[Federal Register Volume 89, Number 191 (Wednesday, October 2, 2024)]
[Rules and Regulations]
[Pages 80132-80134]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2024-22504]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare & Medicaid Services

42 CFR Parts 413 and 488

[CMS-1802-CN]
RIN 0938-AV30


Medicare Program; Prospective Payment System and Consolidated 
Billing for Skilled Nursing Facilities; Updates to the Quality 
Reporting Program and Value-Based Purchasing Program for Federal Fiscal 
Year 2025; Correction

AGENCY: Centers for Medicare & Medicaid Services (CMS), Department of 
Health and Human Services (HHS).

ACTION: Final rule; correction.

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SUMMARY: This document corrects technical errors in the final rule that 
appeared in the August 6, 2024 Federal Register, titled ``Medicare 
Program; Prospective Payment System and Consolidated Billing for 
Skilled Nursing Facilities (SNF); Updates to the Quality

[[Page 80133]]

Reporting Program and Value-Based Purchasing Program for Federal Fiscal 
Year 2025'' (referred to hereafter as the ``FY 2025 SNF final rule''). 
The effective date of the FY 2025 SNF final rule is October 1, 2024.

DATES: The corrections in this document are effective October 1, 2024.

FOR FURTHER INFORMATION CONTACT: Kia Burwell, (410) 786-7816.

SUPPLEMENTARY INFORMATION:

I. Background

    In FR Doc. 2024-16907 of August 6, 2024 (89 FR 64048), there were a 
number of 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 SNF final rule. Accordingly, the 
corrections are effective October 1, 2024.

II. Summary of Errors

A. Summary of Errors in the Preamble

    On page 64120, we inadvertently omitted language in regard to when 
we would apply the 2 percentage point penalty if the SNF fails to 
submit medical records within 45 days of the date on the initial 
request.
    Additionally, a technical error in the calculation of the final FY 
2025 SNF prospective payment system (PPS) wage indexes required us to 
recalculate the impact analysis provided on page 64152 in Table 39. 
Further discussions of these errors are found in section IV. of this 
document.

B. Summary of Errors and Corrections Posted on the CMS Website

    As discussed in the FY 2025 SNF final rule (89 FR 64058 through 
64061), in developing the wage index to be applied to SNFs under the 
SNF PPS, we use the updated, pre-reclassified, pre-rural floor hospital 
inpatient PPS (IPPS) wage data, exclusive of the occupational mix 
adjustment. For FY 2025, the updated, unadjusted, pre-reclassified, 
pre-rural floor IPPS wage data used under the SNF 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 in 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 document 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. The error that affects 
the unadjusted, pre-reclassified, pre-rural floor IPPS wage data and 
thereby affects the SNF PPS wage data, was an error resulting from the 
inadvertent exclusion of the Medicare cost report wage data for a 
hospital (CMS Certification Number (CCN) 260163), which caused a change 
in the wage index for rural Missouri. The wage data for this hospital 
has been restored and included in the wage index.
    As discussed previously in this section, we use the updated, pre-
reclassified, unadjusted IPPS wage data in developing the wage index 
used under the SNF PPS. Due to the technical error described previously 
in this section, the published FY 2025 SNF PPS wage indexes were 
incorrect. Thus, the use of the corrected wage data for rural Missouri 
required us to recalculate the final FY 2025 SNF PPS wage indexes. 
While correcting this wage data had no impact on the FY 2025 SNF PPS 
Federal per diem rates published in the FY 2025 SNF final rule, it did 
cause a slight change in certain results found in the impact analysis 
provided in Table 39 of the FY 2025 SNF final rule (89 FR 64152). The 
corrections to these errors are found in section IV. of this document. 
We are also correcting the wage index in Table B setting forth the wage 
indexes for rural areas based on CBSA labor market areas (Table B), 
which is available exclusively on the CMS website at https://www.cms.gov/medicare/payment/prospective-payment-systems/skilled-nursing-facility-snf/wage-index. Table B has been updated to reflect 
the error discussed in this correcting document, and we are 
republishing the wage indexes in Tables A and B accordingly on the CMS 
website at https://www.cms.gov/medicare/payment/prospective-payment-systems/skilled-nursing-facility-snf/wage-index.

III. Waiver of Proposed Rulemaking and Delay in Effective Date

    Under section 553(b) of the Administrative Procedure Act (the APA) 
(5 U.S.C. 553(b)), the agency is required to publish a notice of 
proposed rulemaking in the Federal Register before the provisions of a 
rule take effect. Similarly, section 1871(b)(1) of the Social Security 
Act (the Act) requires the Secretary to provide for notice of the 
proposed rule in the Federal Register and provide a period of not less 
than 60 days for public comment. In addition, section 553(d) of the APA 
and section 1871(e)(1)(B)(i) of the Act mandate a 30-day delay in 
effective date after issuance or publication of a rule. Sections 
553(b)(B) and 553(d)(3) of the APA provide for exceptions from the APA 
notice and comment, and delay in effective date requirements; in cases 
in which these exceptions apply, sections 1871(b)(2)(C) and 
1871(e)(1)(B)(ii) of the Act provide exceptions from the notice and 60-
day comment period and delay in effective date requirements of the Act 
as well. Section 553(b)(B) of the APA and section 1871(b)(2)(C) of the 
Act authorize an agency to dispense with normal notice and comment 
rulemaking procedures for good cause if the agency makes a finding that 
the notice and comment process is impracticable, unnecessary, or 
contrary to the public interest, and includes a statement of the 
finding and the reasons for it in the rule. In addition, section 
553(d)(3) of the APA and section 1871(e)(1)(B)(ii) allow the agency to 
avoid the 30-day delay in effective date where such delay is contrary 
to the public interest and the agency includes in the rule a statement 
of the finding and the reasons for it.
    In our view, this correcting document does not constitute a 
rulemaking that would be subject to these requirements. This document 
merely corrects technical errors in the FY 2025 SNF final rule. The 
corrections contained in this document are consistent with, and do not 
make substantive changes to, the policies and payment methodologies 
that were proposed, subject to notice and comment procedures, and 
adopted in the FY 2025 SNF final rule. As a result, the corrections 
made through this correcting document are intended to resolve 
inadvertent errors so that the rule accurately reflects the policies 
adopted in the final rule. Even if this were a rulemaking 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 FY 2025 SNF final rule or delaying the effective 
date of the corrections would be contrary to the

[[Page 80134]]

public interest because it is in the public interest to ensure that the 
rule accurately reflects our policies as of the date they take effect. 
Further, such procedures would be unnecessary because we are not making 
any substantive revisions to the final rule, but rather, we are simply 
correcting the Federal Register document to reflect the policies that 
we previously proposed, received public comment on, and subsequently 
finalized in the final rule. For these reasons, we believe there is 
good cause to waive the requirements for notice and comment and delay 
in effective date.

IV. Correction of Errors

    In FR Doc. 2024-16907 of August 6, 2024 (89 FR 64048), make the 
following corrections:
    1. On page 64120, third column, second full paragraph, lines 9 and 
10, the sentence ``If the SNF fails to submit those medical records 
within 45 days of the date on the initial request, then we would apply 
the 2 percentage point penalty to FY 2027 SNF payments.'' is corrected 
to read ``If the SNF fails to submit those medical records within 45 
days of the date on the initial request, then we would apply the 2 
percentage point penalty to the SNF's PPS payments for the applicable 
program determination year.''
    2. On page 64152, TABLE 39: Impact to the SNF PPS for FY 2025 is 
corrected to read as follows:

                                   Table 39--Impact to the SNF PPS for FY 2025
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                                                                    Census data
                Impact categories                    Number of        update        Update wage    Total change
                                                    facilities       (percent)    data (percent)     (percent)
----------------------------------------------------------------------------------------------------------------
                                                      Group
----------------------------------------------------------------------------------------------------------------
Total...........................................          15,477             0.0             0.0             4.2
Urban...........................................          11,202             0.0            -0.2             4.1
Rural...........................................           4,275            -0.1             1.0             5.1
Hospital-based urban............................             364             0.1            -1.0             3.2
Freestanding urban..............................          10,838             0.0            -0.1             4.1
Hospital-based rural............................             376            -0.1             0.8             4.9
Freestanding rural..............................           3,899            -0.1             1.0             5.1
----------------------------------------------------------------------------------------------------------------
                                                 Urban by region
----------------------------------------------------------------------------------------------------------------
New England.....................................             715            -0.3            -1.1             2.7
Middle Atlantic.................................           1,469            -1.0            -0.9             2.3
South Atlantic..................................           1,906             0.6             1.0             5.8
East North Central..............................           2,174             1.0            -0.6             4.6
East South Central..............................             568             0.4             2.3             7.0
West North Central..............................             950             0.0             0.4             4.6
West South Central..............................           1,473             0.2             0.9             5.4
Mountain........................................             541             0.1             1.5             5.8
Pacific.........................................           1,401            -0.1            -1.4             2.6
Outlying........................................               5             0.0            -2.5             1.5
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                                                 Rural by region
----------------------------------------------------------------------------------------------------------------
New England.....................................             120             0.6            -1.4             3.4
Middle Atlantic.................................             226            -0.7             3.8             7.4
South Atlantic..................................             532            -0.1             0.4             4.5
East North Central..............................             897            -0.1             0.5             4.6
East South Central..............................             475            -0.1             1.6             5.8
West North Central..............................             990             0.0             1.2             5.4
West South Central..............................             752            -0.1             1.0             5.1
Mountain........................................             195             0.0             1.8             6.0
Pacific.........................................              87             0.0            -0.7             3.5
Outlying........................................               1             0.0             0.0             4.2
----------------------------------------------------------------------------------------------------------------
                                                    Ownership
----------------------------------------------------------------------------------------------------------------
For profit......................................          10,937             0.0             0.0             4.1
Non-profit......................................           3,513             0.1             0.1             4.3
Government......................................           1,027            -0.1             0.6             4.8
----------------------------------------------------------------------------------------------------------------
Note: The Total column includes FY 2025 SNF market basket update of 4.2 percent. The values in Table 39 may not
  sum due to rounding.


Elizabeth J. Gramling,
Executive Secretary to the Department, Department of Health and Human 
Services.
[FR Doc. 2024-22504 Filed 9-27-24; 4:15 pm]
BILLING CODE 4120-01-P