[Federal Register Volume 89, Number 191 (Wednesday, October 2, 2024)]
[Rules and Regulations]
[Pages 80095-80098]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2024-22496]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare & Medicaid Services

42 CFR Part 412

[CMS-1806-CN]
RIN 0938-AV32


Medicare Program; FY 2025 Inpatient Psychiatric Facilities 
Prospective Payment System--Rate Update; Correction

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

ACTION: Final action; correction.

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SUMMARY: This document corrects technical errors in the final action 
that appeared in the August 7, 2024 Federal Register titled ``Medicare 
Program; FY 2025 Inpatient Psychiatric Facilities Prospective Payment 
System--Rate Update''.

DATES: This correction is effective October 1, 2024.

FOR FURTHER INFORMATION CONTACT: 
    The IPF Payment Policy mailbox at <a href="/cdn-cgi/l/email-protection#7a332a3c2a1b03171f140e2a15161319033a19170954121209541d150c"><span class="__cf_email__" data-cfemail="054c554355647c68606b71556a696c667c456668762b6d6d762b626a73">[email protected]</span></a> for 
information regarding the IPF wage index.
    Nick Brock (410) 786-5148, for general information regarding the 
inpatient psychiatric facilities prospective payment system (IPF PPS).

SUPPLEMENTARY INFORMATION:

I. Background

    In FR Doc. 2024-16909 of August 7, 2024, the fiscal year (FY) 2025 
Inpatient Psychiatric Facilities Prospective Payment System (IPF PPS) 
final rule (89 FR 64582), there were technical errors that are 
identified and corrected in this correcting document. These corrections 
are effective as if they had been included in the FY 2025 IPF PPS final 
rule. Accordingly, the corrections are effective October 1, 2024.

II. Summary of Errors

A. Summary of Errors in the Preamble

    There was a technical error in the calculation of the final FY 2025 
IPF PPS wage indexes, which impacted several calculations. There is an 
impact to the

[[Page 80096]]

wage index for twelve providers in Core-Based Statistical Area (CBSA) 
26 for rural Missouri due to the recalculated wage indexes, and thus we 
recalculated the impact analysis provided in Table 24 of the FY 2025 
IPF PPS final rule (89 FR 64670 through 64671). Therefore, changes are 
needed to the published values in Table 24. We also recalculated the 
wage index budget neutrality factor; however, after recalculating, 
there are no changes needed to the published wage index budget 
neutrality factor because the difference between the previously 
published factor and the newly calculated factor is within the margin 
of error for rounding. This means that the recalculated wage index 
budget neutrality factor remained 0.9996 and the IPF federal per diem 
base rate remained $876.53.
    On pages 64670 and 64671, Table 24 reflects the impact to providers 
based on the inaccurate calculation of the FY 2025 IPF PPS wage index; 
therefore, Table 24 should be updated to reflect the correct 
calculations.
    On page 64672, the payment percent increase for rural areas of 
``3.8 percent'' is incorrect; therefore, ``3.8 percent'' should be 
replaced with ``3.9 percent''.

B. Summary of Errors in and Corrections to the Tables Posted on the CMS 
website for the IPF PPS Wage Index

    As discussed in the FY 2025 IPF PPS final rule (89 FR 64582), we 
used the concurrent pre-floor, pre-reclassified Inpatient Prospective 
Payment System (IPPS) hospital wage index as the basis for the IPF wage 
index. For FY 2025, concurrent pre-floor, pre-reclassified IPPS 
hospital wage data used under the IPF PPS are for cost reporting 
periods beginning on or after October 1, 2020 and before October 1, 
2021 (FY 2021 cost report data), as discussed in the final rule titled, 
``Medicare and Medicaid Programs and the Children's Health Insurance 
Program; Hospital Inpatient Prospective Payment Systems for Acute Care 
Hospitals and the Long-Term Care Hospital Prospective Payment System 
and Policy Changes and Fiscal Year 2025 Rates; Quality Programs 
Requirements; and Other Policy Changes'' (89 FR 68986) (hereinafter 
referred to as the FY 2025 IPPS final rule). In calculating the wage 
index under the FY 2025 IPPS final rule, we made an inadvertent error 
related to the calculation of the wage index. This error is identified, 
discussed, and corrected in the correction notice titled, ``Medicare 
and Medicaid Programs and the Children's Health Insurance Program; 
Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals 
and the Long-Term Care Hospital Prospective Payment System and Policy 
Changes and Fiscal Year 2025 Rates; Quality Programs Requirements; and 
Other Policy Changes; Correction'', published elsewhere in this issue 
of the Federal Register.
    In the FY 2025 Hospital Inpatient Prospective Payment Systems and 
Long-Term Care Hospital Prospective Payment System (IPPS/LTCH PPS) 
final rule (89 FR 68986), we finalized a policy to exclude hospitals 
that have subsequently converted to rural emergency hospitals (REHs) 
from the wage index. Specifically, we stated that any hospital that is 
designated as a REH by 7 days prior to the publication of the 
preliminary wage index public use file (PUF) is excluded from the 
calculation of the wage index. We inadvertently treated a current IPPS 
hospital as a hospital that had converted to REH status, thereby 
erroneously excluding its data from the wage index (CMS Certification 
Number (CCN) 26-0163). Therefore, we restored the wage data for this 
hospital to be included in the wage index.
    This error affects the unadjusted, pre-reclassified, pre-rural 
floor IPPS wage data and thereby affects the IPF PPS wage data for CBSA 
26 for rural Missouri.
    We are correcting the wage index for CBSA 26 rural Missouri in 
Table B setting forth the wage indexes for rural areas based on CBSA 
labor market areas and Table C setting forth the wage indexes for urban 
and rural areas without counties, which are available exclusively on 
the CMS website at https://www.cms.gov/medicare/medicare-fee-for-service-payment/inpatientpsychfacilpps/wageindex.
    The omitted wage data for the one hospital in CBSA 26 required the 
recalculation of the final FY 2025 IPF PPS wage indexes. Additionally, 
as discussed in the FY 2025 IPF PPS final rule (89 FR 64582), changes 
to the wage index are made in a budget neutral manner so that updates 
do not increase expenditures. Due to the recalculation and subsequent 
revision of the final FY 2025 IPF PPS wage indexes, it was necessary to 
recalculate the FY 2025 IPF PPS wage index budget neutrality factor. 
However, as discussed above, no changes are needed to the published 
wage index budget neutrality factor since the difference between the 
previously published factor and the newly calculated factor is within 
the margin of error for rounding. This means that the recalculated wage 
index budget neutrality factor remained 0.9996 and the IPF federal per 
diem base rate remained $876.53.

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.
    We believe that this correcting document does not constitute a rule 
that would be subject to the notice and comment or delayed effective 
date requirements. This document corrects technical errors in the 
preamble of the FY 2025 IPF PPS final rule, as well as two tables on 
the Centers for Medicare & Medicaid Services (CMS) website, 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 information in the FY 2025 IPF 
PPS final rule accurately reflects the policies adopted in that 
document.
    In addition, even if this were a rule to which the notice and 
comment procedures 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 because it is in the public's 
interest for IPFs to receive appropriate payments in a timely manner to 
ensure that the FY 2025 IPF PPS final rule accurately reflects our 
policies as of the date they take effect and are applicable. 
Furthermore, such procedures would be unnecessary, as we are not 
altering our payment methodologies or policies, but rather, we are 
simply correctly implementing the policies that we previously

[[Page 80097]]

proposed, received comment on, and subsequently finalized. This 
correcting document is intended solely to ensure that the FY 2025 IPF 
PPS final rule accurately reflects these payment methodologies and 
policies. For these reasons, we believe we have good cause to waive the 
notice and comment and effective date requirements.

IV. Correction of Errors in the Preamble

    In FR Doc. 2024-16909 of August 7, 2024 (89 FR 64582), make the 
following corrections:
    1. On pages 64670 and 64671, TABLE 24: FY 2025 IPF PPS PAYMENT 
IMPACTS is corrected to read as follows:

                                    Table 24--FY 2025 IPF PPS Payment Systems
                                     [Percent change in columns 3 through 6]
----------------------------------------------------------------------------------------------------------------
                                                                   Refinement of
                                     Number of                     patient-level    Wage index     Total percent
        Facility by type            facilities        Outlier       adjustments   FY25, LRS, and    change \1\
                                                                      and ECT         5% Cap
(1)                                          (2)             (3)             (4)             (5)             (6)
----------------------------------------------------------------------------------------------------------------
All Facilities..................           1,419            -0.3             0.0             0.0             2.5
    Total Urban.................           1,162            -0.3             0.0            -0.2             2.3
        Urban unit..............             645            -0.4             0.5            -0.6             2.3
        Urban hospital..........             517            -0.1            -0.5             0.2             2.5
    Total Rural.................             257            -0.1            -0.3             1.4             3.9
        Rural unit..............             197            -0.1             0.1             1.1             4.0
        Rural hospital..........              60            -0.2            -1.1             2.1             3.6
By Type of Ownership:
 Freestanding IPFs:
 Urban Psychiatric Hospitals:
            Government..........             119            -0.5             1.1            -0.6             2.7
            Non-Profit..........              97            -0.1            -0.1            -0.3             2.3
            For-Profit..........             301             0.0            -0.9             0.6             2.5
 Rural Psychiatric Hospitals:
            Government..........              30            -0.3             1.6            -0.3             3.9
            Non-Profit..........              12            -0.5            -1.5             0.3             1.0
            For-Profit..........              18             0.0            -2.3             3.7             4.2
 IPF Units:
 Urban:
            Government..........              93            -0.8             0.8            -0.1             2.7
            Non-Profit..........             430            -0.4             0.7            -0.9             2.1
            For-Profit..........             122            -0.2            -0.5             0.1             2.3
 Rural:
            Government..........              44            -0.1            -0.1             0.7             3.4
            Non-Profit..........             113            -0.2             0.4             1.2             4.3
            For-Profit..........              40            -0.1            -0.1             1.3             4.0
By Teaching Status:
    Non-teaching................           1,217            -0.2            -0.2             0.3             2.7
    Less than 10% interns and                100            -0.5             0.6            -1.1             1.9
     residents to beds..........
    10% to 30% interns and                    76            -0.6             1.2            -1.2             2.2
     residents to beds..........
    More than 30% interns and                 26            -0.7             1.2            -0.1             3.2
     residents to beds..........
By Region:
    New England.................              99            -0.4             0.9            -1.5             1.8
    Mid-Atlantic................             191            -0.4             0.3            -1.7             0.9
    South Atlantic..............             228            -0.2             0.4             1.3             4.4
    East North Central..........             225            -0.2             0.0             0.5             3.2
    East South Central..........             140            -0.1            -0.2             2.6             5.0
    West North Central..........              95            -0.5             1.1             0.0             3.4
    West South Central..........             213            -0.1            -1.2             1.6             3.2
    Mountain....................             102            -0.2            -0.3             0.8             3.1
    Pacific.....................             126            -0.3            -0.5            -1.8             0.1
By Bed Size:
 Psychiatric Hospitals:
        Beds: 0-24..............              87            -0.1            -0.9             0.8             2.5
        Beds: 25-49.............              86             0.0            -1.3             1.3             2.7
        Beds: 50-75.............              91            -0.1            -0.4             0.9             3.2
        Beds: 76 +..............             313            -0.1            -0.3             0.0             2.3
 Psychiatric Units:
        Beds: 0-24..............             440            -0.2             0.0             0.3             2.9
        Beds: 25-49.............             229            -0.3             0.5            -0.7             2.3
        Beds: 50-75.............             103            -0.4             0.7             0.1             3.2
        Beds: 76 +..............              70            -0.7             0.6            -1.2             1.5
----------------------------------------------------------------------------------------------------------------
\1\ This column includes the impact of the updates in columns (3) through (6) above, and of the IPF market
  basket percentage for FY 2025 of 3.3 percent, reduced by 0.5 percentage point for the productivity adjustment
  as required by section 1886(s)(2)(A)(i) of the Act.


[[Page 80098]]

    2. On page 64672, in the first column, in the first full paragraph, 
in line 6, ``3.8'' is corrected to read ``3.9''.

Elizabeth J. Gramling,
Executive Secretary to the Department, Department of Health and Human 
Services.
[FR Doc. 2024-22496 Filed 9-27-24; 4:15 pm]
BILLING CODE 4120-01-P


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