61184 Federal Register / Vol. 82, No. 247 / Wednesday, December 27, 2017 / Rules and Regulations 

H. Executive Order 13045: Protection of 

Children From Environmental Health 

Risks and Safety Risks 

The EPA interprets Executive Order 

13045 as applying only to those 

regulatory actions that concern 

environmental health or safety risks that 

the EPA has reason to believe may 

disproportionately affect children, per 

the definition of ‘‘covered regulatory 

action’’ in section 2–202 of the 

Executive Order. This action is not 

subject to Executive Order 13045 

because it does not concern an 

environmental health risk or safety risk. 

I. Executive Order 13211: Actions That 

Significantly Affect Energy Supply, 

Distribution, or Use 

This action is not subject to Executive 

Order 13211, because it is not a 

significant regulatory action under 

Executive Order 12866. 

J. National Technology Transfer and 

Advancement Act 

This rulemaking does not involve 

technical standards. 

K. Executive Order 12898: Federal 

Actions To Address Environmental 

Justice in Minority Populations and 

Low-Income Populations 

The EPA believes that this action does 

not have disproportionately high and 

adverse human health or environmental 

effects on minority populations, lowincome populations and/or indigenous 

peoples, as specified in Executive Order 

12898 (59 FR 7629, February 16, 1994). 

This action does not affect the level of 

protection provided to human health or 

the environment. This action corrects a 

potential conflict in the refrigerant 

management regulations as to whether 

or not small cans of refrigerant for use 

in MVAC could be sold to nontechnicians if the cans were 

manufactured or imported prior to 

January 1, 2018, and do not have a selfsealing valve. This action clarifies that 

those small cans of refrigerant for use in 

MVAC may be sold to persons who are 

not certified technicians. 

L. Congressional Review Act (CRA) 

This action is subject to the CRA, and 

EPA will submit a rule report to each 

House of the Congress and to the 

Comptroller General of the United 

States. This action is not a ‘‘major rule’’ 

as defined by 5 U.S.C. 804(2). 

List of Subjects in 40 CFR Part 82 

Environmental protection, Air 

pollution control, Chemicals, Reporting 

and recordkeeping requirements. 

Dated: December 15, 2017. 

E. Scott Pruitt, 

Administrator. 

For the reasons set forth in the 

preamble, the Environmental Protection 

Agency amends 40 CFR part 82 as 

follows: 

PART 82—PROTECTION OF 

STRATOSPHERIC OZONE 

■ 1. The authority citation for part 82 

continues to read as follows: 

Authority: 42 U.S.C. 7414, 7601, 7671– 

7671q. 

■ 2. In § 82.154, revise paragraph 

(c)(1)(ix) to read as follows: 

§ 82.154 Prohibitions. 

* * * * * 

(c) * * * 

(1) * * * 

(ix) The non-exempt substitute 

refrigerant is intended for use in an 

MVAC and is sold in a container 

designed to hold two pounds or less of 

refrigerant, has a unique fitting, and, if 

manufactured or imported on or after 

January 1, 2018, has a self-sealing valve 

that complies with the requirements of 

paragraph (c)(2) of this section. 

* * * * * 

[FR Doc. 2017–27800 Filed 12–26–17; 8:45 am] 

BILLING CODE 6560–50–P 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Centers for Medicare & Medicaid 

Services 

42 CFR Parts 414, 416, and 419 

[CMS–1678–CN] 

RIN 0938–AT03 

Medicare Program: Hospital Outpatient 

Prospective Payment and Ambulatory 

Surgical Center Payment Systems and 

Quality Reporting Programs; 

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 with comment period 

published in the Federal Register on 

December 14, 2017 entitled ‘‘Hospital 

Outpatient Prospective Payment and 

Ambulatory Surgical Center Payment 

Systems and Quality Reporting 

Programs.’’ 

DATES: Effective Date: January 1, 2018. 

FOR FURTHER INFORMATION CONTACT: Lela 

Strong (410) 786–3213. 

SUPPLEMENTARY INFORMATION: 

I. Background 

In FR Doc. R1–2017–23932 of 

December 14, 2017 (82 FR 59216), titled 

‘‘Medicare Program: Hospital Outpatient 

Prospective Payment and Ambulatory 

Surgical Center Payment Systems and 

Quality Reporting Programs’’ 

(hereinafter referred to as the CY 2018 

OPPS/ASC final rule), 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 the document published 

December 14, 2017. Accordingly, the 

corrections are effective January 1, 2018. 

We note that the CY 2018 OPPS/ASC 

final rule was originally published on 

pages 52356 through 52637 in the issue 

of Monday, November 13, 2017. In that 

publication, a section of the document 

was omitted due to a printing error. 

Therefore, on December 14, 2017, the 

CY 2018 OPPS/ASC final rule was 

republished in its entirety. Accordingly, 

any corrections made in this document 

are made to the December 14, 2017 

republished version. 

II. Summary of Errors 

A. Errors in the Preamble 

1. Hospital Outpatient Prospective 

Payment System (OPPS) Corrections 

On page 59256, we are correcting the 

OPPS weight scalar based on the 

conforming policy correction to the 

Ambulatory Payment Classification 

(APC) assignment of Healthcare 

Common Procedure Coding System 

(HCPCS) code 93880 in APC 5522 (Level 

2 Imaging without Contrast) to APC 

5523 (Level 3 Imaging without 

Contrast). 

On page 59262, we are correcting 

language related to hospital-specific 

Cost-to-Charge Ratios (CCRs) and their 

application on payments for passthrough devices. 

On pages 59269 through 59271, we 

use the payment rates available in 

Addenda A and B to display calculation 

of adjusted payment and copayment. 

Due to the correction of OPPS payment 

rates as a result of the corrected OPPS 

weight scalar, we are also correcting the 

payment and copayment numbers used 

in the example. 

On page 59277, due to the corrected 

OPPS APC geometric mean cost as a 

result of the conforming policy 

correction to the imaging without 

contrast APCs, we are correcting the list 

of APCs excepted from the 2 times rule 

for calendar year (CY) 2018. 

Specifically, we are revising Table 14 to 


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Federal Register / Vol. 82, No. 247 / Wednesday, December 27, 2017 / Rules and Regulations 61185 

include APC 5523 (Level 3 Imaging 

without Contrast) to this list, for a total 

of 12 APCs. 

On page 59295, we inadvertently 

excluded a summary of a comment and 

our response to that comment. We are 

revising the discussion to include the 

comment and response. 

On page 59311, due to the correction 

in OPPS APC geometric mean cost as a 

result of the conforming policy 

correction to the imaging without 

contrast APCs in Addendum A and 

Addendum B, we are also correcting the 

CY 2018 APC geometric mean cost for 

APC 5522 (Level 2 Imaging without 

Contrast) and APC 5523 (Level 3 

Imaging without Contrast) in Table 54 as 

well as in the OPPS Addenda A and B. 

On page 59323, we incorrectly listed 

the HCPCS code that describes Lung 

biopsy plug with delivery system as 

C2623 instead of C2613. 

On page 59369, we inadvertently 

omitted vaccines assigned to OPPS 

status indicator ‘‘F’’ from the 340B 

payment adjustment exclusion. 

Specifically, we stated in the preamble 

that ‘‘We remind readers that our 340B 

payment policy applies to only OPPS 

separately payable drugs (status 

indicator ‘‘K’’) and does not apply to 

vaccines (status indicator ‘‘L’’ or ‘‘M’’), 

or drugs with transitional pass-through 

payment status (status indicator ‘‘G’’).’’ 

We are correcting this statement to read 

‘‘We remind readers that our 340B 

payment policy applies to only OPPS 

separately payable drugs (status 

indicator ‘‘K’’) and does not apply to 

vaccines (status indicator ‘‘F’’, ‘‘L’’ or 

‘‘M’’), or drugs with transitional passthrough payment status (status indicator 

‘‘G’’).’’ In addition, we are also 

correcting the statement on page 59369 

that reads ‘‘Part B drugs or biologicals 

excluded from the 340B payment 

adjustment include vaccines (assigned 

status indicator ‘‘L’’ or ‘‘M’’) and drugs 

with OPPS transitional pass-through 

payment status (assigned status 

indicator ‘‘G’’)’’ to correctly state our 

final policy that ‘‘Part B drugs or 

biologicals excluded from the 340B 

payment adjustment include vaccines 

(assigned status indicator ‘‘F’’, ‘‘L’’ or 

‘‘M’’) and drugs with OPPS transitional 

pass-through payment status (assigned 

status indicator ‘‘G’’).’’ 

On pages 59412 through 59413, we 

are correcting a typographical error in 

the title of Table 87. 

On pages 59482 through 59483, we 

are correcting the count of excepted 

Rural Sole Community Hospitals as well 

as the count of other providers that were 

listed in regards to the 340B Program. 

On pages 59486 through 59488, we 

provided and described Table 88— 

Estimated Impact of the CY 2018 

Changes for the Hospital Outpatient 

Prospective Payment System, based on 

rates which applied an incorrect scalar. 

We have updated Table 88 and the 

description of the table to reflect the 

corrections to the scalar as a result of 

the corrections to geometric mean costs 

in APCs 5522 and 5523. 

2. Ambulatory Surgical Center (ASC) 

Payment System Corrections 

On page 59413, the discussion of ASC 

Payment for Covered Ancillary Services 

for CY 2018 was inadvertently omitted. 

We are including that discussion in this 

correcting document. 

On page 59422, we inadvertently 

published an incorrect ASC conversion 

factor of $44.663 for ASCs that do not 

meet the quality reporting requirements. 

With the correct application of our 

established policy, the corrected 2018 

ASC conversion factor for ASCs that do 

not meet the quality reporting 

requirements is $44.674. 

3. Partial Hospitalization Program 

Corrections 

On page 59375, the text states: ‘‘We 

proposed to apply our established 

methodologies in developing the CY 

2018 geometric mean per diem costs 

and payment rates, including the 

application of a ±2 standard deviation 

trim on costs per day for CMHCs and a 

CCR≤5 hospital service day trim for 

hospital-based PHP providers.’’ The less 

than or equal to sign that appears in this 

sentence is incorrect and misstates our 

trim policy. Therefore, we are correcting 

‘‘CCR≤5’’ to read ‘‘CCR>5.’’ 

B. Summary of Errors and Corrections to 

the OPPS and ASC Addenda Posted on 

the CMS Website 

1. OPPS Addenda Posted on the CMS 

Website 

The payment and copayment rates in 

Addendum A (Final OPPS APCs for CY 

2018), Addendum B (Final OPPS 

Payment by HCPCS Code for CY 2018), 

Addendum C (Final HCPCS Codes 

Payable Under the 2018 OPPS by APC), 

and the payment rates in the 2018 OPPS 

APC Offset File and the 2018 OPPS 

HCPCS Device Offset File that were 

published on the CMS website in 

conjunction with the CY 2018 OPPS/ 

ASC final rule are corrected to reflect 

the corrected assignment of HCPCS code 

93880 to APC 5522 (Level 2 Imaging 

without Contrast) and APC 5523 (Level 

3 Imaging without Contrast). 

In addition, in Addendum B, 17 

HCPCS codes were incorrectly assigned 

to OPPS status indicator ‘‘Q4’’ when 

they should have been assigned to status 

indicator ‘‘A.’’ We are correcting the 

mistake by assigning status indicator 

‘‘A’’ to these codes as shown in the 

chart that follows. 

HCPCS code Short descriptor CI SI 

81105 ........... Hpa-1 genotyping .......................................................................................................................... NC A 

81106 ........... Hpa-2 genotyping .......................................................................................................................... NC A 

81107 ........... Hpa-3 genotyping .......................................................................................................................... NC A 

81108 ........... Hpa-4 genotyping .......................................................................................................................... NC A 

81109 ........... Hpa-5 genotyping .......................................................................................................................... NC A 

81110 ........... Hpa-6 genotyping .......................................................................................................................... NC A 

81111 ........... Hpa-9 genotyping .......................................................................................................................... NC A 

81112 ........... Hpa-15 genotyping ........................................................................................................................ NC A 

81120 ........... Idh1 common variants ................................................................................................................... NC A 

81121 ........... Idh2 common variants ................................................................................................................... NC A 

81175 ........... Asxl1 full gene sequence .............................................................................................................. NC A 

81176 ........... Asxl1 gene target seq alys ............................................................................................................ NC A 

81448 ........... Hrdtry perph neurphy panel .......................................................................................................... NC A 

81520 ........... Onc breast mrna 58 genes ........................................................................................................... NC A 

81521 ........... Onc breast mrna 70 genes ........................................................................................................... NC A 

81541 ........... Onc prostate mrna 46 genes ........................................................................................................ NC A 

81551 ........... Onc prostate 3 genes .................................................................................................................... NC A 


daltland on DSKBBV9HB2PROD with RULES
61186 Federal Register / Vol. 82, No. 247 / Wednesday, December 27, 2017 / Rules and Regulations 

In Addendum M, we inadvertently 

excluded Current Procedural 

Terminology (CPT) codes 71045 

(Radiologic examination, chest; single 

view) and 71046 (Radiologic 

examination, chest; 2 views). The 

revised Addendum M includes these 

codes. CPT codes 71045 and 71046 

replaced CPT codes 71010 (Radiologic 

examination, chest; single view, frontal) 

and 71020 (Radiologic examination, 

chest, 2 views, frontal and lateral; with 

apical lordotic procedure) effective 

January 1, 2018. Since the predecessor 

codes were assigned to composite APC 

5041 (Critical Care) and APC 5045 

(Trauma Response with Critical Care) 

before January 1, 2018, the replacement 

codes are assigned to the same 

composite APCs effective January 1, 

2018. 

In Addendum P, we inadvertently 

excluded the following 7 CPT codes: 

• 0409T (Insertion or replacement of 

permanent cardiac contractility 

modulation system, including 

contractility evaluation when 

performed, and programming of sensing 

and therapeutic parameters; pulse 

generator only); 

• 0410T (Insertion or replacement of 

permanent cardiac contractility 

modulation system, including 

contractility evaluation when 

performed, and programming of sensing 

and therapeutic parameters; atrial 

electrode only); 

• 0411T (Insertion or replacement of 

permanent cardiac contractility 

modulation system, including 

contractility evaluation when 

performed, and programming of sensing 

and therapeutic parameters; ventricular 

electrode only); 

• 0414T (Removal and replacement of 

permanent cardiac contractility 

modulation system pulse generator 

only); 

• 0446T (Creation of subcutaneous 

pocket with insertion of implantable 

interstitial glucose sensor, including 

system activation and patient training); 

• 0449T (Insertion of aqueous 

drainage device, without extraocular 

reservoir, internal approach, into the 

subconjunctival space; initial device); 

and 

• 28291 (Hallux rigidus correction 

with cheilectomy, debridement and 

capsular release of the first 

metatarsophalangeal joint; with 

implant). 

CPT codes 0409T, 0410T, 0411T, 

0414T, 0446T, 0449T represent 

procedures requiring the implantation 

of medical devices that do not have yet 

have associated claims data and 

therefore have been granted deviceintensive status with a default device 

offset percentage of 41 percent, per our 

current policy outlined in the CY 2017 

OPPS/ASC final rule with comment (81 

FR 79658). CPT code 28291 replaced 

CPT code 28293 (Correction, hallux 

valgus (bunion), with or without 

sesamoidectomy; resection of joint with 

implant) which previously held the 

device-intensive designation with a 

device offset percentage of 43.78 

percent. Since the predecessor code was 

device-intensive, CPT code 28291 is 

also device-intensive status and a device 

offset percentage of 43.78 percent based 

on the offset from the predecessor code. 

To view the corrected CY 2018 OPPS 

status indicator, payment and 

copayment rates, that result from these 

technical corrections as well as CPT 

codes that were inadvertently excluded, 

we refer readers to the Addenda and 

supporting files that are posted on the 

CMS website at: http://www.cms.gov/ 

Medicare/Medicare-Fee-for-ServicePayment/HospitalOutpatientPPS/ 

index.html. Select ‘‘CMS–1678–CN’’ 

from the list of regulations. All 

corrected Addenda for this correcting 

document are contained in the zipped 

folder titled ‘‘2018 OPPS Final Rule 

Addenda’’ at the bottom of the page for 

CMS–1678–CN. 

2. ASC Payment System Addenda 

Posted on the CMS Website 

As a result of the technical corrections 

described in Section II.A. and II.B.1. of 

this correction notice, we have updated 

Addenda AA and BB to reflect the final 

corrected payment rates and indicators 

for CY 2018 for ASC covered surgical 

procedures and covered ancillary 

services. In addition, in addendum BB, 

we inadvertently included HCPCS code 

Q2040 (Tisagenlecleucel, up to 250 

million car-positive viable t cells, 

including leukapheresis and dose 

preparation procedures, per infusion) as 

a separately payable drug when 

furnished in the ASC setting. Because 

the complement of services required to 

furnish the drug described by HCPCS 

code Q2040 are not all covered ASC 

surgical procedures, we are correcting 

the error by removing HCPCS code 

Q2040 from Addendum BB. 

To view the corrected final CY 2018 

ASC payment rates and indicators that 

result from these technical corrections, 

we refer readers to the Addenda and 

supporting files on the CMS website at: 

https://www.cms.gov/Medicare/ 

Medicare-Fee-for-Service-Payment/ 

ASCPayment/ASC-Regulations-andNotices.html. Select ‘‘CMS–1678–CN’’ 

from the list of regulations. All 

corrected ASC addenda for this 

correcting document are contained in 

the zipped folder entitled ‘‘Addendum 

AA, BB, DD1, DD2, and EE’’ at the 

bottom of the page for CMS–1678–CN. 

In addition, we inadvertently 

excluded the below nine codes from the 

file labeled ‘‘CY 2018 ASC Procedures 

to which the No Cost/Full Credit and 

Partial Credit Device Adjustment Policy 

Applies’’. These nine codes were 

included as ASC device-intensive 

procedures to which the no cost/full 

credit and partial credit device 

adjustment policy applies in the CY 

2017 final rule, and we did not intend 

any changes to them for CY 2018. 

• 0409T (Insertion or replacement of 

permanent cardiac contractility 

modulation system, including 

contractility evaluation when 

performed, and programming of sensing 

and therapeutic parameters; pulse 

generator only); 

• 0410T (Insertion or replacement of 

permanent cardiac contractility 

modulation system, including 

contractility evaluation when 

performed, and programming of sensing 

and therapeutic parameters; atrial 

electrode only); 

• 0411T (Insertion or replacement of 

permanent cardiac contractility 

modulation system, including 

contractility evaluation when 

performed, and programming of sensing 

and therapeutic parameters; ventricular 

electrode only); 

• 0414T (Removal and replacement of 

permanent cardiac contractility 

modulation system pulse generator 

only); 

• 0446T (Creation of subcutaneous 

pocket with insertion of implantable 

interstitial glucose sensor, including 

system activation and patient training); 

• 0449T (Insertion of aqueous 

drainage device, without extraocular 

reservoir, internal approach, into the 

subconjunctival space; initial device); 

• 22867 (Insertion of interlaminar/ 

interspinous process stabilization/ 

distraction device, without fusion, 

including image guidance when 

performed, with open decompression, 

lumbar; single level); 

• 22869 (Insertion of interlaminar/ 

interspinous process stabilization/ 

distraction device, without open 

decompression or fusion, including 

image guidance when performed, 

lumbar; single level); and 

• 28291 (Hallux rigidus correction 

with cheilectomy, debridement and 

capsular release of the first 

metatarsophalangeal joint; with 

implant). 

To view the revised version of the 

‘‘CY 2018 ASC Procedures to which the 

No Cost/Full Credit and Partial Credit 

Device Adjustment Policy Applies,’’ we 

refer readers to the CMS website at: 


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Federal Register / Vol. 82, No. 247 / Wednesday, December 27, 2017 / Rules and Regulations 61187 

https://www.cms.gov/Medicare/ 

Medicare-Fee-for-Service-Payment/ 

ASCPayment/ASC-Policy-Files.html. 

III. Waiver of Proposed Rulemaking 

Under 5 U.S.C. 553(b) of the 

Administrative Procedure Act (APA), 

the agency is required to publish a 

notice of the proposed rule in the 

Federal Register before the provisions 

of a rule take effect. Similarly, section 

1871(b)(1) of 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) 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 notice and 

comment and delay in effective date of 

the APA 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 rulemaking requirements for 

good cause if the agency makes a 

finding that the notice and comment 

process is impracticable, unnecessary, 

or contrary to the public interest. In 

addition, both section 553(d)(3) of the 

APA and section 1871(e)(1)(B)(ii) of the 

Act allow the agency to avoid the 30- 

day delay in effective date where such 

delay is contrary to the public interest 

and an agency includes a statement of 

support. 

We believe that this correcting 

document does not constitute a 

rulemaking that would be subject to 

these requirements. This correcting 

document corrects technical and 

typographic errors in the preamble, 

addenda, payment rates, tables, and 

appendices included or referenced in 

the CY 2018 OPPS/ASC final rule but 

does not make substantive changes to 

the policies or payment methodologies 

that were adopted in the final rule. As 

a result, the corrections made through 

this correcting document are intended 

to ensure that the information in the CY 

2018 OPPS/ASC final rule accurately 

reflects the policies adopted in that rule. 

In addition, even if this were a 

rulemaking 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 providers to receive 

appropriate payments in as timely a 

manner as possible, and to ensure that 

the CY 2018 OPPS/ASC 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 proposed, received comment 

on, and subsequently finalized. This 

correcting document is intended solely 

to ensure that the CY 2018 OPPS/ASC 

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 FR Doc. R1–2017–23932 of 

December 14, 2017 (82 FR 59216), make 

the following corrections: 

1. On page 59256, third column, first 

paragraph, in line 11, correct ‘‘1.4457’’ 

to read ‘‘1.4458’’. 

2. On page 59262, second column, 

second full paragraph, in line 7, add the 

parenthetical phrase ‘‘(in cases where 

we are unable to use the implantable 

device CCR)’’ after the words ‘‘passthrough devices’’. 

3. On page 59269, 

a. Third column, last full paragraph, 

(1) In line 17, correct ‘‘$572.81’’ to 

read ‘‘$575.85.’’ 

(2) In line 21, correct ‘‘$561.35’’ to 

read ‘‘$561.39.’’ 

b. Third column, last partial 

paragraph, 

(1) In lines 5 and 6, correct ‘‘$442.53 

(.60 * $572.81 * 1.2876).’’ to read 

‘‘$442.56 (.60 * $575.85 * 1.2876).’’ 

(2) In line 9, correct ‘‘$443.68 (.60 * 

$561.35 * 1.2876).’’ to read ‘‘$443.70 

(.60 * $561.39 * 1.2876).’’ 

(3) In line 12, correct ‘‘$229.12 (.40 * 

$572.81).’’ to read ‘‘$229.14 (.40 * 

$575.85).’’ 

4. On page 59270, first column, first 

partial paragraph, 

a. In line 2, correct ‘‘$224.54 (.40 * 

$561.35).’’ to read ‘‘$224.56 (.40 * 

$561.39).’’ 

b. In lines 6 and 7, correct ‘‘$671.65 

($442.53 + $229.12).’’ to read ‘‘$671.70 

($442.56 + $229.14).’’ 

c. In lines 9 and 10, correct ‘‘$658.22 

($433.68 + $224.54).’’ to read ‘‘$658.26 

($443.70 + $224.56).’’ 

5. On page 59271, first column, 

second full paragraph, under ‘‘Step 1,’’ 

in line 8, correct ‘‘$572.81’’ to read 

‘‘$575.85.’’ 

6. On page 59277, Table 14—APC 

Exceptions to the 2 Times Rule for CY 

2018, is corrected to read as follows: 

TABLE 14—APC EXCEPTIONS TO THE 2 TIMES RULE FOR CY 2018 

APC CY 2018 APC title 

5112 ................................................................................................................................... Level 2 Musculoskeletal Procedures 

5521 ................................................................................................................................... Level 1 Imaging without Contrast 

5522 ................................................................................................................................... Level 2 Imaging without Contrast 

5523 ................................................................................................................................... Level 3 Imaging without Contrast 

5524 ................................................................................................................................... Level 4 Imaging without Contrast 

5571 ................................................................................................................................... Level 1 Imaging with Contrast 

5691 ................................................................................................................................... Level 1 Drug Administration 

5721 ................................................................................................................................... Level 1 Diagnostic Tests and Related Services 

5731 ................................................................................................................................... Level 1 Minor Procedures 

5732 ................................................................................................................................... Level 2 Minor Procedures 

5771 ................................................................................................................................... Cardiac Rehabilitation 

5823 ................................................................................................................................... Level 3 Health and Behavior Services 

7. On page 59295, third column, a. After the first partial paragraph, add 

the following comment and response: 

Comment: We received a comment to 

the CY 2018 OPPS/ASC proposed rule 


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61188 Federal Register / Vol. 82, No. 247 / Wednesday, December 27, 2017 / Rules and Regulations 

requesting the reassignment of the 

procedures assigned to APCs 5361 

(Level 1 Laparoscopy and Related 

Services) and 5362 (Level 2 

Laparoscopy and Related Services) to 

ensure a more logical distribution of 

procedure costs between these two 

APCs. 

Response: We appreciate the 

suggestion and will consider for future 

rulemaking. We note that in the CY 

2018 OPPS/ASC proposed rule, there 

was no violation of the 2 times rule for 

either APC 5361 or APC 5362. 

b. First full paragraph, in line 2, 

correct ‘‘comment’’ to read ‘‘comments’’. 

8. On page 59311, Table 54— 

Comparison of CY 2017 and CY 2018 

Geometric Mean Costs For The Imaging 

APCs, is corrected to read as follows: 

TABLE 54–COMPARISON OF CY 2017 AND CY 2018 GEOMETRIC MEAN COSTS FOR THE IMAGING APCS

APC APC group title 

CY 2017 APC 

geometric 

mean cost 

CY 2018 APC 

geometric 

mean cost 

5521 ............. Level 1 Imaging without Contrast ............................................................................................... $61.53 $62.08 

5522 ............. Level 2 Imaging without Contrast ............................................................................................... 115.88 114.39 

5523 ............. Level 3 Imaging without Contrast ............................................................................................... 232.21 232.17 

5524 ............. Level 4 Imaging without Contrast ............................................................................................... 462.23 486.38 

5571 ............. Level 1 Imaging with Contrast .................................................................................................... 272.40 252.58 

5572 ............. Level 2 Imaging with Contrast .................................................................................................... 438.42 456.08 

5573 ............. Level 3 Imaging with Contrast .................................................................................................... 675.23 681.45 

9. On page 59323, second column, 

second full paragraph, in line 4, correct 

‘‘C2623’’ to read ‘‘C2613’’. 

10. On page 59369, 

a. Second column, second full 

paragraph, in line 5, correct ‘‘status 

indicator ‘‘L’’ or ‘‘M’’’’ to read ‘‘status 

indicator ‘‘F’’, ‘‘L’’, or ‘‘M’’’’. 

b. Third column, first full paragraph, 

in line 19, correct ‘‘status indicator ‘‘L’’ 

or ‘‘M’’’’ to read ‘‘status indicator ‘‘F’’, 

‘‘L’’, or ‘‘M’’’’. 

11. On page 59375, second column, 

third full paragraph, in line 7, correct 

‘‘CCR ≤5’’ to read ‘‘CCR≤5’’. 

12. On pages 59412 and 59413, in the 

title for Table 87, correct ‘‘ASDC’’ to 

read ‘‘ASC’’. 

13. On page 59413, second column, 

after the second full paragraph, add the 

following paragraphs before the section 

titled, ‘‘D. ASC Payment for Covered 

Surgical Procedures and Covered 

Ancillary Services’’: 

‘‘2. Covered Ancillary Services 

Consistent with the established ASC 

payment system policy, in the CY 2018 

OPPS/ASC proposed rule (82 FR 33662) 

we proposed to update the ASC list of 

covered ancillary services to reflect the 

payment status for the services under 

the CY 2018 OPPS. We noted that 

maintaining consistency with the OPPS 

may result in proposed changes to ASC 

payment indicators for some covered 

ancillary services because of changes 

that are being finalized under the OPPS 

for CY 2018. For example, a covered 

ancillary service that was separately 

paid under the ASC payment system in 

CY 2017 may be proposed for packaged 

status under the CY 2018 OPPS and, 

therefore, also under the ASC payment 

system for CY 2018. 

To maintain consistency with the 

OPPS, we proposed to continue this 

reconciliation of packaged status for the 

ASC payment system for CY 2018. 

Comment indicator ‘‘CH,’’ discussed in 

section XII.F. of the proposed rule, was 

used in Addendum BB to the proposed 

rule (which is available via the internet 

on the CMS website) to indicate covered 

ancillary services for which we 

proposed a change in the ASC payment 

indicator to reflect a proposed change in 

the OPPS treatment of the service for CY 

2018. 

We included all ASC covered 

ancillary services and their proposed 

payment indicators for CY 2018 in 

Addendum BB to the proposed rule. We 

invited public comments on this 

proposal. 

We did not receive any public 

comments on these proposals. 

Therefore, we are finalizing, without 

modification, our proposal to update the 

ASC list of covered ancillary services to 

reflect the payment status for the 

services under the OPPS. All CY 2018 

ASC covered ancillary services and their 

final payment indicators are included in 

Addendum BB to this final rule (which 

is available via the internet on the CMS 

website).’’ 

14. On page 59422, first column, first 

partial paragraph, in line 1, correct 

‘‘44.663’’ to read ‘‘44.674’’. 

15. On page 59482, third column, 

second partial paragraph, in line 43, 

correct ‘‘270’’ to read ‘‘247’’. 

16. On page 59483, first column, third 

partial paragraph, in line 29, correct 

‘‘$199’’ to read ‘‘$169’’. 

17. On page 59486, 

a. First column, first full paragraph, in 

line 16, correct ‘‘0.5’’ to read ‘‘0.6’’. 

b. Third column, first full paragraph, 

in line 6, correct ‘‘1.2’’ to read ‘‘1.3’’. 

18. On page 59487 through 59488, 

Table 88—Estimated Impact of the CY 

2018 Changes for the Hospital 

Outpatient Prospective Payment 

System, is corrected to read as follows: 

TABLE 88—ESTIMATED IMPACT OF THE CY 2018 CHANGES FOR THE HOSPITAL OUTPATIENT PROSPECTIVE PAYMENT

SYSTEM

Number of 

hospitals 

APC 

recalibration 

(all changes) 

New wage 

index and 

provider 

adjustments 

340B 

adjustment 

All budget 

neutral 

changes 

(combined 

cols 2–4) 

with market 

basket update 

All changes 

(1) (2) (3) (4) (5) (6) 

ALL PROVIDERS * .................................. 3,878 0.0 0.0 0.0 1.3 1.4 


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Federal Register / Vol. 82, No. 247 / Wednesday, December 27, 2017 / Rules and Regulations 61189 

TABLE 88—ESTIMATED IMPACT OF THE CY 2018 CHANGES FOR THE HOSPITAL OUTPATIENT PROSPECTIVE PAYMENT

SYSTEM—Continued 

Number of 

hospitals 

APC 

recalibration 

(all changes) 

New wage 

index and 

provider 

adjustments 

340B 

adjustment 

All budget 

neutral 

changes 

(combined 

cols 2–4) 

with market 

basket update 

All changes 

(1) (2) (3) (4) (5) (6) 

ALL HOSPITALS (excludes hospitals 

held harmless and CMHCs) ................. 3,765 0.0 0.1 ¥0.1 1.4 1.5 

URBAN HOSPITALS ............................... 2,951 0.1 0.1 ¥0.3 1.3 1.3 

LARGE URBAN (GT 1 MILL.) .......... 1,589 0.1 0.0 ¥0.2 1.2 1.3 

OTHER URBAN (LE 1 MILL.) .......... 1,362 0.0 0.2 ¥0.3 1.3 1.4 

RURAL HOSPITALS ................................ 814 ¥0.3 0.0 1.4 2.5 2.7 

SOLE COMMUNITY ......................... 372 ¥0.2 0.1 2.6 3.9 4.0 

OTHER RURAL ................................ 442 ¥0.4 ¥0.2 0.0 0.8 0.9 

BEDS (URBAN): 

0–99 BEDS ....................................... 1,021 0.0 0.0 1.9 3.3 3.4 

100–199 BEDS ................................. 850 0.0 0.2 1.2 2.8 2.9 

200–299 BEDS ................................. 468 0.1 0.1 0.5 2.0 2.1 

300–499 BEDS ................................. 399 0.1 0.0 ¥0.4 1.1 1.2 

500 + BEDS ...................................... 213 0.0 0.1 ¥2.2 ¥0.7 ¥0.6 

BEDS (RURAL): 

0–49 BEDS ....................................... 333 ¥0.6 ¥0.2 2.1 2.7 2.9 

50–100 BEDS ................................... 297 ¥0.2 ¥0.2 1.9 2.8 3.0 

101–149 BEDS ................................. 97 ¥0.3 0.1 1.1 2.3 2.4 

150–199 BEDS ................................. 49 ¥0.2 0.1 0.7 2.0 2.1 

200 + BEDS ...................................... 38 ¥0.3 0.4 0.8 2.4 2.5 

REGION (URBAN): 

NEW ENGLAND ............................... 144 0.2 0.4 ¥0.2 1.7 1.8 

MIDDLE ATLANTIC .......................... 348 0.1 ¥0.2 ¥0.1 1.2 1.3 

SOUTH ATLANTIC ........................... 463 0.0 0.3 ¥0.4 1.3 1.4 

EAST NORTH CENT ........................ 471 0.0 0.1 ¥0.2 1.3 1.4 

EAST SOUTH CENT ........................ 178 ¥0.1 ¥0.1 ¥1.6 ¥0.4 ¥0.3 

WEST NORTH CENT ....................... 191 0.1 0.5 ¥0.6 1.4 1.5 

WEST SOUTH CENT ....................... 513 0.0 0.3 0.9 2.5 2.6 

MOUNTAIN ....................................... 211 0.3 ¥0.9 ¥0.2 0.5 0.7 

PACIFIC ............................................ 383 0.1 0.0 ¥0.6 0.8 0.9 

PUERTO RICO ................................. 49 ¥0.4 0.2 2.9 4.1 4.2 

REGION (RURAL): 

NEW ENGLAND ............................... 21 0.1 1.5 1.2 4.2 4.2 

MIDDLE ATLANTIC .......................... 53 ¥0.1 ¥0.5 1.8 2.5 2.7 

SOUTH ATLANTIC ........................... 124 ¥0.4 ¥0.6 0.7 1.1 1.2 

EAST NORTH CENT ........................ 122 ¥0.2 0.0 1.5 2.7 2.8 

EAST SOUTH CENT ........................ 155 ¥0.6 ¥0.1 0.0 0.7 0.8 

WEST NORTH CENT ....................... 98 ¥0.1 0.2 2.4 3.9 4.1 

WEST SOUTH CENT ....................... 161 ¥0.7 0.3 2.6 3.6 3.7 

MOUNTAIN ....................................... 56 0.0 ¥0.3 1.9 2.9 3.3 

PACIFIC ............................................ 24 ¥0.2 0.1 1.7 3.0 3.0 

TEACHING STATUS: 

NON-TEACHING .............................. 2,655 ¥0.1 0.1 1.3 2.8 2.9 

MINOR .............................................. 761 0.1 0.1 0.1 1.6 1.7 

MAJOR ............................................. 349 0.1 0.0 ¥2.4 ¥1.0 ¥0.9 

DSH PATIENT PERCENT: 

0 ........................................................ 10 0.0 0.2 3.2 4.8 4.9 

GT 0–0.10 ......................................... 272 0.2 ¥0.1 2.8 4.4 4.5 

0.10–0.16 .......................................... 263 0.2 0.0 2.7 4.3 4.4 

0.16–0.23 .......................................... 572 0.1 0.3 2.6 4.4 4.5 

0.23–0.35 .......................................... 1132 0.0 0.1 ¥0.4 1.0 1.2 

GE 0.35 ............................................. 935 0.0 0.0 ¥2.2 ¥0.9 ¥0.8 

DSH NOT AVAILABLE ** .................. 581 ¥2.0 0.1 2.0 1.4 1.6 

URBAN TEACHING/DSH: 

TEACHING & DSH ........................... 1,002 0.1 0.0 ¥1.1 0.3 0.4 

NO TEACHING/DSH ........................ 1,386 0.1 0.2 1.3 2.9 3.0 

NO TEACHING/NO DSH .................. 10 0.0 0.2 3.2 4.8 4.9 

DSH NOT AVAILABLE2 ................... 553 ¥1.9 0.1 1.9 1.4 1.6 

TYPE OF OWNERSHIP: 

VOLUNTARY .................................... 1,979 0.0 0.0 ¥0.3 1.2 1.3 

PROPRIETARY ................................ 1,293 0.1 0.1 2.7 4.3 4.5 

GOVERNMENT ................................ 493 ¥0.1 0.2 ¥1.6 ¥0.1 0.0 


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61190 Federal Register / Vol. 82, No. 247 / Wednesday, December 27, 2017 / Rules and Regulations 

TABLE 88—ESTIMATED IMPACT OF THE CY 2018 CHANGES FOR THE HOSPITAL OUTPATIENT PROSPECTIVE PAYMENT

SYSTEM—Continued 

Number of 

hospitals 

APC 

recalibration 

(all changes) 

New wage 

index and 

provider 

adjustments 

340B 

adjustment 

All budget 

neutral 

changes 

(combined 

cols 2–4) 

with market 

basket update 

All changes 

(1) (2) (3) (4) (5) (6) 

CMHCs ..................................................... 49 12.5 0.2 3.2 17.8 17.9 

Column (1) shows total hospitals and/or CMHCs. 

Column (2) includes all final CY 2018 OPPS policies and compares those to the CY 2017 OPPS. 

Column (3) shows the budget neutral impact of updating the wage index by applying the FY 2018 hospital inpatient wage index, including all 

hold harmless policies and transitional wages. The rural adjustment continues our current policy of 7.1 percent so the budget neutrality factor is 

1. The budget neutrality adjustment for the cancer hospital adjustment is 1.0008 because the target payment-to-cost ratio changes from 0.91 in 

CY 2017 to 0.89 in CY 2018 and is further reduced by 1 percentage point to 0.88 in accordance with the 21st Century Cures Act. However, this 

reduction does not affect the budget neutrality adjustment consistent with statute. 

Column (4) shows the impact of the 340B drug payment reductions and the corresponding increase in non-drug payments. 

Column (5) shows the impact of all budget neutrality adjustments and the addition of the 1.35 percent OPD fee schedule update factor (2.7 

percent reduced by 0.6 percentage points for the productivity adjustment and further reduced by 0.75 percentage point as required by law). 

Column (6) shows the additional adjustments to the conversion factor resulting from the frontier adjustment, a change in the pass-through estimate, and adding estimated outlier payments. 

These 3,878 providers include children and cancer hospitals, which are held harmless to pre-BBA amounts, and CMHCs. 

** Complete DSH numbers are not available for providers that are not paid under IPPS, including rehabilitation, psychiatric, and long-term care 

hospitals. 

19. On page 59488, bottom third of 

the page, 

a. Second column, first partial 

paragraph, in line 6, correct ‘‘17.2’’ to 

read ‘‘17.9’’. 

b. Third column, first partial 

paragraph, in line 10, correct ‘‘17.2’’ to 

read ‘‘17.9’’. 

Dated: December 20, 2017. 

Ann C. Agnew, 

Executive Secretary to the Department, 

Department of Health and Human Services. 

[FR Doc. 2017–27949 Filed 12–22–17; 4:15 pm] 

BILLING CODE 4120–01–P 

DEPARTMENT OF COMMERCE 

National Oceanic and Atmospheric 

Administration 

50 CFR Part 679 

[Docket No. 161020985–7181–02] 

RIN 0648–XF908 

Fisheries of the Exclusive Economic 

Zone Off Alaska; Reallocation of 

Pacific Cod in the Bering Sea and 

Aleutian Islands Management Area 

AGENCY: National Marine Fisheries 

Service (NMFS), National Oceanic and 

Atmospheric Administration (NOAA), 

Commerce. 

ACTION: Temporary rule; reallocation. 

SUMMARY: NMFS is reallocating the 

projected unused amount of Pacific cod 

from catcher vessels equal to or greater 

than 60 feet (18.3 meters) length overall 

(LOA) using pot gear to catcher/ 

processors (C/Ps) using pot gear, catcher 

vessels less than 60 feet (18.3 meters) 

LOA using hook-and-line or pot gear, 

and C/Ps using hook-and-line gear in 

the Bering Sea and Aleutian Islands 

management area. This action is 

necessary to allow the 2017 total 

allowable catch of Pacific cod to be 

harvested. 

DATES: Effective December 21, 2017, 

through 2400 hours, Alaska local time 

(A.l.t.), December 31, 2017. 

FOR FURTHER INFORMATION CONTACT: Josh 

Keaton, 907–586–7228. 

SUPPLEMENTARY INFORMATION: NMFS 

manages the groundfish fishery in the 

Bering Sea and Aleutian Islands (BSAI) 

according to the Fishery Management 

Plan for Groundfish of the Bering Sea 

and Aleutian Islands Management Area 

(FMP) prepared by the North Pacific 

Fishery Management Council under 

authority of the Magnuson-Stevens 

Fishery Conservation and Management 

Act. Regulations governing fishing by 

U.S. vessels in accordance with the FMP 

appear at subpart H of 50 CFR part 600 

and 50 CFR part 679. 

The 2017 Pacific cod total allowable 

catch (TAC) specified for catcher vessels 

greater than or equal to 60 feet LOA 

using pot gear in the BSAI is 15,389 

metric tons (mt) as established by the 

final 2017 and 2018 harvest 

specifications for groundfish in the 

BSAI (82 FR 11826, February 27, 2017) 

and reallocation (82 FR 47162, October 

11, 2017). 

The Administrator, Alaska Region, 

NMFS, (Regional Administrator) has 

determined that catcher vessels greater 

than or equal to 60 feet LOA using pot 

gear will not be able to harvest 1,500 mt 

of the remaining 2017 Pacific cod TAC 

allocated to those vessels under 

§ 679.20(a)(7)(ii)(A)(5). Therefore, in 

accordance with § 679.20(a)(7)(iii), 

taking into account the capabilities of 

the sectors to harvest reallocated 

amounts of Pacific cod, and following 

the hierarchies set forth in 

§ 679.20(a)(7)(iii)(A) and 

§ 679.20(a)(7)(iii)(B), NMFS reallocates 

155 mt of Pacific cod to C/Ps using pot 

gear, 200 mt to catcher vessels less than 

60 feet (18.3 m) LOA using hook-andline or pot gear, and 1,145 mt to C/Ps 

using hook-and-line gear. 

The harvest specifications for Pacific 

cod included in the final 2017 harvest 

specifications for groundfish in the 

BSAI (82 FR 11826, February 27, 2017) 

and reallocations (FR 57162, December 

4, 2017; 82 FR 43503, September 18, 

2017; 82 FR 41899, September 5, 2017; 

and 82 FR 8905, February 1, 2017; 82) 

are revised as follows: 13,889 mt for 

catcher vessels greater than or equal to 

60 feet (18.3 m) LOA using pot gear, 

4,999 mt for C/Ps using pot gear, 9,271 

mt for catcher vessels less than 60 feet 

(18.3 m) LOA using hook-and-line or 

pot gear, and 107,589 mt for C/Ps using 

hook-and-line gear. 

Classification 

This action responds to the best 

available information recently obtained 

from the fishery. The Assistant 

Administrator for Fisheries, NOAA 

(AA), finds good cause to waive the 

requirement to provide prior notice and 


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