incorrect scores in the third column and have corrected these errors. The table also corrects how the scoring is broken out for Outcome and Assessment Information Set (OASIS) item M0450, giving separate scores for stage 3 and stage 4 pressure ulcers, separating 1 pressure ulcer and 2 pressure ulcers within both stages 3 and 4, changing 3 pressure ulcers for stage 3 or 4 to 3+ pressure ulcers for stage 3, changing the 4+ pressure ulcers for stage 3 and 4 to 3+ pressure ulcers for stage 4, and deleting the score for 5 or more pressure ulcers. We are republishing Table 12a in its entirety with the corrected information. We are also correcting text on page 25444 describing the calculation of the case-mix and wage-adjusted national standardized 60-day episode payment rate including non-routine supplies to correct an error in the order of the calculation. We are correcting typographical errors in the LUPA calculation example on page 25447. Finally, we are correcting typographical errors in Addendum A on page 25459, in the rural Massachusetts and New Jersey wage indices. The text of the first footnote to Addendum A also incorrectly states that all counties within the State are classified as rural. The first footnote has been corrected. III. Correction of Errors In FR Doc. 07-2167 of May 4, 2007 (72 FR 25356), make the following corrections: 1. On page 25388, in the first column, the first full paragraph, a. In line 1, the word “PSS” is corrected to read “PPS”. b. In lines 5 through 10, the sentence “(To show the coefficients in actual, as opposed to resource cost, dollars, the coefficients were scaled by a multiplier representing the ratio of the HH PPS average payment level to the Abt Associates average resource cost level)” is corrected to read as follows: “(To show the coefficients in actual, as opposed to resource cost, dollars, the coefficients were scaled by a multiplier representing the ratio of the HH PPS average payment level to the Abt Associates average resource cost level after adjusting for budget neutrality in the weights (see section II.A.2.c. for an explanation of budget neutrality adjustment to the weights.))”. c. In line 17, the figure “$861.74” is corrected to read “$869.55”. d. In line 18, the figure “$219.44” is corrected to read “$221.43”. 2. On page 25388, in the first column, second full paragraph, line 4, the figure “$1,265.18” is corrected to read “$1,276.66”. 3. On page 25388, in the second column, first partial paragraph, a. In line 5, the figure “$1,265.18” is corrected to read “$1,276.66”. b. In line 6, the figure “$139.26” is corrected to read “$140.52”. c. In line 7, the figure “$645.90” is corrected to read “$651.76”. d. In line 9, the figure “$210.94” is corrected to read “$212.85”. e. In line 15, the figure “$2,261.28” is corrected to read “$2,281.79”. 4. On page 25388, in Table 4: Regression Coefficients for Calculating Case-Mix Relative Weights, the table is corrected as follows: Table 4.—Regression Coefficients for Calculating Case-Mix Relative Weights
Intercept (constant for all case mix groups)
$1,276.66**1st and 2nd Episodes, 0 to 13 Therapy Visits**C2
384.11C3
869.55F2
221.43F3
382.50S2 (6 therapy visits)
504.49S3 (7-9 therapy visits)
943.50S4 (10 therapy visits)
1,387.86S5 (11-13 therapy visits)
1,771.84**1st and 2nd Episodes, 14 to 19 Therapy Visits**Constant
2,191.26C2
539.55C3
1,257.78F2
270.79F3
429.54S2 (16-17 therapy visits)
429.35S3 (18-19 therapy visits)
705.26**3rd+ Episodes, 0 to 13 Therapy Visits**Constant
212.85C2
140.52C3
619.33F2
418.51F3
825.67S2 (6 therapy visits)
651.76S3 (7-9 therapy visits)
1,093.13S4 (10 therapy visits)
1,521.27S5 (11-13 therapy visits)
1,907.93**3rd+ Episodes, 14 to 19 Therapy Visits**Constant
2,198.69C2
678.75C3
1,405.22F2
394.26F3
693.30S2 (16-17 therapy visits)
294.71S3 (18-19 therapy visits)
719.09**All Episodes, 20+ Therapy Visits**Constant
4,033.07C2
583.74C3
1,396.22F2
490.14F3
1,052.59
 5. On page 25389, in the first column, a. In line 3, the word “two” is deleted. b. In line 3, the word “adjustments” is corrected to read “adjustment”. 6. On page 25389, in the second column, a. In line 1, the words “and the” is deleted. b. In line 2, the phrase “adjustment for nominal changes in case-” is deleted. 7. On page 25389, in the third column, a. In line 1, the words “mix coding” is deleted. b. In line 1, the word “are” is corrected to read “is”. 8. On pages 25389-25392, in Table 5: Case Mix Groups, Average Cost, and 
                    ( print page 33427)
                    Case Mix Weight, the table is corrected to read as follows: Table 5.—Case-Mix Groups, Average Cost, and Case-Mix Weight
Severity level for each dimensionClinical
Functional
Services utilization
Average cost
Case-mix weight**1st and 2nd Episodes, 0 to 13 Therapy Visits+C47**C1
F1
S1
$1,276.66
0.5549C1
F1
S2
1,781.15
0.7742C1
F1
S3
2,220.16
0.9650C1
F1
S4
2,664.52
1.1582C1
F1
S5
3,048.51
1.3251C1
F2
S1
1,498.09
0.6512C1
F2
S2
2,002.59
0.8705C1
F2
S3
2,441.60
1.0613C1
F2
S4
2,885.95
1.2544C1
F2
S5
3,269.94
1.4213C1
F3
S1
1,659.16
0.7212C1
F3
S2
2,163.65
0.9405C1
F3
S3
2,602.66
1.1313C1
F3
S4
3,047.02
1.3244C1
F3
S5
3,431.00
1.4914C2
F1
S1
1,660.77
0.7219C2
F1
S2
2,165.26
0.9412C2
F1
S3
2,604.27
1.1320C2
F1
S4
3,048.63
1.3251C2
F1
S5
3,432.61
1.4921C2
F2
S1
1,882.20
0.8181C2
F2
S2
2,386.69
1.0374C2
F2
S3
2,825.70
1.2282C2
F2
S4
3,270.06
1.4214C2
F2
S5
3,654.04
1.5883C2
F3
S1
2,043.27
0.8881C2
F3
S2
2,547.76
1.1074C2
F3
S3
2,986.77
1.2983C2
F3
S4
3,431.12
1.4914C2
F3
S5
3,815.11
1.6583C3
F1
S1
2,146.21
0.9329C3
F1
S2
2,650.71
1.1522C3
F1
S3
3,089.72
1.3430C3
F1
S4
3,534.07
1.5362C3
F1
S5
3,918.06
1.7031C3
F2
S1
2,367.65
1.0291C3
F2
S2
2,872.14
1.2484C3
F2
S3
3,311.15
1.4393C3
F2
S4
3,755.50
1.6324C3
F2
S5
4,139.49
1.7993C3
F3
S1
2,528.71
1.0992C3
F3
S2
3,033.21
1.3184C3
F3
S3
3,472.22
1.5093C3
F3
S4
3,916.57
1.7024C3
F3
S5
4,300.56
1.8693**1st and 2nd Episodes, 14 to 19 Therapy Visits**C1
F1
S1
3,467.92
1.5074C1
F1
S2
3,897.27
1.6940C1
F1
S3
4,173.18
1.8140C1
F2
S1
3,738.71
1.6251C1
F2
S2
4,168.06
1.8117C1
F2
S3
4,443.97
1.9317C1
F3
S1
3,897.46
1.6941C1
F3
S2
4,326.81
1.8807C1
F3
S3
4,602.72
2.0007C2
F1
S1
4,007.46
1.7419C2
F1
S2
4,436.82
1.9285C2
F1
S3
4,712.73
2.0485C2
F2
S1
4,278.26
1.8596C2
F2
S2
4,707.61
2.0463C2
F2
S3
4,983.52
2.1662C2
F3
S1
4,437.00
1.9286( print page 33428)C2
F3
S2
4,866.36
2.1153C2
F3
S3
5,142.26
2.2352C3
F1
S1
4,725.69
2.0541C3
F1
S2
5,155.05
2.2407C3
F1
S3
5,430.95
2.3607C3
F2
S1
4,996.48
2.1718C3
F2
S2
5,425.84
2.3584C3
F2
S3
5,701.75
2.4784C3
F3
S1
5,155.23
2.2408C3
F3
S2
5,584.59
2.4274C3
F3
S3
5,860.49
2.5474**3rd+ Episodes, 0 to 13 Therapy Visits**C1
F1
S1
1,489.51
0.6474C1
F1
S2
2,141.27
0.9307C1
F1
S3
2,582.64
1.1226C1
F1
S4
3,010.78
1.3087C1
F1
S5
3,397.44
1.4768C1
F2
S1
1,908.02
0.8294C1
F2
S2
2,559.78
1.1127C1
F2
S3
3,001.15
1.3045C1
F2
S4
3,429.29
1.4906C1
F2
S5
3,815.95
1.6587C1
F3
S1
2,315.18
1.0063C1
F3
S2
2,966.94
1.2896C1
F3
S3
3,408.31
1.4815C1
F3
S4
3,836.46
1.6676C1
F3
S5
4,223.12
1.8357C2
F1
S1
1,630.03
0.7085C2
F1
S2
2,281.79
0.9918C2
F1
S3
2,723.16
1.1837C2
F1
S4
3,151.31
1.3698C2
F1
S5
3,537.97
1.5378C2
F2
S1
2,048.54
0.8904C2
F2
S2
2,700.30
1.1737C2
F2
S3
3,141.67
1.3656C2
F2
S4
3,569.81
1.5517C2
F2
S5
3,956.47
1.7198C2
F3
S1
2,455.71
1.0674C2
F3
S2
3,107.47
1.3507C2
F3
S3
3,548.84
1.5426C2
F3
S4
3,976.98
1.7287C2
F3
S5
4,363.64
1.8967C3
F1
S1
2,108.84
0.9166C3
F1
S2
2,760.60
1.1999C3
F1
S3
3,201.97
1.3918C3
F1
S4
3,630.11
1.5779C3
F1
S5
4,016.77
1.7460C3
F2
S1
2,527.34
1.0986C3
F2
S2
3,179.10
1.3819C3
F2
S3
3,620.47
1.5737C3
F2
S4
4,048.62
1.7598C3
F2
S5
4,435.28
1.9279C3
F3
S1
2,934.51
1.2755C3
F3
S2
3,586.27
1.5588C3
F3
S3
4,027.64
1.7507C3
F3
S4
4,455.78
1.9368C3
F3
S5
4,842.44
2.1049**3rd+ Episodes, 14 to 19 Therapy Visits**C1
F1
S1
3,475.35
1.5106C1
F1
S2
3,770.07
1.6387C1
F1
S3
4,194.44
1.8232C1
F2
S1
3,869.61
1.6820C1
F2
S2
4,164.33
1.8101C1
F2
S3
4,588.70
1.9946C1
F3
S1
4,168.65
1.8120C1
F3
S2
4,463.37
1.9401( print page 33429)C1
F3
S3
4,887.74
2.1246C2
F1
S1
4,154.10
1.8057C2
F1
S2
4,448.82
1.9338C2
F1
S3
4,873.19
2.1182C2
F2
S1
4,548.37
1.9770C2
F2
S2
4,843.08
2.1051C2
F2
S3
5,267.45
2.2896C2
F3
S1
4,847.40
2.1070C2
F3
S2
5,142.12
2.2351C2
F3
S3
5,566.49
2.4196C3
F1
S1
4,880.57
2.1214C3
F1
S2
5,175.29
2.2495C3
F1
S3
5,599.66
2.4340C3
F2
S1
5,274.84
2.2928C3
F2
S2
5,569.55
2.4209C3
F2
S3
5,993.92
2.6054C3
F3
S1
5,573.87
2.4228C3
F3
S2
5,868.59
2.5509C3
F3
S3
6,292.96
2.7354**All Episodes, 20+ Therapy Visits**C1
F1
S1
5,309.73
2.3080C1
F1
S1
5,799.87
2.5210C1
F1
S1
6,362.32
2.7655C2
F2
S1
5,893.47
2.5617C2
F2
S1
6,383.61
2.7748C2
F2
S1
6,946.06
3.0192C3
F3
S1
6,705.95
2.9149C3
F3
S1
7,196.09
3.1279C3
F3
S1
7,758.55
3.3724
 9. On pages 25430-25431, in Table 12a: NRS Case-Mix Adjustment Variables and Scores, the table is corrected to read as follows: Table 12
                        a
                        .—NRS Case-Mix Adjustment Variables and Scores
Description
ScoreSelected Skin Conditions:1
Primary diagnosis = Anal fissure, fistula and abscess
192
Primary diagnosis = Cellulitis and abscess
133
Primary diagnosis = Gangrene
104
Primary diagnosis = Malignant neoplasms of skin
165
Primary diagnosis = Non-pressure and non-stasis ulcers
106
Primary diagnosis = Other infections of skin and subcutaneous tissue
197
Primary diagnosis = Post-operative Complications 1
328
Primary diagnosis = Post-operative Complications 2
239
Primary diagnosis = Traumatic Wounds and Burns
1610
Other diagnosis = Anal fissure, fistula and abscess
811
Other diagnosis = Cellulitis and abscess
612
Other diagnosis = Gangrene
1113
Other diagnosis = Non-pressure and non-stasis ulcers
814
Other diagnosis = Other infections of skin and subcutaneous tissue
715
Other diagnosis = Post-operative Complications 1
1516
Other diagnosis = Post-operative Complications 2
1517
Other diagnosis = Traumatic Wounds and Burns
718
M0450 = 1 pressure ulcer, stage 1 or 2
1219
M0450 = 2 or 3 pressure ulcers, stage 1 or 2
2020
M0450 = 4+ pressure ulcers, stage 1 or 2
3021
M0450 = 1 pressure ulcer, stage 3
3122
M0450 = 2 pressure ulcers, stage 3
4123
M0450 = 3+ pressure ulcers, stage 3
5724
M0450 = 1 pressure ulcer, stage 4
5225
M0450 = 2 pressure ulcers, stage 4
8026
M0450 = 3+ pressure ulcers, stage 4
10427
M0450e = 1(unobserved pressure ulcer(s))
16( print page 33430)28
M0476 = 2 (status of most problematic stasis ulcer: early/partial granulation)
1829
M0476 = 3 (status of most problematic stasis ulcer: not healing)
2830
M0488 = 3 (status of most problematic surgical wound: not healing)
1831
M0488 = 2 (status of most problematic surgical wound: early/partial granulation)
5Other Clinical Factors:32
M0550 = 1 (ostomy not related to inpt stay/no regimen change)
2133
M0550 = 2 (ostomy related to inpt stay/regimen change)
3534
Any “Selected Skin Conditions” AND M0550 = 1 (ostomy not related to inpt stay/no regimen change)
2235
Any “Selected Skin Conditions” AND M0550 = 2 (ostomy related to inpt stay/regimen change)
736
M0250 (Therapy at home) = 1 (IV/Infusion)
1137
M0470 = 2 or 3 (2 or 3 stasis ulcers)
1738
M0470 = 4 (4 stasis ulcers)
3439
M0520 = 2 (patient requires urinary catheter)
17
 10. On page 25444, after Table 23b entitled “Proposed National 60-Day Episode Amounts Updated by the Estimated Home Health Market Basket Update for CY 2008, Before Case-Mix Adjustment, Wage Index Adjustment Based on the Site of Service for the Beneficiary or Applicable Payment Adjustment for Episodes Beginning and Ending in CY 2008,” in the first column, in the first full paragraph, in lines 14 through 43, the sentence “Therefore, to calculate an episode's prospective payment amount * * *” and ending with the sentence “The resulting amount is the national case-mix and wage adjusted national standardized 60-day episode payment rate for that particular episode” is corrected to read as follows: “To calculate an episode's prospective payment amount, take the non-adjusted national standardized 60-day episode payment rate and multiply it by the appropriate case-mix weight from Table 5 of this rule. Next, multiply the case-mix adjusted national standardized 60-day episode payment by the labor portion (77.082 percent); multiply this result by the appropriate wage index factor listed in Addendum A or B to wage-adjust the 60-day episode payment. Next multiply the case-mix adjusted national standardized 60-day episode payment by 22.918 percent to compute the non-labor portion. Add this result to the wage-adjusted labor portion to get the case-mix and wage adjusted national 60-day episode payment without NRS. Calculate the NRS amount by multiplying the episode's NRS weight (taken from Table 11 of this proposed rule) by the NRS conversion factor. This adjusted NRS payment is added to the case-mix and wage-adjusted national standardized 60-day episode payment. The resulting amount is the case-mix and wage-adjusted national standardized 60-day episode payment rate including NRS for that particular episode.” 11. On page 25447, in the 12th line, the figure “0.22198” is corrected to read “0.22918”. 12. On page 25459, in Addendum A, a. In the first column, in line 29, the Wage Index for “Massachusetts” the figure “1.0661” is corrected to read “1.1662”. b. In the second column, in line 15, the superscript “1” which appears after “New Jersey” is deleted. c. In the third column, in lines 17 through 22, the footnote “1” at the end of Addendum A, the sentence “All counties within the State are classified as rural. No short-term acute care hospitals are located in the area(s)” is corrected to read as follows: “There are no short-term, acute care hospitals located in rural area(s) in Massachusetts from which to calculate a wage index for CY 2008.” (Catalog of Federal Domestic Assistance Program No. 93.773, Medicare—Hospital Insurance; and Program No. 93.774, Medicare—Supplementary Medical Insurance Program) Dated: June 12, 2007. Ann C. Agnew, Executive Secretary to the Department.


[FR Doc. 07-2987 Filed 6-13-07; 11:55 am] BILLING CODE 4120-01-P