46138 Federal Register / Vol. 82, No. 191 / Wednesday, October 4, 2017 / Rules and Regulations 

[FR Doc. 2017–21246 Filed 10–3–17; 8:45 am] 

BILLING CODE 6560–50–P 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Centers for Medicare & Medicaid 

Services 

42 CFR Parts 405, 412, 413, 414, 416, 

486, 488, 489, and 495 

[CMS–1677–CN] 

RIN–0938–AS98 

Medicare Program; Hospital Inpatient 

Prospective Payment Systems for 

Acute Care Hospitals and the LongTerm Care Hospital Prospective 

Payment System and Policy Changes 

and Fiscal Year 2018 Rates; Quality 

Reporting Requirements for Specific 

Providers; Medicare and Medicaid 

Electronic Health Record (EHR) 

Incentive Program Requirements for 

Eligible Hospitals, Critical Access 

Hospitals, and Eligible Professionals; 

Provider-Based Status of Indian Health 

Service and Tribal Facilities and 

Organizations; Costs Reporting and 

Provider Requirements; Agreement 

Termination Notices; Correction 

AGENCY: Centers for Medicare & 

Medicaid Services (CMS), HHS. 

ACTION: Final rule; correction. 

SUMMARY: This document corrects 

technical and typographical errors in 

the final rule that appeared in the 

August 14, 2017, issue of the Federal 

Register, which will amend the 

Medicare hospital inpatient prospective 

payment systems (IPPS) for operating 

and capital related costs of acute care 

hospitals to implement changes arising 

from our continuing experience with 

these systems for FY 2018. 

DATES: This correction is effective 

October 1, 2017. 

FOR FURTHER INFORMATION CONTACT: 

Donald Thompson, (410) 786–4487. 

SUPPLEMENTARY INFORMATION: 

I. Background 

In FR Doc. 2017–16434 of August 14, 

2017 (82 FR 37990) there were a number 

of technical and typographical errors 

that are identified and corrected by the 

Correction of Errors section of this 

correcting document. The provisions in 

this correcting document are effective as 

if they had been included in the 

document that appeared in the August 

14, 2017 Federal Register. Accordingly, 

the corrections are effective October 1, 

2017. 

II. Summary of Errors 

A. Summary of Errors in the Preamble 

On page 37990, we are making a 

conforming correction, removal of the 

reference to part 488, based on the 

removal of the regulations text for 

§ 488.5 described in section II.B. of this 

correcting document. 

On pages 38067 and 38068, we are 

correcting technical errors in our 

discussion and summary of and 

response to public comment regarding 

ICD–10–PCS procedure codes 

describing procedures involving 

percutaneous insertion of intraluminal 

or monitoring device. Specifically, we 

erroneously referred to a count of 28 

procedure codes describing procedures 

involving the percutaneous insertion of 

intraluminal and monitoring devices 

into central nervous system and other 

cardiovascular body parts rather than 18 

procedure codes. Of the 28 codes listed 

in Table 6P.4b associated with the 

proposed rule, 10 procedure codes were 

duplicative, and erroneously included 

in the table and in the total number of 

codes referenced in the preamble. As 

indicated in the final rule, after 

consideration of the public comments 

we received, we maintained the 

designation of 15 procedure codes 

identified by the commenters. For this 

reason, we are also correcting Table 

6P.4b associated with the final rule (as 

discussed in section II.E. of this 

correcting document) to reflect the 3 

distinct procedure codes for which we 

finalized a change in designation, 

including to remove the listings of ICD– 

10–PCS procedure codes 00H032Z 

(Insertion of Monitoring Device into 

Brain, Percutaneous Approach) and 

00H632Z (Insertion of Monitoring 

Device into Cerebral Ventricle, 

Percutaneous Approach), which we 

finalized to maintain as O.R. procedures 

for FY 2018, and are making conforming 

changes to the corresponding count of 

codes listed in that table as indicated on 

page 38068. Consistent with these 

corrections, we are also correcting the 

description of the proposal on page 

38067 of the final rule. As a result of the 

corrections to Table 6P.4b associated 

with the final rule and the conforming 

corrections on pages 38067 and 38068, 

we have made conforming changes to 

the ICD–10 MS–DRG Definitions 

Manual Version 35 and ICD–10 MS– 

DRG Grouper Software Version 35 for 

FY 2018 to reflect the O.R. designation 

of ICD–10–PCS procedure codes 

00H032Z (Insertion of Monitoring 

Device into Brain, Percutaneous 

Approach) and 00H632Z (Insertion of 

Monitoring Device into Cerebral 

Ventricle, Percutaneous Approach), as 

finalized on page 38068 of the final rule 

for FY 2018. 

In addition, after publication of the 

FY 2018 IPPS/LTCH PPS final rule, we 

became aware that the logic for the ICD– 

10 MS–DRG Definitions Manual Version 

35 and the ICD–10 MS–DRG Grouper 

and Medicare Code Editor (MCE) 

Version 35 Software erroneously 

designated the following ICD–10–PCS 

procedure code as a non-O.R. procedure 

rather than as an O.R. procedure as 

finalized on page 38072 of the final rule 

for FY 2018: 0BCC8ZZ (Extirpation of 

matter from right upper lung lobe, via 

natural or artificial opening 

endoscopic). Therefore, we also made 

changes to the ICD–10 MS–DRG 

Definitions Manual Version 35 and the 

ICD–10 MS–DRG Grouper and MCE 

Version 35 Software to correctly reflect 

the O.R. designation for this procedure 

code for FY 2018. 

We recalculated the FY 2018 MS– 

DRG relative weights (and associated 

statistics, such as average length of stay 

(ALOS)) as a result of the corrections to 

the logic for the ICD–10 MS–DRG 

Grouper Version 35 Software discussed 

above. In addition, since the MS–LTC– 

DRGs used under the LTCH PPS for FY 

2018 are the same as the MS DRGs used 

under the IPPS for FY 2018 (and as such 

use the same ICD–10 MS–DRG Grouper 

Version 35 Software), we also 

recalculated the FY 2018 MS–LTC–DRG 

relative weights (and associated 

statistics, such as geometric ALOS) for 

the same reasons. 

On page 38119, we made a technical 

error in describing which ICD–10–PCS 

procedure codes will be used to identify 

cases involving ZINPLAVATM that are 

eligible for new technology add-on 

payments in FY 2018. Specifically, 

cases involving ZINPLAVATM that are 

eligible for new technology add-on 

payments will be identified by either of 

the ICD–10–PCS procedure codes listed 

in the final rule (XW033A3 or 

XW043A3) (rather than requiring the 

combination of both ICD–10–PCS 

procedure codes). 

On pages 38132 and 38137, in our 

discussion of the wage indexes, we 

provided incorrect values for the FY 

2018 national average hourly wage 

(unadjusted for occupational mix) and 

the FY 2018 occupational mix adjusted 

national average hourly wage due to 

inadvertent errors related to the wage 

data collected from the Medicare cost 

reports of six hospitals (CMS 

Certification Numbers (CCNs) 240010, 

420033, 420037, 420038, 420078, and 

420102). 

On page 38144, we made an 

inadvertent error in the mailing address 


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Federal Register / Vol. 82, No. 191 / Wednesday, October 4, 2017 / Rules and Regulations 46139 

for the Medicare Geographic Review 

Board (MGCRB). 

On page 38195, in our discussion 

regarding disproportionate share 

hospitals (DSHs), we made errors in the 

June 2017 Office of the Actuary’s 

estimate for FY 2018 Medicare DSH 

payments. 

On page 38225, we made 

typographical errors in our description 

of several Hospital Readmissions 

Reduction Program (HRRP) measures. 

On page 38249, in our response to a 

comment, we advertently referenced the 

MORT–30–PN measure, instead of the 

PN Payment measure. 

On page 38257 through 38259, in our 

discussion of the Hospital Value-Based 

Purchasing (HVBP) Program, we made 

several typographical and technical 

errors to references and dates. 

On pages 38309 and 38310, we are 

correcting the MS–LTC–DRG 

normalization factor and the MS–LTC 

DRG budget neutrality factor based on 

the recalculation of the MS–LTC–DRG 

relative weights due to the corrections 

to the MS–DRG Grouper Software 

Version 35 described previously. 

(Because the MS–LTC–DRGs used under 

the LTCH PPS are the same as the MS– 

DRGs used under the IPPS, the 

corrections to the MS–DRG Grouper 

Software Version 35 described 

previously affect the MS–LTC–DRGs 

groupings by extension.) 

On pages 38426, 38434, 38440, and 

38458, in our discussion of the LTCH 

Quality Reporting Program (QRP), we 

made technical and typographical errors 

including an error in our description of 

a quality measure. 

B. Summary of Errors in the Regulations 

Text 

On page 38516, we inadvertently 

retained regulations language from the 

proposed rule at § 488.5(a)(21), 

regarding accrediting organizations, 

after stating in the preamble of the final 

rule that we had decided not to adopt 

such language. In addition, on page 

38509, we inadvertently retained a 

description of subjects set out in 42 CFR 

part 488 in the ‘‘List of Subjects.’’ We 

are correcting these errors by removing 

the description of subjects, amendatory 

instructions, and regulations text for 

part 488. 

On page 38516, in the regulations text 

provisions for § 495.4 (definitions for 

the Electronic Health Record (EHR) 

Incentive Program), we inadvertently 

omitted the definition of certified 

electronic health record technology 

(CEHRT) for 2018. 

On page 38517, in the regulations text 

provisions for § 495.24, we 

inadvertently omitted an EHR measure 

change for eligible professionals (EPs) in 

§ 495.24(d)(6)(i)(B)(1)(iv). 

C. Summary of Errors in the Addendum 

As discussed in section II.A. of this 

correcting document, we are making 

corrections to the logic for the ICD–10 

MS–DRG Grouper Version 35 Software 

for three ICD–10–PCS procedure codes 

(0BCC8ZZ, 00H032Z and 00H632Z) that 

had been erroneously designated as 

non-O.R. procedures rather than as O.R. 

procedures as finalized for FY 2018. As 

a result, we have recalculated the FY 

2018 MS–DRG relative weights after 

applying the changes in the Version 35 

MS–DRG groupings to the FY 2016 

MedPAR data used for the final rule. 

The FY 2018 MS–DRG relative 

weights are used to calculate the MS– 

DRG reclassification and recalibration 

budget neutrality factor when 

comparing total payments using FY 

2017 MS–DRG relative weights to total 

payments using the FY 2018 MS–DRG 

relative weights. Additionally, the FY 

2018 MS–DRG relative weights are used 

when determining total payments for 

purposes of all other budget neutrality 

factors and the final outlier threshold, 

which are discussed in this section II.C. 

of this correcting document. 

As discussed in section II.E. of this 

correcting document, we made several 

technical errors with regard to the 

calculation of Factor 3 of the 

uncompensated care payment 

methodology. Factor 3 is used to 

determine the total amount of the 

uncompensated care payment a hospital 

is eligible to receive for a fiscal year. 

This amount is then used to calculate 

the amount of the interim 

uncompensated care payments a 

hospital receives per discharge. Per 

discharge uncompensated care 

payments are included when 

determining total payments for purposes 

of all of the budget neutrality factors 

and the final outlier threshold. 

As a result, the revisions made to 

address these technical errors regarding 

the calculation of Factor 3 directly 

affected the calculation of total 

payments and required the recalculation 

of all the budget neutrality factors and 

the final outlier threshold. 

Because of the errors in the wage data 

for the six hospitals (CCNs 240010, 

420033, 420037, 420038, 420078, and 

420102), as discussed in section II.A. of 

this correcting document, we 

recalculated the FY 2018 national 

average hourly wages unadjusted for 

occupational mix and adjusted for 

occupational mix which resulted in the 

recalculation of the final FY 2018 IPPS 

wage indexes and the geographic 

adjustment factors (GAFs) (which are 

computed from the wage index). The 

final FY 2018 IPPS wage data are used 

in the calculation of the wage index 

budget neutrality adjustment when 

comparing total payments using the 

final FY 2017 IPPS wage index data to 

total payments using the final FY 2018 

IPPS wage index data. Additionally, the 

final FY 2018 IPPS wage index data are 

used when determining total payments 

for purposes of the rest of the budget 

neutrality factors (except for the MS– 

DRG reclassification and recalibration 

budget neutrality factor) and the final 

outlier threshold. In addition, the final 

FY 2018 IPPS wage index data are used 

to calculate the FY 2018 LTCH PPS 

wage index values, certain budget 

neutrality factors, and the LTCH PPS 

standard Federal payment rate in the FY 

2018 IPPS/LTCH PPS final rule. 

Due to the correction of the 

combination of errors listed previously 

(recalculation of the MS–DRG relative 

weights, revisions to Factor 3 of the 

uncompensated care methodology and 

correction to the final FY 2018 IPPS 

wage index data), we recalculated all 

IPPS budget neutrality adjustment 

factors, the fixed-loss cost threshold, the 

final wage indexes (and GAFs), and the 

national operating standardized 

amounts and capital Federal rate. 

Therefore, we made conforming changes 

to the following: 

• On page 38522 and 38532, the MS– 

DRG reclassification and recalibration 

budget neutrality factor. 

• On page 38522, the wage index 

budget neutrality adjustment. 

• On page 38522, the reclassification 

hospital budget neutrality adjustment. 

• On page 38523, the rural and 

imputed floor budget neutrality 

adjustment. 

• On page 38527, the calculation of 

the outlier fixed-loss cost threshold, the 

national outlier adjustment factors, total 

operating Federal payments, total 

operating outlier payments, and 

percentage of capital outlier payments. 

• On page 38529, the table titled 

‘‘Changes From FY 2017 Standardized 

Amounts to the FY 2018 Standardized 

Amounts’’. 

On pages 38532 and 38534 through 

38535, in our discussion of the 

determination of the Federal hospital 

inpatient capital related prospective 

payment rate update, due to the 

recalculation of the MS–DRG relative 

weights and GAFs we have made 

conforming corrections to the increase 

in the capital Federal rate, the capital 

outlier payment adjustment (budget 

neutrality) factor, the GAF/DRG budget 

neutrality adjustment factors, the capital 

Federal rate, and the outlier threshold 

(as discussed previously), along with 


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46140 Federal Register / Vol. 82, No. 191 / Wednesday, October 4, 2017 / Rules and Regulations 

certain statistical figures (for example, 

percent change) in the accompanying 

discussions. 

Also, as a result of these errors, on 

page 38535, we have made conforming 

corrections in the tables showing the 

comparison of factors and adjustments 

for the FY 2017 capital Federal rate and 

FY 2018 capital Federal rate and the 

proposed FY 2018 capital Federal rate 

and final FY 2018 capital Federal rate. 

On pages 38537 and 38539, we are 

correcting the area wage level budget 

neutrality factor and making a 

conforming change to the FY 2018 

LTCH PPS standard Federal payment 

rate due to corrections to the wage data 

discussed previously. 

On page 38544, we are making 

conforming corrections to the fixed-loss 

amount for FY 2018 LTCH PPS standard 

Federal payment rate discharges and the 

high-cost outlier (HCO) threshold 

determined in absence of the required 

changes under the 21st Century Cures 

Act due to corrections in the MS–LTC– 

DRG data discussed previously. 

On page 38545, we are making 

conforming corrections to the fixed-loss 

amount for site neutral discharges due 

to corrections in the IPPS rates and 

factors discussed previously. 

On pages 38546 and 38547, we are 

making conforming corrections to the 

figures used in the example of 

computing the adjusted LTCH PPS 

Federal prospective payment for FY 

2018. 

On page 38548, we have made 

conforming corrections to the following: 

• National adjusted operating 

standardized amounts and capital 

standard Federal payment rate (which 

also include the rates payable to 

hospitals located in Puerto Rico) in 

Tables 1A, 1B, 1C, and 1D as a result of 

the conforming corrections to certain 

budget neutrality factors and the outlier 

threshold (as described previously). 

• LTCH PPS standard Federal 

payment rate in Table 1E as a result of 

the correction to area wage level budget 

neutrality factor (as discussed 

previously). 

Also, on page 38548, in Table 1E, we 

are correcting a technical error in our 

terminology by replacing ‘‘Standard 

Federal Rate’’ with ‘Standard Federal 

Payment Rate’’. 

D. Summary of Errors in the Appendices 

On pages 38552 through 38560 and 

38572 through 38574 in our regulatory 

impact analyses, we made conforming 

corrections to the factors, values, and 

tables and accompanying discussion of 

the changes in operating and capital 

IPPS payments for FY 2018 and the 

effects of certain budget neutrality 

factors as a result of the technical errors 

that lead to conforming changes in our 

calculation of the operating and capital 

IPPS budget neutrality factors, outlier 

threshold, final wage indexes, operating 

standardized amounts, and capital 

Federal rate (as described in sections 

II.A. and II.C. of this correcting 

document). 

In particular, we made changes to the 

following tables. 

• On pages 38552 through 38554, the 

table titled ‘‘Table I.—Impact Analysis 

of Changes to the IPPS for Operating 

Costs for FY 2018’’. 

• On pages 38557 through 38558, the 

table titled ‘‘FY 2018 IPPS Estimated 

Payments Due To Rural and Imputed 

Floor With National Budget Neutrality’’. 

• On pages 38559 and 38560, the 

table titled ‘‘Table II—Impact Analysis 

of Changes for FY 2018 Acute Care 

Hospital Operating Prospective Payment 

System [Payments per Discharge]’’. 

• On pages 38572 through 38574, the 

table titled ‘‘Table III—Comparison of 

Total Payments Per Case [FY 2017 

Payments Compared to FY 2018 

Payments]’’. 

On pages 38561 through 38564, we 

are correcting the discussion of the 

‘‘Effects of the Changes to Medicare 

DSH and Uncompensated Care 

Payments for FY 2018’’ for purposes of 

the Regulatory Impact Analysis in 

Appendix A of the FY 2018 IPPS/LTCH 

PPS final rule in light of the corrections 

discussed in sections II.D. and II.E. of 

this correcting document. 

On pages 38576 and 38578 through 

38579, we made conforming corrections 

to the area wage level budget neutrality 

factor and the LTCH PPS standard 

Federal payment rate as described in 

section II.C. of this correcting document. 

On page 38579, we are making 

conforming corrections to ‘‘Table IV.— 

Impact of Payment Rate and Policy 

Changes to LTCH PPS Payments for 

Standard Payment Rate Cases for FY 

2018.’’ We are also correcting technical 

errors in the terminology used in the 

title and column headings of Table IV 

by ensuring the use of ‘‘Standard 

Federal Payment Rate’’. 

On page 38585, we made conforming 

corrections to the estimated increase in 

capital payments in FY 2018 compared 

to FY 2017. 

E. Summary of Errors in and Corrections 

to Files and Tables Posted on the CMS 

Web Site 

We are correcting the errors in the 

following IPPS tables that are listed on 

pages 38547 and 38548 of the FY 2018 

IPPS/LTCH PPS final rule and are 

available on the Internet on the CMS 

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

Medicare/Medicare-Fee-for-ServicePayment/AcuteInpatientPPS/FY2018- 

IPPS-Final-Rule-Home-Page.html. The 

tables that are available on the Internet 

have been updated to reflect the 

revisions discussed in this correcting 

document. 

Table 2—Case-Mix Index and Wage 

Index Table- FY 2018. The wage data 

errors related to the six hospitals 

required the recalculation of the FY 

2018 national average hourly wages 

unadjusted for occupational mix and 

adjusted for occupational mix which 

resulted in recalculating the FY 2018 

wage indexes. Also, the recalculation of 

the MS–DRG relative weights, the 

revisions to Factor 3 of the 

uncompensated care payment 

methodology and recalculation of the 

FY 2018 wage index necessitated the 

recalculation of the rural and imputed 

floor budget neutrality factor (as 

discussed in section II.C. of this 

correcting document). Therefore, we are 

correcting the values in the column 

titled ‘‘FY 2018 Wage Index’’ for all 

hospitals. Additionally, for the six 

hospitals for which we inadvertently 

used the incorrect wage data (as 

discussed in section II.A. of this 

correcting document), we are correcting 

the average hourly wages in the 

columns titled ‘‘Average Hourly Wage 

FY 2018’’ and ‘‘3-Year Average Hourly 

Wage (2016, 2017, 2018)’’. 

Table 3.—Wage Index Table by 

CBSA–FY 2018. The wage data errors 

related to the six hospitals required the 

recalculation of the FY 2018 national 

average hourly wage adjusted for 

occupational mix which resulted in 

recalculating the FY 2018 wage indexes. 

Also, the recalculation of the MS–DRG 

relative weights, the revisions to Factor 

3 of the uncompensated care payment 

methodology, and recalculation of the 

FY 2018 wage index necessitated the 

recalculation of the rural and imputed 

floor budget neutrality factor (as 

discussed in section II.C. of this 

correcting document). Therefore, we are 

making corresponding changes to the 

wage indexes and GAFs of all CBSAs 

listed in Table 3. Specifically, we are 

correcting the values and flags in the 

columns titled ‘‘Wage Index’’, 

‘‘Reclassified Wage Index’’, ‘‘GAF’’, 

‘‘Reclassified GAF’’, ‘‘Pre-Frontier and/ 

or Pre-Rural or Imputed Floor Wage 

Index’’ and ‘‘Eligible for Rural or 

Imputed Floor Wage Index’’. 

Additionally, for the two CBSAs (24860 

and 40340) where the six hospitals for 

which we inadvertently used the 

incorrect wage data are located (as 

discussed in section II.A. of this 

correcting document), we are correcting 

the average hourly wages in the 


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Federal Register / Vol. 82, No. 191 / Wednesday, October 4, 2017 / Rules and Regulations 46141 

columns titled ‘‘FY 2018 Average 

Hourly Wage’’ and ‘‘3-Year Average 

Hourly Wage (2016, 2017, 2018)’’. As we 

described previously, we inadvertently 

used the incorrect wage data for the 

following hospitals: CCNs 240010, 

420033, 420037, 420038, 420078 and 

420102. 

Table 5.—List of Medicare Severity 

Diagnosis-Related Groups (MS–DRGs), 

Relative Weighting Factors, and 

Geometric and Arithmetic Mean Length 

of Stay—FY 2018. We are correcting this 

table to reflect the recalculation of the 

FY 2018 MS–DRG relative weights and 

associated statistics as a result of the 

corrections to the logic for the ICD–10 

MS–DRG Grouper Version 35 Software 

discussed in section II.A. of this 

correcting document. Specifically, we 

are correcting the values in the columns 

titled ‘‘Weights’’, ‘‘Geometric mean 

LOS’’, and ‘‘Arithmetic mean LOS’’. 

Table 6P.—ICD–10–CM and ICD–10– 

PCS Code Designations, MCE and MS– 

DRG Changes—FY 2018. As discussed 

in section II.A of this correcting 

document, we are correcting the list of 

the ICD–10–PCS procedure codes in 

Table 6P.4b to reflect the three ICD–10– 

PCS procedure codes relating to the 

percutaneous insertion of intraluminal 

or monitoring devices that are finalized 

as non-O.R. procedures for FY 2018. 

Table 7B.—Medicare Prospective 

Payment System Selected Percentile 

Lengths of Stay: FY 2016 MedPAR 

Update—March 2017 GROUPER V35.0 

MS–DRGs. We are correcting this table 

to reflect the recalculation of the FY 

2018 MS–DRG relative weights and 

associated statistics as a result of the 

corrections to the logic for the ICD–10 

MS–DRG Grouper Version 35 Software 

discussed in section II.A. of this 

correcting document. 

Table 10—New Technology Add-On 

Payment Thresholds for Applications 

for FY 2019. We are correcting the 

thresholds in this table as a result of the 

corrections to the operating 

standardized amounts discussed in 

section II.C. of this correcting document. 

Table 18.—Final FY 2018 Medicare 

DSH Uncompensated Care Payment 

Factor 3. We are correcting this table to 

reflect revisions to the Factor 3 

calculations for purposes of determining 

uncompensated care payments for the 

FY 2018 IPPS/LTCH PPS final rule for 

the following reasons: 

• To apply our finalized policy of 

double weighting the 2013 Factor 3 

instead of developing a 2014 Factor 3 

using uncompensated care cost data 

from Worksheet S–10 for several allinclusive rate providers. 

• To reflect mergers where data for 

the merged hospital were not combined 

with the data for the surviving hospital 

for purposes of calculating Factor 3 for 

the FY 2018 IPPS/LTCH PPS Final Rule. 

• To correct the Factor 3 that was 

computed for a hospital whose FY 2014 

cost report in the March 2017 extract of 

Healthcare Cost Report Information 

System (HCRIS) inadvertently omitted 

amended uncompensated care cost data 

reported on an amended Worksheet S– 

10 that had been received timely per CR 

9648 issued on July, 15, 2016, and that 

was inadvertently omitted from the 

hospital’s 2014 cost report when it was 

uploaded into HCRIS. 

• To correct the Factor 3 that was 

computed for a hospital that only had 

Factor 3 values for two cost reporting 

periods, but whose Factor 3 was 

inadvertently calculated by dividing by 

three cost reporting periods when 

averaging the Factor 3 values. 

• To correct the misapplication of our 

new hospital policy, where hospitals 

with a CMS Certification Number (CCN) 

established after October 1, 2013, but 

before October 1, 2014, were 

inadvertently considered subject to that 

policy when calculating Factor 3. As 

stated in the FY 2018 IPPS/LTCH PPS 

final rule (82 FR 38212), only those 

hospitals with a CCN established after 

October 1, 2014, are considered new 

and subject to the new hospital policy 

when calculating Factor 3 for FY 2018. 

We are revising Factor 3 for all 

hospitals to correct these errors. We are 

also revising the amount of the total 

uncompensated care payment 

calculated for each DSH-eligible 

hospital. The total uncompensated care 

payment that a hospital receives is used 

to calculate the amount of the interim 

uncompensated care payments the 

hospital receives per discharge. Per 

discharge uncompensated care 

payments are included when 

determining total payments for purposes 

of all of the budget neutrality factors 

and the final outlier threshold. As a 

result, these corrections to the 

uncompensated care payments 

impacted the calculation of all the 

budget neutrality factors as well as the 

outlier fixed-loss cost threshold for 

outlier payments. These corrections will 

be reflected in Table 18 and the 

Medicare DSH Supplemental Data File. 

In section II.D. of this correcting 

document, we have made corresponding 

revisions to the discussion of the 

‘‘Effects of the Changes to Medicare 

DSH and Uncompensated Care 

Payments for FY 2018’’ for purposes of 

the Regulatory Impact Analysis in 

Appendix A of the FY 2018 IPPS/LTCH 

PPS final rule to reflect the corrections 

discussed previously. 

We are also correcting the errors in 

the following LTCH PPS tables that are 

listed on page 38548 of the FY 2018 

IPPS/LTCH PPS final rule and are 

available on the Internet on the CMS 

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

Medicare/Medicare-Fee-forServicePayment/LongTermCareHospital

PPS/index.html under the list item for 

regulation number CMS–1677–F. The 

tables that are available on the Internet 

have been updated to reflect the 

revisions discussed in this correcting 

document. 

Table 11.—MS–LTC–DRGs, Relative 

Weights, Geometric Average Length of 

Stay, and Short-Stay Outlier (SSO) 

Threshold for LTCH PPS Discharges 

Occurring from October 1, 2017 through 

September 30, 2018. We are correcting 

this table to reflect the recalculation of 

the FY 2018 MS–LTC–DRG relative 

weights and associated statistics as a 

result of the corrections to the logic for 

the Version 35 Grouper Software 

discussed in section II.A. of this 

correcting document. 

Table 12A.—LTCH PPS Wage Index 

for Urban Areas for Discharges 

Occurring from October 1, 2017 through 

September 30, 2018. We are correcting 

this table to reflect the revisions to the 

LTCH PPS wage index values discussed 

in section II.C. of this correcting 

document. 

Table 12B.—LTCH PPS Wage Index 

for Rural Areas for Discharges Occurring 

from October 1, 2017 through 

September 30, 2018. We are correcting 

this table to reflect the revisions to the 

LTCH PPS wage index values discussed 

in section II.C. of this correcting 

document. 

We also note that we have made 

conforming changes to the ICD–10 MS– 

DRG Definitions Manual Version 35 for 

consistency with the ICD–10 MS–DRG 

Grouper and Medicare Code Editor 

(MCE) Version 35 Software. First, the 

ICD–10–CM diagnosis code P05.18 

(Newborn small for gestational age, 

2000–2499 grams) was displayed in the 

ICD–10 MS–DRG Definitions Manual 

Version 35 as grouping to both MS– 

DRGs 793 (Full Term Neonate with 

Major Problems) and 795 (Normal 

Newborn). The correct MS–DRG 

assignment for diagnosis code P05.18 is 

only MS–DRG 795; therefore, 

corrections were made to the ICD–10 

MS–DRG Definitions Manual Version 35 

to reflect the correct MS–DRG 

assignment. Second, the following 9 

diagnosis codes were not included in 

the major problem list in the MS–DRG 

Definitions Manual: K56.600 (Partial 

intestinal obstruction, unspecified as to 

cause); K56.601 (Complete intestinal 

obstruction, unspecified as to cause); 


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46142 Federal Register / Vol. 82, No. 191 / Wednesday, October 4, 2017 / Rules and Regulations 

K56.609 (Unspecified intestinal 

obstruction, unspecified as to partial 

versus complete obstruction); K56.690 

(Other partial intestinal obstruction); 

K56.691(Other complete intestinal 

obstruction); K56.699 (Other intestinal 

obstruction unspecified as to partial 

versus complete obstruction); K91.30 

(Postprocedural intestinal obstruction, 

unspecified as to partial versus 

complete); K91.31 (Postprocedural 

partial intestinal obstruction); and 

K91.32 (Postprocedural complete 

intestinal obstruction). We made 

corrections to add these 9 diagnosis 

codes to the major problems list for MS– 

DRG 793 under Major Diagnostic 

Category (MDC) 15 (Newborns & Other 

Neonates with Conditions Originating in 

Perinatal Period) in the ICD–10 MS– 

DRG Definitions Manual Version 35. 

III. Waiver of Proposed Rulemaking 

and Delay in Effective Date 

We ordinarily publish a notice of 

proposed rulemaking in the Federal 

Register to provide a period for public 

comment before the provisions of a rule 

take effect in accordance with section 

553(b) of the Administrative Procedure 

Act (APA) (5 U.S.C. 553(b)). However, 

we can waive this notice and comment 

procedure if the Secretary finds, for 

good cause, that the notice and 

comment process is impracticable, 

unnecessary, or contrary to the public 

interest, and incorporates a statement of 

the finding and the reasons therefore in 

the notice. 

Section 553(d) of the APA ordinarily 

requires a 30-day delay in the effective 

date of final rules after the date of their 

publication in the Federal Register. 

This 30-day delay in effective date can 

be waived, however, if an agency finds 

for good cause that the delay is 

impracticable, unnecessary, or contrary 

to the public interest, and the agency 

incorporates a statement of the findings 

and its reasons in the rule issued. 

We believe that this correcting 

document does not constitute a rule that 

would be subject to the APA notice and 

comment or delayed effective date 

requirements. This correcting document 

corrects technical and typographic 

errors in the preamble, regulations text, 

addendum, payment rates, tables, and 

appendices included or referenced in 

the FY 2018 IPPS/LTCH PPS final rule 

but does not make substantive changes 

to the policies or payment 

methodologies that were adopted in the 

final rule. As a result, this correcting 

document is intended to ensure that the 

information in the FY 2018 IPPS/LTCH 

PPS final rule accurately reflects the 

policies adopted in that final rule. 

In addition, even if this were a rule to 

which the notice and comment 

procedures and delayed effective date 

requirements applied, we find that there 

is good cause to waive such 

requirements. Undertaking further 

notice and comment procedures to 

incorporate the corrections in this 

document into the final rule or delaying 

the effective date would be contrary to 

the public interest because it is in the 

public’s interest for providers to receive 

appropriate payments in as timely a 

manner as possible, and to ensure that 

the FY 2018 IPPS/LTCH PPS final rule 

accurately reflects our policies. 

Furthermore, such procedures would be 

unnecessary, as we are not altering our 

payment methodologies or policies, but 

rather, we are simply implementing 

correctly the policies that we previously 

proposed, received comment on, and 

subsequently finalized. This correcting 

document is intended solely to ensure 

that the FY 2018 IPPS/LTCH PPS final 

rule accurately reflects these payment 

methodologies and policies. Therefore, 

we believe we have good cause to waive 

the notice and comment and effective 

date requirements. 

Correction of Errors 

In FR Doc. 2017–16434 of August 14, 

2017 (82 FR 37990), we are making the 

following corrections: 

A. Corrections of Errors in the Preamble 

1. On page 37990, first column, line 

8 (Part headings), the figures ‘‘486, 488, 

489, and 495’’ are corrected to read 

‘‘486, 489, and 495’’. 

2. On page 38067— 

a. Second column, last partial 

paragraph, line 1, the figure ‘‘28’’ is 

corrected to read ‘‘18’’. 

b. Third column— 

(1) First partial paragraph— 

(a) Line 7, the phrase ‘‘28 ICD–10– 

PCS’’ is corrected to read ‘‘28 (18 

discrete) ICD–10–PCS’’. 

(b) Line 15, the phrase ‘‘O.R. 

procedures. We invite public’’ is 

corrected to read ‘‘O.R. procedures. (We 

note that Table 6P.4b. associated with 

the proposed rule listed 28 rather than 

18 ICD–10–PCS codes because we 

inadvertently included 10 duplicate 

codes. However only 18 discrete ICD– 

10–PCS codes were listed in that table.) 

We invite public’’. 

(2) First full paragraph— 

(a) Line 3, the figure ‘‘28’’ is corrected 

to read ‘‘18’’. 

(b) Line 9, the figure ‘‘28’’ is corrected 

to read ‘‘18’’. 

3. On page 38068, top half of the page 

(between the untitled tables) first 

column— 

a. First paragraph, line 5, the figure 

‘‘28’’ is corrected to read ‘‘18’’. 

b. Second paragraph, line 4, the figure 

‘‘13’’ is corrected to read ‘‘3’’. 

4. On page 38119, third column, first 

partial paragraph, lines 25 and 26, the 

phrase ‘‘XW033A3 and XW043A3.’’ is 

corrected to read ‘‘XW033A3 or 

XW043A3.’’ 

5. On page 38132— 

a. Second column, first paragraph, last 

line, the figure ‘‘$42.1027’’ is corrected 

to read ‘‘$42.0795’’. 

b. Third column, first partial 

paragraph, line 4, the figure $42.1027’’ 

is corrected to read ‘‘$42.0795’’. 

6. On page 38137, third column— 

a. First full paragraph, last line, the 

figure $42.0564’’ is corrected to read 

‘‘$42.0332’’. 

b. Last full paragraph, last line, the 

figure $42.0564’’ is corrected to read 

‘‘$42.0332’’. 

7. On page 38144, first column, first 

partial paragraph, lines 8 through 10, 

the phrase ‘‘2520 Lord Baltimore Drive, 

Suite L, Baltimore, MD 21244– 2670.’’ is 

corrected to read ‘‘1508 Woodlawn 

Drive, Suite 100, Baltimore, MD 

21207.’’. 

8. On page 38195— 

a. Top of the page, third column, first 

full paragraph, line 19, the figure 

‘‘$15.533’’ is corrected to read 

‘‘$15.553’’. 

b. Bottom of the page in the table 

titled ‘‘FACTORS APPLIED FOR FY 

2015 THROUGH FY 2018 TO 

ESTIMATE MEDICARE DSH 

EXPENDITURES USING 2014 

BASELINE’’ last row (FY 2018), last 

column (Estimated DSH payment), the 

entry ‘‘15.533’’ is corrected to read 

‘‘15.553’’. 

9. On page 38225— 

a. First column, last bulleted 

paragraph, lines 3 through 5, the phrase 

‘‘(AMI–Version 8.0, HF–Version 8.0, 

Pneumonia–Version 8.0, COPD–Version 

4.0, and Stroke–Version 4.0: 2016’’ is 

corrected to read ‘‘(AMI–Version 9.0, 

HF–Version 9.0, Pneumonia–Version 

9.0, COPD–Version 5.0, and Stroke– 

Version 5.0: 2016’’. 

b. Second column; first bulleted 

paragraph, lines 2 through 4, the phrase 

‘‘(THA and/or TKA–Version 4.0, CABG– 

Version 2.0: 2016’’ is corrected to read 

‘‘(THA and/or TKA–Version 5.0, CABG– 

Version 3.0: 2016)’’. 

10. On page 38249, second column, 

last paragraph, lines 23 and 24, the 

parenthetical phrase ‘‘(for example, the 

MORT–30–PN measure)’’ is corrected to 

read ‘‘(for example, PN Payment 

measure)’’. 

11. On page 38257, third column, 

footnote paragraph (footnote 69), last 

line, the date ‘‘Mar 1997’’ is corrected to 

read ‘‘Mar 1977’’. 

12. On page 38258, first column, third 

paragraph— 


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Federal Register / Vol. 82, No. 191 / Wednesday, October 4, 2017 / Rules and Regulations 46143 

a. Lines 8 and 9, the reference ‘‘(78 FR 

50074;’’ is corrected to read ‘‘(79 FR 

50074;’’. 

b. Line 9, the reference ‘‘80 FR 

49588).’’ is corrected to read ‘‘80 FR 

49558).’’. 

13. On page 38259, first column, first 

partial paragraph, line 14, the date 

‘‘June 0’’ is corrected to read ‘‘June 30’’. 

14. On page 38309, third column, first 

full paragraph, line 29 the figure 

‘‘1.28590’’ is corrected to read 

‘‘1.28593’’. 

15. On page 38310, first column— 

a. First full paragraph, line 29, the 

figure ‘‘0.9907845’’ is corrected to read 

‘‘0.9907437’’. 

b. Second full paragraph— 

(1) Line 5, the figure ‘‘1.28590’’ is 

corrected to read ‘‘1.28593’’. 

(2) Line 6, the figure ‘‘0.9907845’’ is 

corrected to read ‘‘0.9907437’’. 

16. On page 38426— 

a. First column, second full 

paragraph, line 21, the phrase ‘‘an 

Application of Percent’’ is corrected to 

read ‘‘Application of Percent’’. 

b. Third column, third full paragraph, 

line 10, the phrase ‘‘criteria; however 

should’’ is corrected to read ‘‘criteria. 

However, the measure should’’. 

17. On page 38434, in the first 

column, second paragraph— 

a. Line 29, the phrase ‘‘Stage 3 or 4 

ulcers.’’ is corrected to read ‘‘Stage 3 or 

4 pressure ulcers.’’. 

b. Line 31, the phrase ‘‘Stage 1 and 2 

ulcers decreased’’ is corrected to read 

‘‘Stage 1 and 2 pressure ulcers 

decreased’’. 

c. Line 32, the phrase ’’ of Stage 3 and 

4 ulcers’’ is corrected to read ‘‘of Stage 

3 and 4 pressure ulcers’’. 

18. On page 38440, third column, last 

paragraph— 

a. Lines 10 and 11, the phrase ‘‘That 

nearly one third’’ is corrected to read 

‘‘The fact that nearly one third’’. 

b. Lines 16 and 17, the phrase ‘‘LTCH, 

and also indicates’’ is corrected to read 

‘‘LTCH. It also indicates’’. 

19. On page 38458, third column, 

second full paragraph— 

a. Lines 21 through 23, the phrase 

(measure name) ‘‘Functional Outcome 

Measure: Change in Mobility Among 

Patients Requiring Ventilator Support 

(NQF #2632).’’ is corrected to read 

‘‘Functional Outcome Measure: Change 

in Mobility Among Long-Term Care 

Hospital (LTCH) Patients Requiring 

Ventilator Support (NQF #2632).’’. 

b. Lines 31 through 34, the phrase 

(measure name) ‘‘Functional Outcome 

Measure: Change in Mobility Among 

Patients Requiring Ventilator Support 

(NQF #2632)’’ is corrected to read 

‘‘Functional Outcome Measure: Change 

in Mobility Among Long-Term Care 

Hospital (LTCH) Patients Requiring 

Ventilator Support (NQF #2632).’’ 

20. On page 38509, second column, 

eighth full paragraph (List of subjects 42 

CFR 488), the paragraph is corrected by 

removing the paragraph. 

B. Correction of Errors in the 

Regulations Text 

1. On page 38516, in the first column, 

remove the part heading for part 488 

and remove amendatory instructions 34 

and 35 in their entirety. 

§ 495.4 [Corrected] 

2. On page 38516, in the second 

column, after amendatory instruction 

39a, add amendatory instruction a2 to 

read— 

‘‘a2. In the definition of ‘‘Certified 

electronic health record technology 

(CEHRT)’’: 

i. In paragraph (1)(iii), removing the 

phrase ‘‘for 2018 subsequent years’’ and 

adding in its place the phrase ‘‘for 2019 

and subsequent years’’; and 

ii. In the introductory text of 

paragraph (2), removing the phrase ‘‘For 

2018 and subsequent years,’’ and adding 

in its place the phrase ‘‘For 2019 and 

subsequent years,’’.’’ 

§ 495.24 [Corrected] 

3. On page 38517, second column, 

sixth full paragraph, amendatory 

instruction 41d is corrected and 

amendatory instructions 41e and f are 

correctly added to read as follows: 

‘‘d. Revising the paragraph (d) 

heading. 

e. In paragraph (d)(6)(i)(B)(1)(iv) by 

removing the phrase ‘‘For an EHR 

reporting period in 2017 only, an EP’’ 

and adding in its place the phrase ‘‘For 

an EHR reporting period in 2017 and 

2018, an EP’’. 

f. Revising paragraphs (d)(6)(i)(B)(2)(i) 

and (ii), (d)(6)(ii)(B)(1)(iv), and 

(d)(6)(ii)(B)(2)(i) and (ii).’’ 

C. Correction of Errors in the Addendum 

1. On page 38522 — 

a. Second column, first full 

paragraph— 

(1) Line 3, the figure ‘‘0.997432’’ is 

corrected to read ‘‘0.997439’’. 

(2) Line 8, the figure ‘‘0.997432’’ is 

corrected to read ‘‘0.997439’’. 

b. Third column— 

(1) First full paragraph, line 9, the 

figure ‘‘1.001148’’ is corrected to read 

‘‘1.000882’’. 

(2) Last paragraph, line 11 the figure 

‘‘0.988008’’ is corrected to read 

‘‘0.987985’’. 

2. On page 38523, second column, 

first partial paragraph, line 2, the figure 

‘‘0.993348’’ is corrected to read 

‘‘0.993324’’. 

3. On page 38527, lower two-thirds of 

the page (after the first untitled table), 

third column— 

a. First partial paragraph— 

(1) Line 4, the figure ‘‘$26,601’’ is 

corrected to read ‘‘$26,537’’. 

(2) Line 5, the figure ‘‘85,942,484,975’’ 

is corrected to read ‘‘$90,203,348,168’’. 

(3) Line 6, the figure ‘‘$4,618,707,285’’ 

is corrected to read ‘‘$4,600,554,656’’. 

(4) Line 17, the figure ‘‘$26,601’’ is 

corrected to read ‘‘$26,537’’. 

b. First full paragraph, line 13, the 

figure ‘‘5.16’’ is corrected to read ‘‘5.17’’. 

c. Following the third full paragraph, 

the untitled table is corrected to read as 

follows: 

Operating 

standardized 

amounts 

Capital 

federal 

rate 

National .................................................................................................................................................................... 0.948998 0.948259 

4. On page 38529, top of the page, the 

table titled ‘‘CHANGES FROM FY 2017 

STANDARDIZED AMOUNTS TO THE 

FY 2018 STANDARDIZED AMOUNTS’’, 

is corrected to read as follows: 


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46144 Federal Register / Vol. 82, No. 191 / Wednesday, October 4, 2017 / Rules and Regulations 

CHANGES FROM FY 2017 STANDARDIZED AMOUNTS TO THE FY 2018 STANDARDIZED AMOUNTS

Hospital submitted quality 

data and is a meaningful 

EHR user 

Hospital submitted quality 

data and is NOT a 

meaningful EHR user 

Hospital did NOT submit 

quality data and is a 

meaningful EHR user 

Hospital did NOT submit 

quality data and is NOT a 

meaningful EHR user 

FY 2018 Base Rate after 

removing: 

1. FY 2017 Geographic Reclassification Budget Neutrality (0.988136).If Wage Index is Greater 

Than 1.0000: 

If Wage Index is Greater 

Than 1.0000: 

If Wage Index is Greater 

Than 1.0000: 

If Wage Index is Greater 

Than 1.0000: 

2. FY 2017 Operating 

Outlier Offset 

(0.948998).

Labor (68.3%): 

$3,993.72.

Labor (68.3%): 

$3,993.72.

Labor (68.3%): 

$3,993.72.

Labor (68.3%): 

$3,993.72. 

3. FY 2017 2-Midnight 

Rule One-Time Prospective Increase 

(1.006).

Nonlabor (30.4%): 

$1,853.60.

Nonlabor (30.4%): 

$1,853.60.

Nonlabor (30.4%): 

$1,853.60.

Nonlabor (30.4%): 

$1,853.60. 

4. FY 2017 Labor Market Delineation 

Wage Index Transition Budget Neutrality Factor 

(0.999997).

If Wage Index is less 

Than or Equal to 

1.0000: 

If Wage Index is less 

Than or Equal to 

1.0000: 

If Wage Index is less 

Than or Equal to 

1.0000: 

If Wage Index is less 

Than or Equal to 

1.0000: 

Labor (62%): $3,625.34 .... Labor (62%): $3,625.34 .... Labor (62%): $3,625.34 .... Labor (62%): $3,625.34. 

Nonlabor (38%): $2,221.98 Nonlabor (38%): $2,221.98 Nonlabor (38%): $2,221.98 Nonlabor (38%): 

$2,221.98. 

FY 2018 Update Factor ..... 1.0135 ............................... 0.99325 ............................. 1.00675 ............................. 0.9865. 

FY 2018 MS–DRG Recalibration Budget Neutrality Factor.0.997439 ........................... 0.997439 ........................... 0.997439 ........................... 0.997439. 

FY 2018 Wage Index 

Budget Neutrality Factor.

1.000882 ........................... 1.000882 ........................... 1.000882 ........................... 1.000882. 

FY 2018 Reclassification 

Budget Neutrality Factor.

0.987985 ........................... 0.987985 ........................... 0.987985 ........................... 0.987985. 

FY 2018 Operating Outlier 

Factor.

0.948998 ........................... 0.948998 ........................... 0.948998 ........................... 0.98998. 

Adjustment for FY 2018 

Required under Section 

414 of Pub. L. 114–10 

(MACRA) and Section 

15005 of Pub. L. 114– 

255.

1.004588 ........................... 1.004588 ........................... 1.004588 ........................... 1.004588. 

National Standardized 

Amount for FY 2018 if 

Wage Index is Greater 

Than 1.0000; Labor/NonLabor Share Percentage 

(68.3/31.7).

Labor: $3,806.04 ...............

Nonlabor: $1,766.49 .........

Labor: $3,729.99 ...............

Nonlabor: $1,731.20 .........

Labor: $3,780.69 ...............

Nonlabor: $1,754.73 .........

Labor: $3,704.65. 

Nonlabor: $1,719.43. 

National Standardized 

Amount for FY 2018 if 

Wage Index is less Than 

or Equal to 1.0000; 

Labor/Non-Labor Share 

Percentage (62/38).

Labor: $3,454.97 ...............

Nonlabor: $2,117.56 .........

Labor: $3,385.94 ...............

Nonlabor: $2,075.25 .........

Labor: $3,431.96 ...............

Nonlabor: $2,103.46 .........

Labor: $3,362.93. 

Nonlabor: $2,061.15. 

5. On page 38532, lower two-thirds of 

the page (after the untitled table)— 

a. First column, second full 

paragraph, line 13, the figure 

‘‘0.997432’’ is corrected to read 

‘‘0.997439’’. 

b. Third column, second full 

paragraph, line 6, the figure ‘‘1.61’’ is 

corrected to read ‘‘1.60’’. 

6. On page 38534— 

a. First column— 

(1) First full paragraph— 

(a) Line 8, the figure ‘‘5.16’’ is 

corrected to read ‘‘5.17’’. 

(b) Line 12, the figure ‘‘0.9484’’ is 

corrected to read ‘‘0.9483’’. 

(2) Second full paragraph— 

(a) Lines 5 and 6, the phrase ‘‘outlier 

adjustment of 0.9484 is a 1.04 percent 

change’’ is corrected to read ‘‘outlier 

adjustment of 0.9483 is a 1.03 percent 

change’’. 

(b) Line 10, the figures ‘‘1.0104 

(0.9484/0.9386)’’ are corrected to read 

‘‘1.0103(0.9483/0.9386)’’. 

(c) Line 12, the figure ‘‘1.04’’ is 

corrected to read ‘‘1.03’’. 

(3) Fourth full paragraph— 

(a) Line 13, the figure ‘‘0.9994’’ is 

corrected to read ‘‘0.9995’’. 

(b) Line 16, the figure ‘‘0.9844’’ is 

corrected to read ‘‘0.99845’’. 

b. Second column— 

(1). First partial paragraph, line 8, the 

figure ‘‘0.9837’’ is corrected to read 

‘‘0.9838’’. 

(2). Third full paragraph— 

(a) Line 1, the figure ‘‘0.9986’’ is 

corrected to read ‘‘0.9987’’. 

(b) Line 3, the figure ‘‘0.9994’’ is 

corrected to read ‘‘0.9995’’. 

c. Third column— 

(1). First full paragraph— 

(a) Line 4, the figure ‘‘1.61’’ is 

corrected to read ‘‘1.60’’. 

(b) Line 15, the figure ‘‘$453.97’’ is 

corrected to read ‘‘$453.95’’. 


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Federal Register / Vol. 82, No. 191 / Wednesday, October 4, 2017 / Rules and Regulations 46145 

(c) Second bulleted paragraph, last 

line, the figure ‘‘0.9986’’ is corrected to 

read ‘‘0.9987’’. 

(d) Third bulleted paragraph, last line, 

the figure ‘‘0.9484’’ is corrected to read 

‘‘0.9483’’. 

(e) Last paragraph— 

(1) Line 15, the figure ‘‘0.14’’ is 

corrected to read ‘‘0.13’’. 

(2) Line 18, the figure ‘‘1.04’’ is 

corrected to read ‘‘1.03’’. 

7. On page 38535— 

a. Top of page— 

(1) Second column, first partial 

paragraph, last line, the figure ‘‘1.61’’ is 

corrected to read ‘‘1.60’’. 

(2) The table titled ‘‘COMPARISON 

OF FACTORS AND ADJUSTMENTS: FY 

2017 CAPITAL FEDERAL RATE AND 

FY 2018 CAPITAL FEDERAL RATE’’ is 

corrected to read as follows: 

COMPARISON OF FACTORS AND ADJUSTMENTS: FY 2017 CAPITAL FEDERAL RATE AND FY 2018 CAPITAL FEDERAL RATE

FY 2017 FY 2018 Change Percent 

change 3

Update Factor 1 ................................................................................................ 1.0090 1.0130 1.0130 1.30 

GAF/DRG Adjustment Factor 1 ........................................................................ 0.9990 0.9987 0.9987 ¥0.13 

Outlier Adjustment Factor 2 .............................................................................. 0.9386 0.9483 1.0103 1.03 

Removal of One-Time 2-Midnight Policy Adjustment Factor .......................... 1.0060 1/1.006 0.9940 ¥0.60 

Capital Federal Rate ........................................................................................ $446.79 $453.95 1.0160 1.60 

1The update factor and the GAF/DRG budget neutrality adjustment factors are built permanently into the capital Federal rates. Thus, for example, the incremental change from FY 2017 to FY 2018 resulting from the application of the 0.9987 GAF/DRG budget neutrality adjustment factor 

for FY 2018 is a net change of 0.9987 (or -0.13 percent). 2The outlier reduction factor is not built permanently into the capital Federal rate; that is, the factor is not applied cumulatively in determining 

the capital Federal rate. Thus, for example, the net change resulting from the application of the FY 2018 outlier adjustment factor is 0.9483/ 

0.9386 or 1.0103 (or 1.03 percent). 3Percent change may not sum due to rounding. 

b. Middle of page, the table titled 

‘‘COMPARISON OF FACTORS AND 

ADJUSTMENTS: PROPOSED FY 2018 

CAPITAL FEDERAL RATE AND FINAL 

FY 2018 CAPITAL FEDERAL RATE’’ is 

corrected to read as follows: 

COMPARISON OF FACTORS AND ADJUSTMENTS: PROPOSED FY 2018 CAPITAL FEDERAL RATE AND FINAL FY 2018 

CAPITAL FEDERAL RATE

Proposed 

FY 2018 

Final 

FY 2018 Change Percent change 

Update Factor 1 ................................................................................................ 1.0120 1.0130 1.0010 1.10 

GAF/DRG Adjustment Factor 1 ........................................................................ 0.9992 0.9987 0.9985 ¥0.05 

Outlier Adjustment Factor 2 .............................................................................. 0.9434 0.9483 1.0052 0.52 

Removal of One-Time 2-Midnight Policy Adjustment Factor .......................... 1/1.006 1/1.006 0.0000 0.00 

Capital Federal Rate ........................................................................................ $451.37 $453.95 1.0057 0.57 

c. Lower third of the page, first 

column, second full paragraph, last line, 

the figure, ‘‘$26,601’’ is corrected to 

read ‘‘$26,537’’. 

8. On page 38537— 

a. First column last paragraph— 

(1) Line 22, the figure ‘‘1.0006434’’ is 

corrected to read ‘‘1.0002704’’. 

(2) Line 35, the figure ‘‘$41,430.56’’ is 

corrected to read ‘‘$41,415.11’’. 

(3) Line 36, the figure ‘‘1.0006434’’ is 

corrected to read ‘‘1.0002704’’. 

b. Second column, first partial 

paragraph— 

(1) Line 5, the figure ‘‘40,610.16’’ is 

corrected to read ‘‘$40,595.02’’. 

(2) Line 6, the figure ‘‘1.0006434’’ is 

corrected to read ‘‘1.0002704’’. 

9. On page 38539, second column, 

fourth full paragraph— 

a. Line 6, the figure ‘‘1.0006434’’ is 

corrected to read ‘‘1.0002704’’. 

b. Line 11, the figure ‘‘1.0006434’’ is 

corrected to read ‘‘1.0002704’’. 

10. On page 38544— 

a. First column— 

(1) First partial paragraph— 

(a) Line 6, the figure ‘‘27,382’’ is 

corrected to read ‘‘27,381’’. 

(b) Last line, the figure ‘‘27,382’’ is 

corrected to read ‘‘27,381’’. 

(2) First full paragraph— 

(a) Line 4, the figure ‘‘27,382’’ is 

corrected to read ‘‘27,381’’. 

(b) Line 27, the figure ‘‘27,240’’ is 

corrected to read ‘‘27,239’’. 

(3) Second column, first partial 

paragraph, line 25, the figure ‘‘27,382’’ 

is corrected to read ‘‘27,381’’. 

10. On page 38545— 

a. Second column, second full 

paragraph— 

(1) Line 14, the figure, ‘‘$26,601’’ is 

corrected to read ‘‘$26,537’’. 

(2) Last line, the figure, ‘‘$26,601’’ is 

corrected to read ‘‘$26,537’’. 

b. Third column, second full 

paragraph, line 3, the figure, ‘‘$26,601’’ 

is corrected to read ‘‘$26,537’’. 

11. On page 38546, third column— 

a. Second full paragraph, line 27, the 

figure ‘‘$41,430.56’’ is corrected to read 

‘‘$41,415.11’’. 

b. Last paragraph, line 7, the figure 

‘‘1.0547’’ is corrected to read ‘‘1.0553’’. 

12. On page 38547, top of the page— 

a. Second column, partial paragraph— 

(1) Line 2, the figure ‘‘$41,430.56’’ is 

corrected to read ‘‘$41,415.11’’. 

(2) Line 3, the figure ‘‘1.0547’’ is 

corrected to read ‘‘1.0553’’. 

b. Third column, partial paragraph, 

line 5, the figure ‘‘$41,449.71’’ is 

corrected to read ‘‘$41,450.13’’. 

c. Untitled table, the table is corrected 

to read as follows: 

LTCH PPS Standard Federal Payment Rate ...................................................................................................................................... $41,415.11 

Labor-Related Share ........................................................................................................................................................................... × 0.662 

Labor-Related Portion of the LTCH PPS Standard Federal Payment Rate ....................................................................................... = $27,416.80 

Wage Index (CBSA 16974) ................................................................................................................................................................. × 1.0553 


sradovich on DSK3GMQ082PROD with RULES
46146 Federal Register / Vol. 82, No. 191 / Wednesday, October 4, 2017 / Rules and Regulations 

Wage-Adjusted Labor Share of LTCH PPS Standard Federal Payment Rate ................................................................................... = $28,932.95 

Nonlabor-Related Portion of the LTCH PPS Standard Federal Payment Rate ($41,415.11 x 0.338) ............................................... + $13,998.31 

Adjusted LTCH PPS Standard Federal Payment Amount .................................................................................................................. = $42,931.26 

MS–LTC–DRG 189 Relative Weight ................................................................................................................................................... × 0.9655 

Total Adjusted LTCH PPS Standard Federal Payment Rate .............................................................................................................. = $41,450.13 

13. On page 38548— 

a. Middle of the page, 

(1) The table titled ‘‘TABLE 1A.— 

NATIONAL ADJUSTED OPERATING 

STANDARDIZED AMOUNTS, LABOR/ 

NONLABOR [(68.3 PERCENT LABOR 

SHARE/31.7 PERCENT NONLABOR 

SHARE IF WAGE INDEX IS GREATER 

THAN 1)—FY 2018’’] is corrected to 

read as follows: 

TABLE 1A—NATIONAL ADJUSTED OPERATING STANDARDIZED AMOUNTS, LABOR/NONLABOR

[(68.3 percent labor share/31.7 percent nonlabor share if wage index is greater than 1)—FY 2018] 

Hospital submitted quality data 

and is a meaningful EHR user 

(update = 1.35 percent) 

Hospital submitted quality data 

and is not a meaningful EHR user 

(update = ¥0.675 percent) 

Hospital did NOT submit quality 

data and is a meaningful EHR 

user 

(update = 0.675 percent) 

Hospital did NOT submit quality 

data and is NOT a meaningful 

EHR user 

(update = ¥1.35 percent) 

Labor Nonlabor Labor Nonlabor Labor Nonlabor Labor Nonlabor 

$3,806.04 $1,766.49 $3,729.99 $1,731.20 $3,780.69 $1,754.73 $3,704.65 $1,719.43 

(2) The table titled ‘‘TABLE 1B.— 

NATIONAL ADJUSTED OPERATING 

STANDARDIZED AMOUNTS, LABOR/ 

NONLABOR [(62 PERCENT LABOR 

SHARE/38 PERCENT NONLABOR 

SHARE IF WAGE INDEX IS LESS 

THAN OR EQUAL TO 1)—FY 2018]’’ is 

corrected to read as follows: 

TABLE 1B—NATIONAL ADJUSTED OPERATING STANDARDIZED AMOUNTS, LABOR/NONLABOR

[(62 percent labor share/38 percent nonlabor share if wage index is less than or equal to 1)—FY 2018] 

Hospital submitted quality data 

and is a meaningful EHR user 

(update = 1.35 percent) 

Hospital submitted quality data 

and is not a meaningful EHR user 

(update = ¥0.675 percent) 

Hospital did NOT submit quality 

data and is a meaningful EHR 

user 

(update = 0.675 percent) 

Hospital did NOT submit quality 

data and is NOT a meaningful 

EHR user 

(update = ¥1.35 percent) 

Labor Nonlabor Labor Nonlabor Labor Nonlabor Labor Nonlabor 

$3,454.97 $2,117.56 $3,385.94 $2,075.25 $3,431.96 $2,103.46 $3,362.93 $2,061.15 

(3) The table titled ‘‘TABLE 1C.— 

ADJUSTED OPERATING 

STANDARDIZED AMOUNTS FOR 

HOSPITALS IN PUERTO RICO, 

LABOR/NONLABOR [(NATIONAL: 62 

PERCENT LABOR SHARE/38 PERCENT 

NONLABOR SHARE BECAUSE WAGE 

INDEX IS LESS THAN OR EQUAL TO 

1);—FY 2018]’’ is corrected to read as 

follows: 

TABLE 1C—ADJUSTED OPERATING STANDARDIZED AMOUNTS FOR HOSPITALS IN PUERTO RICO, LABOR/NONLABOR

[(National: 62 percent labor share/38 percent nonlabor share because wage index is less than or equal to 1);—FY 2018] 

Standardized amount 

Rates if wage index is greater than 1 Rates if wage index is less 

than or equal to 1 

Labor Nonlabor Labor Nonlabor 

National 1 ........................................ Not Applicable ................................ Not Applicable ................................ $3,454.97 $2,117.56 

1For FY 2018, there are no CBSAs in Puerto Rico with a national wage index greater than 1. 

b. Bottom of the page— 

(1) The table titled ‘‘TABLE 1D.— 

CAPITAL STANDARD FEDERAL 

PAYMENT RATE [FY 2018]’’ is 

corrected to read as follows: 

TABLE 1D—CAPITAL STANDARD

FEDERAL PAYMENT RATE

[FY 2018] 

Rate 

National ................................. $453.95 

(2) The table titled ‘‘TABLE 1E.— 

LTCH PPS STANDARD FEDERAL 

PAYMENT RATE [FY 2018]’’ is 

corrected to read as follows: 


sradovich on DSK3GMQ082PROD with RULES
Federal Register / Vol. 82, No. 191 / Wednesday, October 4, 2017 / Rules and Regulations 46147 

TABLE 1E—LTCH PPS STANDARD FEDERAL PAYMENT RATE

[FY 2018] 

Full update 

(1 percent) 

Reduced 

update * 

(¥1.0 

percent) 

Standard Federal Payment Rate ............................................................................................................................. $41,415.11 $40,595.02 

D. Corrections of Errors in the 

Appendices 

1. On pages 38552 through 38554, the 

table and table notes for the table titled 

‘‘TABLE I.—IMPACT ANALYSIS OF 

CHANGES TO THE IPPS FOR 

OPERATING COSTS FOR FY 2018’’ are 

corrected to read as follows: 

BILLING CODE 4120–01–P 


sradovich on DSK3GMQ082PROD with RULES

ER04OC17.000</GPH>sradovich on DSK3GMQ082PROD with RULES

TABLE I.-IMPACT ANALYSIS OF CHANGES TO THE IPPS FOR OPERATING COSTS 

FY 2018 

Weights and 

DRG Application 

Changes FY 2018 Rural and of the 

with Wage Data Imputed Frontier 

Application with Floor with Wage Index 

of Application Application and 

Number Hospital Rate Recalibration of Wage of National Out-Migra- 

of Update and Budget Budget FY 2018 MGCRB Budget tion 

HosP,itals Adjustments Neutrality Neutrality Reclassifications Neutrality Adjustment 

(1) 2 (2)3 (3)4 (4)5 (5)6 (6)7 

All Hospitals 3,292 1.2 0 0 0 0 0.1 

By Geographic Location: 

Urban hospitals 2,492 1.2 0 0 -0.1 0 0.1 

Large urban areas 1,340 1.2 0 0 -0.5 -0.1 0 

Other urban areas 1,152 1.2 0 0 0.3 0.2 0.2 

Rural hospitals 800 0.9 0.1 0 1.4 -0.2 0.2 

Bed Size (Urban): 

0-99 beds 648 1.1 0.4 0.1 -0.6 0.1 0.2 

1 00-199 beds 763 1.2 0.2 0.1 0 0.3 0.2 

200-299 beds 441 1.2 0.1 0 0.1 0.1 0.1 

300-499 beds 426 1.2 0 0.0 -0.1 0 0.1 

500 or more beds 214 1.2 -0.2 -0.1 -0.2 -0.1 0.1 

Bed Size (Rural): 

0-49 beds 318 0.9 0.3 0 0.4 -0.2 0.3 

50-99 beds 282 0.9 0.2 0 0.6 -0.1 0.4 

1 00-149 beds 117 0.8 0.1 -0.1 1.1 -0.2 0.1 

150-199 beds 44 0.9 0.1 0 2.2 -0.2 0.1 

200 or more beds 39 0.9 0 0.2 2.9 -0.2 0 

Urban by Region: 

New England 114 1.2 0 -0.5 1.2 1.4 0.1 

Middle Atlantic 315 1.2 0 -0.1 0.6 -0.3 0.1 

South Atlantic 404 1.2 0 0.1 -0.4 -0.2 0 

East North Central 385 1.2 0.1 0.1 -0.3 -0.4 0 

East South Central 147 1.2 0 -0.2 -0.3 -0.3 0 

West North Central 160 1.1 -0.1 0.4 -0.8 -0.3 0.7 

West South Central 378 1.2 0 0.5 -0.5 -0.3 0 

Mountain 162 1.1 0 -0.2 0 0.1 0.3 

Pacific 375 1.1 -0.1 -0.4 -0.2 0.9 0.1 

Puerto Rico 52 1.2 -0.5 1.4 -1.0 0.2 0.1 

Rural by Region: 

New England 20 1.0 0.1 1.1 2.1 -0.3 0.2 

Middle Atlantic 53 0.8 0.2 0 0.8 -0.2 0.2 

South Atlantic 125 1.0 0.2 -0.1 1.8 -0.2 0.2 

ER04OC17.001</GPH>sradovich on DSK3GMQ082PROD with RULES

FY 2018 

Weights and 

DRG Application 

Changes FY 2018 Rural and of the 

with Wage Data Imputed Frontier 

Application with Floor with Wage Index 

of Application Application and 

Number Hospital Rate Recalibration of Wage of National Out-Migra- 

of Update and Budget Budget FY 2018 MGCRB Budget tion 

Hospitals Adjustments Neutrality Neutrality Reclassifications Neutrality Adjustment 

1 (1) 2 (2)3 (3) 4 (4)5 (5)6 (6)7 

East North Central 115 0.9 0.1 -0.3 1.2 -0.1 0.1 

East South Central 154 1.1 0.3 0.1 2.4 -0.3 0.1 

West North Central 97 0.6 -0.1 0 0.2 0.0 0.3 

West South Central 154 0.9 0.3 0.2 1.5 -0.2 0.2 

Mountain 58 0.6 0.2 -0.1 0.2 -0.1 0.3 

Pacific 24 0.6 0 0 1.2 -0.1 0 

By Payment 

Classification: 

Urban hospitals 2,373 1.2 0 0 -0.3 0 0.1 

Large urban areas 1,354 1.2 0 0 -0.5 -0.1 0 

Other urban areas 1,019 1.2 0 0 -0.1 0.2 0.2 

Rural areas 919 1.0 0.1 0.1 1.6 -0.1 0.2 

Teaching Status: 

Nonteaching 2,204 1.1 0.1 0 0.2 0.2 0.1 

Fewer than 100 839 1.2 0.1 0 -0.1 -0.1 0.2 

residents 

100 or more residents 249 1.2 -0.2 -0.1 -0.1 -0.1 0 

Urban DSH: 

Non-DSH 551 1.2 0 0 -0.2 -0.1 0.2 

100 or more beds 1,543 1.2 0 0 -0.3 0 0.1 

Less than 100 beds 370 1.1 0.3 0 -0.2 0.1 0.2 

Rural DSH: 

SCH 257 0.6 0 0 -0.1 0 0 

RRC 293 1.0 0 0.1 2.0 -0.1 0.2 

100 or more beds 34 1.2 0.2 0 1.7 -0.2 0.1 

Less than 100 beds 244 1.1 0.5 0 0.5 -0.3 0.7 

Urban teaching and 

DSH: Both teaching and DSH 863 1.2 -0.1 -0.1 -0.3 -0.1 0.1 

Teaching and no DSH 92 1.2 0 -0.1 -0.2 -0.2 0.1 

No teaching and DSH 1,050 1.2 0.2 0 -0.2 0.3 0.1 

No teaching and no 368 1.2 0.1 0.1 -0.4 -0.1 0.2 

DSH 

Special Hospital 

Types: 

RRC 263 1.2 0.1 0.1 2.5 -0.1 0.3 

SCH 316 0.7 -0.2 -0.2 -0.1 0 0 

ER04OC17.002</GPH>sradovich on DSK3GMQ082PROD with RULES

FY 2018 

Weights and 

DRG Application 

Changes FY 2018 Rural and of the 

with Wage Data Imputed Frontier 

Application with Floor with Wage Index 

of Application Application and 

Number Hospital Rate Recalibration of Wage of National Out-Migra- 

of Update and Budget Budget FY 2018 MGCRB Budget tion 

Hospitals Adjustments Neutrality Neutrality Reclassifications Neutrality Adjustment 

1 (1) 2 (2)3 (3) 4 (4)5 (5)6 (6)7 

SCH and RRC 131 0.7 -0.1 0.1 0.3 0 0 

Type of Ownership: 

Voluntary 1,914 1.2 0 0 0 0 0.1 

Proprietary 863 1.2 0.2 0.2 0 0 0.1 

Government 513 1.1 0 -0.1 -0.2 0.1 0.1 

Medicare Utilization 

as a Percent of 

Inpatient Days: 

0-25 554 1.2 0 0 -0.3 0.1 0.1 

25-50 2,149 1.2 0 0 0 0.0 0.1 

50-65 485 1.1 0.1 0.1 0.6 0.2 0.2 

Over65 103 1.0 0.6 0.4 -0.9 -0.2 0.3 

FY 2018 

Reclassifications by 

the Medicare 

Geographic 

Classification Review 

Board: 

All Reclassified 858 1.1 0.1 0.1 2.2 -0.1 0 

Hospitals 

Non-Reclassified 2,434 1.2 0 0 -0.9 0 0.2 

Hospitals Urban Hospitals 590 1.2 0.1 0.1 2.2 -0.1 0 Reclassified Urban Nonreclassified 1,858 1.2 0 0.0 -0.9 0 0.1 

Hospitals Rural Hospitals 268 0.9 0.1 0 2.3 -0.2 0 

Reclassified Rural Nonreclassified 485 0.9 0.2 0 -0.3 -0.1 0.4 

Hospitals 

All Section 401 166 1.1 0 0.1 1.9 0 0.3 

Reclassified Hospitals: 

Other Reclassified 47 1.1 0.4 0.3 3.3 -0.3 0 

Hospitals (Section 

1886(d)(8)(B)) 

Because data necessary to classify some hospitals by category were missing, the total number of hospitals in each category may not equal the national total. 

and hospital cost report data are from reporting periods beginning in FY 2014 and FY 2015. 
BILLING CODE 4120–01–C 


ER04OC17.003</GPH>sradovich on DSK3GMQ082PROD with RULES

2 This column displays the payment impact of the hospital rate update and other adjustments, including the 1.35 percent adjustment to the national standardize

rate (the estimated 2.7 percent market basket update reduced by 0.6 percentage point for the multifactor productivity adjustment and the 0.75 percentage point 

Act), the 0.4588 percent adjustment to the national standardized amount required under section 15005 of the 21st Century Cures Act and a factor of (1/1.006) t

time adjustment made in FY 2017 to address the effects of the 0.2 percent reduction in effect for FYs 2014 through 2016 related to the 2-midnight policy. 

3 This column displays the payment impact of the changes to the Version 35 GROUPER, the changes to the relative weights and the recalibration ofthe MS-DR

MedPAR data in accordance with section 1886(d)(4)(C)(iii) of the Act. This column displays the application of the recalibration budget neutrality factor of 0.997

1886(d)(4)(C)(iii) of the Act. 

4 This column displays the payment impact of the update to wage index data using FY 2014 and 2013 cost report data and the OMB labor market area delineat

Census data. This column displays the payment impact of the application of the wage budget neutrality factor, which is calculated separately from the recalibra

calculated in accordance with section 1886(d)(3)(E)(i) of the Act. The wage budget neutrality factor is .1.000882. 

5 Shown here are the effects of geographic reclassifications by the Medicare Geographic Classification Review Board (MGCRB). The effects demonstrate the 

from no reclassifications to the reclassifications scheduled to be in effect for FY 2018. Reclassification for prior years has no bearing on the payment impacts s

budget neutrality factor of 0.987985. 

This column displays the effects of the rural floor and imputed floor. The Affordable Care Act requires the rural floor budget neutrality adjustment to be 100 pe

rural floor budget neutrality factor (which includes the imputed floor) applied to the wage index is 0.993324. 

7 This column shows the combined impact of the policy required under section 10324 of the Affordable Care Act that hospitals located in frontier States have a section 1886(d)(13) of the Act, as added by section 505 of Pub. L. 108-173, which provides for an increase in a hospital's wage index if a threshold percentage 

hospital is located commute to work at hospitals in counties with higher wage indexes. These are not budget neutral policies. 

8 Th is column displays the impact of the expiration of MDH status for FY 2018, a non-budget neutral payment provision. 

9 This column shows the estimated change in payments from FY 2017 to FY 2018. 
46152 Federal Register / Vol. 82, No. 191 / Wednesday, October 4, 2017 / Rules and Regulations 

2. On page 38555, 

a. Second column, second full 

paragraph— 

(1) Line 6, the figure ‘‘0.997432’’ is 

corrected to read ‘‘0.997439’’. 

(2) Line 14, the figure ‘‘0.2’’ is 

corrected to read ‘‘0.1’’. 

b. Third column, first full paragraph, 

line 26, the figure ‘‘1.001148’’ is 

corrected to read ‘‘1.000882’’. 

3. On page 38556, lower half of the 

page— 

a. First column, third full paragraph, 

line 6, the figure ‘‘0.988008’’ is 

corrected to read ‘‘0.987985’’. 

b. Third column— 

(1) First full paragraph, line 8, the 

figure ‘‘0.993348’’ is corrected to read 

‘‘0.993324’’. 

(2) Last paragraph, line 5, the figure 

‘‘0.993348’’ is corrected to read 

‘‘0.993324’’. 

4. On page 38557, top of the page, first 

column, first partial paragraph, line 20, 

the figure ‘‘$44 million’’ is corrected to 

read ‘‘$43 million’’. 

5. On pages 38557 and 38558, the 

table titled ‘‘FY 2018 IPPS ESTIMATED 

PAYMENTS DUE TO RURAL AND 

IMPUTED FLOOR WITH NATIONAL 

BUDGET NEUTRALITY’’ is corrected to 

read as follows: 

FY 2018 IPPS ESTIMATED PAYMENTS DUE TO RURAL AND IMPUTED FLOOR WITH NATIONAL BUDGET NEUTRALITY

State Number of 

hospitals 

Number of 

hospitals that 

will receive the 

rural or 

imputed floor 

Percent 

change in 

payments due 

to application 

of rural floor 

and imputed 

floor with 

budget 

neutrality 

Difference 

(in $ millions) 

(1) (2) (3) (4) 

Alabama ........................................................................................................... 84 3 ¥0.3 ¥5 

Alaska .............................................................................................................. 6 4 1.4 3 

Arizona ............................................................................................................. 57 38 0.4 7

Arkansas .......................................................................................................... 44 1 ¥0.3 ¥4 

California .......................................................................................................... 299 177 1.2 134 

Colorado .......................................................................................................... 47 4 0.4 5 

Connecticut ...................................................................................................... 30 7 0.1 2 

Delaware .......................................................................................................... 6 6 1.8 8 

Washington, DC ............................................................................................... 7 0 ¥0.4 ¥2 

Florida .............................................................................................................. 171 17 ¥0.2 ¥16 

Georgia ............................................................................................................ 103 0 ¥0.3 ¥9 

Hawaii .............................................................................................................. 12 0 ¥0.3 ¥1 

Idaho ................................................................................................................ 14 0 ¥0.2 ¥1 

Illinois ............................................................................................................... 127 3 ¥0.4 ¥17 

Indiana ............................................................................................................. 85 0 ¥0.3 ¥8 

Iowa ................................................................................................................. 34 0 ¥0.3 ¥3 

Kansas ............................................................................................................. 53 0 ¥0.3 ¥3 

Kentucky .......................................................................................................... 66 0 ¥0.3 ¥5 

Louisiana .......................................................................................................... 94 2 ¥0.3 ¥5 

Maine ............................................................................................................... 17 0 ¥0.4 ¥2 

Massachusetts ................................................................................................. 57 36 1.3 43 

Michigan ........................................................................................................... 94 0 ¥0.3 ¥14 

Minnesota ........................................................................................................ 49 0 ¥0.3 ¥6 

Mississippi ........................................................................................................ 60 0 ¥0.3 ¥4 

Missouri ............................................................................................................ 74 0 ¥0.2 ¥6 

Montana ........................................................................................................... 13 4 0 0 

Nebraska .......................................................................................................... 24 0 ¥0.3 ¥2 

Nevada ............................................................................................................. 23 0 ¥0.4 ¥3 

New Hampshire ............................................................................................... 13 9 3.7 20 

New Jersey ...................................................................................................... 64 17 ¥0.1 ¥4 

New Mexico ..................................................................................................... 25 0 ¥0.2 ¥1 

New York ......................................................................................................... 154 11 ¥0.3 ¥23 

North Carolina .................................................................................................. 84 0 ¥0.3 ¥10 

North Dakota .................................................................................................... 6 0 ¥0.2 ¥1 

Ohio ................................................................................................................. 128 6 ¥0.3 ¥12 

Oklahoma ......................................................................................................... 84 4 ¥0.2 ¥3 

Oregon ............................................................................................................. 34 5 ¥0.3 ¥3 

Pennsylvania .................................................................................................... 150 3 ¥0.4 ¥17 

Puerto Rico ...................................................................................................... 52 10 0.2 0 

Rhode Island .................................................................................................... 11 10 5.0 19 

South Carolina ................................................................................................. 56 0 ¥0.3 ¥5 

South Dakota ................................................................................................... 17 0 ¥0.2 ¥1 

Tennessee ....................................................................................................... 91 3 ¥0.3 ¥8 

Texas ............................................................................................................... 310 4 ¥0.3 ¥22 

Utah ................................................................................................................. 31 1 ¥0.3 ¥2 

Vermont ........................................................................................................... 6 0 ¥0.2 0 

Virginia ............................................................................................................. 73 1 ¥0.3 ¥7 

Washington ...................................................................................................... 48 3 ¥0.2 ¥5 

West Virginia .................................................................................................... 29 3 ¥0.1 ¥1 


sradovich on DSK3GMQ082PROD with RULES
Federal Register / Vol. 82, No. 191 / Wednesday, October 4, 2017 / Rules and Regulations 46153 

FY 2018 IPPS ESTIMATED PAYMENTS DUE TO RURAL AND IMPUTED FLOOR WITH NATIONAL BUDGET NEUTRALITY— 

Continued 

State Number of 

hospitals 

Number of 

hospitals that 

will receive the 

rural or 

imputed floor 

Percent 

change in 

payments due 

to application 

of rural floor 

and imputed 

floor with 

budget 

neutrality 

Difference 

(in $ millions) 

(1) (2) (3) (4) 

Wisconsin ......................................................................................................... 66 8 ¥0.2 ¥3 

Wyoming .......................................................................................................... 10 0 ¥0.1 0 

6. On pages 38559 and 38560, the 

table titled ‘‘TABLE II.—IMPACT 

ANALYSIS OF CHANGES FOR FY 2018 

ACUTE CARE HOSPITAL OPERATING 

PROSPECTIVE PAYMENT SYSTEM 

(PAYMENTS PER DISCHARGE)’’ is 

corrected to read as follows: 

TABLE II—IMPACT ANALYSIS OF CHANGES FOR FY 2018 ACUTE CARE HOSPITAL OPERATING PROSPECTIVE PAYMENT

SYSTEM

[Payments per discharge] 

Number of 

hospitals 

Estimated 

average 

FY 2017 

payment per 

discharge 

Estimated 

average 

FY 2018 

payment per 

discharge 

FY 2018 

changes 

(1) (2) (3) (4) 

All Hospitals ..................................................................................................... 3,292 $11,867 $12,024 1.3 

By Geographic Location: 

Urban hospitals ......................................................................................... 2,492 12,207 12,379 1.4

Large urban areas .................................................................................... 1,340 12,881 13,061 1.4 

Other urban areas .................................................................................... 1,152 11,477 11,642 1.4 

Rural hospitals .......................................................................................... 800 8,911 8,930 0.2 

Bed Size (Urban): 

0–99 beds ................................................................................................. 648 9,730 9,813 0.8 

100–199 beds ........................................................................................... 763 10,248 10,404 1.5 

200–299 beds ........................................................................................... 441 11,079 11,245 1.5 

300–499 beds ........................................................................................... 426 12,366 12,538 1.4 

500 or more beds ..................................................................................... 214 15,011 15,224 1.4 

Bed Size (Rural): 

0–49 beds ................................................................................................. 318 7,523 7,486 ¥0.5 

50–99 beds ............................................................................................... 282 8,487 8,372 ¥1.4 

100–149 beds ........................................................................................... 117 8,896 8,966 0.8 

150–199 beds ........................................................................................... 44 9,292 9,410 1.3 

200 or more beds ..................................................................................... 39 10,514 10,679 1.6 

Urban by Region: 

New England ............................................................................................ 114 13,125 13,303 1.4 

Middle Atlantic .......................................................................................... 315 13,819 13,967 1.1 

South Atlantic ........................................................................................... 404 10,783 10,952 1.6 

East North Central .................................................................................... 385 11,537 11,727 1.6 

East South Central ................................................................................... 147 10,245 10,375 1.3 

West North Central ................................................................................... 160 11,915 12,107 1.6 

West South Central .................................................................................. 378 10,948 11,134 1.7 

Mountain ................................................................................................... 162 12,824 12,898 0.6 

Pacific ....................................................................................................... 375 15,634 15,867 1.5 

Puerto Rico ............................................................................................... 52 8,851 8,947 1.1 

Rural by Region: 

New England ............................................................................................ 20 12,091 12,166 0.6 

Middle Atlantic .......................................................................................... 53 8,891 8,812 ¥0.9 

South Atlantic ........................................................................................... 125 8,274 8,269 ¥0.1 

East North Central .................................................................................... 115 9,224 9,144 ¥0.9 

East South Central ................................................................................... 154 7,900 7,987 1.1 

West North Central ................................................................................... 97 9,736 9,794 0.6 

West South Central .................................................................................. 154 7,539 7,587 0.6 

Mountain ................................................................................................... 58 10,620 10,718 0.9

Pacific ....................................................................................................... 24 12,466 12,517 0.4 

By Payment Classification: 

Urban hospitals ......................................................................................... 2,373 12,148 12,320 1.4


sradovich on DSK3GMQ082PROD with RULES
46154 Federal Register / Vol. 82, No. 191 / Wednesday, October 4, 2017 / Rules and Regulations 

TABLE II—IMPACT ANALYSIS OF CHANGES FOR FY 2018 ACUTE CARE HOSPITAL OPERATING PROSPECTIVE PAYMENT

SYSTEM—Continued 

[Payments per discharge] 

Number of 

hospitals 

Estimated 

average 

FY 2017 

payment per 

discharge 

Estimated 

average 

FY 2018 

payment per 

discharge 

FY 2018 

changes 

(1) (2) (3) (4) 

Large urban areas .................................................................................... 1,354 12,867 13,047 1.4 

Other urban areas .................................................................................... 1,019 11,200 11,362 1.4 

Rural areas ............................................................................................... 919 10,568 10,656 0.8

Teaching Status: 

Nonteaching .............................................................................................. 2,204 9,850 9,967 1.2 

Fewer than 100 residents ......................................................................... 839 11,372 11,535 1.4 

100 or more residents .............................................................................. 249 17,228 17,461 1.4 

Urban DSH: 

Non-DSH .................................................................................................. 551 10,357 10,456 1.0 

100 or more beds ..................................................................................... 1,543 12,512 12,689 1.4 

Less than 100 beds .................................................................................. 370 8,960 9,102 1.6 

Rural DSH: 

SCH .......................................................................................................... 257 9,526 9,578 0.5 

RRC .......................................................................................................... 293 11,384 11,568 1.6 

100 or more beds ..................................................................................... 34 10,297 10,339 0.4 

Less than 100 beds .................................................................................. 244 7,035 6,764 ¥3.9 

Urban teaching and DSH: 

Both teaching and DSH ............................................................................ 863 13,579 13,766 1.4 

Teaching and no DSH .............................................................................. 92 11,410 11,522 1.0 

No teaching and DSH .............................................................................. 1,050 10,217 10,374 1.5 

No teaching and no DSH ......................................................................... 368 9,854 10,000 1.5 

Special Hospital Types: 

RRC .......................................................................................................... 263 11,165 11,360 1.8 

SCH .......................................................................................................... 316 10,774 10,820 0.4 

SCH and RRC .......................................................................................... 131 11,265 11,362 0.9 

Type of Ownership: 

Voluntary ................................................................................................... 1,914 12,058 12,212 1.3 

Proprietary ................................................................................................ 863 10,392 10,554 1.6 

Government .............................................................................................. 513 12,810 12,980 1.3 

Medicare Utilization as a Percent of Inpatient Days: 

0–25 .......................................................................................................... 554 14,910 15,115 1.4 

25–50 ........................................................................................................ 2,149 11,728 11,890 1.4 

50–65 ........................................................................................................ 485 9,617 9,695 0.8 

Over 65 ..................................................................................................... 103 7,591 7,444 ¥1.9 

FY 2018 Reclassifications by the Medicare Geographic Classification Review Board: 

All Reclassified Hospitals ......................................................................... 858 11,661 11,830 1.5 

Non-Reclassified Hospitals ....................................................................... 2,434 11,956 12,108 1.3 

Urban Hospitals Reclassified .................................................................... 590 12,202 12,396 1.6 

Urban Nonreclassified Hospitals .............................................................. 1,858 12,210 12,381 1.4 

Rural Hospitals Reclassified Full Year ..................................................... 268 9,339 9,399 0.7 

Rural Nonreclassified Hospitals Full Year ................................................ 485 8,422 8,379 ¥0.5 

All Section 401 Reclassified Hospitals: .................................................... 166 12,504 12,677 1.4 

Other Reclassified Hospitals (Section 1886(d)(8)(B)) .............................. 47 8,122 8,165 0.5 

7. On pages 38561 through 38564 in 

the section titled ‘‘Effects of the Changes 

to Medicare DSH and Uncompensated 

Care Payments for FY 2018’’ (which 

begins with the phrase ‘‘As discussed in 

section V.G of the preamble’’ and ends 

with the phrase ‘‘hospitals are projected 

to receive large increases’’) the section 

is corrected to read as follows: 

‘‘5. Effects of the Changes to Medicare 

DSH and Uncompensated Care 

Payments for FY 2018. 

As discussed in section V.G. of the 

preamble of this final rule, under 

section 3133 of the Affordable Care Act, 

hospitals that are eligible to receive 

Medicare DSH payments will receive 25 

percent of the amount they previously 

would have received under the statutory 

formula for Medicare DSH payments 

under section 1886(d)(5)(F) of the Act. 

The remainder, equal to an estimate of 

75 percent of what formerly would have 

been paid as Medicare DSH payments 

(Factor 1), reduced to reflect changes in 

the percentage of uninsured individuals 

and additional statutory adjustments 

(Factor 2), is available to make 

additional payments to each hospital 

that qualifies for Medicare DSH 

payments and that has uncompensated 

care. Each hospital eligible for Medicare 

DSH payments will receive an 

additional payment based on its 

estimated share of the total amount of 

uncompensated care for all hospitals 

eligible for Medicare DSH payments. 

The uncompensated care payment 

methodology has redistributive effects 

based on the proportion of a hospital’s 

uncompensated care relative to the 

uncompensated care for all hospitals 

eligible for Medicare DSH payments 

(Factor 3). 


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Federal Register / Vol. 82, No. 191 / Wednesday, October 4, 2017 / Rules and Regulations 46155 

For FY 2018, we are establishing a 

Factor 2 of 58.01 percent determined 

using the uninsured estimates produced 

by CMS’ Office of the Actuary (OACT) 

as part of the development of the 

National Health Expenditure Accounts 

(NHEA). Although we are continuing to 

use low-income insured patient days as 

a proxy for uncompensated care, for the 

first time, we are using these data in 

combination with data on 

uncompensated care costs from 

Worksheet S–10 in the calculation of 

Factor 3. The uncompensated care 

payment methodology has redistributive 

effects based on the proportion of a 

hospital’s uncompensated care relative 

to the total uncompensated care for all 

hospitals eligible for Medicare DSH 

payments. The change to Medicare DSH 

payments under section 3133 of the 

Affordable Care Act is not budget 

neutral. 

In this final rule, we are establishing 

the amount to be distributed as 

uncompensated care payments to DSH 

eligible hospitals, which for FY 2018 is 

$6,766,695,163.56. This figure 

represents 75 percent of the amount that 

otherwise would have been paid for 

Medicare DSH payment adjustments 

adjusted by a Factor 2 of 58.01 percent. 

For FY 2017, the amount available to be 

distributed for uncompensated care was 

$5,977,483,146.86, or 75 percent of the 

amount that otherwise would have been 

paid for Medicare DSH payment 

adjustments adjusted by a Factor 2 of 

55.36 percent. To calculate Factor 3 for 

FY 2018, we used an average of data 

computed using Medicaid days from 

hospitals’ 2012 and 2013 cost reports 

from the March 2017 update of the 

HCRIS database, uncompensated care 

costs from hospitals’ 2014 cost reports 

from the same extract of HCRIS, 

Medicaid days from 2012 cost report 

data submitted to CMS by IHS hospitals, 

and SSI days from the FY 2014 and FY 

2015 SSI ratios. For each eligible 

hospital, we calculated an individual 

Factor 3 for cost reporting years FYs 

2012, 2013, and 2014. We then added 

the individual amounts and divided the 

sum by the number of cost reporting 

periods with data to calculate an 

average Factor 3 for FY 2018. For 

purposes of this final rule, as we 

proposed, we used the most recent data 

from the March 2017 update of the 

HCRIS database for the Medicaid days 

component of the Factor 3 calculation as 

well as for the Worksheet S–10 

uncompensated care cost component. 

The FY 2018 policy of using data from 

hospitals’ FY 2012, FY 2013, and FY 

2014 cost reporting years to determine 

Factor 3 is based on our FY 2017 final 

policy (81 FR 56943 through 56973), 

which is in contrast to the methodology 

used in FY 2016, when we used 

Medicaid days from the more recent of 

a hospital’s full year 2012 or 2011 cost 

report from the March 2015 update of 

the HCRIS database, Medicaid days 

from 2012 cost report data submitted to 

CMS by IHS hospitals, and SSI days 

from the FY 2013 SSI ratios to calculate 

Factor 3. In addition, as explained in 

section V.G.4.c. of the preamble of this 

final rule, we are making several 

additional modifications to the Factor 3 

methodology: (1) To annualize Medicaid 

data and uncompensated care data if a 

hospital’s cost report does not equal 12 

months of data; (2) to apply a scaling 

factor to the uncompensated care 

payment amount calculated for each 

DSH eligible hospital so that total 

uncompensated care payments are 

consistent with the estimated amount 

available to make uncompensated care 

payments for FY 2018; (3) to apply 

statistical trims to the CCRs on 

Worksheet S–10 that are considered 

anomalies to ensure reasonable CCRs 

are used to convert charges to costs for 

purposes of determining 

uncompensated care costs; (4) to 

calculate Factor 3 for Puerto Rico 

hospitals, all-inclusive rate providers, 

and Indian Health Service and Tribal 

hospitals by substituting data regarding 

low-income insured days for FY 2013 

for the Worksheet S–10 data on 

uncompensated care costs from FY 2014 

cost reports; and (5) to determine the 

ratio of uncompensated care costs 

relative to total operating costs on the 

hospital’s 2014 cost report (as of March 

2017), and in cases where the ratio of 

uncompensated care costs relative to 

total operating costs exceeds 50 percent, 

to determine the ratio of uncompensated 

care costs to total operating costs from 

the hospital’s 2015 cost report (as of 

March 2017) and apply that ratio to the 

hospital’s total operating costs from its 

2014 cost report to determine 

uncompensated care costs for FY 2014. 

We also are continuing the policies 

that were finalized in the FY 2015 IPPS/ 

LTCH PPS final rule (79 FR 50020 

through 50022) to address several 

specific issues concerning the process 

and data to be employed in determining 

Factor 3 in the case of hospital mergers 

for FY 2018 and subsequent years, as 

well as continuing the policies finalized 

in the FY 2017 IPPS/LTCH PPS final 

rule concerning the methodology for 

calculating each hospital’s relative share 

of uncompensated care, such as 

combining data from multiple cost 

reports beginning in the same fiscal year 

and calculating Factor 3 based on an 

average of the three individual Factor 3s 

for FYs 2012, 2013, and 2014, 

determined by adding the Factor 3 

values for these years, and dividing by 

the number of cost reporting periods 

with data. 

To estimate the impact of the 

combined effect of changes in Factors 1 

and 2, as well as the changes to the data 

used in determining Factor 3, on the 

calculation of Medicare DSH payments, 

including both empirically justified 

Medicare DSH payments and 

uncompensated care payments, we 

compared total DSH payments 

estimated in the FY 2017 IPPS/LTCH 

PPS final rule to total DSH payments 

estimated in this FY 2018 IPPS/LTCH 

PPS final rule. For FY 2017, for each 

hospital, we calculated the sum of: (1) 

25 percent of the estimated amount of 

what would have been paid as Medicare 

DSH in FY 2017 in the absence of 

section 3133 of the Affordable Care Act; 

and (2) 75 percent of the estimated 

amount of what would have been paid 

as Medicare DSH payments in the 

absence of section 3133 of the 

Affordable Care Act, adjusted by a 

Factor 2 of 55.36 percent and multiplied 

by a Factor 3 calculated as described in 

the FY 2017 IPPS/LTCH PPS final rule. 

For FY 2018, we calculated the sum of: 

(1) 25 percent of the estimated amount 

of what would be paid as Medicare DSH 

payments in FY 2018 absent section 

3133 of the Affordable Care Act; and (2) 

75 percent of the estimated amount of 

what would be paid as Medicare DSH 

payments absent section 3133 of the 

Affordable Care Act, adjusted by a 

Factor 2 of 58.01 percent and multiplied 

by a Factor 3 calculated using the 

methodology described previously. 

Our analysis included 2,438 hospitals 

that are projected to be eligible for DSH 

in FY 2018. It did not include hospitals 

that had terminated their participation 

in the Medicare program as of July 1, 

2017, Maryland hospitals, and SCHs 

that are expected to be paid based on 

their hospital specific rates. In addition, 

data from merged or acquired hospitals 

were combined under the surviving 

hospital’s CCN, and the non-surviving 

CCN was excluded from the analysis. 

The estimated impact of the changes to 

Factors 1, 2, and 3 across all hospitals 

projected to be eligible for DSH 

payments in FY 2018, by hospital 

characteristic, is presented in the 

following table. 


sradovich on DSK3GMQ082PROD with RULES
46156 Federal Register / Vol. 82, No. 191 / Wednesday, October 4, 2017 / Rules and Regulations 

MODELED DISPROPORTIONATE SHARE HOSPITAL PAYMENTS FOR ESTIMATED FY 2018 DSHS BY HOSPITAL TYPE: MODEL

DSH $ (IN MILLIONS) FROM FY 2017 TO FY 2018 

Number of 

estimated 

DSHs 

(FY 2018) 

FY 2017 final 

rule estimated 

DSH 

$ (in millions) 

FY 2018 final 

rule estimated 

DSH 

$ (in millions) 

Dollar 

difference: FY 

2017–FY 2018 

(in millions) 

Percent 

change ** 

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

Total ..................................................................................... 2,438 $9,553 $10,630 $1,077 11.3 

By Geographic Location: 

Urban Hospitals ............................................................ 1,938 9,113 10,110 996 10.9 

Large Urban Areas ....................................................... 1,043 5,717 6,377 660 11.5 

Other Urban Areas ....................................................... 895 3,396 3,733 336 9.9 

Rural Hospitals ............................................................. 500 439 520 80 18.3 

Bed Size (Urban): 

0 to 99 Beds ................................................................. 342 185 241 57 30.7 

100 to 249 Beds ........................................................... 843 2,154 2,386 233 10.8 

250+ Beds .................................................................... 753 6,775 7,482 707 10.4 

Bed Size (Rural): 

0 to 99 Beds ................................................................. 371 190 238 48 25.2 

100 to 249 Beds ........................................................... 115 193 221 28 14.6 

250+ Beds .................................................................... 14 56 60 5 8.2 

Urban by Region: 

New England ................................................................ 91 387 415 29 7.4 

Middle Atlantic .............................................................. 241 1,570 1,643 73 4.7 

South Atlantic ................................................................ 316 1,724 2,037 314 18.2 

East North Central ........................................................ 322 1,252 1,372 120 9.6 

East South Central ....................................................... 131 566 618 53 9.3 

West North Central ....................................................... 103 439 488 48 11.0 

West South Central ...................................................... 257 1,165 1,448 283 24.3 

Mountain ....................................................................... 121 448 497 49 11.0 

Pacific ........................................................................... 316 1,448 1,463 15 1.0 

Puerto Rico ................................................................... 40 116 129 13 10.9 

Rural by Region: 

New England ................................................................ 12 16 21 5 32.0 

Middle Atlantic .............................................................. 25 33 32 ¥1 ¥3.9 

South Atlantic ................................................................ 86 92 115 23 25.2 

East North Central ........................................................ 68 44 58 13 29.9 

East South Central ....................................................... 136 141 150 9 6.2 

West North Central ....................................................... 30 19 23 4 22.1 

West South Central ...................................................... 111 72 95 23 32.1 

Mountain ....................................................................... 27 15 20 5 32.2 

Pacific ........................................................................... 5 7 6 ¥1 ¥11.4 

By Payment Classification: 

Urban Hospitals ............................................................ 1,928 9,106 10,101 994 10.9 

Large Urban Areas ....................................................... 1,043 5,717 6,377 660 11.5 

Other Urban Areas ....................................................... 885 3,389 3,724 334 9.9 

Rural Hospitals ............................................................. 510 447 529 82 18.5 

Teaching Status: 

Nonteaching .................................................................. 1,526 2,955 3,276 321 10.9 

Fewer than 100 residents ............................................. 669 3,213 3,501 288 9.0 

100 or more residents .................................................. 243 3,384 3,853 468 13.8 

Type of Ownership: 

Voluntary ....................................................................... 1,434 5,971 6,533 563 9.4 

Proprietary .................................................................... 552 1,650 1,662 12 0.7 

Government .................................................................. 452 1,932 2,434 502 30.0 

Medicare Utilization Percent: 

Missing or Unknown ..................................................... 15 1 15 14 2147.4 

0 to 25 ........................................................................... 425 2,972 3,365 393 13.2 

25 to 50 ......................................................................... 1,642 6,218 6,829 611 9.8 

50 to 65 ......................................................................... 310 352 408 57 16.1 

Greater than 65 ............................................................ 46 11 13 2 17.4 

Source: Dobson | DaVanzo analysis of 2012–2014 Hospital Cost Reports. 

* Dollar DSH calculated by [0.25 * estimated section 1886(d)(5)(F) payments] + [0.75 * estimated section 1886(d)(5)(F) payments * Factor 2 * 

Factor 3]. When summed across all hospitals projected to receive DSH payments, DSH payments are estimated to be $9,553 million in FY 2017 

and $10,630 million in FY 2018. 

** Percentage change is determined as the difference between Medicare DSH payments modeled for the FY 2018 IPPS/LTCH PPS final rule 

(column 3) and Medicare DSH payments modeled for the FY 2017 IPPS/LTCH PPS final rule (column 2) divided by Medicare DSH payments 

modeled for the FY 2017 final rule (column 2) times 100 percent. 

Changes in projected FY 2018 DSH 

payments from DSH payments in FY 

2017 are primarily driven by (1) changes 

to Factor 1, which increased from 

$10.797 billion to $11.665 billion; (2) 

changes to Factor 2, which increased 


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Federal Register / Vol. 82, No. 191 / Wednesday, October 4, 2017 / Rules and Regulations 46157 

from 55.36 percent to 58.01 percent; (3) 

changes to the data used to determine 

Factor 3; and (4) changes to the number 

of DSH-eligible hospitals within a given 

hospital type. The impact analysis 

found that, across all projected DSH 

eligible hospitals, FY 2018 DSH 

payments are estimated at 

approximately $10.630 billion, or an 

increase of approximately 11.3 percent 

from FY 2017 DSH payments 

(approximately $9.553 billion). While 

these changes result in a net increase in 

the amount available to be distributed in 

uncompensated care payments, DSH 

payments to select hospital types are 

expected to decrease. This 

redistribution of DSH payments is 

caused by changes in the data used to 

determine Factor 3 and changes in the 

number of DSH-eligible hospitals within 

a given hospital type. 

As seen in the above table, percent 

changes in DSH payments of less than 

11.3 percent indicate that hospitals 

within the specified category are 

projected to experience a smaller 

increase in DSH payments, on average, 

compared to the universe of projected 

FY 2018 DSH hospitals. Conversely, 

percent changes in DSH payments that 

are greater than 11.3 percent indicate a 

hospital type is projected to have a 

larger increase than the overall percent 

change on average, a larger increase 

than the overall percent change. The 

variation in the distribution of DSH 

payments by hospital characteristic is 

largely dependent on the change in a 

given hospital’s number of Medicaid 

days and SSI days for purposes of the 

low-income insured days proxy between 

FY 2017 and FY 2018, as well as on its 

uncompensated care costs as reported 

on its FY 2014 Worksheet S–10. 

Many rural hospitals, grouped by 

geographic location, payment 

classification, and bed size, are 

projected to experience a larger increase 

in DSH payments than their urban 

counterparts. Overall, rural hospitals are 

projected to receive an 18.3 percent 

increase in DSH payments, and urban 

hospitals are projected to receive a 10.9 

percent increase. However, only smaller 

and medium-sized rural hospitals are 

projected to receive increases in DSH 

payments that are, on average, higher 

than the 11.3 percent change across all 

hospitals that are projected to be eligible 

for DSH in FY 2018. Rural hospitals that 

have 0–99 beds are projected to 

experience a 25.2 percent payment 

increase, those with 100–249 beds are 

projected to receive a 14.6 percent 

increase, and larger rural hospitals with 

250+ beds are projected to experience 

an 8.2 percent payment increase. This 

trend is somewhat consistent with 

urban hospitals, in which the smallest 

urban hospitals (0– 99 beds) are 

projected to receive an increase in DSH 

payments of 30.7 percent. Medium sized 

hospitals (100–250 beds) and larger 

hospitals (250+ beds) are projected to 

receive increases of 10.8 and 10.4 

percent in DSH payments, respectively, 

which are relatively consistent with the 

overall average. 

By region, projected DSH payment 

increases for urban hospitals are smaller 

than the overall percent change in the 

New England, Middle Atlantic, East 

North Central, East South Central, and 

Pacific regions. Hospitals in the South 

Atlantic and West South Central regions 

are projected to receive increases in 

DSH payments that are, on average, 

larger than the 11.3 percent change 

across all hospitals projected to be 

eligible for DSH in FY 2018. Increases 

in the West North Central, Mountain, 

and Puerto Rico regions are generally 

consistent with the overall average 

percent increase of 11.3 percent. 

Regionally, rural hospitals are projected 

to receive a wider range of increases. 

Rural hospitals in the Middle Atlantic 

and Pacific regions are expected to 

receive a decrease in DSH payments, 

while those in the East South Central 

region are projected to receive an 

increase in DSH payments smaller than 

the 11.3 overall percent change. 

Increases are projected to be 

substantially larger than the overall 

average in many regions, including New 

England, South Atlantic, East North 

Central, West North Central, West South 

Central, and Mountain. 

Nonteaching hospitals and teaching 

hospitals with fewer than 100 residents 

are projected to receive smaller 

increases than the overall percent 

change, at 10.9 and 9.0 percent 

respectively. Conversely, teaching 

hospitals with 100 or more residents are 

projected to receive, on average, larger 

increases than the overall percent 

change of 11.3 percent, with a projected 

increase of 13.8 percent. Voluntary 

hospitals are expected to receive a 9.4 

percent increase, which is somewhat 

smaller than the overall percent change, 

while proprietary hospitals are expected 

to receive almost no change in DSH 

payments. Government hospitals are 

projected to receive a larger than 

average 30.0 percent increase. Hospitals 

with 25 to 50 percent Medicare 

utilization are projected to receive 

increases in DSH payments slightly 

below the overall average at 9.8 percent, 

while all other hospitals are projected to 

receive larger increases.’’ 

8. On page 38572 top of the page— 

a. First column, fourth bulleted 

paragraph— 

(1) Line 4, the figure ‘‘0.9986’’ is 

corrected to read ‘‘0.9987’’ 

(2) Line 5, the figure ‘‘0.9484’’ is 

corrected to read ‘‘0.9483’’ 

b Second column, first full 

paragraph— 

(1) Line 8, the figure ‘‘0.9484’’ is 

corrected to read ‘‘0.9483’’ 

(2) Line 9, the figure ‘‘1.04’’ is 

corrected to read ‘‘1.03’’. 

c. Third column— 

(1) First partial paragraph— 

(a) Line 1, the figure ‘‘2.9’’ is corrected 

to read ‘‘3.0’’ 

(b) Line 4, the figure 2.0’’ is corrected 

to read ‘‘1.9’’. 

(2) First full paragraph – 

(a) Line 4, the figure ‘‘3.7’’ is corrected 

to read ‘‘3.8’’. 

(b) Line 9, the figure ‘‘5.2’’ is 

corrected to read ‘‘5.3’’. 

(c) Line 12, the figure ‘‘1.9’’ is 

corrected to read ‘‘2.0’’. 

(3) Second full paragraph— 

(a) Line 7, the figure ‘‘2.3’’ is corrected 

to read ‘‘2.2’’. 

(b) Lines 10 and 11, the phrase ‘‘3.2 

percent.’’ is corrected to read ‘‘3.2 

percent and 3.3 percent, respectively.’’. 

(4) Last paragraph— 

(a) Line 14, the figure ‘‘1.6’’ is 

corrected to read ‘‘1.7’’. 

(b) Line 27, the figure ‘‘6.6’’ is 

corrected to read ‘‘6.5’’. 

9. On pages 38572 through 38574, the 

table titled ‘‘TABLE III.—COMPARISON 

OF TOTAL PAYMENTS PER CASE [FY 

2017 PAYMENTS COMPARED TO FY 

2018 PAYMENTS]’’ is corrected to read 

as follows: 

BILLING CODE 4120–01–P 


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46158 Federal Register / Vol. 82, No. 191 / Wednesday, October 4, 2017 / Rules and Regulations 


sradovich on DSK3GMQ082PROD with RULESER04OC17.004</GPH>

TABLE 111.-COMP ARISON OF TOTAL PAYMENTS PER CASE [FY 2017 

PAYMENTS COMPARED TO FY 2018 PAYMENTS] 

Average Average 

Number of FY 2017 FY 2018 

hospitals payments/ payments/ 

case case 

By Geographic Location: 

All hospitals 3,292 920 943 

Large urban areas (populations over 1 million) 1,340 1,007 1,037 

Other urban areas (populations of 1 million of fewer) 1,152 896 913 

Rural areas 800 625 644 

Urban hospitals 2,492 953 977 

0-99 beds 648 768 798 

1 00-199 beds 763 825 850 

200-299 beds 441 877 897 

300-499 beds 426 965 989 

500 or more beds 214 1,142 1,167 

Rural hospitals 800 625 644 

0-49 beds 318 523 544 

50-99 beds 282 584 599 

100-149 beds 117 625 642 

150-199 beds 44 663 687 

200 or more beds 39 749 771 

By Region: 

Urban by Region 2,492 953 977 

New England 114 1,038 1,056 

Middle Atlantic 315 1,054 1,074 

South Atlantic 404 849 869 

East North Central 385 918 941 

East South Central 147 800 815 

West North Central 160 933 958 

West South Central 378 863 896 

Mountain 162 1,005 1,013 

Pacific 375 1,209 1,250 

Puerto Rico 52 437 451 

Rural by Region 800 625 644 

New England 20 860 905 

Middle Atlantic 53 603 616 

South Atlantic 125 584 596 

East North Central 115 645 661 

East South Central 154 574 591 

West North Central 97 667 690 

West South Central 154 555 574 

Mountain 58 695 716 

Pacific 24 805 836 

By Payment Classification: 

All hospitals 3,292 920 943 

Large urban areas (populations over 1 million) 1,354 1,005 1,036 

Other urban areas (populations of 1 million of fewer) 1,019 883 907 

Rural areas 919 768 771 

Teaching Status: 

Non-teaching 2,204 779 802 

Fewer than 100 Residents 839 890 910 

100 or more Residents 249 1,283 1,314 

Urban DSH: 

100 or more beds 1,543 975 1,003 

Less than 100 beds 370 697 727 

Rural DSH: 

Sole Community (SCH/EACH) 257 622 632 

Referral Center (RRC/EACH) 293 833 834 

Other Rural: 

100 or more beds 34 820 791 

Change 

2.5 

3.0 

1.9 

3.0 

2.5 

3.9 

3.0 

2.3 

2.4 

2.2 

3.0 

3.9 

2.5 

2.7 

3.6 

2.9 

2.5 

1.8 

1.9 

2.4 

2.5 

1.8 

2.8 

3.8 

0.8 

3.4 

3.2 

3.0 

5.3 

2.2 

2.0 

2.5 

3.0 

3.4 

3.4 

3.1 

3.8 

2.5 

3.0 

2.8 

0.4 

2.9 

2.3 

2.4 

2.8 

4.3 

1.7 

0.1 

-3.5 
Federal Register / Vol. 82, No. 191 / Wednesday, October 4, 2017 / Rules and Regulations 46159 

BILLING CODE 4120–01–C 

10. On page 38576— 

a. First column, last paragraph, line 4, 

the figure ‘‘$41,430.56’’ is corrected to 

read ‘‘$41,415.11’’. 

b. Second column— 

(1) First partial paragraph— 

(a) Line 1, the figure ‘‘1.0006434’’ is 

corrected to read ‘‘1.0002704’’. 

(b) Line 12, the figure ‘‘$40,610.16’’ is 

corrected to read ‘‘$40,595.02’’. 

(2) Second full paragraph, line 14, the 

figure ‘‘1.0006434’’ is corrected to read 

‘‘1.0002704’’. 

11. On page 38578, second column, 

second full paragraph— 

a. Line 21, the figure ‘‘$41,430.56’’ is 

corrected to read ‘‘$41,415.11’’. 

b. Line 22, the figure ‘‘$40,610.16’’ is 

corrected to read ‘‘$40,595.02’’. 

12. On page 38579— 

a. Top of the page, the table title and 

the table titled ‘‘TABLE IV: IMPACT OF 

PAYMENT RATE AND POLICY 

CHANGES TO LTCH PPS PAYMENTS 

FOR STANDARD PAYMENT RATE 

CASES FOR FY 2018 [Estimated FY 

2017 payments compared to estimated 

FY 2018 payments]’’ are corrected to 

read as follows: 

BILLING CODE 4120–01–P 


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TABLE IV: IMPACT OF PAYMENT RATE AND POLICY CHANGES 

TO LTCH PPS PAYMENTS FOR STANDARD FEDERAL PAYMENT RATE CASES F

[Estimated FY 2017 payments compared to estimated FY 2018 payments] 

Percent 

Change 

Due to 

AverageFY Average Change Percent 

Number 2017 LTCH FY 2018 to the Change C

ofLTCH PPS LTCHPPS Annual Due to t

PPS Payment Payment Update to Changes to 

Standard Per Per the Area Wage 

Federal Standard Standard Standard Adjustment 

Payment Federal Federal Federal with Wage 

No. of Rate Payment Payment Payment Budget M

L TCH Classification LTCHs Cases Rate Rate1 Rate2 Neutrality3 

(1) (2) (3) (4) (5) (6) (7) 

ALL PROVIDERS 415 73,915 $46,637 $47,109 0.9 0.0 

BY LOCATION: 

RURAL 21 2,223 $38,004 $37,969 0.9 -0.3 

URBAN 394 71,692 $46,905 $47,392 0.9 0.0 

LARGE 199 41,253 $49,568 $50,141 0.9 0.1 

OTHER 195 30,439 $43,294 $43,665 0.9 -0.1 

BY PARTICIPATION DATE: 

BEFORE OCT. 1983 II 1,832 $43,730 $44,550 0.9 -0.6 

OCT. 1983- SEPT.1993 42 9,202 $52,289 $52,672 0.8 -0.1 OCT. 1993- SEPT. 2002 167 27,657 $46,363 $46,847 0.9 0.1 

AFTER OCTOBER 2002 195 35,224 $45,527 $45,993 0.9 0.0 

ER04OC17.007</GPH>sradovich on DSK3GMQ082PROD with RULES

Percent 

Change 

Due to 

AverageFY Average Change Percent 

Number 2017 LTCH FY 2018 to the Change C

ofLTCH PPS LTCHPPS Annual Due to t

PPS Payment Payment Update to Changes to 

Standard Per Per the Area Wage 

Federal Standard Standard Standard Adjustment 

Payment Federal Federal Federal with Wage 

No. of Rate Payment Payment Payment Budget M

L TCH Classification LTCHs Cases Rate Rate1 Rate2 Neutrality3 

(1) (2) (3) (4) (5) (6) (7) 

BY OWNERSHIP TYPE: 

VOLUNTARY 72 9,636 $48,980 $49,287 0.9 -0.1 

PROPRIETARY 329 62,783 $46,105 $46,619 0.9 0.0 

GOVERNMENT 14 1,496 $53,851 $53,609 0.9 -0.2 

BY REGION: 

NEW ENGLAND 12 2,757 $43,309 $44,407 0.9 -0.3 

MIDDLE ATLANTIC 25 5,896 $51,862 $52,195 0.9 -0.1 

SOUTH ATLANTIC 66 13,333 $46,700 $47,213 0.9 -0.1 

EAST NORTH CENTRAL 68 11,540 $46,371 $46,731 0.9 0.0 EAST SOUTH CENTRAL 34 5,276 $43,787 $44,297 0.9 0.0 

WEST NORTH CENTRAL 28 4,402 $45,291 $45,233 0.9 0.1 WEST SOUTH CENTRAL 126 18,529 $41,578 $41,921 0.9 0.01 

MOUNTAIN 31 4,279 $48,360 $48,774 0.9 -0.2 PACIFIC 25 7,903 $57,760 $58,810 0.8 0.0 

BY BED SIZE: 

BEDS: 0-24 26 1,770 $46,206 $46,345 0.9 0.5 

BEDS: 25-49 195 26,171 $43,608 $43,971 0.9 -0.1 BEDS: 50-74 117 20,276 $48,220 $48,529 0.9 -0.1 BEDS: 75-124 45 12,708 $49,890 $50,560 0.9 0.2 BEDS: 125-199 23 8,079 $47,633 $48,228 0.9 0.0 BEDS: 200+ 9 4,911 $46,341 $47,463 0.8 0.0 
b. Lower fourth of the page, third 

column, partial paragraph, line 5, the ‘‘1.0002704’’. 

figure ‘‘1.0006434’’ is corrected to read 13. On page 38585, middle of the 

page, first column, first paragraph— 


ER04OC17.008</GPH>sradovich on DSK3GMQ082PROD with RULES

1 Estimated FY 2018 LTCH PPS payments for LTCH PPS standard Federal payment rate criteria based on the payment rate and factor changes ap

in the preamble of and the Addendum to this final rule. 

2 Percent change in estimated payments per discharge for L TCH PPS standard Federal payment rate cases from FY 2017 to FY 20 18 for the annua

standard Federal payment rate. 

3 Percent change in estimated payments per discharge for LTCH PPS standard Federal payment rate cases from FY 2017 to FY 2018 for changes 

under§ 412.525(c) (as discussed in section V.B. ofthe Addendum to this final rule). 

4 Percent change in estimated payments per discharge for LTCH PPS standard Federal payment rate cases from FY 2017 to FY 2018 for change to 

5 Percent change in estimated payments per discharge for LTCH PPS standard Federal payment rate cases from FY 2017 (shown in Column 4) to 

including all of the changes to the rates and factors applicable to such cases presented in the preamble and the Addendum to this final rule. We no

the percent change in estimated payments per discharge for all changes, does not equal the sum of the percent changes in estimated payments per 

the LTCH PPS standard Federal payment rate (Column 6) and the changes to the area wage level adjustment with budget neutrality (Column 7) du

changes in both estimated payments to SSO cases (prior to accounting for the change to the SSO payment methodology) and aggregate HCO paym

Federal payment rate cases (as discussed in this impact analysis), as well as other interactive effects that cannot be isolated. 
Federal Register / Vol. 82, No. 191 / Wednesday, October 4, 2017 / Rules and Regulations 46163 

a. Lines 34, the figure ‘‘2.7’’ is 

corrected to read ‘‘2.5’’. 

b. Line 38, the figure ‘‘$226’’ is 

corrected to read ‘‘$227’’. 

Dated: September 29, 2017. 

Ann C. Agnew, 

Executive Secretary to the Department, 

Department of Health and Human Services. 

[FR Doc. 2017–21325 Filed 9–29–17; 4:15 pm] 

BILLING CODE 4120–01–C 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Centers for Medicare & Medicaid 

Services 

42 CFR Parts 409, 411, 413, 424, and 

488 

[CMS–1679–CN] 

RIN 0938–AS96 

Medicare Program; Prospective 

Payment System and Consolidated 

Billing for Skilled Nursing Facilities for 

FY 2018, SNF Value-Based Purchasing 

Program, SNF Quality Reporting 

Program, Survey Team Composition, 

and Correction of the Performance 

Period for the NHSN HCP Influenza 

Vaccination Immunization Reporting 

Measure in the ESRD QIP for PY 2020; 

Correction 

AGENCY: Centers for Medicare & 

Medicaid Services (CMS), HHS. 

ACTION: Final rule; correction. 

SUMMARY: This document corrects 

technical errors in the final rule that 

appeared in the August 4, 2017 Federal 

Register, which will update the 

payment rates used under the 

prospective payment system (PPS) for 

skilled nursing facilities (SNFs) for 

fiscal year (FY) 2018. 

DATES: This correction is effective 

October 1, 2017. 

FOR FURTHER INFORMATION CONTACT: John 

Kane, (410) 786–0557. 

SUPPLEMENTARY INFORMATION: 

I. Background 

In FR Doc. 2017–16256 (82 FR 36530), 

the final rule entitled ‘‘Medicare 

Program; Prospective Payment System 

and Consolidated Billing for Skilled 

Nursing Facilities for FY 2018, SNF 

Value-Based Purchasing Program, SNF 

Quality Reporting Program, Survey 

Team Composition, and Correction of 

the Performance Period for the NHSN 

HCP Influenza Vaccination 

Immunization Reporting Measure in the 

ESRD QIP for PY 2020’’, there were a 

number of technical errors that are 

identified and corrected in section IV., 

Correction of Errors. The provisions in 

this correcting document are effective as 

if they had been included in the 

document that appeared in the August 

4, 2017, Federal Register (hereinafter 

referred to as the FY 2018 SNF PPS final 

rule). Accordingly, the corrections are 

effective October 1, 2017. 

II. Summary of Errors 

A. Summary of Errors in the Preamble 

As discussed in the FY 2018 SNF PPS 

final rule (82 FR 36539), in developing 

the wage index to be applied to skilled 

nursing facilities (SNFs) under the SNF 

prospective payment system (PPS), we 

use the updated, pre-reclassified 

hospital inpatient prospective payment 

system (IPPS) wage data, exclusive of 

the occupational mix adjustment. For 

FY 2018, the updated, unadjusted, prereclassified IPPS wage data used under 

the SNF PPS are for hospital cost 

reporting periods beginning on or after 

October 1, 2013, and before October 1, 

2014 (FY 2014 cost report data), as 

discussed in the FY 2018 IPPS final rule 

(82 FR 38130). In calculating the wage 

index under the FY 2018 IPPS final rule, 

we made inadvertent errors related to 

the wage data collected from the 

Medicare cost reports of six hospitals 

which are located in CBSAs 24860 and 

40340. Specifically, we used incorrect 

wage data for these six hospitals to 

calculate the final FY 2018 IPPS wage 

indexes, the geographic adjustment 

factor (GAF) (which is computed from 

the wage index), as well as certain other 

IPPS factors and adjustments. 

These errors are identified, discussed 

and corrected in the Medicare 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 2018 Rates; 

Quality Reporting Requirements for 

Specific Providers; Medicare and 

Medicaid Electronic Health Record 

(EHR) Incentive Program Requirements 

for Eligible Hospitals, Critical Access 

Hospitals, and Eligible Professionals; 

Provider-Based Status of Indian Health 

Services and Tribal Facilities and 

Organizations; Cost Reporting and 

Provider Requirements; Agreement 

Termination Notices; Correction (CMS– 

1677–CN) that appears elsewhere in this 

issue of the Federal Register. 

As discussed above, we use the 

updated, pre-reclassified, unadjusted 

IPPS wage data in developing the wage 

index used under the SNF PPS. Due to 

the technical errors described above, the 

published FY 2018 SNF PPS wage 

indexes were incorrect. Thus, the use of 

the corrected wage data for the six 

hospitals required the recalculation of 

the final FY 2018 SNF PPS wage 

indexes. Additionally, as discussed on 

page 36543 of the FY 2018 SNF PPS 

final rule, section 1888(e)(4)(G)(ii) of the 

Act requires that we apply the wage 

index in a manner that does not result 

in aggregate payments under the SNF 

PPS that are greater or less than would 

otherwise be made if the wage index 

adjustment had not been made. To 

achieve this, we apply a budget 

neutrality factor to the unadjusted SNF 

PPS federal per diem base rates. Due to 

the recalculation and subsequent 

revision of the final FY 2018 SNF PPS 

wage indexes, it was necessary to 

recalculate the FY 2018 SNF PPS wage 

index budget neutrality factor as well. 

Revising the wage index budget 

neutrality factor causes a change in the 

unadjusted SNF PPS federal per diem 

rates (provided in Tables 2 and 3 of the 

FY 2018 SNF PPS final rule (82 FR 

36535)), which then causes changes in 

the case-mix adjusted SNF PPS rates 

(provided in Tables 4 and 5 in the FY 

2018 SNF PPS final rule (82 FR 36537 

through 36538), as well as the labor 

adjusted SNF PPS rates (provided in 

Tables 6 and 7 of the FY 2018 SNF PPS 

final rule (82 FR 36541 through 36543). 

Finally, due to the recalculated wage 

indexes, we recalculated the impact 

analysis provided in Table 26 of the FY 

2018 SNF PPS final rule (82 FR 36629). 

The corrections to these errors are found 

in section IV. of this document. 

B. Summary of Errors in and Corrections 

to Tables Posted on the CMS Web Site 

We are correcting the wage indexes in 

Tables A and B setting forth the wage 

indexes for urban (Table A) and nonurban (Table B) areas based on CBSA 

labor market areas, which are available 

exclusively on the CMS Web site at 

http://www.cms.gov/Medicare/ 

Medicare-Fee-for-Service-Payment/ 

SNFPPS/WageIndex.html. These tables 

have been updated to reflect the 

revisions discussed in this correcting 

document. 

We are republishing the wage indexes 

in Tables A and B accordingly on the 

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

Medicare/Medicare-Fee-for-ServicePayment/SNFPPS/WageIndex.html. 

III. Waiver of Proposed Rulemaking 

and Delayed Effective Date 

We ordinarily publish a notice of 

proposed rulemaking in the Federal 

Register to provide a period for public 

comment before the provisions of a rule 

take effect in accordance with section 

553(b) of the Administrative Procedure 

Act (APA) (5 U.S.C. 553(b)). However, 


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