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, 


sradovich on DSK3GMQ082PROD with RULES
46164 Federal Register / Vol. 82, No. 191 / Wednesday, October 4, 2017 / Rules and Regulations 

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 therefor in 

the notice. 

Section 553(d) of the APA ordinarily 

requires a 30-day delay in effective date 

of final rules after the date of their 

publication in the Federal Register. 

This 30-day delay in effective date can 

be waived, however, if an agency finds 

for good cause that the delay is 

impracticable, unnecessary, or contrary 

to the public interest, and the agency 

incorporates a statement of the findings 

and its reasons in the rule issued. 

We believe that this correcting 

document does not constitute a rule that 

would be subject to the APA notice and 

comment or delayed effective date 

requirements. The document corrects 

technical errors in the FY 2018 SNF PPS 

final rule and in the tables referenced in 

the 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 SNF 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 SNF PPS final rule and the 

tables referenced in the final rule 

accurately reflect our methodologies, 

payment rates, and policies. 

Furthermore, such procedures would be 

unnecessary, as we are not making 

substantive changes to our payment 

methodologies or policies, but rather, 

we are simply implementing correctly 

the methodologies and policies that we 

previously proposed, requested 

comment on, and subsequently 

finalized. This correcting document is 

intended solely to ensure that the FY 

2018 SNF PPS final rule and the tables 

referenced in the final rule accurately 

reflect these 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. 2017–16256 of August 4, 

2017 (82 FR 36530), make the following 

corrections: 

1. On page 36535, TABLE 2—FY 2018 

UNADJUSTED FEDERAL RATE PER 

DIEM URBAN is corrected to read as 

follows: 

TABLE 2—FY 2018 UNADJUSTED FEDERAL RATE PER DIEM URBAN

Rate component Nursing— 

case-mix 

Therapy— 

case-mix 

Therapy—noncase-mix Non-case-mix 

Per Diem Amount ............................................................................................ $177.21 $133.48 $17.58 $90.44 

2. On page 36535, TABLE 3—FY 2018 

UNADJUSTED FEDERAL RATE PER 

DIEM RURAL is corrected to read as 

follows: 

TABLE 3—FY 2018 UNADJUSTED FEDERAL RATE PER DIEM RURAL

Rate component Nursing— 

case-mix 

Therapy— 

case-mix 

Therapy—noncase-mix Non-case-mix 

Per Diem Amount ............................................................................................ $169.29 $153.92 $18.78 $92.11 

3. On page 36536, third column, first 

full paragraph, 

a. Line 21, the figure ‘‘$443.08’’ is 

corrected to read ‘‘$442.95’’. 

b. Line 26, the figure ‘‘$1,010.22.’’ is 

corrected to read ‘‘$1,009.93.’’. 

4. On page 36537, TABLE 4—RUG-IV 

CASE-MIX ADJUSTED FEDERAL 

RATES AND ASSOCIATED INDEXES— 

URBAN is corrected to read as follows: 

TABLE 4—RUG-IV CASE-MIX ADJUSTED FEDERAL RATES AND ASSOCIATED INDEXES—URBAN

RUG-IV category Nursing index Therapy index Nursing 

component 

Therapy 

component 

Non-case mix 

therapy comp 

Non-case mix 

component Total rate 

RUX .............................. 2.67 1.87 $473.15 $249.61 ........................ $90.44 $813.20 

RUL .............................. 2.57 1.87 455.43 249.61 ........................ 90.44 795.48 

RVX .............................. 2.61 1.28 462.52 170.85 ........................ 90.44 723.81 

RVL .............................. 2.19 1.28 388.09 170.85 ........................ 90.44 649.38 

RHX .............................. 2.55 0.85 451.89 113.46 ........................ 90.44 655.79 

RHL .............................. 2.15 0.85 381.00 113.46 ........................ 90.44 584.90 

RMX ............................. 2.47 0.55 437.71 73.41 ........................ 90.44 601.56 

RML .............................. 2.19 0.55 388.09 73.41 ........................ 90.44 551.94 

RLX .............................. 2.26 0.28 400.49 37.37 ........................ 90.44 528.30 

RUC ............................. 1.56 1.87 276.45 249.61 ........................ 90.44 616.50 

RUB .............................. 1.56 1.87 276.45 249.61 ........................ 90.44 616.50 

RUA .............................. 0.99 1.87 175.44 249.61 ........................ 90.44 515.49 

RVC .............................. 1.51 1.28 267.59 170.85 ........................ 90.44 528.88 

RVB .............................. 1.11 1.28 196.70 170.85 ........................ 90.44 457.99 

RVA .............................. 1.10 1.28 194.93 170.85 ........................ 90.44 456.22 


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TABLE 4—RUG-IV CASE-MIX ADJUSTED FEDERAL RATES AND ASSOCIATED INDEXES—URBAN—Continued 

RUG-IV category Nursing index Therapy index Nursing 

component 

Therapy 

component 

Non-case mix 

therapy comp 

Non-case mix 

component Total rate 

RHC ............................. 1.45 0.85 256.95 113.46 ........................ 90.44 460.85 

RHB .............................. 1.19 0.85 210.88 113.46 ........................ 90.44 414.78 

RHA .............................. 0.91 0.85 161.26 113.46 ........................ 90.44 365.16 

RMC ............................. 1.36 0.55 241.01 73.41 ........................ 90.44 404.86 

RMB ............................. 1.22 0.55 216.20 73.41 ........................ 90.44 380.05 

RMA ............................. 0.84 0.55 148.86 73.41 ........................ 90.44 312.71 

RLB .............................. 1.50 0.28 265.82 37.37 ........................ 90.44 393.63 

RLA .............................. 0.71 0.28 125.82 37.37 ........................ 90.44 253.63 

ES3 .............................. 3.58 ........................ 634.41 ........................ 17.58 90.44 742.43 

ES2 .............................. 2.67 ........................ 473.15 ........................ 17.58 90.44 581.17 

ES1 .............................. 2.32 ........................ 411.13 ........................ 17.58 90.44 519.15 

HE2 .............................. 2.22 ........................ 393.41 ........................ 17.58 90.44 501.43 

HE1 .............................. 1.74 ........................ 308.35 ........................ 17.58 90.44 416.37 

HD2 .............................. 2.04 ........................ 361.51 ........................ 17.58 90.44 469.53 

HD1 .............................. 1.60 ........................ 283.54 ........................ 17.58 90.44 391.56 

HC2 .............................. 1.89 ........................ 334.93 ........................ 17.58 90.44 442.95 

HC1 .............................. 1.48 ........................ 262.27 ........................ 17.58 90.44 370.29 

HB2 .............................. 1.86 ........................ 329.61 ........................ 17.58 90.44 437.63 

HB1 .............................. 1.46 ........................ 258.73 ........................ 17.58 90.44 366.75 

LE2 ............................... 1.96 ........................ 347.33 ........................ 17.58 90.44 455.35 

LE1 ............................... 1.54 ........................ 272.90 ........................ 17.58 90.44 380.92 

LD2 ............................... 1.86 ........................ 329.61 ........................ 17.58 90.44 437.63 

LD1 ............................... 1.46 ........................ 258.73 ........................ 17.58 90.44 366.75 

LC2 ............................... 1.56 ........................ 276.45 ........................ 17.58 90.44 384.47 

LC1 ............................... 1.22 ........................ 216.20 ........................ 17.58 90.44 324.22 

LB2 ............................... 1.45 ........................ 256.95 ........................ 17.58 90.44 364.97 

LB1 ............................... 1.14 ........................ 202.02 ........................ 17.58 90.44 310.04 

CE2 .............................. 1.68 ........................ 297.71 ........................ 17.58 90.44 405.73 

CE1 .............................. 1.50 ........................ 265.82 ........................ 17.58 90.44 373.84 

CD2 .............................. 1.56 ........................ 276.45 ........................ 17.58 90.44 384.47 

CD1 .............................. 1.38 ........................ 244.55 ........................ 17.58 90.44 352.57 

CC2 .............................. 1.29 ........................ 228.60 ........................ 17.58 90.44 336.62 

CC1 .............................. 1.15 ........................ 203.79 ........................ 17.58 90.44 311.81 

CB2 .............................. 1.15 ........................ 203.79 ........................ 17.58 90.44 311.81 

CB1 .............................. 1.02 ........................ 180.75 ........................ 17.58 90.44 288.77 

CA2 .............................. 0.88 ........................ 155.94 ........................ 17.58 90.44 263.96 

CA1 .............................. 0.78 ........................ 138.22 ........................ 17.58 90.44 246.24 

BB2 .............................. 0.97 ........................ 171.89 ........................ 17.58 90.44 279.91 

BB1 .............................. 0.90 ........................ 159.49 ........................ 17.58 90.44 267.51 

BA2 .............................. 0.70 ........................ 124.05 ........................ 17.58 90.44 232.07 

BA1 .............................. 0.64 ........................ 113.41 ........................ 17.58 90.44 221.43 

PE2 .............................. 1.50 ........................ 265.82 ........................ 17.58 90.44 373.84 

PE1 .............................. 1.40 ........................ 248.09 ........................ 17.58 90.44 356.11 

PD2 .............................. 1.38 ........................ 244.55 ........................ 17.58 90.44 352.57 

PD1 .............................. 1.28 ........................ 226.83 ........................ 17.58 90.44 334.85 

PC2 .............................. 1.10 ........................ 194.93 ........................ 17.58 90.44 302.95 

PC1 .............................. 1.02 ........................ 180.75 ........................ 17.58 90.44 288.77 

PB2 .............................. 0.84 ........................ 148.86 ........................ 17.58 90.44 256.88 

PB1 .............................. 0.78 ........................ 138.22 ........................ 17.58 90.44 246.24 

PA2 .............................. 0.59 ........................ 104.55 ........................ 17.58 90.44 212.57 

PA1 .............................. 0.54 ........................ 95.69 ........................ 17.58 90.44 203.71 

5. On page 36538, TABLE 5—RUG-IV 

CASE-MIX ADJUSTED FEDERAL 

RATES AND ASSOCIATED INDEXES— 

RURAL is corrected to read as follows: 

TABLE 5—RUG-IV CASE-MIX ADJUSTED FEDERAL RATES AND ASSOCIATED INDEXES—RURAL

RUG-IV 

Category 

Nursing 

index 

Therapy 

index 

Nursing 

component 

Therapy 

component 

Non-case mix 

therapy comp 

Non-case mix 

component 

Total 

rate 

RUX .............................. 2.67 1.87 $452.00 $287.83 ........................ $92.11 $831.94 

RUL .............................. 2.57 1.87 435.08 287.83 ........................ 92.11 815.02 

RVX .............................. 2.61 1.28 441.85 197.02 ........................ 92.11 730.98 

RVL .............................. 2.19 1.28 370.75 197.02 ........................ 92.11 659.88 

RHX .............................. 2.55 0.85 431.69 130.83 ........................ 92.11 654.63 

RHL .............................. 2.15 0.85 363.97 130.83 ........................ 92.11 586.91 

RMX ............................. 2.47 0.55 418.15 84.66 ........................ 92.11 594.92 

RML .............................. 2.19 0.55 370.75 84.66 ........................ 92.11 547.52 

RLX .............................. 2.26 0.28 382.60 43.10 ........................ 92.11 517.81 


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46166 Federal Register / Vol. 82, No. 191 / Wednesday, October 4, 2017 / Rules and Regulations 

TABLE 5—RUG-IV CASE-MIX ADJUSTED FEDERAL RATES AND ASSOCIATED INDEXES—RURAL—Continued 

RUG-IV 

Category 

Nursing 

index 

Therapy 

index 

Nursing 

component 

Therapy 

component 

Non-case mix 

therapy comp 

Non-case mix 

component 

Total 

rate 

RUC ............................. 1.56 1.87 264.09 287.83 ........................ 92.11 644.03 

RUB .............................. 1.56 1.87 264.09 287.83 ........................ 92.11 644.03 

RUA .............................. 0.99 1.87 167.60 287.83 ........................ 92.11 547.54 

RVC .............................. 1.51 1.28 255.63 197.02 ........................ 92.11 544.76 

RVB .............................. 1.11 1.28 187.91 197.02 ........................ 92.11 477.04 

RVA .............................. 1.10 1.28 186.22 197.02 ........................ 92.11 475.35 

RHC ............................. 1.45 0.85 245.47 130.83 ........................ 92.11 468.41 

RHB .............................. 1.19 0.85 201.46 130.83 ........................ 92.11 424.40 

RHA .............................. 0.91 0.85 154.05 130.83 ........................ 92.11 376.99 

RMC ............................. 1.36 0.55 230.23 84.66 ........................ 92.11 407.00 

RMB ............................. 1.22 0.55 206.53 84.66 ........................ 92.11 383.30 

RMA ............................. 0.84 0.55 142.20 84.66 ........................ 92.11 318.97 

RLB .............................. 1.50 0.28 253.94 43.10 ........................ 92.11 389.15 

RLA .............................. 0.71 0.28 120.20 43.10 ........................ 92.11 255.41 

ES3 .............................. 3.58 ........................ 606.06 ........................ 18.78 92.11 716.95 

ES2 .............................. 2.67 ........................ 452.00 ........................ 18.78 92.11 562.89 

ES1 .............................. 2.32 ........................ 392.75 ........................ 18.78 92.11 503.64 

HE2 .............................. 2.22 ........................ 375.82 ........................ 18.78 92.11 486.71 

HE1 .............................. 1.74 ........................ 294.56 ........................ 18.78 92.11 405.45 

HD2 .............................. 2.04 ........................ 345.35 ........................ 18.78 92.11 456.24 

HD1 .............................. 1.60 ........................ 270.86 ........................ 18.78 92.11 381.75 

HC2 .............................. 1.89 ........................ 319.96 ........................ 18.78 92.11 430.85 

HC1 .............................. 1.48 ........................ 250.55 ........................ 18.78 92.11 361.44 

HB2 .............................. 1.86 ........................ 314.88 ........................ 18.78 92.11 425.77 

HB1 .............................. 1.46 ........................ 247.16 ........................ 18.78 92.11 358.05 

LE2 ............................... 1.96 ........................ 331.81 ........................ 18.78 92.11 442.70 

LE1 ............................... 1.54 ........................ 260.71 ........................ 18.78 92.11 371.60 

LD2 ............................... 1.86 ........................ 314.88 ........................ 18.78 92.11 425.77 

LD1 ............................... 1.46 ........................ 247.16 ........................ 18.78 92.11 358.05 

LC2 ............................... 1.56 ........................ 264.09 ........................ 18.78 92.11 374.98 

LC1 ............................... 1.22 ........................ 206.53 ........................ 18.78 92.11 317.42 

LB2 ............................... 1.45 ........................ 245.47 ........................ 18.78 92.11 356.36 

LB1 ............................... 1.14 ........................ 192.99 ........................ 18.78 92.11 303.88 

CE2 .............................. 1.68 ........................ 284.41 ........................ 18.78 92.11 395.30 

CE1 .............................. 1.50 ........................ 253.94 ........................ 18.78 92.11 364.83 

CD2 .............................. 1.56 ........................ 264.09 ........................ 18.78 92.11 374.98 

CD1 .............................. 1.38 ........................ 233.62 ........................ 18.78 92.11 344.51 

CC2 .............................. 1.29 ........................ 218.38 ........................ 18.78 92.11 329.27 

CC1 .............................. 1.15 ........................ 194.68 ........................ 18.78 92.11 305.57 

CB2 .............................. 1.15 ........................ 194.68 ........................ 18.78 92.11 305.57 

CB1 .............................. 1.02 ........................ 172.68 ........................ 18.78 92.11 283.57 

CA2 .............................. 0.88 ........................ 148.98 ........................ 18.78 92.11 259.87 

CA1 .............................. 0.78 ........................ 132.05 ........................ 18.78 92.11 242.94 

BB2 .............................. 0.97 ........................ 164.21 ........................ 18.78 92.11 275.10 

BB1 .............................. 0.90 ........................ 152.36 ........................ 18.78 92.11 263.25 

BA2 .............................. 0.70 ........................ 118.50 ........................ 18.78 92.11 229.39 

BA1 .............................. 0.64 ........................ 108.35 ........................ 18.78 92.11 219.24 

PE2 .............................. 1.50 ........................ 253.94 ........................ 18.78 92.11 364.83 

PE1 .............................. 1.40 ........................ 237.01 ........................ 18.78 92.11 347.90 

PD2 .............................. 1.38 ........................ 233.62 ........................ 18.78 92.11 344.51 

PD1 .............................. 1.28 ........................ 216.69 ........................ 18.78 92.11 327.58 

PC2 .............................. 1.10 ........................ 186.22 ........................ 18.78 92.11 297.11 

PC1 .............................. 1.02 ........................ 172.68 ........................ 18.78 92.11 283.57 

PB2 .............................. 0.84 ........................ 142.20 ........................ 18.78 92.11 253.09 

PB1 .............................. 0.78 ........................ 132.05 ........................ 18.78 92.11 242.94 

PA2 .............................. 0.59 ........................ 99.88 ........................ 18.78 92.11 210.77 

PA1 .............................. 0.54 ........................ 91.42 ........................ 18.78 92.11 202.31 

6. On pages 36541 through 36542, 

TABLE 6—RUG-IV CASE–MIX 

ADJUSTED FEDERAL RATES FOR 

URBAN SNFS BY LABOR AND NONLABOR COMPONENT is corrected to read as follows: 

TABLE 6—RUG-IV CASE-MIX ADJUSTED FEDERAL RATES FOR URBAN SNFS BY LABOR AND NON-LABOR COMPONENT

RUG-IV category Total rate Labor portion Non-labor 

portion 

RUX ............................................................................................................................................. $813.20 $575.75 $237.45 

RUL .............................................................................................................................................. 795.48 563.20 232.28 

RVX .............................................................................................................................................. 723.81 512.46 211.35 


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Federal Register / Vol. 82, No. 191 / Wednesday, October 4, 2017 / Rules and Regulations 46167 

TABLE 6—RUG-IV CASE-MIX ADJUSTED FEDERAL RATES FOR URBAN SNFS BY LABOR AND NON-LABOR COMPONENT— 

Continued 

RUG-IV category Total rate Labor portion Non-labor 

portion 

RVL .............................................................................................................................................. 649.38 459.76 189.62 

RHX ............................................................................................................................................. 655.79 464.30 191.49 

RHL .............................................................................................................................................. 584.90 414.11 170.79 

RMX ............................................................................................................................................. 601.56 425.90 175.66 

RML ............................................................................................................................................. 551.94 390.77 161.17 

RLX .............................................................................................................................................. 528.30 374.04 154.26 

RUC ............................................................................................................................................. 616.50 436.48 180.02 

RUB ............................................................................................................................................. 616.50 436.48 180.02 

RUA ............................................................................................................................................. 515.49 364.97 150.52 

RVC ............................................................................................................................................. 528.88 374.45 154.43 

RVB .............................................................................................................................................. 457.99 324.26 133.73 

RVA .............................................................................................................................................. 456.22 323.00 133.22 

RHC ............................................................................................................................................. 460.85 326.28 134.57 

RHB ............................................................................................................................................. 414.78 293.66 121.12 

RHA ............................................................................................................................................. 365.16 258.53 106.63 

RMC ............................................................................................................................................. 404.86 286.64 118.22 

RMB ............................................................................................................................................. 380.05 269.08 110.97 

RMA ............................................................................................................................................. 312.71 221.40 91.31 

RLB .............................................................................................................................................. 393.63 278.69 114.94 

RLA .............................................................................................................................................. 253.63 179.57 74.06 

ES3 .............................................................................................................................................. 742.43 525.64 216.79 

ES2 .............................................................................................................................................. 581.17 411.47 169.70 

ES1 .............................................................................................................................................. 519.15 367.56 151.59 

HE2 .............................................................................................................................................. 501.43 355.01 146.42 

HE1 .............................................................................................................................................. 416.37 294.79 121.58 

HD2 .............................................................................................................................................. 469.53 332.43 137.10 

HD1 .............................................................................................................................................. 391.56 277.22 114.34 

HC2 .............................................................................................................................................. 442.95 313.61 129.34 

HC1 .............................................................................................................................................. 370.29 262.17 108.12 

HB2 .............................................................................................................................................. 437.63 309.84 127.79 

HB1 .............................................................................................................................................. 366.75 259.66 107.09 

LE2 ............................................................................................................................................... 455.35 322.39 132.96 

LE1 ............................................................................................................................................... 380.92 269.69 111.23 

LD2 .............................................................................................................................................. 437.63 309.84 127.79 

LD1 .............................................................................................................................................. 366.75 259.66 107.09 

LC2 .............................................................................................................................................. 384.47 272.20 112.27 

LC1 .............................................................................................................................................. 324.22 229.55 94.67 

LB2 ............................................................................................................................................... 364.97 258.40 106.57 

LB1 ............................................................................................................................................... 310.04 219.51 90.53 

CE2 .............................................................................................................................................. 405.73 287.26 118.47 

CE1 .............................................................................................................................................. 373.84 264.68 109.16 

CD2 .............................................................................................................................................. 384.47 272.20 112.27 

CD1 .............................................................................................................................................. 352.57 249.62 102.95 

CC2 .............................................................................................................................................. 336.62 238.33 98.29 

CC1 .............................................................................................................................................. 311.81 220.76 91.05 

CB2 .............................................................................................................................................. 311.81 220.76 91.05 

CB1 .............................................................................................................................................. 288.77 204.45 84.32 

CA2 .............................................................................................................................................. 263.96 186.88 77.08 

CA1 .............................................................................................................................................. 246.24 174.34 71.90 

BB2 .............................................................................................................................................. 279.91 198.18 81.73 

BB1 .............................................................................................................................................. 267.51 189.40 78.11 

BA2 .............................................................................................................................................. 232.07 164.31 67.76 

BA1 .............................................................................................................................................. 221.43 156.77 64.66 

PE2 .............................................................................................................................................. 373.84 264.68 109.16 

PE1 .............................................................................................................................................. 356.11 252.13 103.98 

PD2 .............................................................................................................................................. 352.57 249.62 102.95 

PD1 .............................................................................................................................................. 334.85 237.07 97.78 

PC2 .............................................................................................................................................. 302.95 214.49 88.46 

PC1 .............................................................................................................................................. 288.77 204.45 84.32 

PB2 .............................................................................................................................................. 256.88 181.87 75.01 

PB1 .............................................................................................................................................. 246.24 174.34 71.90 

PA2 .............................................................................................................................................. 212.57 150.50 62.07 

PA1 .............................................................................................................................................. 203.71 144.23 59.48 

7. On pages 36542 through 36543, 

TABLE 7–RUG-IV CASE-MIX 

ADJUSTED FEDERAL RATES FOR 

RURAL SNFS BY LABOR AND NONLABOR COMPONENT is corrected to read as follows: 


sradovich on DSK3GMQ082PROD with RULES
46168 Federal Register / Vol. 82, No. 191 / Wednesday, October 4, 2017 / Rules and Regulations 

TABLE 7—RUG–IV CASE-MIX ADJUSTED FEDERAL RATES FOR RURAL SNFS BY LABOR AND NON-LABOR COMPONENT

RUG–IV category Total rate Labor portion Non-labor 

portion 

RUX ............................................................................................................................................. $831.94 $589.01 $242.93 

RUL .............................................................................................................................................. 815.02 577.03 237.99 

RVX .............................................................................................................................................. 730.98 517.53 213.45 

RVL .............................................................................................................................................. 659.88 467.20 192.68 

RHX ............................................................................................................................................. 654.63 463.48 191.15 

RHL .............................................................................................................................................. 586.91 415.53 171.38 

RMX ............................................................................................................................................. 594.92 421.20 173.72 

RML ............................................................................................................................................. 547.52 387.64 159.88 

RLX .............................................................................................................................................. 517.81 366.61 151.20 

RUC ............................................................................................................................................. 644.03 455.97 188.06 

RUB ............................................................................................................................................. 644.03 455.97 188.06 

RUA ............................................................................................................................................. 547.54 387.66 159.88 

RVC ............................................................................................................................................. 544.76 385.69 159.07 

RVB .............................................................................................................................................. 477.04 337.74 139.30 

RVA .............................................................................................................................................. 475.35 336.55 138.80 

RHC ............................................................................................................................................. 468.41 331.63 136.78 

RHB ............................................................................................................................................. 424.40 300.48 123.92 

RHA ............................................................................................................................................. 376.99 266.91 110.08 

RMC ............................................................................................................................................. 407.00 288.16 118.84 

RMB ............................................................................................................................................. 383.30 271.38 111.92 

RMA ............................................................................................................................................. 318.97 225.83 93.14 

RLB .............................................................................................................................................. 389.15 275.52 113.63 

RLA .............................................................................................................................................. 255.41 180.83 74.58 

ES3 .............................................................................................................................................. 716.95 507.60 209.35 

ES2 .............................................................................................................................................. 562.89 398.53 164.36 

ES1 .............................................................................................................................................. 503.64 356.58 147.06 

HE2 .............................................................................................................................................. 486.71 344.59 142.12 

HE1 .............................................................................................................................................. 405.45 287.06 118.39 

HD2 .............................................................................................................................................. 456.24 323.02 133.22 

HD1 .............................................................................................................................................. 381.75 270.28 111.47 

HC2 .............................................................................................................................................. 430.85 305.04 125.81 

HC1 .............................................................................................................................................. 361.44 255.90 105.54 

HB2 .............................................................................................................................................. 425.77 301.45 124.32 

HB1 .............................................................................................................................................. 358.05 253.50 104.55 

LE2 ............................................................................................................................................... 442.70 313.43 129.27 

LE1 ............................................................................................................................................... 371.60 263.09 108.51 

LD2 .............................................................................................................................................. 425.77 301.45 124.32 

LD1 .............................................................................................................................................. 358.05 253.50 104.55 

LC2 .............................................................................................................................................. 374.98 265.49 109.49 

LC1 .............................................................................................................................................. 317.42 224.73 92.69 

LB2 ............................................................................................................................................... 356.36 252.30 104.06 

LB1 ............................................................................................................................................... 303.88 215.15 88.73 

CE2 .............................................................................................................................................. 395.30 279.87 115.43 

CE1 .............................................................................................................................................. 364.83 258.30 106.53 

CD2 .............................................................................................................................................. 374.98 265.49 109.49 

CD1 .............................................................................................................................................. 344.51 243.91 100.60 

CC2 .............................................................................................................................................. 329.27 233.12 96.15 

CC1 .............................................................................................................................................. 305.57 216.34 89.23 

CB2 .............................................................................................................................................. 305.57 216.34 89.23 

CB1 .............................................................................................................................................. 283.57 200.77 82.80 

CA2 .............................................................................................................................................. 259.87 183.99 75.88 

CA1 .............................................................................................................................................. 242.94 172.00 70.94 

BB2 .............................................................................................................................................. 275.10 194.77 80.33 

BB1 .............................................................................................................................................. 263.25 186.38 76.87 

BA2 .............................................................................................................................................. 229.39 162.41 66.98 

BA1 .............................................................................................................................................. 219.24 155.22 64.02 

PE2 .............................................................................................................................................. 364.83 258.30 106.53 

PE1 .............................................................................................................................................. 347.90 246.31 101.59 

PD2 .............................................................................................................................................. 344.51 243.91 100.60 

PD1 .............................................................................................................................................. 327.58 231.93 95.65 

PC2 .............................................................................................................................................. 297.11 210.35 86.76 

PC1 .............................................................................................................................................. 283.57 200.77 82.80 

PB2 .............................................................................................................................................. 253.09 179.19 73.90 

PB1 .............................................................................................................................................. 242.94 172.00 70.94 

PA2 .............................................................................................................................................. 210.77 149.23 61.54 

PA1 .............................................................................................................................................. 202.31 143.24 59.07 


sradovich on DSK3GMQ082PROD with RULES
Federal Register / Vol. 82, No. 191 / Wednesday, October 4, 2017 / Rules and Regulations 46169 

8. On page 36543, under Table 7, 

a. Second column, first partial 

paragraph, line 15, the figure ‘‘1.0013’’ 

is corrected to read ‘‘1.0010’’. 

b. Third column, first full paragraph, 

line 16, the figure ‘‘$47,596.42’’ is 

corrected to read ‘‘$47,602.52’’. 

9. On page 36543, TABLE 8— 

ADJUSTED RATE COMPUTATION 

EXAMPLE SNF XYZ: LOCATED IN 

FREDERICK, MD (URBAN CBSA 43524) 

WAGE INDEX: 0.9863 [See Wage Index 

in Table A] 1 is corrected to read as 

follows: 

TABLE 8—ADJUSTED RATE COMPUTATION EXAMPLE SNF XYZ: LOCATED IN FREDERICK, MD (URBAN CBSA 43524) 

[WAGE INDEX: 0.9869 (See Wage Index in Table A)] 1

RUG-IV group Labor Wage index Adjusted 

labor Non-labor Adjusted rate 

Percent adjustment Medicare 

days Payment 

RVX .................................. $512.46 0.9869 $505.75 $211.35 $717.10 $717.10 14 $10,039.40 

ES2 .................................. 411.47 0.9869 406.08 169.70 575.78 575.78 30 17,273.40 

RHA .................................. 258.53 0.9869 255.14 106.63 361.77 361.77 16 5,788.32 

CC2 * ................................ 238.33 0.9869 235.21 98.29 333.50 760.38 10 7,603.80 

BA2 .................................. 164.31 0.9869 162.16 67.76 229.92 229.92 30 6,897.60 

.................... .................... .................... .................... .................... .................... 100 47,602.52 

* Reflects a 128 percent adjustment from section 511 of the MMA. 

1Available on the CMS Web site at http://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/SNFPPS/WageIndex.html. 

10. On pages 36629, TABLE 26— 

PROJECTED IMPACT TO THE SNF PPS 

FOR FY 2018 is corrected to read as 

follows: 

TABLE 26—PROJECTED IMPACT TO THE SNF PPS FOR FY 2018 

Number of 

facilities 

FY 2018 

Update wage 

data Total change 

Group 

Total ............................................................................................................................................. 15,468 0.0% 1.0% 

Urban ........................................................................................................................................... 11,008 0.1% 1.1% 

Rural ............................................................................................................................................ 4,460 ¥0.6% 0.4% 

Hospital-based urban ................................................................................................................... 518 0.2% 1.2% 

Freestanding urban ...................................................................................................................... 10,490 0.1% 1.1% 

Hospital-based rural ..................................................................................................................... 577 ¥0.7% 0.3% 

Freestanding rural ........................................................................................................................ 3,883 ¥0.6% 0.4% 

Urban by region 

New England ............................................................................................................................... 791 0.2% 1.2% 

Middle Atlantic ............................................................................................................................. 1,487 0.4% 1.4% 

South Atlantic ............................................................................................................................... 1,867 ¥0.2% 0.8% 

East North Central ....................................................................................................................... 2,121 0.0% 1.0% 

East South Central ...................................................................................................................... 551 ¥0.6% 0.4% 

West North Central ...................................................................................................................... 919 0.4% 1.4% 

West South Central ..................................................................................................................... 1,339 0.1% 1.1% 

Mountain ...................................................................................................................................... 511 ¥0.2% 0.8% 

Pacific .......................................................................................................................................... 1,417 0.5% 1.5% 

Outlying ........................................................................................................................................ 5 ¥2.0% ¥1.0% 

Rural by region 

New England ............................................................................................................................... 137 1.5% 2.5% 

Middle Atlantic ............................................................................................................................. 215 ¥0.5% 0.5% 

South Atlantic ............................................................................................................................... 502 ¥0.7% 0.3% 

East North Central ....................................................................................................................... 937 ¥1.1% ¥0.1% 

East South Central ...................................................................................................................... 528 ¥0.9% 0.1% 

West North Central ...................................................................................................................... 1,076 ¥0.4% 0.6% 

West South Central ..................................................................................................................... 738 ¥0.6% 0.4% 

Mountain ...................................................................................................................................... 228 ¥0.3% 0.7% 

Pacific .......................................................................................................................................... 99 0.1% 1.1% 

Ownership 

Profit ............................................................................................................................................. 1,045 ¥0.3% 0.7% 

Non-profit ..................................................................................................................................... 10,822 0.0% 1.0% 

Government ................................................................................................................................. 3,601 0.0% 1.0% 

Note: The Total column includes the 1.0 percent market basket increase required by section 1888(e)(5)(B)(iii) of the Act. Additionally, we 

found no SNFs in rural outlying areas. 


sradovich on DSK3GMQ082PROD with RULES
46170 Federal Register / Vol. 82, No. 191 / Wednesday, October 4, 2017 / Rules and Regulations 

Dated: September 29, 2017. 

Ann C. Agnew, 

Executive Secretary to the Department, 

Department of Health and Human Services. 

[FR Doc. 2017–21327 Filed 9–29–17; 4:15 pm] 

BILLING CODE 4120–01–P 

DEPARTMENT OF COMMERCE 

National Oceanic and Atmospheric 

Administration 

50 CFR Part 622 

[Docket Nos. 090206140–91081–03 and 

120405260–4258–02] 

RIN 0648–XF723 

Authorization of Revised Reporting 

Requirements Due to Catastrophic 

Conditions for Federal Seafood 

Dealers and Individual Fishing Quota 

Dealers in Portions of Florida 

AGENCY: National Marine Fisheries 

Service (NMFS), National Oceanic and 

Atmospheric Administration (NOAA), 

Commerce. 

ACTION: Temporary delay in reporting 

requirements; determination of 

catastrophic conditions. 

SUMMARY: In accordance with the 

regulations implementing the individual 

fishing quota (IFQ) and Federal dealer 

reporting programs specific to the 

commercial reef fish fishery in the Gulf 

of Mexico (Gulf), the coastal migratory 

pelagic (CMP) fisheries in the Gulf and 

the Atlantic, the spiny lobster fishery of 

the Gulf and Atlantic, and the snappergrouper and dolphin-wahoo fisheries in 

the South Atlantic, the Regional 

Administrator, Southeast Region, NMFS 

(RA) has determined that Hurricane 

Irma has caused catastrophic conditions 

in the following Florida counties: 

Manatee, Sarasota, DeSoto, Charlotte, 

Lee, Collier, Monroe, Miami-Dade, and 

Broward. Consistent with those 

regulations, the RA has authorized any 

dealer in the affected area who does not 

have access to electronic reporting to 

delay reporting of trip tickets to NOAA 

Fisheries from September 29, 2017, 

through October 31, 2017. The RA has 

also authorized IFQ participants within 

this affected area to use paper-based 

forms, if necessary, for basic required 

administrative functions, e.g., landing 

transactions, from September 29, 2017, 

through October 31, 2017. This 

temporary rule announcing the 

determination of catastrophic 

conditions and allowance of alternative 

methods for completing required IFQ 

and other dealer reporting 

administrative functions is intended to 

facilitate continuation of IFQ and dealer 

reporting operations during the period 

of catastrophic conditions. NMFS will 

continue to monitor and evaluate 

conditions. A subsequent Federal 

Register notice will be published, if 

needed. 

DATES: The RA is authorizing applicable 

Federal dealers and IFQ participants 

reporting within this affected area to use 

revised reporting methods from 

September 29, 2017, through October 

31, 2017. 

FOR FURTHER INFORMATION CONTACT: IFQ 

Customer Service, telephone: 866–425– 

7627, fax: 727–824–5308, email: SERIFQ.Support@noaa.gov. For federal 

dealer reporting, Fisheries Monitoring 

Branch, telephone: 305–361–4581. 

SUPPLEMENTARY INFORMATION: The reef 

fish fishery of the Gulf is managed 

under the Fishery Management Plan 

(FMP) for Reef Fish Resources of the 

Gulf of Mexico, prepared by the Gulf of 

Mexico Fishery Management Council. 

The snapper-grouper fishery of the 

South Atlantic is managed under the 

Snapper-Grouper FMP of the South 

Atlantic, prepared by the South Atlantic 

Fishery Management Council. The 

dolphin-wahoo fishery of the South 

Atlantic is managed under the DolphinWahoo FMP of the South Atlantic, 

prepared by the South Atlantic Fishery 

Management Council. The fishery for 

CMP fish (king mackerel, Spanish 

mackerel, and cobia) is managed under 

the FMP for the CMP Resources of the 

Gulf of Mexico and South Atlantic, 

prepared by both Councils. The fishery 

for spiny lobster is managed under the 

FMP for Spiny Lobster of the Gulf of 

Mexico and South Atlantic, prepared by 

both Councils. All FMPs are 

implemented through regulations at 50 

CFR part 622 under the authority of the 

Magnuson-Stevens Fishery 

Conservation and Management Act 

(Magnuson-Stevens Act). 

The Generic Dealer Amendment 

established Federal dealer reporting 

requirements for federally permitted 

dealers in the Gulf and South Atlantic 

(79 FR 19490, April 9, 2014). 

Amendment 26 to the FMP established 

an IFQ program for the commercial red 

snapper component of the Gulf reef fish 

fishery (71 FR 67447, November 22, 

2006). Amendment 29 to the FMP 

established an IFQ program for the 

commercial grouper and tilefish 

components of the Gulf reef fish fishery 

(74 FR 44732, August 31, 2009). 

Regulations implementing these IFQ 

programs (50 CFR 622.21 and 622.22) 

and the dealer reporting requirements 

(50 CFR 622.5(c)) require that Federal 

dealers and IFQ participants have access 

to a computer and Internet and that they 

conduct administrative functions 

associated with dealer reporting and the 

IFQ program, e.g., landing transactions, 

online. However, these regulations also 

specify that during catastrophic 

conditions, as determined by the RA, 

the RA may waive or modify the 

reporting time requirements for dealers 

and authorize IFQ participants to use 

paper-based forms to complete 

administrative functions for the 

duration of the catastrophic conditions. 

The RA must determine that 

catastrophic conditions exist, specify 

the duration of the catastrophic 

conditions, and specify which 

participants or geographic areas are 

deemed affected. 

Hurricane Irma made landfall in the 

U.S. near Cudjoe Key, Florida, as a 

Category 4 hurricane then made a 

subsequent landfall near Marco Island, 

Florida, as a Category 3 hurricane on 

September 10, 2017. Strong winds and 

flooding from this hurricane impacted 

communities throughout Florida, 

resulting in power outages and damage 

to homes, businesses, and 

infrastructure. As a result, the RA has 

determined that catastrophic conditions 

exist in the following Florida counties: 

Manatee, Sarasota, DeSoto, Charlotte, 

Lee, Collier, Monroe, Miami-Dade, and 

Broward. Through this temporary rule, 

the RA is authorizing Federal dealers to 

delay reporting of trip tickets to NOAA 

Fisheries and IFQ participants within 

this affected area to use paper-based 

forms, from September 29, 2017, 

through October 31, 2017. NMFS will 

provide additional notification to 

affected participants via NOAA Weather 

Radio, Fishery Bulletins, and other 

appropriate means. NOAA Fisheries 

will continue to monitor and re-evaluate 

the areas and duration of the 

catastrophic conditions. 

Dealers may delay electronic 

reporting of trip tickets to NMFS during 

catastrophic conditions. Dealers are to 

report all landings to NMFS as soon as 

possible. Assistance for Federal dealers 

in effected areas is available from the 

Fisheries Monitoring Branch at 1–305– 

361–4581. NMFS previously provided 

IFQ dealers with the necessary paper 

forms (sequentially coded) and 

instructions for submission in the event 

of catastrophic conditions. Paper forms 

are also available from the RA upon 

request. The electronic systems for 

submitting information to NMFS will 

continue to be available to all 

participants, and participants in the 

affected area are encouraged to continue 

using these systems, if accessible. 

The administrative program functions 

available to IFQ participants in the area 


sradovich on DSK3GMQ082PROD with RULES