Federal Register / Vol. 78, No. 192 / Thursday, October 3, 2013 / Rules and Regulations 61197 

V. Response to Comments 

Because of the large number of public 

comments we normally receive on 

Federal Register documents, we are not 

able to acknowledge or respond to them 

individually. We will consider all 

comments we receive by the date and 

time specified in the DATES section of 

this preamble, and, when we proceed 

with a subsequent document, we will 

respond to the comments in the 

preamble to that document. 

VI. Regulatory Impact Statement 

We have examined the impact of this 

rule as required by Executive Order 

12866 on Regulatory Planning and 

Review (September 30, 1993), Executive 

Order 13563 on Improving Regulation 

and Regulatory Review (January 18, 

2011), the Regulatory Flexibility Act 

(RFA) (September 19, 1980, Pub. L. 

96–354), section 1102(b) of the Social 

Security Act, section 202 of the 

Unfunded Mandates Reform Act of 1995 

(March 22, 1995, Pub. L. 104–4), 

Executive Order 13132 on Federalism 

(August 4, 1999) and the Congressional 

Review Act (5 U.S.C. 804(2)). 

Executive Orders 12866 and 13563 

direct agencies to assess all costs and 

benefits of available regulatory 

alternatives and, if regulation is 

necessary, to select regulatory 

approaches that maximize net benefits 

(including potential economic, 

environmental, public health and safety 

effects, distributive impacts, and 

equity). Executive Order 13563 

emphasizes the importance of 

quantifying both costs and benefits, of 

reducing costs, of harmonizing rules, 

and of promoting flexibility. A 

regulatory impact analysis (RIA) must 

be prepared for major rules with 

economically significant effects ($100 

million or more in any 1 year). The 

monetary impact of this final rule is 

approximately a $15 million increase in 

payments to hospitals relative to the 

estimates included in the FY 2014 IPPS/ 

LTCH PPS final rule. Therefore, this 

interim final rule with comment period 

does not reach the economic threshold 

and thus is not considered a major rule. 

The RFA requires agencies to analyze 

options for regulatory relief of small 

entities if a rule has a significant impact 

on a substantial number of small 

entities. For purposes of the RFA, small 

entities include small businesses, 

nonprofit organizations, and small 

governmental jurisdictions. Most 

hospitals and most other providers and 

suppliers are small entities, either by 

nonprofit status or by having revenues 

of less than $7.0 million to $35.5 

million in any 1 year. Individuals and 

States are not included in the definition 

of a small entity. For purposes of the 

RFA, all hospitals and other providers 

and suppliers are considered to be small 

entities. Individuals and States are not 

included in the definition of a small 

entity. We believe that this interim final 

rule with comment period will have an 

impact on small entities. 

In addition, section 1102(b) of the Act 

requires us to prepare a regulatory 

impact analysis if a rule may have a 

significant impact on the operations of 

a substantial number of small rural 

hospitals. This analysis must conform to 

the provisions of section 604 of the 

RFA. With the exception of hospitals 

located in certain New England 

counties, for purposes of section 1102(b) 

of the Act, we define a small rural 

hospital as a hospital that is located 

outside a metropolitan statistical area 

and has fewer than 100 beds. Section 

601(g) of the Social Security 

Amendments of 1983 (Pub. L. 98–21) 

designated hospitals in certain New 

England counties as belonging to the 

adjacent urban area. Thus, for purposes 

of the IPPS and the LTCH PPS, we 

continue to classify these hospitals as 

urban hospitals. (We refer readers to 

Table I in section I.G. of the Appendix 

for the FY 2014 IPPS/LTCH PPS final 

rule for the quantitative effects of the 

final policy changes under the IPPS for 

operating costs.) 

Section 202 of the Unfunded 

Mandates Reform Act of 1995 also 

requires that agencies assess anticipated 

costs and benefits before issuing any 

rule whose mandates require spending 

in any 1 year of $100 million in 1995 

dollars, updated annually for inflation. 

In 2013, that threshold is approximately 

$141 million. This interim final rule 

with comment period will have no 

consequential effect on State, local, or 

tribal governments, nor will it affect 

private sector costs. 

Executive Order 13132 establishes 

certain requirements that an agency 

must meet when it promulgates a final 

rule that imposes substantial direct 

requirement costs on State and local 

governments, preempts State law, or 

otherwise has Federalism implications. 

Since this regulation does not impose 

any costs on State or local governments, 

the requirements of Executive Order 

13132 are not applicable. 

In accordance with the provisions of 

Executive Order 12866, this rule was 

not reviewed by the Office of 

Management and Budget. 

(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, 2013. 

Marilyn Tavenner, 

Administrator, Centers for Medicare & 

Medicaid Services. 

Approved: September 27, 2013. 

Kathleen Sebelius, 

Secretary, Department of Health and Human 

Services. 

[FR Doc. 2013–24209 Filed 9–30–13; 4:15 pm] 

BILLING CODE 4120–01–P 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Centers for Medicare & Medicaid 

Services 

42 CFR Parts 412, 482, 485, and 489 

[CMS–1599 & 1455–CN2] 

RINs 0938–AR53 and 0938–AR73 

Medicare Program; Hospital Inpatient 

Prospective Payment Systems for 

Acute Care Hospitals and the LongTerm Care Hospital Prospective 

Payment System and Fiscal Year 2014 

Rates; Quality Reporting Requirements 

for Specific Providers; Hospital 

Conditions of Participation; Payment 

Policies Related to Patient Status; 

Corrections 

AGENCY: Centers for Medicare & 

Medicaid Services (CMS), HHS. 

ACTION: Final rule; correction. 

SUMMARY: This document corrects 

technical and typographical errors in 

the final rules that appeared in the 

August 19, 2013 Federal Register titled 

‘‘Medicare Program; Hospital Inpatient 

Prospective Payment Systems for Acute 

Care Hospitals and the Long-Term Care 

Hospital Prospective Payment System 

and Fiscal Year 2014 Rates; Quality 

Reporting Requirements for Specific 

Providers; Hospital Conditions of 

Participation; Payment Policies Related 

to Patient Status.’’ 

DATES: This correcting document is 

effective October 1, 2013. 

FOR FURTHER INFORMATION CONTACT: Tzvi 

Hefter, (410) 786–4487. 

SUPPLEMENTARY INFORMATION:

I. Background 

In FR Doc. 2013–18956, which 

appeared in the August 19, 2013 

Federal Register (78 FR 50496), there 

were a number of technical errors that 

are identified and corrected in the 

Correction of Errors section. The 

provisions in this correction document 

are effective as if they had been 

included in the document that appeared 

in the August 19, 2013 Federal Register. 


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61198 Federal Register / Vol. 78, No. 192 / Thursday, October 3, 2013 / Rules and Regulations 

Accordingly, the corrections are 

effective October 1, 2013. 

II. Summary of Errors 

A. Errors in the Preamble 

On page 50546, in our discussion of 

the four new procedure codes, we 

inadvertently made a typographical 

error in the effective date. 

On page 50591, we made a 

typographical error in the number of 

hospitals approved for reclassification 

in FY 2013. 

On pages 50630, 50631, 50634, 50641, 

and 50642, in our discussion of 

disproportionate share hospitals (DSHs), 

we made inadvertent errors in the: (1) 

Actuarial estimate of the aggregate 

amount of Medicare DSH payments for 

FY 2014 without regard to section 

1886(r)(1) of the Social Security Act (the 

Act); (2) actuarial estimate of the 

aggregate amount of empirically 

justified Medicare DSH payments for FY 

2014 with the application of section 

1886(r)(1) of the Act; (3) calculation of 

Factor 1; (4) determination of the 

amount available for uncompensated 

care payments for 2014; and (5) number 

of hospitals that we projected to be 

eligible to receive a Medicare DSH 

payment in FY 2014. 

On page 50678, in our discussion of 

Hospital Value-Based Purchasing 

(HVBP) Program FY 2014 payment 

details, we made an inadvertent error in 

the slope of the linear exchange 

function that was used to calculate the 

updated proxy value-based incentive 

payment adjustment factors in Table 

16A. 

On page 50772, in our discussion of 

the LTCH PPS 25-percent threshold 

payment adjustment, we inadvertently 

misstated the time period for the 

application of the policy. 

On page 50859, in our discussion of 

LTCH CARE Data, we inadvertently 

misstated commenter’s statement. 

On page 50867, in our discussion of 

the LTCH Quality Reporting (LTCHQR) 

Program, we made a technical error in 

describing a type of claim-based 

measure. 

On pages 50854, 50855, 50856, 50862, 

50864, 50866, and 50876 in our 

discussion of the LTCHQR Program, we 

made grammatical errors. 

On pages 50855, 50858, 50859, 50860, 

50861, 50871, 50876, 50879, 50880, 

50881, and 50882 in our discussion 

regarding the LTCHQR Program 

measures, we made typographical and 

technical errors in referencing an NQFendorsed measure name. 

B. Summary of Errors in and Corrections 

to Files and Tables Posted on the CMS 

Web Site 

1. Errors and Corrections to the 

Medicare DSH Files 

Supplemental Medicare DSH File.— 

FY 2014 Uncompensated Care Payment 

Factors. For the FY 2014 IPPS/LTCH 

PPS Final Rule, we published a list of 

hospitals that we identified to be 

subsection (d) hospitals and subsection 

(d) Puerto Rico hospitals eligible to 

receive empirically justified Medicare 

DSH payment adjustments and 

uncompensated care payments for FY 

2014. As stated in the FY 2014 IPPS/

LTCH PPS final rule (78 FR 50642), we 

allowed the public an additional period 

after the issuance of the final rule to 

contact us with comments on whether 

any of the hospitals should be removed 

from the list or if any hospitals should 

be added to the list, based on their 

subsection (d) status. Based on the 

comments received during this 

additional period, we are making 

several corrections to the Supplemental 

Medicare DSH File. First, in calculating 

Factor 3 of the uncompensated care 

payment methodology, we inadvertently 

excluded the FY 2011 SSI days and the 

Medicaid days from the most recently 

available 2011 or 2010 cost report for 

certain providers that were projected to 

receive Medicare DSH in FY 2014. 

These providers had submitted their 

2010 and/or 2011 Medicare hospital 

cost reports to their Medicare contractor 

prior to the March 2013 update of 

HCRIS but the Medicare contactor had 

been unable to upload either the 2010 

or 2011 Medicare hospital cost reports 

in a timely manner to be included in the 

March 2013 update of HCRIS. As a 

result, the Medicaid days for these 

providers were inadvertently excluded 

from the calculation of Factor 3. In 

addition, due to a programming error, 

these providers had SSI days reported 

for their FY 2011 SSI ratios that were 

inadvertently excluded in the 

calculation of their Factor 3. The 

Medicaid days and SSI days for these 

providers were excluded from the 

numerator of Factor 3 for the affected 

providers and from the denominator of 

Factor 3 for all providers. Second, as a 

result of the exclusion of these Medicare 

hospital cost reports from the March 

2013 update of HCRIS, the Medicare 

DSH payments for these providers were 

not included in the Office of the 

Actuary’s Medicare DSH estimates for 

the calculation of Factor 1. Third, seven 

providers listed as eligible to receive 

Medicare DSH payments are no longer 

subsection(d) hospitals and have been 

removed from the list of hospitals 

eligible to receive empirically justified 

Medicare DSH payment adjustments 

and uncompensated care payments for 

FY 2014. We are changing the number 

of hospitals that are eligible to receive 

empirically justified Medicare DSH 

payment adjustments and 

uncompensated care payments for FY 

2014. In order to correct these errors, we 

have revised Factor 3 for all hospitals to 

incorporate the changes to the data. 

Specifically, to account for the removal 

of hospitals that are not subsection (d) 

hospitals and the addition of data for 

the two hospitals whose data was 

inadvertently excluded from the 

calculation of Factor 3, we have 

recalculated the denominator of Factor 

3 for all hospitals. In addition, we have 

also recalculated the numerator of 

Factor 3 for the hospitals that had data 

inadvertently excluded. We have also 

revised Factor 1 to include in our 

estimates the Medicare DSH payments 

for the providers whose Medicare 

hospital cost report data was not 

included in the March 2013 update of 

HCRIS. 

2. Errors in and Corrections to the IPPS 

Tables 

We are correcting the errors in the 

following IPPS tables that are listed on 

page 51002 of FY 2014 IPPS/LTCH PPS 

final rule and are available on the 

Internet on the CMS Web site at http:// 

www.cms.gov/Medicare/Medicare-Feefor-Service-Payment/

AcuteInpatientPPS/FY-2014-IPPSProposed-Rule-Home-Page.html: 

In Table 2.—Acute Care Hospitals 

Case-Mix Indexes for Discharges 

Occurring in Federal Fiscal Year 2012; 

Hospital Wage Indexes for Federal 

Fiscal Year 2014; Hospital Average 

Hourly Wages for Federal Fiscal Years 

2012 (2008 Wage Data), 2013 (2009 

Wage Data), and 2014 (2010 Wage Data); 

and 3-Year Average of Hospital Average 

Hourly Wages. We determined that we 

used incorrect wages and hours for 

provider 040029 located in core-based 

statistical area (CBSA) 30780. Therefore, 

we are correcting the FY 2014 wage 

indexes for the following providers in, 

or reclassified into, CBSA 30780: 

040007, 040014, 040016, 040029, 

040036, 040041, 040071, 040074, 

040084, 040114, 040119, 040134, 

040137, and 040147. In addition, for 

provider 040029, we are correcting the 

average hourly wage FY 2014, and the 

average hourly wage (3 Years). We also 

are making a correction to the FY 2014 

wage index of provider 330386 because 

we inadvertently did not treat provider 

330386 as being redesignated under 

section 1886(d)(8)(B) of the Act to CBSA 

39100. By treating provider 330386 as 


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Federal Register / Vol. 78, No. 192 / Thursday, October 3, 2013 / Rules and Regulations 61199 

being redesignated under section 

1886(d)(8)(B) of the Act to CBSA 39100, 

the reclassified wage index of CBSA 

39100 is changing as well. Since 

provider 330224 is reclassifying into 

CBSA 39100, provider 330224’s FY 

2014 wage index is being corrected 

accordingly. 

In Table 3A.—FY 2014 and 3-Year 

Average Hourly Wage for Acute Care 

Hospitals in Urban Areas by CBSA. We 

determined that we used incorrect 

wages and hours for provider 040029 

located in CBSA 30780. Therefore, we 

are correcting the FY 2014 average 

hourly wage and the 3-year average 

hourly wage for CBSA 30780, Little 

Rock-North Little Rock-Conway, AR. 

In Table 4A.—Wage Index and Capital 

Geographic Adjustment Factor (GAF) for 

Urban Areas by CBSA and by State—FY 

2014. We determined that we used 

incorrect wages and hours for provider 

040029 located in CBSA 30780. 

Therefore, for CBSA 30780, Little RockNorth Little Rock-Conway, AR, we are 

correcting the data in the columns titled 

‘‘Wage Index’’ and ‘‘GAF.’’ 

In Table 4C.—Wage Index and Capital 

Geographic Adjustment Factor (GAF) 

For Hospitals That Are Reclassified by 

CBSA and by State—FY 2014. We 

determined that we used incorrect 

wages and hours for provider 040029 

located in CBSA 30780. Therefore, for 

CBSA 30780, Little Rock-North Little 

Rock-Conway, AR, we are correcting the 

data in the columns titled ‘‘Wage Index’’ 

and ‘‘GAF.’’ We are also correcting the 

data in the columns titled ‘‘Wage Index’’ 

and ‘‘GAF’’ for CBSA 39100, 

Poughkeepsie-Newburgh-Middletown, 

NY, because we inadvertently did not 

treat provider 330386 as being 

redesignated under section 

1886(d)(8)(B) of the Act to CBSA 39100, 

and therefore, we inadvertently 

excluded the data of provider 330386 

from the calculation of the wage index 

and GAF for CBSA 39100. 

In Table 4J.—Out-Migration 

Adjustment for Acute Care Hospitals— 

FY 2014. First, the column titled 

‘‘Reclassified for FY 2013’’ is being 

corrected to read ‘‘Reclassified for FY 

2014’’. Second, we determined that we 

used incorrect wages and hours for 

provider 040029 located in CBSA 

30780. As a result, we are adjusting the 

wage index for CBSA 30780, which, in 

turn, changes the out-migration 

adjustment of certain providers located 

in counties that are receiving an outmigration adjustment based on 

commuting into a county located within 

CBSA 30780. Specifically, we are 

correcting the value in the column titled 

‘‘Out-Migration Adjustment’’ of 

providers 040014, 040071, and 040076. 

Third, we inadvertently did not treat 

provider 330386 as being redesignated 

under section 1886(d)(8)(B) of the Act to 

CBSA 39100. Because we had not 

treated provider 330386 as being 

redesignated under section 

1886(d)(8)(B) of the Act, we had listed 

provider 330386 in Table 4J as receiving 

the out-migration adjustment. However, 

since a hospital that is redesignated 

under section 1886(d)(8)(B) of the Act 

cannot simultaneously receive the outmigration adjustment, we are correcting 

Table 4J for provider 330386 by placing 

an asterisk in the column titled 

‘‘Reclassified for FY 2014’’ (previously 

incorrectly titled ‘‘Reclassified for FY 

2013’’), indicating that this provider is 

not receiving the out-migration 

adjustment. 

In Table 9A.—Hospital 

Reclassifications and Redesignations— 

FY 2014. We inadvertently did not treat 

provider 330386 as being redesignated 

from rural to urban under section 

1886(d)(8)(B) of the Act. We are 

correcting Table 9A to include provider 

330386 as being redesignated from the 

geographic CBSA of 33 to the 

reclassified CBSA of 39100, and 

indicating LUGAR in the column titled 

‘‘LUGAR’’. 

In Table 15.—FY 2014 Readmissions 

Adjustment Factors, we are correcting a 

technical error in the calculation of the 

readmissions adjustment factors. For 

some hospitals, we inadvertently 

included high cost outlier payments 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 2014 IPPS/ 

LTCH final rule. As specified in the 

definitions in § 412.152, the base 

operating DRG payment amount does 

not include any additional payments for 

high cost outliers under subpart F of 42 

CFR part 412. The technical correction 

to the determination of the base 

operating DRG payment amounts 

changes the readmissions payment 

adjustment factor for some hospitals in 

Table 15 by a small amount. 

In Table 16A.—Updated Proxy 

Hospital Inpatient Value-Based 

Purchasing (VBP) Program Adjustment 

Factors for FY 2014. Due to a technical 

error in including high cost outlier 

payments for some hospitals in the 

proxy Hospital VBP Program adjustment 

factors calculations, we are correcting 

the proxy Hospital VBP Program 

adjustment factors for all hospitals 

listed in the table. 

3. Errors in and Corrections to a LTCH 

PPS Table 

We are also correcting the errors in 

the following LTCH PPS table that is 

listed on page 51002 of the FY 2014 

IPPS/LTCH PPS final rule and that 

available on the Internet on the CMS 

Web site at http://www.cms.gov/

Medicare/Medicare-Fee-for-ServicePayment/LongTermCare HospitalPPS/

index.html. 

Table 12A.—LTCH PPS Wage Index 

for Urban Areas for Discharges 

Occurring from October 1, 2013 through 

September 30, 2014. Due to a technical 

error found in the data of a provider in 

CBSA 30780, we are correcting the 

LTCH PPS wage index value for that 

CBSA. 

III. Waiver of Proposed 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)). 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 and typographical errors in 

the preamble 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 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. 


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61200 Federal Register / Vol. 78, No. 192 / Thursday, October 3, 2013 / Rules and Regulations 

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 

because it is in the public’s interest for 

providers to receive appropriate 

payments in as timely a manner as 

possible. 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. 

Correction of Errors 

In FR Doc. 2013–18956 of August 19, 

2013 (78 FR 50496), make the following 

corrections: 

A. Corrections of Errors in the Preamble 

1. On page 50546, first column, 

second full paragraph, lines 17 and 18, 

the date, ‘‘October 1, 2014’’ is corrected 

to read ‘‘October 1, 2013.’’ 

2. On page 50591, third column, last 

full paragraph, line 15, the figure ‘‘196’’ 

is corrected to read ‘‘169’’. 

3. On page 50630, third column, last 

paragraph, 

a. Line 12, the figure ‘‘$12.772’’ is 

corrected to read ‘‘$12.775’’. 

b. Line 26, the figure ‘‘$3.193’’ is 

corrected to read ‘‘$3.194’’. 

4. On page 50631, first column, first 

paragraph, line 3, the figure ‘‘$9.579’’ is 

corrected to read ‘‘$9.581’’. 

5. On page 50634, first column, 

second full paragraph, 

a. Line 9, the figure ‘‘$9.033’’ is 

corrected to read ‘‘$9.035’’. 

b. Line 10, the figure ‘‘9.579’’ is 

corrected to read ‘‘$9.581’’. 

6. On page 50641, third column, 

second full paragraph, 

a. Line 12, the figure ‘‘2,695’’ is 

corrected to read ‘‘2687’’. 

b. Line 17, the figure ‘‘2,437’’ is 

corrected to read ‘‘2430’’. 

7. On page 50642, first column, first 

paragraph, 

a. Line 2, 

(1) The figure ‘‘2,437’’ is corrected to 

read ‘‘2,430’’. 

(2) The figure ‘‘72’’ is corrected to 

read ‘‘71’’. 

b. Line 7, the figure ‘‘2,437’’ is 

corrected to read ‘‘2430’’. 

8. On page 50678, top two-thirds of 

the page, second column, partial 

paragraph, line 30, the figure 

‘‘1.8363321306’’ is corrected to read 

‘‘1.8363054116.’’ 

9. On page 50772, bottom third of the 

page, second column, third paragraph, 

lines 9 through 11, the phrase ‘‘applied 

to discharges occurring on or after 

October 1, 2013.’’ is corrected to read 

‘‘applied for cost reporting periods 

beginning on or after October 1, 2013.’’ 

10. On page 50854, first column, 

a. First full paragraph, last two lines, 

the phrase ‘‘testing and development’’ is 

corrected to read ‘‘measure testing and 

development’’. 

b. Second full paragraph, 

(1) Line 8, the phrase ‘‘that are fully’’ 

is corrected to read ‘‘that are either 

fully’’. 

(2) Last line through the second 

column first partial paragraph line 1, the 

phrase ‘‘why a particular measure is 

high priority’’ is corrected to read ‘‘why 

particular measures are high priority’’. 

11. On page 50855, 

a. First column, second full 

paragraph, lines 31 through 33, the 

phrase ‘‘when LTCHs are required to 

submit data on the new measures we 

included in the proposed rule.’’ is 

corrected to read ‘‘LTCHs are required 

to submit data on the new measures.’’ 

b. Second column, first partial 

paragraph, line 9, the phrase ‘‘we refer 

readers to that final rule’’ is corrected to 

read ‘‘we refer readers to the FY 2013 

IPPS/LTCH PPS final rule’’. 

c. Third column, 

(1) First partial paragraph, lines 7 and 

8, the phrase ‘‘More specifically, this 

commenter’’ is corrected to read ‘‘More 

specifically, these commenters’’. 

(2) Last paragraph, line 6, the phrase 

‘‘compliance for October 1, 2012’’ is 

corrected to read ‘‘compliance for the 

October 1, 2012’’. 

12. On page 50856, 

a. Upper third of the page, first 

column, second partial paragraph, line 

4, the phrase ‘‘that it will use’’ is 

corrected to read ‘‘that we will use’’. 

b. Lower two-thirds of the page, third 

column, last paragraph, lines 13 and 14, 

the phrase ‘‘an healthcare-associated 

infection (HAI)’’ is corrected to read ‘‘a 

healthcare-associated infection (HAI)’’. 

13. On page 50858, lower two-thirds 

of the page, second column, last 

paragraph, line 3, the phrase ‘‘NQF 

#0680, Percentage’’ is corrected to read 

‘‘NQF #0680, Percent’’. 

14. On pages 50859, 

a. Upper third of the page, in the 

table, PROPOSED TIMELINE FOR 

SUBMISSION OF LTCHQR PROGRAM 

QUALITY DATA FOR THE FY 2016 

AND FY 2017 PAYMENT 

DETERMINATIONS: NQF #0680 

PERCENTAGE OF RESIDENTS OR 

PATIENTS WHO WERE ASSESSED 

AND APPROPRIATELY GIVEN THE 

SEASONAL INFLUENZA VACCINE 

[Short Stay], in the table heading, line 

2, the phrase ‘‘PERCENTAGE OF 

RESIDENTS’’ is corrected to read 

‘‘PERCENT OF RESIDENTS’’. 

b. Lower two-thirds of the page, 

second column, 

(1) Third full paragraph, line 18, the 

phrase ‘‘calculation of the measure’’ is 

corrected to read ‘‘calculation and 

public reporting of the measure’’. 

(2) Last paragraph, line 2, the phrase 

‘‘CMS align the data’’ is corrected to 

read ‘‘CMS update the data’’. 

15. On page 50860, 

a. First column, first partial 

paragraph, line 18, the phrase ‘‘LTCHs 

to show if’’ is corrected to read ‘‘LTCHs 

to report whether’’. 

b. Second column, second paragraph, 

line 19, the parenthetical phrase ‘‘(shortstay)’’ is corrected to read ‘‘(ShortStay)’’. 

c. Third column, 

(1) Third full paragraph, 

(a) Lines 13 and 14, the parenthetical 

phrase ‘‘(short-stay)’’ is corrected to read 

‘‘(Short-Stay)’’. 

(b) Line 17, the parenthetical phrase 

‘‘(short-stay)’’ is corrected to read 

‘‘(Short-Stay)’’. 

(c) Line 26, the phrase ‘‘measure and 

endorsement by’’ is corrected to read 

‘‘measure and endorsed by’’. 

(2) Last paragraph, lines 5 and 6, the 

parenthetical phrase ‘‘(short-stay)’’ is 

corrected to read ‘‘(Short-Stay)’’. 

16. On page 50861, upper half of the 

page, 

a. Third column, partial paragraph, 

line 5, the parenthetical phrase ‘‘(shortstay)’’ is corrected to read ‘‘(ShortStay)’’. 

b. In the table, FINAL TIMELINE FOR 

SUBMISSION OF LTCHQR PROGRAM 

QUALITY DATA FOR THE FY 2016 

AND FY 2017 PAYMENT 

DETERMINATIONS: NQF #0680 

PERCENTAGE OF RESIDENTS OR 

PATIENTS WHO WERE ASSESSED 

AND APPROPRIATELY GIVEN THE 

SEASONAL INFLUENZA VACCINE 

[Short Stay], in the table heading, line 

2, the phrase ‘‘PERCENTAGE OF 

RESIDENTS’’ is corrected to read 

‘‘PERCENT OF RESIDENTS’’. 

17. On page 50862, 

a. First column, third full paragraph, 

lines 5 and 6, the phrase, ‘‘setting and 

NQF endorsement for LTCH setting’’ is 

corrected to read ‘‘setting and to obtain 

NQF endorsement for the LTCH 

setting’’. 

b. Second column, 

(1) First full paragraph, lines 23 and 

24, the phrase ‘‘SNF/nursing home 

patient population’’ is corrected to read 

‘‘SNF/nursing home short-stay resident 

population’’. 

(2) Second full paragraph, line 4, the 

phrase ‘‘ulcers and is committed’’ is 

corrected to read ‘‘ulcers, and we are 

committed’’. 

18. On page 50864, second column, 


sroberts on DSK5SPTVN1PROD with RULES
Federal Register / Vol. 78, No. 192 / Thursday, October 3, 2013 / Rules and Regulations 61201 

a. First full paragraph, line 5, the 

phrase ‘‘commenters urge’’ is corrected 

to read ‘‘commenters urged’’. 

b. Third full paragraph, line 1, the 

phrase ‘‘noted it is’’ is corrected to read 

‘‘noted that is it’’. 

19. On page 50866, second column, 

first partial paragraph, line 19, the 

phrase ‘‘and measuring infection rates 

is’’ is corrected to read ‘‘and measuring 

infection rates are’’. 

20. On page 50867, 

a. First column, second full 

paragraph, line 11, the phrase ‘‘LTCHQR 

measure scores’’ is corrected to read 

‘‘LTCHQR Program measures scores’’. 

b. Third column, first partial 

paragraph, line 9, the phrase ‘‘claimsbased MRSA’’ is corrected to read 

‘‘claims-based CDI’’. 

21. On page 50869, third column, first 

full paragraph, lines 22 and 23, the 

phrase ‘‘discharge, or the date of patient 

death’’ is corrected to read ‘‘discharge or 

until the date of the patient’s death’’. 

22. On page 50870, first full 

paragraph, lines 5 and 6, the phrase 

‘‘discharge date, or date of death’’ is 

corrected to read ‘‘discharge or until the 

date of the patient’s death’’. 

23. On page 50871, 

a. Second column, last paragraph, line 

6, the phrase ‘‘but note that but note 

that’’ is corrected to read ‘‘but note 

that’’. 

b. Third column, third full paragraph, 

line 11, the phrase ‘‘are typically not’’ 

is corrected to read ‘‘is typically not’’. 

24. On page 50872, 

a. First column, last paragraph, lines 

10 and 11, the phrase ‘‘LTCH 

harmonizes’’ is corrected to read ‘‘LTCH 

readmission measure harmonizes’’. 

b. Second column, third full 

paragraph, 

(1) Line 1, the phrase ‘‘Some 

comments’’ is corrected to read ‘‘Some 

commenters’’. 

(2) Line 5, the phrase ‘‘They suggest’’ 

is corrected to read ‘‘They suggested’’. 

25. On page 50873, 

a. Second column, 

(1) First full paragraph, line 25, the 

phrase ‘‘readmissions are considered’’ is 

corrected to read ‘‘readmissions were 

considered’’. 

(2) Last paragraph, lines 1 and 2, the 

phrase ‘‘The two years of data for each 

report period’’ is corrected to read ‘‘The 

2 years of data for each reporting 

period’’. 

b. Third column, first full paragraph, 

line 1, the phrase ‘‘Some commenters 

are’’ is corrected to read ‘‘Some 

commenters were’’. 

26. On page 50875, second column, 

first full paragraph, 

a. Line 1, the phrase ‘‘We note that,’’ 

is corrected to read ‘‘We noted that,’’. 

b. Line 14, the phrase ‘‘LTCH setting’’ 

is corrected to read ‘‘the LTCH setting’’. 

27. On page 50876, second column, 

a. First partial paragraph, line 1, the 

phrase ‘‘but it concluded’’ is corrected 

to read ‘‘it concluded’’. 

b. Last paragraph, line 14 through the 

third column first partial paragraph, the 

sentences ‘‘In this instance, for example, 

an application of the Percent of 

Residents Experiencing One or More 

Falls with Major Injury (Long Stay) 

measure (NQF #0674) is NQF-endorsed 

for the LTCH setting, an indication that 

it is appropriate for LTCH patients. In 

addition, this measure is appropriate in 

light of the fact that fall-related injury is 

an important patient safety concern for 

LTCH patients. For the reasons listed 

above, this measure is appropriate for 

LTCH patients.’’ are corrected to read 

‘‘In light of the TEP feedback and the 

fact that fall-related injury is an 

important patient safety concern for 

patients in health care settings, 

including LTCHs, this measure is 

appropriate for the LTCHQR Program.’’ 

28. On page 50879, 

a. First column, fourth full paragraph 

(section heading), line 5, the 

parenthetical phrase ‘‘(Short Stay)’’ is 

corrected to read ‘‘(Short-Stay)’’. 

b. Second column, 

(1) First partial paragraph, line 1, the 

parenthetical phrase ‘‘(Short Stay)’’ is 

corrected to read ‘‘(Short-Stay)’’. 

(2) First full paragraph, 

(a) Line 8, the page reference 

‘‘277322’’ is corrected to read ‘‘27732’’. 

(b) Lines 16 and 17, the phrase ‘‘Data 

collection and submission of this 

measure will continue’’ is corrected to 

read ‘‘We proposed in the FY 2014 

IPPS/LTCH PPS proposed rule (78 FR 

27722 and 27723) that data collection 

and submission for this measure would 

continue’’. 

29. On page 50880, upper half of the 

page, the table, TIMELINE FOR 

SUBMISSION OF LTCHQR PROGRAM 

QUALITY DATA FOR THE FY 2016 

PAYMENT DETERMINATION: NQF 

#0680 PERCENTAGE OF RESIDENTS 

OR PATIENTS WHO WERE ASSESSED 

AND APPROPRIATELY GIVEN THE 

SEASONAL INFLUENZA VACCINE 

(SHORT STAY), in the table heading, 

a. Line 2, the phrase ‘‘PERCENTAGE 

OF RESIDENTS’’ is corrected to read 

‘‘PERCENT OF RESIDENTS’’. 

b. Line 3, the parenthetical phrase 

‘‘(SHORT STAY)’’ is corrected to read 

‘‘(SHORT-STAY)’’. 

30. On page 50881, lower two-thirds 

of the page, the table, TIMELINE FOR 

SUBMISSION OF LTCHQR PROGRAM 

QUALITY DATA FOR THE FY 2017 

PAYMENT DETERMINATION: NQF 

#0680 PERCENTAGE OF RESIDENTS 

OR PATIENTS WHO WERE ASSESSED 

AND APPROPRIATELY GIVEN THE 

SEASONAL INFLUENZA VACCINE 

(SHORT STAY), in the table heading, 

a. Line 2, the phrase ‘‘PERCENTAGE 

OF RESIDENTS’’ is corrected to read 

‘‘PERCENT OF RESIDENTS’’. 

b. Line 3, the parenthetical phrase 

‘‘(SHORT STAY)’’ is corrected to read 

‘‘(SHORT-STAY)’’. 

31. On page 50882, lower two-thirds 

of the page, 

a. In the table, TIMELINE FOR 

SUBMISSION OF LTCHQR PROGRAM 

QUALITY DATA FOR THE FY 2018 

PAYMENT DETERMINATION FOR ALL 

MEASURES EXCEPT #0431 

INFLUENZA VACCINATION 

COVERAGE AMONG HEALTH CARE 

PERSONNEL AND #0680 PERCENTAGE 

OF RESIDENTS OR PATIENTS WHO 

WERE ASSESSED AND 

APPROPRIATELY GIVEN THE 

SEASONAL INFLUENZA VACCINE 

(SHORT STAY), in the table heading, 

(1) Line 2, the phrase ‘‘EXCEPT 

#0431’’ is corrected to read ‘‘EXCEPT 

NQF #0431’’. 

(2) Lines 1 and 2, the phrase ‘‘# 0680 

PERCENTAGE OF RESIDENTS’’ is 

corrected to read ‘‘NQF # 0680 

PERCENT OF RESIDENTS’’. 

(3) Line 3, the parenthetical phrase 

‘‘(SHORT STAY)’’ is corrected to read 

‘‘(SHORT-STAY)’’. 

b. In the table TIMELINE FOR 

SUBMISSION OF LTCHQR PROGRAM 

QUALITY DATA FOR THE FY 2018 

PAYMENT DETERMINATION: #0680 

PERCENTAGE OF RESIDENTS OR 

PATIENTS WHO WERE ASSESSED 

AND APPROPRIATELY GIVEN THE 

SEASONAL INFLUENZA VACCINE 

(SHORT STAY), in the table heading, 

(1) Lines 2 and 3, the phrase ‘‘# 0680 

PERCENTAGE OF RESIDENTS’’ is 

corrected to read ‘‘NQF # 0680 

PERCENT OF RESIDENTS’’. 

(2) Line 4, the parenthetical phrase 

‘‘(SHORT STAY)’’ is corrected to read 

‘‘(SHORT-STAY)’’. 

32. On page 50887, second column, 

first full paragraph, line 2, the phrase 

‘‘two-percentage point reduction’’ is 

corrected to read ‘‘2.0 percentage point 

reduction’’. 

(Catalog of Federal Domestic Assistance 

Program No. 93.778, Medical Assistance 

Program) 

(Catalog of Federal Domestic Assistance 

Program No. 93.773, Medicare—Hospital 

Insurance; and Program No. 93.774, 

Medicare—Supplementary Medical 

Insurance Program) 


sroberts on DSK5SPTVN1PROD with RULES
61202 Federal Register / Vol. 78, No. 192 / Thursday, October 3, 2013 / Rules and Regulations 

Dated: September 30, 2013. 

Oliver Potts, 

Deputy Executive Secretary to the 

Department, Department of Health and 

Human Services. 

[FR Doc. 2013–24211 Filed 9–30–13; 4:15 pm] 

BILLING CODE 4120–01–P 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Centers for Medicare & Medicaid 

Services 

42 CFR Parts 413 and 424 

[CMS–1446–CN] 

RIN 0938–AR65 

Medicare Program; Prospective 

Payment System and Consolidated 

Billing for Skilled Nursing Facilities for 

FY 2014; Correction 

AGENCY: Centers for Medicare & 

Medicaid Services (CMS), HHS. 

ACTION: Final rule; correction. 

SUMMARY: This document corrects 

technical errors that appeared in the 

final rule published in the August 6, 

2013, Federal Register entitled 

‘‘Medicare Program; Prospective 

Payment System and Consolidated 

Billing for Skilled Nursing Facilities for 

FY 2014.’’ 

DATES: These corrections are effective 

October 1, 2013. 

FOR FURTHER INFORMATION CONTACT: John 

Kane, (410) 786–0557. 

SUPPLEMENTARY INFORMATION: 

I. Background 

In FR Doc. 2013–18776 of August 6, 

2013 (78 FR 47936), there were a 

number of technical errors that are 

identified and corrected in the 

Correction of Errors section below. The 

provisions in this correction document 

are effective as if they had been 

included in FR Doc. 2013–18776 

published August 6, 2013, hereinafter 

referred to as the FY 2014 SNF PPS final 

rule. Accordingly, the corrections are 

effective October 1, 2013. 

II. Summary of Errors 

A. Summary of Errors in the Preamble 

On page 47958, in our discussion of 

consolidated billing, a citation to the 

Medicare Claims Processing Manual 

(CMS Publication 100–04) was 

inadvertently abbreviated incorrectly. 

On page 47963, in our discussion of 

ensuring accuracy in grouping to 

rehabilitation RUG–IV categories, a 

citation to the Medicare Benefit Policy 

Manual (CMS Publication 100–02) was 

inadvertently abbreviated incorrectly. 

B. Summary of Errors in the Addenda 

On pages 47969 through 47975, in 

Table A: FY 2014 Wage Index for Urban 

Areas Based on CBSA Labor Market 

Areas, we inadvertently included 

several incorrect urban area titles for 

certain core-based statistical areas 

(CBSAs). As the result of receiving a 

corrected hospital cost report file, we 

also determined that we had 

inadvertently used incorrect wage data 

in calculating the wage index value for 

CBSA 30780 (Little Rock-North Little 

Rock-Conway AR), producing an 

incorrect wage index value for this 

CBSA. 

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)). 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. 

We find for good cause that it is 

unnecessary to undertake notice and 

comment rulemaking because this 

document merely provides technical 

corrections to the FY 2014 SNF PPS 

final rule in the preamble and addenda. 

We are not making substantive changes 

to our payment methodologies or 

policies, but rather, are simply 

implementing correctly the payment 

methodologies and policies that we 

previously proposed, received comment 

on, and subsequently finalized. This 

correction document is intended solely 

to ensure that the FY 2014 SNF PPS 

final rule accurately reflects these 

payment methodologies and policies. 

Therefore, we believe that undertaking 

further notice and comment rulemaking 

activity in connection with it would be 

unnecessary and contrary to the public 

interest. 

Further, we believe a delayed 

effective date is unnecessary because 

this correction document merely 

corrects inadvertent technical errors. 

The corrections noted above do not 

make any substantive changes to the 

SNF PPS payment methodologies or 

policies. Moreover, we regard imposing 

a delay in the effective date as being 

contrary to the public interest. We 

believe that it is in the public interest 

for providers to receive appropriate SNF 

PPS payments in as timely a manner as 

possible and to ensure that the FY 2014 

SNF PPS final rule accurately reflects 

our payment methodologies, payment 

rates, and policies. Therefore, we find 

good cause to waive notice and 

comment procedures, as well as the 30- 

day delay in effective date. 

Correction of Errors 

In FR Doc. 2013–18776 of August 6, 

2013 (78 FR 47936), make the following 

corrections: 

A. Corrections to the Preamble 

1. On page 47958, third column, first 

paragraph, lines 30 and 31, the 

parenthetical citation ‘‘(see Pub. L. 100– 

04, ch. 6, § 20.4)’’ is corrected to read 

‘‘(see Pub. 100–04, ch. 6, § 20.4)’’. 

2. On page 47963, first column, third 

full paragraph, lines 10 and 11, the 

parenthetical citation ‘‘(see Pub. L. 100– 

02, ch. 8, § 30.6)’’ is corrected to read 

‘‘(see Pub. 100–02, ch. 8, sec. 30.6)’’. 

B. Corrections to the Addendum 

1. On pages 47969 through 47975 in 

Table A—FY 2014 Wage Index for 

Urban Areas Based on CBSA Labor 

Market Areas, 

a. The urban areas for the listed 

entries (CBSAs) are corrected to read as 

follows: 

CBSA 

code 

Urban area 

(constituent counties) 

Wage 

index 

12420 ..... Austin-Round RockSan Marcos, TX.0.9576 

12540 ..... Bakersfield-Delano, 

CA.

1.1579 

13644 ..... Bethesda-RockvilleFrederick, MD.1.0319 

16740 ..... Charlotte-GastoniaRock Hill, NC-SC.0.9447 

22744 ..... Fort Lauderdale-Pompano Beach-Deerfield, FL.1.0378 

b. The wage index for the listed entry 

(CBSA 30780) is corrected to read as 

follows: 


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