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[Federal Register Volume 77, Number 192 (Wednesday, October 3, 2012)]
[Rules and Regulations]
[Pages 60315-60318]
From the Federal Register Online via the Government Printing Office [www.gpo.gov]
[FR Doc No: 2012-24307]

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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare & Medicaid Services

42 CFR Parts 412, 413, 424, and 476

[CMS-1588-CN2]
RIN 0938-AR12

Medicare Program; Hospital Inpatient Prospective Payment Systems 
for Acute Care Hospitals and the Long-Term Care Hospital Prospective 
Payment System and Fiscal Year 2013 Rates; Hospitals' Resident Caps for 
Graduate Medical Education Payment Purposes; Quality Reporting 
Requirements for Specific Providers and for Ambulatory Surgical 
Centers; Corrections

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

ACTION: Final rule; correction.

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SUMMARY: This document corrects technical errors in the final rule that 
appeared in the August 31, 2012 Federal Register entitled ``Medicare 
Program; Hospital Inpatient Prospective Payment Systems for Acute Care 
Hospitals and the Long-Term Care Hospital Prospective Payment System 
and Fiscal Year 2013 Rates; Hospitals' Resident Caps for Graduate 
Medical Education Payment Purposes; Quality Reporting Requirements for 
Specific Providers and for Ambulatory Surgical Centers.''

DATES: Effective Date: October 1, 2012.

FOR FURTHER INFORMATION CONTACT: Tzvi Hefter, (410) 786-4487.

SUPPLEMENTARY INFORMATION:

I. Background

    In FR Doc. 2012-19079 of August 31, 2012 (77 FR 53258), there were 
a number of technical errors that are identified and corrected in the 
Correction of Errors section of this correcting document. The 
provisions in this correcting document are effective as if they had 
been included in the final rule appearing in the August 31, 2012 
Federal Register. Accordingly, the corrections are effective October 1, 
2012.

II. Summary of Errors and Corrections Posted on the CMS Web Site

A. Errors in the Preamble

    On page 53268, in our summary of the provisions of the Hospital 
Inpatient Quality Reporting (IQR) Program, we inadvertently referenced 
hospital-acquired condition (HAC) measure sets

[[Page 60316]]

instead of healthcare-associated infection (HAI) measures sets. Also on 
this page, in our discussion of the cost and benefits of the Hospital 
Readmission Reduction Program, we made a technical error in the dollar 
amount by which the Hospital Readmission Reduction Program will reduce 
payments to hospitals.
    On page 53278, we made an inadvertent typographical error in the 
discussion of prospective adjustments for FY 2010 documentation and 
coding effect.
    On page 53315, in our discussion of International Classification of 
Disease, Ninth Revisions, Clinical Modification (ICD-9-CM), we 
inadvertently reference ICD-9-CM coding system instead of ICD-9-CM 
diagnosis codes.
    On pages 53386 and 53392, we made typographical errors in our 
summation of a public comment regarding the Hospital Readmission 
Reduction Program.
    On page 53387, we are correcting the Web site for obtaining the 
MedPAR files referenced in our discussion of aggregate payments for 
excess readmissions and aggregate payments for all discharges under the 
Hospital Readmission Reduction Program.
    On page 53485, in our discussion of long-term care hospital (LTCH) 
moratorium on the 25-percent payment adjustment threshold policy, we 
made typographical errors in an example.
    On page 53508, we made a grammatical error in our discussion of the 
Agency for Healthcare Research and Quality (AHRQ) indicators.
    On page 53545, in our discussion of validation approaches for the 
Hospital IQR Program, we made a typographical error.
    On page 53557, in our discussion of CDC/NHSN-based HAI measures for 
the PPS-Exempt Cancer Hospital Quality Reporting Program (PCHQR), we 
made a grammatical error.
    On page 53601, in the table regarding the final performance 
standards for the FY 2015 Hospital Value-Base Purchasing (HVBP) 
Program, we inadvertently omitted a clinical process of care measure.
    On page 53648, in our discussion of hospital-based inpatient 
psychiatric service (HBIPS) under the IPFQR Program, we made a 
typographical error.
    On page 53655, in our discussion of the reporting and submission 
requirements for 2014 IPFQR payment determinations, we inadvertently 
made technical and typographical errors in a response to a public 
comment.
    On page 53668, in our discussion of the information collection 
requirements for the LTCH Quality Reporting Program, we made two 
technical errors in describing the number of hospitals that report data 
to the National Health Safety Network (NHSN).
    On page 53669, in our discussion of the information collection 
requirements for the LTCH Quality Reporting Program, we made a 
grammatical error in our response to a comment regarding the cost 
associated with reported pressure ulcer data.

B. Errors in the Addendum

    On page 53706, in the table titled ``Comparison of Factors and 
Adjustments: FY 2012 Capital Federal Rate and FY 2013 Capital Federal 
Rate,'' there was a typographical error in the GAF/DRG Adjustment 
Factor shown for FY 2012.
    On page 53731, we made a technical error in the number and 
hospitals that we estimate will have their base operating payments 
reduced by readmission reduction program.

C. Summary of Errors in and Corrections to Tables Posted on the CMS Web 
site

    On pages 53717, we list the tables that are tables available only 
through the Internet. We are correcting the following errors in Tables 
9A, 9C, and 15:
    In Table 9A.--Hospital Reclassifications and Redesignations--FY 
2013, Provider 010164 was inadvertently omitted.
    In Table 9C.--Hospitals Redesignated as Rural under Section 
1886(d)(8)(E) of the Act--FY 2013, Provider 040118 was mistakenly 
listed as a section 401 provider and will be removed. Provider 290009 
was inadvertently omitted and will be listed as a rural 
reclassification from CBSA 39900 to CBSA 29.
    In addition, we note that the correction of errors for Tables 9A 
and 9C require us to make conforming changes to Tables 2, 4A, 4B, 4C, 
and 4J, respectively.
    In Table 15.--FY 2013 Final Readmissions Adjustment Factors, we 
inadvertently included Medicare inpatient claims from the FY 2008 
MedPAR file with discharge dates occurring prior to July 1, 2008 in 
determining the base operating DRG payment amounts in the calculation 
of aggregate payments for excess readmissions and aggregate payments 
for all discharges that were used to calculate the readmissions 
adjustment factors published for the FY 2013 IPPS/LTCH final rule. 
Under the policy we adopted in that final rule, for FY 2013, aggregate 
payments for excess readmissions and aggregate payments for all 
discharges are calculated using data from Medicare inpatient MedPAR 
claims with discharge dates occurring on or after July 1, 2008, and no 
later than June 30, 2011.

III. Waiver of Proposed Rulemaking and Delay in the 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 this 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 therefore in the notice.
    Section 553(d) of the APA ordinarily requires a 30-day delay in 
effective date of final rules after the date of their publication in 
the Federal Register. 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.
    In our view, this correcting document does not constitute a rule 
that would be subject to the APA notice and comment or delayed 
effective date requirements. This correcting document corrects 
technical errors and typographical errors in the preamble, regulations 
text, tables included in the Addendum of the FY 2013 IPPS/LTCH PPS 
final rule, and tables posted on the CMS Web site but does not make 
substantive changes to the policies or payment methodologies that were 
adopted in the final rule. As a result, this correcting document is 
intended to ensure that the preamble, regulations text, tables included 
in the Addendum of the FY 2013 IPPS/LTCH PPS final rule, and tables 
posted on the CMS Web site accurately reflect the policies adopted in 
that final rule.
    In addition, even if this were a rule to which the notice and 
comment and delayed effective date requirements applied, we find that 
there is good cause to waive such requirements. Undertaking further 
notice and comment procedures to incorporate the corrections in this 
document into the final rule or delaying the effective date would be 
contrary to the public interest. Furthermore, such procedures would be 
unnecessary, as we are not altering the policies that were already 
subject to comment and finalized in our final rule. Therefore, we 
believe we have good cause to waive the notice and comment and 
effective date requirements.

[[Page 60317]]

IV. Correction of Errors

    In FR Doc. 2012-19079 of August 31, 2012 (77 FR 53258), make the 
following corrections:

A. Corrections of Errors in the Preamble

    1. On page 53268,
    a. First column, first partial paragraph, line 10, the phrase ``HAC 
measures sets'' is corrected to read ``HAI measures sets''.
    b. Third column, last paragraph, second line from the bottom, the 
figure ``$280'' is corrected to read ``$290''.
    2. On page 53278, third column, first partial paragraph, line 32, 
the phrase ``in FY 2010.'' is correct to read ``in FY 2013.''.
    3. On page 53315, third column, last paragraph, line 4, the phrase 
``the ICD-9-CM coding system'' is corrected to read ``the ICD-9-CM 
diagnosis codes''.
    4. On page 53386, third column, third paragraph, line 7, the phrase 
``for applicable conditions.'' is deleted.
    5. On page 53387, third column, second paragraph, lines 37 and 38, 
the Web site ``http://www.cms.hhs.gov/LimitedDataSets/'' is corrected 
to read ``http://www.cms.gov/Research-Statistics-Data-and-Systems/Files-for-Order/LimitedDataSets/index.html''.
    6. On page 53392, lower half of the page, first column, first 
paragraph--
    a. Line 10, the phrase ``all discharges for applicable conditions'' 
is corrected to read ``all discharges''.
    b. Lines 12 and 13, the phrase ``all discharges for applicable 
conditions.'' is corrected to read ``all discharges.''.
    7. On page 53485, second column, first partial paragraph--
    a. Line 26, the phrase ``IPPS Hospital A'' is corrected to read 
``IPPS Hospital B''.
    b. Line 29, the phrase ``LTCH B'' is corrected to read ``LTCH A''.
    c. Line 31, the phrase ``Sec.  412.536(a)(3)(1)'' is corrected to 
read ``Sec.  412.536(a)(3)(i)''.
    8. On page 53508, second column, last paragraph, line 1, the phrase 
``We wish to clarify'' is corrected to read ``We are clarifying''.
    9. On page 53545, second column, first partial paragraph, line 5, 
the bracketed phrase ``[or catheter?]'' is corrected to read ``or 
catheter''.
    10. On page 53557, second column, first full paragraph, line 2, the 
phrase ``with other our'' is corrected to read ``with our other''.
    11. On page 53601, bottom of the page, the table entitled ``FINAL 
PERFORMANCE STANDARDS FOR THE FY 2015 HOSPITAL VBP PROGRAM CLINICAL 
PROCESS OF CARE, OUTCOME, AND EFFICIENCY DOMAINS,'' the listed entry is 
added after Measure ID AMI-8a to read as follows:

                                        Clinical Process of Care Measures
----------------------------------------------------------------------------------------------------------------
                                                                                  Achievement
                Measure ID                              Description                threshold        Benchmark
----------------------------------------------------------------------------------------------------------------
HF-1......................................  Discharge Instructions............         0.94118          1.00000
----------------------------------------------------------------------------------------------------------------

    12. On page 53648, first column, first full paragraph, lines 9 and 
10, the phrase ``physical restraint (HBIPS-2) use'' is corrected to 
``physical restraint use''
    13. On page 53655, third column, second paragraph, lines 6 and 7, 
the phrase ``behavioral services in the IPF settings'' is corrected to 
read ``behavioral health services in the IPF setting.''
    14. On page 53668,
    a. Second column, second full paragraph, line 9, the phrase ``over 
200'' is corrected to read ``upwards of 300''.
    b. Third column, first partial paragraph, lines 17 and 18, the 
phrase ``321 LTCHs'' is corrected to read ``upwards of 300 LTCHs''.
    15. On page 53669, third column, first full paragraph, lines 9 
through 11, the phrase ``to comply with the reporting pressure ulcer 
data.'' is corrected to read ``to report pressure ulcer data.''.

B. Corrections of Errors in the Addendum

    1. On page 53706, middle of the page, the table entitled, 
``COMPARISON OF FACTORS AND ADJUSTMENTS: FY 2012 CAPITAL FEDERAL RATE 
AND FY 2013 CAPITAL FEDERAL RATE,'' listed entry is corrected to read 
as follows:

----------------------------------------------------------------------------------------------------------------
                                                  FY 2012          FY 2013           Change       Percent change
----------------------------------------------------------------------------------------------------------------
GAF/DRG Adjustment Factor \1\...............          1.0004           0.9998           0.9998            -0.02
----------------------------------------------------------------------------------------------------------------
\1\ The update factor and the GAF/DRG budget neutrality adjustment factors are built permanently into the
  capital Federal rates. Thus, for example, the incremental change from FY 2012 to FY 2013 resulting from the
  application of the 0.9998 GAF/DRG budget neutrality adjustment factor for FY 2013 is a net change of 0.9998
  (or -0.02 percent).

    2. On page 53731, first column, first paragraph, line 28, the 
figure ``2,206'' is corrected to read ``2,217''.

(Catalog of Federal Domestic Assistance Program No. 93.773, 
Medicare--Hospital Insurance; and Program No. 93.774, Medicare--
Supplementary Medical Insurance Program)

    Dated: September 27, 2012.
Oliver Potts,
Deputy Executive Secretary to the Department, Department of Health and 
Human Services.
[FR Doc. 2012-24307 Filed 9-28-12; 4:15 pm]
BILLING CODE 4120-01-P
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