```

[Federal Register Volume 76, Number 186 (Monday, September 26, 2011)]
[Rules and Regulations]
[Pages 59256-59263]
From the Federal Register Online via the Government Printing Office [www.gpo.gov]
[FR Doc No: 2011-24671]

=======================================================================
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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare & Medicaid Services

42 CFR Part 412

[CMS-1349-CN]
RIN 0938-AQ28

Medicare Program; Inpatient Rehabilitation Facility Prospective 
Payment System for Federal Fiscal Year 2012; Changes in Size and Square 
Footage of Inpatient Rehabilitation Units and Inpatient Psychiatric 
Units; 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 Federal Register on August 5, 2011 entitled 
``Medicare Program; Inpatient Rehabilitation Facility Prospective 
Payment System for Federal Fiscal Year 2012; Changes in Size and Square 
Footage of Inpatient Rehabilitation Units and Inpatient Psychiatric 
Units,'' (hereinafter FY 2012 IRF PPS final rule (76 FR 47836)).

DATES: Effective Date. The corrections are effective October 1, 2011.

FOR FURTHER INFORMATION CONTACT: Susanne Seagrave, (410) 786-0044.

SUPPLEMENTARY INFORMATION: 

I. Background

    There were technical errors in the August 5, 2011 FY 2012 IRF PPS 
final rule (76 FR 47836). These technical errors are identified and 
corrected in the ``Summary of Errors'' and ``Correction of Errors'' 
sections below. The provisions in this correction document are 
effective as if they were included in the final rule published on 
August 5, 2011. Accordingly, the corrections are effective October 1, 
2011.

II. Summary of Errors

    In the August 5, 2011 final rule (76 FR 47836), we applied our 
established formula for calculating the relative weight values for 
case-mix groups (CMG). The CMG relative weight values for CMGs 1201, 
1202, 1203, 1301, 1302, and 1303 in Table 1 on pages 47842 through 
47844 of the final rule did not reflect our policy that the relative 
weight values for higher-paying tiers must always be greater than or 
equal to the relative weight values for lower-paying tiers. That is, a 
tier 1 payment for a given CMG must always be at least as high as a 
tier 2 payment for that same CMG, the tier 2 payment must always be at 
least as high as the tier 3 payment, and the tier 3 payment must always 
be at least as high as the ``no-comorbidity'' tier payment. We have 
used this policy in calculating the CMG relative weights since the 
inception of the IRF PPS. However, we inadvertently did not apply this 
policy correctly for CMGs 1201, 1202, 1203, 1301, 1302, and 1303 in 
Table 1 on pages 47842 through 47844 of the FY 2012 IRF PPS final rule.
    Further, as discussed in ``Step 4'' in the CMG relative weights 
discussion, column 1, on page 47841 of the FY 2012 IRF PPS final rule, 
we normalized the FY 2012 CMG relative weights to the same average CMG 
relative weight values from the FY 2011 IRF PPS notice (75 FR 42836). 
As this process utilized the incorrect values that had been listed for 
the relative weight values for CMGs 1201, 1202, 1203, 1301, 1302, and 
1303, upon correction we also needed to reapply the normalization 
process to the other CMGs using the corrected relative weight values. 
This process corrects the relative weight values for all CMGs so that 
we are appropriately applying the policy of normalizing the FY 2012 CMG 
relative weights to the same average CMG relative weight values from 
the FY 2011 IRF PPS notice.
    Since the FY 2012 payment rates listed in Table 11 on pages 47865 
through 47866 of the final rule are based on the CMG relative weights 
in Table 1 (the payment rates are equal to the CMG relative weights 
multiplied by the FY 2012 Standard Payment Conversion Factor), we are 
also providing corrections to Table 11 in the final rule to reflect the 
corrections to the CMG relative weights in Table 1. In addition, we are 
correcting the example of computing the IRF FY 2012 Federal prospective 
payment in Table 12 on page 47867 of the final rule to reflect the 
correction to the unadjusted Federal prospective payment rate for CMG 
0110 (without comorbidities) from Table 11.
    Finally, we utilized the CMG payment rates reflected in Table 11 of 
the IRF PPS final rule to determine the FY 2012 outlier threshold. As 
described in the final rule, the outlier threshold is to be set so that 
the estimated total outlier payments in FY 2012 will equal 3 percent of 
total estimated payments. Since corrections to the FY 2012 payment 
rates result in slight differences in the amount of outlier payments we 
estimate for FY 2012, the use of the corrected data results in an 
outlier threshold for FY 2012 IRF PPS of $10,713. Therefore, we are 
correcting the outlier threshold amount for FY 2012 from $10,660 to 
$10,713 to ensure

[[Page 59257]]

that estimated outlier payments for FY 2012 continue to equal 3 percent 
of total estimated payments.
    We note that the corrections to the CMG relative weight values in 
Table 1 of the FY 2012 IRF PPS final rule do not affect the average 
length of stay values, which we have republished here for simplicity. 
The average length of stay values are the same values that were 
published correctly in Table 1 of the August 5, 2011 final rule (76 FR 
47836).
    As a result of the corrections to Table 1 and Table 11 of the final 
rule, as well as the correction to the FY 2012 outlier threshold 
amount, some of the numbers in Table 14 on page 47887 of the final rule 
(the IRF Impact Table for FY 2012), also need to be corrected. We are 
correcting these numbers both in Table 14 and in the preamble text that 
references Table 14.

III. Waiver of Proposed Rulemaking and Delayed Effective Date

    In accordance with the Administrative Procedure Act (APA) (5 U.S.C. 
553(b)), 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. We also ordinarily provide a 30-day 
delay in the effective date of the provisions of a rule in accordance 
with section 553(d) of the APA (5 U.S.C. 553(d)). However, we can waive 
both notice and comment procedures and the 30-day delay in effective 
date if the Secretary finds, for good cause, that such procedures are 
impracticable, unnecessary, or contrary to the public interest, and 
incorporates a statement of the finding and the reasons into the 
notice.
    The corrections that are laid out in this document were 
necessitated by an inadvertent error to accurately apply our stated 
policies as we calculated and laid out the CMG relative weight values 
in Table 1 of the FY 2012 IRF PPS final rule. As a result of those 
calculation errors, corrections were needed in Tables 1, 11, 12 and 14. 
Corrections were also needed as a result of these calculation errors in 
the places indicated above in the preamble discussion.
    Upon recognition of these calculation errors, we reviewed the 
comments that were submitted in response to our FY 2012 IRF PPS 
proposed rule. We found that the necessary corrections would not have 
altered the substantive content of those comments.
    As the corrections necessitated by the calculation errors outlined 
above do not change the stated policies in the FY 2012 IRF PPS final 
rule, as the policies and payment methodology expressed in the FY 2012 
IRF PPS final rule (76 FR 47836) have previously been subjected to 
notice and comment procedures, and as the public's comments would not 
have been affected if we had published the correctly calculated data 
elements, we find it unnecessary to undertake further notice and 
comment procedures with respect to this correction document. Further, 
the corrections made in this document will not significantly affect 
anticipated overall reimbursements to IRF providers and, as such, will 
only result in negligible changes to anticipated revenues and will not 
necessitate any actions on the part of individual providers. Therefore, 
we find good cause to waive notice and comment procedures and the 30-
day delay in the effective date for this correction document.

IV. Correction of Errors

    In the August 5, 2011 FY 2012 IRF PPS final rule (76 FR 47836), 
make the following corrections:
    1. On pages 47842 through 47844, Table 1, ``Relative Weights and 
Average Length of Stay Values for Case-Mix Groups,'' is corrected as 
follows:

                 Table 1--Relative Weights and Average Length of Stay Values for Case-Mix Groups
----------------------------------------------------------------------------------------------------------------
                                                    Relative weight                 Average length of stay
  CMG    CMG Description (M = motor, C = -----------------------------------------------------------------------
               cognitive, A = age)         Tier 1   Tier 2   Tier 3    None    Tier 1   Tier 2   Tier 3    None
----------------------------------------------------------------------------------------------------------------
0101...  Stroke M>51.05.................   0.7671   0.7177   0.6447   0.6098       10       10        9        8
0102...  Stroke M>44.45 and M18.5.
0103...  Stroke M>44.45 and M38.85 and M34.25 and M30.05 and M26.15 and M84.5......   2.2165   2.0738   1.8629   1.7619       31       25       23       22
0109...  Stroke M>22.35 and M53.35    0.7466   0.6128   0.5677   0.5154        8        8        7        8
          and C>23.5.
0202...  Traumatic brain injury M>44.25    1.0607   0.8707   0.8065   0.7323       12       12       10       10
          and M23.5.
0203...  Traumatic brain injury M>44.25    1.2074   0.9911   0.9181   0.8336       16       11       13       12
          and C40.65    1.2649   1.0383   0.9618   0.8733       16       12       12       12
          and M28.75    1.5974   1.3113   1.2146   1.1029       17       18       15       14
          and M22.05    1.9887   1.6325   1.5122   1.3731       23       19       19       18
          and M41.05.
0302...  Non-traumatic brain injury        1.3383   1.2039   1.0681   0.9782       12       15       13       13
          M>35.05 and M26.15 and M48.45.
0402...  Traumatic spinal cord injury      1.3772   1.1465   1.0430   0.9151       17       14       13       12
          M>30.35 and M16.05 and M63.5.
0405...  Traumatic spinal cord injury      3.8573   3.2113   2.9213   2.5632       52       39       36       29
          M51.35.
0502...  Non-traumatic spinal cord         0.9809   0.9418   0.8399   0.7444       13       13       11       10
          injury M>40.15 and M31.25 and M29.25 and M23.75 and M47.75...........   0.9452   0.7987   0.7286   0.6586       10       11        9        9

[[Page 59258]]

 
0602...  Neurological M>37.35 and          1.2511   1.0572   0.9644   0.8717       12       13       12       11
          M25.85 and          1.6157   1.3654   1.2455   1.1258       17       16       14       14
          M42.15.
0702...  Fracture of lower extremity       1.0462   1.0299   0.9919   0.8854       12       13       12       12
          M>34.15 and M28.15 and M49.55.
0802...  Replacement of lower extremity    0.7792   0.7792   0.7262   0.6630        8       11        9        9
          joint M>37.05 and M28.65 and M83.5.
0804...  Replacement of lower extremity    0.9510   0.9510   0.8863   0.8092       10       12       11       10
          joint M>28.65 and M22.05 and M44.75.......   0.8460   0.7455   0.6746   0.6112       10       10        9        8
0902...  Other orthopedic M>34.35 and      1.1316   0.9971   0.9023   0.8175       12       13       12       11
          M24.15 and      1.4493   1.2770   1.1556   1.0470       16       16       14       13
          M47.65.
1002...  Amputation, lower extremity       1.3551   1.1914   1.0645   0.9514       16       14       13       12
          M>36.25 and M36.35.
1102...  Amputation, non-lower extremity   1.5611   1.5611   1.4808   1.3897       14       18       16       16
          M37.65.........   0.8554   0.8554   0.8088   0.7645       13       13       11       10
1202...  Osteoarthritis M>30.75 and        1.1152   1.1152   1.0544   0.9966       16       16       14       13
          M36.35.
1302...  Rheumatoid, other arthritis       1.1759   1.1759   1.1632   1.0370       17       17       14       13
          M>26.15 and M48.85................   0.9405   0.7530   0.6659   0.6022       10       10        9        8
1402...  Cardiac M>38.55 and M31.15 and M49.25..............   0.9606   0.8970   0.7731   0.7308       10       11        8        9
1502...  Pulmonary M>39.05 and M29.15 and M37.15..........   1.1167   0.8790   0.7713   0.7211       12       12       10       10
1602...  Pain syndrome M>26.75 and         1.4957   1.1773   1.0331   0.9658       19       13       13       13
          M39.25.
1702...  Major multiple trauma without     1.3755   1.2242   1.1110   0.9712       13       15       14       13
          brain or spinal cord injury
          M>31.05 and M25.55 and M40.85.
1802...  Major multiple trauma with        1.6464   1.3507   1.3040   1.1927       18       20       15       15
          brain or spinal cord injury
          M>23.05 and M35.95.........   1.1440   1.0078   0.9143   0.8879       13       14       12       12
1902...  Guillian Barre M>18.05 and        2.1760   1.9170   1.7390   1.6888       22       22       21       21
          M49.15..........   0.8533   0.7540   0.6760   0.6073        9       10        9        8
2002...  Miscellaneous M>38.75 and         1.1420   1.0091   0.9047   0.8128       12       12       11       10
          M27.85 and         1.4421   1.2742   1.1425   1.0264       15       15       13       13
          M0......................   2.4686   2.1368   1.7017   1.3793       34       23       19       18
5001...  Short-stay cases, length of      .......  .......  .......   0.1474  .......  .......  .......        3
          stay is 3 days or fewer.
5101...  Expired, orthopedic, length of   .......  .......  .......   0.5851  .......  .......  .......        7
          stay is 13 days or fewer.
5102...  Expired, orthopedic, length of   .......  .......  .......   1.4705  .......  .......  .......       18
          stay is 14 days or more.
5103...  Expired, not orthopedic, length  .......  .......  .......   0.6965  .......  .......  .......        8
          of stay is 15 days or fewer.

[[Page 59259]]

 
5104...  Expired, not orthopedic, length  .......  .......  .......   1.8764  .......  .......  .......       23
          of stay is 16 days or more.
----------------------------------------------------------------------------------------------------------------

    2. On pages 47865 through 47866, Table 11, ``FY 2012 Payment 
Rates,'' is corrected as follows:

                                         Table 11--FY 2012 Payment Rates
----------------------------------------------------------------------------------------------------------------
                                            Payment rate      Payment rate      Payment rate    Payment rate  no
                   CMG                         tier 1            tier 2            tier 3          comorbidity
----------------------------------------------------------------------------------------------------------------
0101....................................        $10,797.70        $10,102.35         $9,074.80         $8,583.54
0102....................................         13,401.76         12,538.90         11,263.62         10,652.72
0103....................................         16,003.00         14,972.64         13,449.62         12,720.48
0104....................................         16,626.57         15,556.80         13,974.65         13,215.96
0105....................................         19,319.31         18,074.99         16,236.67         15,356.92
0106....................................         22,247.12         20,815.59         18,698.56         17,685.09
0107....................................         25,189.00         23,567.45         21,170.30         20,023.11
0108....................................         31,199.45         29,190.81         26,222.18         24,800.50
0109....................................         28,850.17         26,993.55         24,247.32         22,932.62
0110....................................         37,185.98         34,791.65         31,252.94         29,559.60
0201....................................         10,509.14          8,625.77          7,990.95          7,254.77
0202....................................         14,930.41         12,255.97         11,352.29         10,307.85
0203....................................         16,995.36         13,950.72         12,923.18         11,733.75
0204....................................         17,804.73         14,615.11         13,538.30         12,292.57
0205....................................         22,485.00         18,457.86         17,096.71         15,524.42
0206....................................         27,992.94         22,979.07         21,285.73         19,327.76
0207....................................         37,867.26         31,085.44         28,792.46         26,144.76
0301....................................         14,875.52         13,382.05         11,871.70         10,873.71
0302....................................         18,837.91         16,946.10         15,034.58         13,769.14
0303....................................         22,397.73         20,149.79         17,875.11         16,371.80
0304....................................         31,012.24         27,898.63         24,749.83         22,667.99
0401....................................         14,869.89         12,379.84         11,262.21          9,881.35
0402....................................         19,385.47         16,138.13         14,681.27         12,880.95
0403....................................         34,610.07         28,813.57         26,212.33         22,998.78
0404....................................         61,464.26         51,170.48         46,549.33         40,842.92
0405....................................         54,295.35         45,202.26         41,120.22         36,079.60
0501....................................          9,226.82          8,859.43          7,900.86          7,002.81
0502....................................         13,807.15         13,256.78         11,822.43         10,478.17
0503....................................         17,528.84         16,829.27         15,009.24         13,301.82
0504....................................         21,135.11         20,291.96         18,096.11         16,038.19
0505....................................         24,701.97         23,715.24         21,150.60         18,745.01
0506....................................         34,624.14         33,241.88         29,646.87         26,275.67
0601....................................         13,304.64         11,242.50         10,255.77          9,270.45
0602....................................         17,610.48         14,881.15         13,574.89         12,270.05
0603....................................         22,742.59         19,219.37         17,531.66         15,846.76
0604....................................         30,157.83         25,486.01         23,246.51         21,014.06
0701....................................         11,255.17         11,079.22         10,671.02          9,525.23
0702....................................         14,726.31         14,496.87         13,961.98         12,462.89
0703....................................         17,720.28         17,444.39         16,802.52         14,996.57
0704....................................         22,901.65         22,545.53         21,713.64         19,381.24
0801....................................          8,131.71          8,131.71          7,577.11          6,918.35
0802....................................         10,968.02         10,968.02         10,221.99          9,332.39
0803....................................         15,086.66         15,086.66         14,059.11         12,835.90
0804....................................         13,386.28         13,386.28         12,475.56         11,390.30
0805....................................         16,516.78         16,516.78         15,393.51         14,053.48
0806....................................         20,224.40         20,224.40         18,847.76         17,207.91
0901....................................         11,908.30         10,493.66          9,495.67          8,603.25
0902....................................         15,928.40         14,035.18         12,700.77         11,507.13
0903....................................         20,400.35         17,975.05         16,266.23         14,737.57
0904....................................         26,433.32         23,291.56         21,075.99         19,095.50
1001....................................         14,527.84         12,772.56         11,411.41         10,199.47
1002....................................         19,074.39         16,770.15         14,983.90         13,391.91
1003....................................         28,177.34         24,773.76         22,134.51         19,783.82
1101....................................         14,603.85         14,603.85         13,852.19         13,000.59
1102....................................         21,974.04         21,974.04         20,843.74         19,561.42
1201....................................         12,040.61         12,040.61         11,384.67         10,761.10
1202....................................         15,697.56         15,697.56         14,841.73         14,028.14

[[Page 59260]]

 
1203....................................         19,336.20         19,336.20         18,283.32         17,281.11
1301....................................         12,568.46         12,568.46         12,433.33         11,084.85
1302....................................         16,551.97         16,551.97         16,373.20         14,596.81
1303....................................         21,392.70         21,392.70         21,163.27         18,866.06
1401....................................         13,238.48         10,599.23          9,373.21          8,476.57
1402....................................         17,777.99         14,233.65         12,585.35         11,383.26
1403....................................         21,471.53         17,191.02         15,200.67         13,748.03
1404....................................         27,809.95         22,265.42         19,688.10         17,807.55
1501....................................         13,521.41         12,626.17         10,882.16         10,286.74
1502....................................         17,019.29         15,891.80         13,698.76         12,947.10
1503....................................         20,988.72         19,598.01         16,892.61         15,966.41
1504....................................         26,513.55         24,758.28         21,339.22         20,170.91
1601....................................         15,718.67         12,372.80         10,856.82         10,150.20
1602....................................         21,053.47         16,571.67         14,541.92         13,594.60
1603....................................         27,197.65         21,409.60         18,787.24         17,562.63
1701....................................         14,672.82         13,058.31         11,850.58         10,359.94
1702....................................         19,361.54         17,231.84         15,638.44         13,670.61
1703....................................         22,835.49         20,324.34         18,445.19         16,124.06
1704....................................         29,230.22         26,015.26         23,609.67         20,639.64
1801....................................         16,878.53         13,846.56         13,367.98         12,227.82
1802....................................         23,174.73         19,012.45         18,355.10         16,788.45
1803....................................         39,677.43         32,549.34         31,424.67         28,743.19
1901....................................         16,102.94         14,185.79         12,869.69         12,498.08
1902....................................         30,629.38         26,983.69         24,478.16         23,771.55
1903....................................         51,143.74         45,055.87         40,872.48         39,692.91
2001....................................         12,011.05         10,613.30          9,515.38          8,548.35
2002....................................         16,074.79         14,204.09         12,734.56         11,440.97
2003....................................         20,299.00         17,935.64         16,081.83         14,447.61
2004....................................         27,218.76         24,050.25         21,563.02         19,372.80
2101....................................         34,748.01         30,077.60         23,953.13         19,415.03
5001....................................  ................  ................  ................          2,074.80
5101....................................  ................  ................  ................          8,235.87
5102....................................  ................  ................  ................         20,698.76
5103....................................  ................  ................  ................          9,803.93
5104....................................  ................  ................  ................         26,412.21
----------------------------------------------------------------------------------------------------------------

    3. On page 47867:
    a. In table 12, ``Example of Computing the IRF FY 2012 Federal 
Prospective Payment,'' correct the entire table to read as follows:

                 Table 12--Example of Computing the IRF PPS FY 2012 Federal Prospective Payment
----------------------------------------------------------------------------------------------------------------
                                                                                Rural  Facility  Urban  Facility
            Steps                                                                 A  (Spencer      B  (Harrison
                                                                                    Co., IN)         Co., IN)
----------------------------------------------------------------------------------------------------------------
1...........................  Unadjusted Federal Prospective Payment..........     29,559.60        29,559.60
2...........................  Labor Share.....................................          0.70199          0.70199
3...........................  Labor Portion of Federal Payment................    $20,750.54       $20,750.54
4...........................  CBSA Based Wage Index (shown in the Addendum ,            0.8391           0.8896
                               Tables 1 and 2).
5...........................  Wage-Adjusted Amount............................    $17,411.78       $18,459.68
6...........................  Nonlabor Amount.................................     $8,809.06        $8,809.06
7...........................  Wage-Adjusted Federal Payment...................    $26,220.84       $27,268.74
8...........................  Rural Adjustment................................          1.184            1.0000
9...........................  Wage- and Rural-Adjusted Federal Payment........    $31,045.47       $27,268.74
10..........................  LIP Adjustment..................................          1.0228           1.0666
11..........................  FY 2012 Wage-, Rural- and LIP-Adjusted Federal      $31,753.31       $29,084.84
                               Prospective Payment Rate.
12..........................  FY 2012 Wage- and Rural-Adjusted Federal            $31,045.47       $27,268.74
                               Prospective Payment.
13..........................  Teaching Status Adjustment......................          0.0000           0.0610
14..........................  Teaching Status Adjustment Amount...............         $0.00        $1,663.39
15..........................  FY2012 Wage-, Rural-, and LIP-Adjusted Federal      $31,753.31       $29,084.84
                               Prospective Payment Rate.
16..........................  Total FY 2012 Adjusted Federal Prospective          $31,753.31       $30,748.23
                               Payment.
----------------------------------------------------------------------------------------------------------------

    b. In the 1st column, the 4th paragraph, in line 2, the amount 
``$31,771.45'' is corrected to read ``$31,753.31.''
    c. In the 1st column, the 2nd paragraph, in line 4, the amount

[[Page 59261]]

``$30,765.80'' is corrected to read ``$30,748.23.''
    4. On page 47868, in the 3rd column, in the 1st full paragraph, in 
line 6, the amount ``$10,660'' is corrected to read ``$10,713.''
    5. On page 47887, Table 14, ``IRF Impact Table for FY 2012,'' is 
corrected as follows:

[[Page 59262]]

                                                         Table 14--IRF Impact Table for FY 2012
--------------------------------------------------------------------------------------------------------------------------------------------------------
                                                                                              FY 2012
                                                                                             adjusted      FY 2012 CBSA
         Facility classification          Number of IRFs    Number  of        Outlier     market  basket    wage  index         CMG        Total percent
                                                               cases                          increase      and  labor-                       change
                                                                                            factor \1\         share
(1)                                                  (2)             (3)             (4)             (5)             (6)             (7)             (8)
--------------------------------------------------------------------------------------------------------------------------------------------------------
Total...................................           1,152         397,388            0.4%            1.8%            0.0%            0.0%            2.2%
Urban unit..............................             752         200,587             0.6             1.8            -0.1             0.0             2.3
Rural unit..............................             175          27,997             0.5             1.8             0.8             0.1             3.2
Urban hospital..........................             205         162,171             0.2             1.8             0.0             0.0             1.9
Rural hospital..........................              20           6,633             0.2             1.8             1.6            -0.1             3.5
Urban For-Profit........................             317         151,821             0.2             1.8             0.1            -0.1             2.1
Rural For-Profit........................              63          12,437             0.4             1.8             1.1             0.1             3.4
Urban Non-Profit........................             596         199,313             0.5             1.8            -0.3             0.0             2.1
Rural Non-Profit........................             122          20,442             0.5             1.8             0.7             0.1             3.1
Urban Government........................              44          11,624             0.7             1.8             0.2             0.0             2.8
Rural Government........................              10           1,751             0.9             1.8             1.3             0.1             4.1
Urban...................................             957         362,758             0.4             1.8            -0.1             0.0             2.1
Rural...................................             195          34,630             0.5             1.8             0.9             0.1             3.2
Urban by region: \2\
    Urban New England...................              32          16,393             0.4             1.8            -1.2             0.0             1.0
    Urban Middle Atlantic...............             142          66,363             0.3             1.8            -0.7             0.0             1.4
    Urban South Atlantic................             132          63,793             0.4             1.8             0.0             0.0             2.2
    Urban East North Central............             188          57,269             0.5             1.8             0.0             0.0             2.4
    Urban East South Central............              49          26,375             0.2             1.8             0.4            -0.1             2.2
    Urban West North Central............              73          18,118             0.6             1.8             0.0             0.0             2.3
    Urban West South Central............             169          66,313             0.4             1.8             0.5             0.0             2.7
    Urban Mountain......................              70          23,834             0.4             1.8             0.2            -0.1             2.3
    Urban Pacific.......................             102          24,300             0.7             1.8            -0.3             0.0             2.2
Rural by region: \2\
    Rural New England...................               6           1,354             1.0             1.9             0.7             0.1             3.7
    Rural Middle Atlantic...............              16           3,232             0.2             1.8             1.8             0.1             4.0
    Rural South Atlantic................              25           5,988             0.3             1.8             0.8             0.0             2.9
    Rural East North Central............              33           5,776             0.4             1.8             0.1             0.1             2.4
    Rural East South Central............              23           4,017             0.2             1.8             1.4             0.0             3.4
    Rural West North Central............              31           3,945             0.7             1.8            -0.2             0.1             2.5
    Rural West South Central............              50           9,261             0.5             1.8             1.6             0.1             4.0
    Rural Mountain......................               7             670             0.6             1.8             0.3             0.2             2.9
    Rural Pacific.......................               4             387             1.4             1.8            -0.4            -0.1             2.7
Teaching status:
    Non-teaching........................           1,036         345,500             0.4             1.8             0.1             0.0             2.3
    Resident to ADC less than 10%.......              69          36,878             0.5             1.8            -0.4             0.0             2.0
    Resident to ADC 10%-19%.............              33          12,497             0.6             1.8            -0.3             0.1             2.2
    Resident to ADC greater than 19%....              14           2,513             0.7             1.8            -0.7            -0.1             1.8
Disproportionate Share Patient
 Percentage (DSH):
    DSH = 0%............................              39          10,534             0.4             1.8             0.4             0.0             2.7
    DSH 20%............................             233          66,328             0.5             1.8             0.0             0.0             2.3
--------------------------------------------------------------------------------------------------------------------------------------------------------
\1\ This column reflects the impact of the rebased RPL market basket increase factor for FY 2012 of 1.8 percent, which includes a market basket update
  of 2.9 percent, a 0.1 percentage point reduction in accordance with sections 1886(j)(3)(C)(ii)(II) and 1886(j)(3)(D)(ii) of the Act and a 1.0 percent
  reduction for the productivity adjustment as required by section 1886(j)(3)(C)(ii)(I) of the Act, as finalized in 76 FR 47860.
\2\ A map of States that comprise the 9 geographic regions can be found at: http://www.census.gov/geo/www/us_regdiv.pdf.

[[Page 59263]]

    6. On page 47888:
    a. In the 1st column, in the 1st full paragraph, in line 18, the 
amount ``$10,660'' is corrected to read ``$10,713.''
    b. In the 1st column, in the 2nd full paragraph, in line 9, the 
value ``1.5'' is corrected to read ``1.4.''
    c. In the 2nd column, the 2nd full paragraph, lines 9 through 14, 
the sentence: ``The largest decrease in payments as a result of these 
updates is a 0.1 percent decrease to rural freestanding IRFs, urban 
IRFs in the East South Central and Mountain regions, and rural IRFs in 
the Pacific region.'' is corrected to read, ``The largest decrease in 
payments as a result of these updates is a 0.1 percent decrease to 
rural IRF hospitals, urban for-profit IRFs, urban IRFs in the East 
South Central and Mountain regions, rural IRFs in the Pacific region, 
and teaching IRFs with resident to ADC ratios greater than 19 
percent.''
    7. On page 47890, in the 1st column, the 2nd full paragraph, lines 
1 through 4, the sentence, ``Overall the largest payment increase is 
estimated at 4.1 percent for rural government-owned IRFs and rural IRFs 
in the West South Central region.'' is corrected to read, ``Overall, 
the largest payment increases are estimated at 4.1 percent for rural 
government-owned IRFs, and 4.0 percent for rural IRFs in the Middle 
Atlantic and West South Central regions.''

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

    Dated: September 19, 2011.
Barbara J. Holland,
Deputy Executive Secretary to the Department.
[FR Doc. 2011-24671 Filed 9-23-11; 8:45 am]
BILLING CODE 4120-01-P
```