81 FR 68947 - 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 2017 Rates; Quality Reporting Requirements for Specific Providers; Graduate Medical Education; Hospital Notification Procedures Applicable to Beneficiaries Receiving Observation Services; Technical Changes Relating to Costs to Organizations and Medicare Cost Reports; Finalization of Interim Final Rules With Comment Period on LTCH PPS Payments for Severe Wounds, Modifications of Limitations on Redesignation by the Medicare Geographic Classification Review Board, and Extensions of Payments to MDHs and Low-Volume Hospitals; Correction
DEPARTMENT OF HEALTH AND HUMAN SERVICES
Centers for Medicare & Medicaid Services Federal Register Volume 81, Issue 193 (October 5, 2016)
Centers for Medicare & Medicaid Services
Federal Register Volume 81, Issue 193 (October 5, 2016)
| Page Range | 68947-68963 | |
| FR Document | 2016-24042 |
[Federal Register Volume 81, Number 193 (Wednesday, October 5, 2016)] [Rules and Regulations] [Pages 68947-68963] From the Federal Register Online [www.thefederalregister.org] [FR Doc No: 2016-24042] [[Page 68947]] ======================================================================= ----------------------------------------------------------------------- DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Medicare & Medicaid Services 42 CFR Parts 405, 412, 413, and 489 [CMS-1655-F; CMS-1664-F; CMS-1632-F2] RIN 0938-AS77; 0938-AS88; 0938-AS41 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 2017 Rates; Quality Reporting Requirements for Specific Providers; Graduate Medical Education; Hospital Notification Procedures Applicable to Beneficiaries Receiving Observation Services; Technical Changes Relating to Costs to Organizations and Medicare Cost Reports; Finalization of Interim Final Rules With Comment Period on LTCH PPS Payments for Severe Wounds, Modifications of Limitations on Redesignation by the Medicare Geographic Classification Review Board, and Extensions of Payments to MDHs and Low-Volume Hospitals; 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 22, 2016 Federal Register titled ``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 2017 Rates; Quality Reporting Requirements for Specific Providers; Graduate Medical Education; Hospital Notification Procedures Applicable to Beneficiaries Receiving Observation Services; Technical Changes Relating to Costs to Organizations and Medicare Cost Reports; Finalization of Interim Final Rules With Comment Period on LTCH PPS Payments for Severe Wounds, Modifications of Limitations on Redesignation by the Medicare Geographic Classification Review Board, and Extensions of Payments to MDHs and Low-Volume Hospitals.'' DATES: This correction is effective October 1, 2016. FOR FURTHER INFORMATION CONTACT: Donald Thompson, (410) 786-4487. SUPPLEMENTARY INFORMATION: I. Background In FR Doc. 2016-18476 of August 22, 2016 (81 FR 56761) there were a number of technical and typographical errors identified and corrected in 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 22, 2016 Federal Register. Accordingly, the corrections are effective October 1, 2016. II. Summary of Errors A. Summary of Errors in the Preamble On page 56775, we made a typographical error in stating the cost reduction. On page 56796, we are correcting errors and inadvertent omissions in the summary and response to a comment on the assignment of 18 additional diagnosis codes. On page 56797, we erroneously referred to the wrong table. On page 56801, we are correcting errors and inadvertent omissions in our response to comments on our proposal to redesignate four ICD-10- PCS procedure codes. On page 56803 and in the table on page 56804 describing ICD-10-PCS Endovascular Thrombectomy Procedure Codes Reassigned to MS-DRGs 270, 271, and 272 for FY 2017, we are correcting technical errors in our discussion in response to comments to remove 34 ICD-10-PCS procedure codes describing endovascular thrombectomy of non-lower limbs from the proposed list of codes to be reassigned to MS-DRGs 270, 271 and 272. In this response, we erroneously referred to 34 procedure codes describing non-lower limb procedures (as included in the list submitted by the commenter) rather than 32 non-lower limb procedure codes. Two of the 34 procedure codes identified by the commenter, ICD-10-PCS procedure codes 04CT3ZZ (Extirpation of matter from right peroneal artery, percutaneous approach) and 04CU3ZZ (Extirpation of matter from left peroneal artery, percutaneous approach), describe endovascular thrombectomy of lower limbs. These codes are assigned to MS-DRGs 270, 271 and 272, accurately replicating the logic of ICD-9-CM MS-DRGs Version 32 and supporting clinical and resource use homogeneity as originally proposed and in accordance with the finalized policy to add procedures describing endovascular thrombectomy of lower limbs to ICD-10 Version 34 MS-DRGS 270, 271 and 272. On page 56804, as a result of our correction of the MS-DRG assignment in Table 6B--New Procedure Codes for 13 ICD-10-PCS procedure codes that describe endovascular thrombectomy procedures of the lower limb, as described in section II.D. of this correction document, we are making additional conforming corrections to the table describing ICD- 10-PCS Endovascular Thrombectomy Procedure Codes Reassigned to MS-DRGs 270, 271, and 272 for FY 2017. On pages 56821 and 56823, we erroneously stated there were 58 additional combination codes for removal and replacement of knee joints. There were 57 additional combination codes. On pages 56822 and 56823, we erroneously listed the code number for (Replacement of Left Knee Joint, Femoral Surface with Synthetic Substitute, Cemented, Open Approach) as code 0SRU0JA three times within the table. The correct code number should be 0SRU0J9 (Replacement of Left Knee Joint, Femoral Surface with Synthetic Substitute, Cemented, Open Approach). As a result of the corrections to pages 56803, 56804, 56821, 56822, and 56823, we have made conforming changes to the ICD-10 MS-DRG Definitions Manual Version 34 and ICD-10 MS-DRG Grouper Software Version 34 for FY 2017. On page 56858, we erroneously omitted MS-DRG 265 from the table of MS-DRGs subject to the policy for replaced devices offered without cost or with a credit. On pages 56895 and 56897, we inadvertently made an error to the title of ICD-10-PCS procedure code XW03331 and omitted an additional procedure code that describes Idarucizumab. Cases involving Idarucizumab that are eligible for new technology add-on payments will be identified by ICD-10-PCS procedure codes XW03331 (Introduction of Idarucizumab, Dabigatran reversal agent into peripheral vein, percutaneous approach, New Technology Group 1) and XW04331 (Introduction of Idarucizumab, Dabigatran reversal agent into central vein, percutaneous approach, New Technology Group 1). On page 56927, as a result of the correction of the technical errors described in section II.B of this correction document, we have made conforming changes to the following: The number of hospitals approved for wage index reclassifications by the Medicare Geographic Classification Review Board (MGCRB) starting in FY 2017 and the number of hospitals in a [[Page 68948]] MGCRB reclassification status for FY 2017. On page 57002 in the table titled, ``Previously Adopted and Newly Finalized Baseline and Performance Periods for the FY 2021 Program Year'' we erroneously repeated the same information three times, and in the first instance provided incorrect performance period years for the Mortality (MORT-30-AMI, MORT-30-HF, MORT-30-COPD) and THA/TKA measures. On page 57033, we made a typographical error and omitted a dash within the web link address creating a non-functional link. On pages 57195, 57196, 57199, 57211, 57213, 57218, and 57220 through 57223 we inadvertently made technical and typographical errors to the Long-Term Care Hospital Quality Reporting Program section and have corrected those errors for clarification. B. Summary of Errors in the Addendum As discussed in section II.D. of this correcting document, we made technical errors with regard to the calculation of Factor 3 of the uncompensated care payment methodology. The revisions made to address some of these errors directly affected and required the recalculation of all the budget neutrality factors and final outlier threshold. Factor 3 is used to determine the amount of total uncompensated care payment a hospital is eligible to receive as well as the amount of the uncompensated care payment a hospital receives per discharge. Per discharge uncompensated care payments are then included when determining total payments for purposes of all of the budget neutrality factors and the final outlier threshold. Therefore, we made conforming changes to pages 57278 through 57280, 57286, and 57291 to take into account the updated per-discharge uncompensated care payments determined using revised Factor 3 amounts. We made further conforming corrections to the national outlier adjustment factors on page 57286 and the table on page 57288 as a result of these changes. Finally, we made conforming corrections to the national operating standardized amounts. We made inadvertent errors related to the MGCRB reclassification status of one provider as well as the status of three providers reclassified as urban to rural under section 1886(d)(8)(E) of the Act (codified in the regulations under Sec. 412.103 and hereinafter referred to as Sec. 412.103). Specifically, the reclassification status in the FY 2017 IPPS/LTCH PPS final rule did not properly reflect the following:Withdrawal of a MGCRB reclassification for FY 2017 for one provider. Application of urban to rural reclassification under Sec. 412.103 for three providers. Therefore, on page 57279, we recalculated the reclassification hospital budget neutrality adjustment. The reclassification errors also required the recalculation of additional budget neutrality adjustment factors, the fixed-loss cost threshold, the final wage indexes, and the national operating standardized amounts. Therefore, we made conforming changes to the following: On page 57280, the rural floor budget neutrality adjustment and the wage index transition budget neutrality adjustment. On page 57286, the calculation of the outlier fixed-loss cost threshold and the national outlier adjustment factors. On page 57288, the table titled ``Change of FY 2016 Standardized Amounts to the FY 2017 Standardized Amounts''. On pages 57291 and 57293 through 57295, in our discussion of the determination of the Federal hospital inpatient capital related prospective payment rate update, we have made conforming corrections to the increase in the capital Federal rate, the incremental and cumulative budget neutrality adjustment factors for changes in the GAFs and the MS-DRG relative weights, the GAF/MS-DRG budget neutrality adjustment factor (due to the errors in our calculation of the GAFs, which are computed from the wage index), the capital Federal rate, and the outlier threshold (as discussed previously). Also, as a result of these errors, on pages 57294 and 57295, we have made conforming corrections in the tables showing the comparison of factors and adjustments for the FY 2016 capital Federal rate and FY 2017 capital Federal rate and the proposed FY 2017 capital Federal rate and final FY 2017 capital Federal rate. On page 57307, we are making conforming corrections the fixed-loss amount for site neutral discharges due to corrections in the IPPS rates and factors discussed previously. On page 57312, we have made conforming corrections to the national 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). C. Summary of Errors in the Appendices On pages 57312, 57315 through 57317, 57319 through 57323, 57330 through 57332 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 2017 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 section II.B. of this correction document). On pages 57324 through 57326, in the table titled ``Modeled Disproportionate Share Hospital Payments for Estimated FY 2017 DSHs by Hospital Type: Model DSH $ (In Millions) From FY 2016 To FY 2017'' and the accompanying discussion, we made corrections to address technical and formatting errors in the estimated impacts resulting from inadvertent errors in the calculation of Factor 3 for certain hospitals. On pages 57331 through 57332, we made conforming corrections to Table III--Comparison of Total Payments Per Case [FY 2016 Payments Compared to FY 2017 Payments]. On page 57342, we made conforming corrections to the discussion of the estimated changes in operating and capital IPPS payments and the accounting statement and table for acute care hospitals that arose from the corrections of errors and conforming changes as described in sections II.B. and II.D. of this correcting document. D. 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 page 57311 of the FY 2017 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-Service-Payment/AcuteInpatientPPS/FY2017-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 2017. Because the uncompensated care and reclassification errors discussed in section II.B. of this correction document required that we recalculate the rural and imputed floor budget neutrality factor, we are [[Page 68949]] correcting the values in the column titled FY 2017 Wage Index for all providers. For the three providers for which we are applying urban to rural reclassification under Sec. 412.103, we are correcting the values in the column titled ``FY 2017 Wage Index'', inserting the rural reclassified CBSA in the column titled ``Reclassified/Redesignated CBSA'', and inserting a ``Y'' in the column titled ``Hospital Reclassified as Rural Under Section 1886(d)(8)(E) of the Act (Sec. 412.103)''. For the provider that withdrew its MGCRB reclassification for FY 2017, we are revising the wage index in the column titled FY 2017 Wage Index, and we are removing the MGCRB flag in the column titled MGCRB Reclass. Table 3--Wage Index Table by CBSA--FY 2017. Because the uncompensated care and reclassification errors discussed in section II.B. of this correction document required that we recalculate the rural and imputed floor budget neutrality factor, 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 Floor Wage Index'' and ``Eligible for Rural Floor Wage Index''. Table 6B--New Procedure Codes for FY 2017. In Table 6B--New Procedure Codes, we inadvertently listed the incorrect MS-DRG assignment for 13 ICD-10-PCS procedure codes that describe endovascular thrombectomy procedures of the lower limb involving a bifurcation. We are correcting the MS-DRG assignment of these 13 ICD-10-PCS codes in Table 6B. Table 10--New Technology Add-On Payment Thresholds for Applications for FY 2018. We are correcting the thresholds in this table as a result of the corrections to the operating standardized amounts discussed in section II.B. of this correcting document. Table 18--FY 2017 Medicare DSH Uncompensated Care Payment Factor 3 and Projected DSH Eligibility. For the FY 2017 IPPS/LTCH PPS final rule, we published a list of hospitals that we identified to be subsection (d) hospitals and subsection (d) Puerto Rico hospitals eligible to receive empirically justified Medicare DSH payment adjustments and uncompensated care payments for FY 2017. We also published, in the Supplemental Medicare DSH File located in the FY 2017 IPPS/LTCH PPS final rule data files page at https://www.cms.gov/Medicare/Medicare-Feefor-Service-Payment/AcuteInpatientPPS/FY2017-IPPS-FinalRule-Home-Page-Items/FY2017-IPPSFinal-Rule-Data-Files.html, the data used to calculate each hospital's Factor 3, total uncompensated care payment, and estimated uncompensated care payment per discharge. Shortly after the publication of the FY2017 IPPS/LTCH PPS final rule, we discovered that, in calculating Factor 3 of the uncompensated care payment methodology, we had understated the low-income insured days of hospitals that merged after 2011 with one surviving provider number because we inadvertently excluded the low income insured days of acquired hospitals from the low income insured days used in the Factor 3 calculation of surviving hospitals that were projected to receive Medicare DSH in FY 2017. In addition, we discovered that we had calculated a Factor 3 for hospitals that have ceased operations and erroneously calculated Factor 3 using Medicaid days reported on Worksheet S-3 instead of Worksheet S-2 of certain hospitals' FY 2013 cost reports. We are revising Factor 3 for all hospitals to correct these errors. 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. In addition, we discovered that we had inadvertently excluded the Medicaid days from the 2011 cost report for a provider as well as the Medicaid days from the 2012 cost report for another provider from the calculation of Factor 3. Due to technical errors by our Medicare Administrative Contractors the Medicaid days from these cost reports were not included in the March 2016 update of HCRIS. We projected that both providers would be eligible to receive Medicare DSH in FY 2017. Accordingly, we are revising Factor 3 for all hospitals to reflect these Medicaid days; however, the impact of these revisions is too small to affect other aspects of the IPPS ratesetting, such as the calculation of the fixed-loss threshold for outlier payments. We are also correcting the errors in the following LTCH PPS table that is listed on page 57311 of the FY 2017 IPPS/LTCH PPS final rule and is available on the Internet on the CMS Web site at https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/LongTermCareHospitalPPS/index.html under the list item for regulation number CMS-1655-F. The table that is available on the Internet has been updated to reflect the revisions discussed in this correcting document. Table 11--MS-LTC-DRGs, Relative Weights, Geometric Average Length of Stay, Short Stay Outlier (SSO) Threshold, and ``IPPS Comparable Threshold'' for LTCH PPS Discharges Occurring from October 1, 2016 through September 30, 2017. We are correcting this table by correcting typographical errors for MS-LTC-DRGs 627 and 658 in the columns titled ``Relative Weight,'' ``Geometric Average Length of Stay,'' ``Short-Stay Outlier (SSO) Threshold,'' and ``IPPS Comparable Threshold.'' 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, addendum, payment rates, tables, and appendices included or referenced in the FY 2017 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 2017 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 [[Page 68950]] appropriate payments in as timely a manner as possible, and to ensure that the FY 2017 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 2017 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. IV. Correction of Errors In FR Doc. 2016-18476 of August 22, 2016 (81 FR 56761), we are making the following corrections: A. Corrections of Errors in the Preamble 1. On page 56775, third column, second bulleted paragraph, line 25, the figure ``$50.4 million'' is corrected to read ``$56.4 million''. 2. On page 56796-- a. Top half of the page, third column, third full paragraph, (1) Lines 4 and 5, the phrase ``describing similar conditions'' is corrected to read ``displayed in Table 6A--New Diagnosis Codes associated with the proposed rule (which is available via the Internet on the CMS Web site at: http://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/AcuteInpatientPPS/index.html) that describe similar conditions''. (2) Lines 9 and 10, the phrase, ``18 ICD-10-CN diagnosis codes in the following table be reassigned'' is corrected to read ``18 ICD-10-CM diagnosis codes in the following table also be reassigned''. b. Lower half of the page, first column, last paragraph-- (1) Lines 6 and 7, the phrase ``describing procedures performed on'' is corrected to read ``describing conditions affecting''. (2) Line 14, the phrase ``MS DRGs 091, 092 and 093.'' is corrected to read ``MS-DRGs 091, 092, and 093 because they are also nervous system codes.'' 3. On page 56797, first column, first paragraph, lines 15 and 16, the phrase ``These 18 codes also are reflected in Table 6E'' is corrected to read ``These 18 codes are reflected in Table 6A''. 4. On page 56801, second column, second full paragraph-- a. Lines 11 and 12, the phrase ``performing such procedures because loop'' is corrected to read ``performing such procedures because, as noted in the FY 2017 IPPS/LTCH PPS proposed rule, loop''. b. Lines 25 and 26, the phrase ``were not able to finalize that specific request.'' is corrected to read ``were not able to replicate that specific request in the ICD-9-CM based MS-DRGs.''. c. Lines 26 through 29, the sentence ``Rather, we finalized an alternative option, which was to change the designation for four of the six codes requested.'' is corrected to read ``Rather, we proposed an alternative option, which was to change the designation for four of the six codes requested, because we believed that if we limited the change in designation to these four codes, the change would not have any impact.''. d. Lines 40 through 41, the phrase ``not finalizing the proposal to change the two'' is corrected to read ``not changing the designation of the two''. 5. On page 56803, bottom of the page-- a. First column, last paragraph, lines 7 and 8, the phrase ``removing the 34 codes'' is corrected to read ``removing 32 of the 34 codes''. b. Second column, first partial paragraph-- (1) Lines 5 and 6, the phrase ``34 non-lower'' is corrected to read ``32 non-lower''. (2) Lines 8 and 9, the phrase ``These 34 non-lower'' is corrected to read ``These 32 non-lower''. (3) Line 13, after the phrase ``for FY 2017.'' the paragraph is corrected by adding sentences to read as follows: ``Two of the procedure codes identified by the commenter, ICD-10- PCS procedure codes 04CT3ZZ (Extirpation of matter from right peroneal artery, percutaneous approach) and 04CU3ZZ (Extirpation of matter from left peroneal artery, percutaneous approach) describe endovascular thrombectomy of lower limbs and are not non-lower limb procedure codes.''. c. Third column, first full paragraph, line 11, the phrase ``34 procedure'' is corrected to read ``32 procedure''. 6. On page 56804, top of page, the table titled ``ICD-10-PCS ENDOVASCULAR THROMBECTOMY PROCEDURE CODES REASSIGNED TO MS-DRGs 270, 271, AND 272 FOR FY 2017'' is corrected by adding the following entries: ------------------------------------------------------------------------ ------------------------------------------------------------------------ 04CK3Z6........................... Extirpation of Matter from Right Femoral Artery, Bifurcation, Percutaneous Approach. 04CL3Z6........................... Extirpation of Matter from Left Femoral Artery, Bifurcation, Percutaneous Approach. 04CM3Z6........................... Extirpation of Matter from Right Popliteal Artery, Bifurcation, Percutaneous Approach. 04CN3Z6........................... Extirpation of Matter from Left Popliteal Artery, Bifurcation, Percutaneous Approach. 04CP3Z6........................... Extirpation of Matter from Right Anterior Tibial Artery, Bifurcation, Percutaneous Approach. 04CQ3Z6........................... Extirpation of Matter from Left Anterior Tibial Artery, Bifurcation, Percutaneous Approach. 04CR3Z6........................... Extirpation of Matter from Right Posterior Tibial Artery, Bifurcation, Percutaneous Approach. 04CS3Z6........................... Extirpation of Matter from Left Posterior Tibial Artery, Bifurcation, Percutaneous Approach. 04CT3Z6........................... Extirpation of Matter from Right Peroneal Artery, Bifurcation, Percutaneous Approach. 04CT3ZZ........................... Extirpation of Matter from Right Peroneal Artery, Percutaneous Approach. 04CU3Z6........................... Extirpation of Matter from Left Peroneal Artery, Bifurcation, Percutaneous Approach. 04CU3ZZ........................... Extirpation of Matter from Left Peroneal Artery, Percutaneous Approach. 04CV3Z6........................... Extirpation of Matter from Right Foot Artery, Bifurcation, Percutaneous Approach. 04CW3Z6........................... Extirpation of Matter from Left Foot Artery, Bifurcation, Percutaneous Approach. 04CY3Z6........................... Extirpation of Matter from Lower Artery, Bifurcation, Percutaneous Approach. ------------------------------------------------------------------------ 7. On page 56821, middle of the page-- a. Second column, first partial paragraph, line 2, the phrase ``identified 58'' is corrected to read ``identified 57''. b. Third column, first partial paragraph, line 3, the phrase ``following 58'' is corrected to read ``following 57''. 8. On pages 56821 through 56823, in the table titled ``ICD-10-PCS CODE PAIRS PROPOSED TO BE ADDED TO VERSION 34 ICD-10 MS-DRGs 466, 467, and 468: PROPOSED NEW KNEE REVISION ICD-10-PCS COMBINATIONS'', the codes (in the 4th column) for the following entries are corrected to read as follows: [[Page 68951]] ICD-10-PCS Code Pairs Proposed To Be Added to Version 34 ICD-10 MS-DRGs 466, 467, and 468: Proposed New Knee Revision ICD-10-PCS Combinations ---------------------------------------------------------------------------------------------------------------- Code Code description Code Code description ---------------------------------------------------------------------------------------------------------------- 0SPD08Z.................. Removal of Spacer from and 0SRU0J9.................. Replacement of Left Knee Left Knee Joint, Open Joint, Femoral Surface Approach. with Synthetic Substitute, Cemented, Open Approach. 0SPD38Z.................. Removal of Spacer from and 0SRU0J9.................. Replacement of Left Knee Left Knee Joint, Joint, Femoral Surface Percutaneous Approach. with Synthetic Substitute, Cemented, Open Approach. 0SPD48Z.................. Removal of Spacer from and 0SRU0J9.................. Replacement of Left Knee Left Knee Joint, Joint, Femoral Surface Percutaneous Endoscopic with Synthetic Approach. Substitute, Cemented, Open Approach. ---------------------------------------------------------------------------------------------------------------- 9. On page 56823, lower half of the page-- a. First column, second paragraph, line 10, the phrase ``58 new'' is corrected to read ``57 new''. b. Second column-- (1) First partial paragraph, line 11, the phrase ``58 new'' is corrected to read `` new''. (2) First full paragraph, lines 3 and 4, the phrase ``58 new'' is corrected to read ``57 new''. 10. On page 56858, top of the page, the untitled table is corrected by adding the following entry after line 34 (which is the entry for MDC 5, MS-DRG 262): ------------------------------------------------------------------------ MDC MS-DRG MS-DRG Title ------------------------------------------------------------------------ 5 265 AICD Lead Procedures. ------------------------------------------------------------------------ 11. On page 56895, third column, first partial paragraph-- a. Lines 8 and 9, the phrase ``a unique ICD-10-PCS procedure code'' is corrected to read ``two unique ICD-10-PCS procedure codes''. b. Lines 10 through 15, the sentence ``The approved procedure code is XW0331 (Introduction of Idarucizumab, Dabigatran reversal agent into central vein, percutaneous approach, New Technology Group 1).'' is corrected to read ``The approved procedure codes are XW0331 (Introduction of Idarucizumab, Dabigatran reversal agent into peripheral vein, percutaneous approach, New Technology Group 1) and XW04331 (Introduction of Idarucizumab, Dabigatran reversal agent into central vein, percutaneous approach, New Technology Group 1).''. 12. On page 56897, third column, third full paragraph, line 11, the phrase ``procedure code XW03331.'' is corrected to read ``procedure codes XW03331 and XW04331.''. 13. On page 56927-- a. Second column, last partial paragraph, line 5 the phrase ``265 hospitals'' is corrected to read ``264 hospitals''. b. Third column, first partial paragraph, line 12, the phrase ``817 hospitals'' is corrected to read ``816 hospitals''. 14. On page 57002, bottom of the page, the table titled ``PREVIOUSLY ADOPTED AND NEWLY FINALIZED BASELINE AND PERFORMANCE PERIODS FOR THE FY 2021 PROGRAM YEAR'' is corrected to read as follows: Previously Adopted and Newly Finalized Baseline and Performance Periods for the FY 2021 Program Year ------------------------------------------------------------------------ Domain Baseline period Performance period ------------------------------------------------------------------------ Clinical Care Mortality (MORT-30-AMI, July 1, July 1, MORT-30-HF, MORT-30-COPD) * 2011-June 30, 2016-June 30, 2014. 2019 THA/TKA *.............. April 1, April 1, 2011-March 31, 2016-March 31, 2014. 2019 MORT-30-PN (updated July 1, September cohort). 2012-June 30, 1, 2017-June 30, 2015. 2019 Efficiency and Cost Reduction MSPB................... January January 1, 2017-December 1, 2019-December 31, 2017. 31, 2019 Payment (AMI Payment July 1, July 1, and HF Payment). 2012-June 30, 2017-June 30, 2015. 2019 ------------------------------------------------------------------------ * Previously adopted baseline and performance periods that remain unchanged (80 FR 49562 through 49563). 15. On page 57033, first column, last paragraph, lines 2 through 4, the web link ``http://www.cms.gov/Medicare/Medicare-Fee-for-ServicePayment/AcuteInpatientPPS/dgme.html'' is corrected to read ``http://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/AcuteInpatientPPS/dgme.html.'' 16. On page 57195-- a. First column, last partial paragraph, lines 4 and 5, the phrase ``it recommended'' is corrected to read ``the commenters recommended''. b. Third column, third full paragraph-- (1). Line 14, the phrase ``This measure'' is corrected to read ``The Drug Regimen Review Conducted with Follow-Up for Identified Issues-PAC LTCH QRP quality measure''. (2) Lines 23 through 25, the phrase `` and Potentially Preventable 30-Day Post-Discharge Readmission Measure for LTCH QRP,'' is corrected to read ``, Potentially Preventable 30-Day Post-Discharge Readmission Measure for LTCH QRP and Medicare Spending Per Beneficiary-PAC LTCH QRP,''. 17. On page 57196, third column, first full paragraph, lines 13 through 16, the phrase ``with information more frequently, such as unadjusted counts of potentially preventable readmissions (PPRs) and discharge data.'' is corrected to read ``with information, such as unadjusted counts of potentially preventable readmissions (PPRs) and discharge data, more frequently.'' 18. On page 57199, first column, second full paragraph, lines 3 and 4, the phrase ``SES or SDS status.'' is corrected to read ``SES or SDS.'' 19. On page 57211, third column, second full paragraph, line 16, the phrase ``to discharge'' is corrected to read ``to be discharged''. 20. On page 57213-- a. Second column, last partial paragraph, lines 6 through 8, the phrase [[Page 68952]] ``and a SNF stay within a 30-day window, the SNF stay is a candidate to for'' is corrected to read ``and then a SNF stay within a 30-day window, the SNF stay is a candidate for''. b. Third column, after the last paragraph, Footnote 280, lines 1 and 2, the measure name ``Hospital-Wide All-Cause Readmission Measure (HWR) (CMS/Yale).'' is corrected to read ``Hospital-Wide All-Cause Unplanned Readmission Measure (HWR) (CMS/Yale).'' 21. On page 57218, third column, first full paragraph, lines 4 and 5, the phrase ``The commenter was correct in its interpretation of'' is corrected to read ``The commenter's interpretation was correct regarding''. 22. On page 57220, second column, second footnoted full paragraph (Footnote 311), lines 1 through 6, the footnote ``\311\Greenwald, J.L., Halasyamani, L., Greene, J., LaCivita, C., et al. (2010). Making inpatient medication reconciliation patient centered, clinically relevant and implementable: A consensus statement on key principles and necessary first steps. Journal of Hospital Medicine, 5(8), 477-485.'' is corrected to read ``\311\Institute of Medicine. Preventing Medication Errors. Washington, DC: National Academies Press; 2006.'' 23. On page 57221, second column, second full paragraph, lines 3 and 4, the phrase ``cross-setting and quality measure'' is corrected to read ``cross-setting quality measure''. 24. On page 57222-- a. Second column, first full paragraph, lines 11 and 12, the phrase ``however, the adoption of the measure'' is corrected to read ``however, the measure''. b. Third column, first full paragraph-- (1) Line 4, the word ``facilities'' is corrected to read ``facility's''. (2) Line 22, the phrase ``collected admission'' is corrected to read ``collected at admission''. 25. On page 57223-- a. First column, second paragraph-- (1) Lines 1 through 4, the phrase ``Since the time of the MAP consideration, with our measure contractor, we tested this measure in a pilot test involving twelve PAC facilities,'' is corrected to read ``Since the time of the NQF-convened MAP consideration we have further tested this measure in a pilot test involving twelve PAC facilities''. (2) Lines 7 and 8, the phrase, ``record collection system'' is corrected to read ``records system''. b. Second column, third full paragraph, lines 9 and 10, the phrase ``PAC facility.'' is corrected to read ``PAC facility. We appreciate MedPAC and other commenters' recommendation for a quality measure that assesses post-discharge medication communication with primary care providers for patients discharged to home.'' B. Correction of Errors in the Addendum 1. On page 57278, third column, fifth full paragraph, a. Line 3, the figure ``0.999079'' is corrected to read ``0.999078''. b. Line 9, the figure ``0.999079'' is corrected to read ``0.999078''. 2. On page 57279-- a. Second column, first full paragraph, line 9, the figure ``1.000209'' is corrected to read ``1.00021''. b. Third column, third full paragraph, line 12, the figure ``0.988224'' is corrected to read ``0.988136''. 3. On page 57280-- a. First column, fifth full paragraph, line 4, the figure ``0.993200'' is corrected to read ``0.991987''. b. Third column, second full paragraph, (1) Line 3, the figure ``0.999994'' is corrected to read ``0.999997''. (2) Line 6, the figure ``0.999994'' is corrected to read ``0.999997''. 4. On page 57286-- a. Second column, last paragraph-- (1) Line 6, the figure ``$23,570'' is corrected to read ``$23,573''. (2) Line 8, the figure ``$83,347,416,971'' is corrected to read ``$83,364,479,923''. (3) Line 9, the figure ``$4,479,256,519'' is corrected to read ``$4,479,256,368''. b. Third column-- (1) First partial paragraph, line 11, the figure ``$23,570'' is corrected to read ``$23,573''. (2) Following the third full paragraph, the untitled table is corrected to read as follows: ------------------------------------------------------------------------ Operating standardized Capital amounts Federal rate ------------------------------------------------------------------------ National................................ 0.948998 0.938602 ------------------------------------------------------------------------ 5. On page 57288, middle of the page, the table titled ``CHANGE OF FY 2016 STANDARDIZED AMOUNTS TO THE FY 2017 STANDARDIZED AMOUNTS'', is corrected to read as follows: Change of FY 2016 Standardized Amounts to the FY 2017 Standardized Amounts ---------------------------------------------------------------------------------------------------------------- Hospital submitted Hospital did NOT Hospital did NOT Hospital submitted quality data and submit quality submit quality quality data and is NOT a data and is a data and is NOT a is a meaningful meaningful EHR meaningful EHR meaningful EHR EHR user user user user ---------------------------------------------------------------------------------------------------------------- FY 2016 Base Rate after If Wage Index is If Wage Index is If Wage Index is If Wage Index is removing: Greater Than Greater Than Greater Than Greater Than 1. FY 2016 Geographic 1.0000: 1.0000: 1.0000: 1.0000: Reclassification Budget Labor (69.6 Labor (69.6 Labor (69.6 Labor (69.6 Neutrality (0.988169). percent): percent): percent): percent): 2. FY 2016 Rural Community $4,394.09.. $4,394.09.. $4,394.09.. $4,394.09. Hospital Demonstration Program Nonlabor (30.4 Nonlabor (30.4 Nonlabor (30.4 Nonlabor (30.4 Budget Neutrality (0.999837). percent): percent): percent): percent): $1,919.26.. $1,919.26.. $1,919.26.. $1,919.26. [[Page 68953]] 3. Cumulative FY 2008, FY 2009, If Wage Index is If Wage Index is If Wage Index is If Wage Index is FY 2012, FY 2013, FY 2014, FY less Than or less Than or less Than or less Than or 2015 and FY 2016 Documentation Equal to 1.0000: Equal to 1.0000: Equal to 1.0000: Equal to 1.0000: and Coding Adjustments as Labor (62 Labor (62 Labor (62 Labor (62 Required under Sections percent): percent): percent): percent): 7(b)(1)(A) and 7(b)(1)(B) of $3,914.28.. $3,914.28.. $3,914.28.. $3,914.28. Public Law 110-90 and Nonlabor (38 Nonlabor (38 Nonlabor (38 Nonlabor (38 Documentation and Coding percent): percent): percent): percent): Recoupment Adjustment as $2,399.07.. $2,399.07.. $2,399.07.. $2,399.07. required under Section 631 of the American Taxpayer Relief Act of 2012 (0.9255). 4. FY 2016 Operating Outlier Offset (0.948998). 5. FY 2016 New Labor Market Delineation Wage Index Transition Budget Neutrality Factor (0.999998). 6. FY 2017 2-Midnight Rule Permanent Adjustment (1/0.998). FY 2017 Update Factor........... 1.0165............ 0.99625........... 1.00975........... 0.9895. FY 2017 MS[dash]DRG 0.999078.......... 0.999078.......... 0.999078.......... 0.999078. Recalibration Budget Neutrality Factor. FY 2017 Wage Index Budget 1.00021........... 1.00021........... 1.00021........... 1.00021. Neutrality Factor. FY 2017 Reclassification Budget 0.988136.......... 0.988136.......... 0.988136.......... 0.988136. Neutrality Factor. FY 2017 Operating Outlier Factor 0.948998.......... 0.948998.......... 0.948998.......... 0.98998. Cumulative Factor: FY 2008, FY 0.9118............ 0.9118............ 0.9118............ 0.9118. 2009, FY 2012, FY 2013, FY 2014, FY 2015, FY 2016 and FY 2017 Documentation and Coding Adjustment as Required under Sections 7(b)(1)(A) and 7(b)(1)(B) of Public Law 110-90 and Documentation and Coding Recoupment Adjustment as required under Section 631 of the American Taxpayer Relief Act of 2012. FY 2017 New Labor Market 0.999997.......... 0.999997.......... 0.999997.......... 0.999997. Delineation Wage Index 3-Year Hold Harmless Transition Budget Neutrality Factor. FY 2017 2[dash]Midnight Rule One- 1.006............. 1.006............. 1.006............. 1.006. Time Prospective Increase. National Standardized Amount for Labor: $3,839.23.. Labor: $3,762.75.. Labor: $3,8143.74. Labor: $3,737.25. FY 2017 if Wage Index is Nonlabor: Nonlabor: Nonlabor: Nonlabor: Greater Than 1.0000; Labor/Non- $1,676.91. $1,643.50. $1,665.77. $1,632.37. Labor Share Percentage (69.6/ 30.4). [[Page 68954]] National Standardized Amount for Labor: $3,420.01.. Labor: $3,351.88.. Labor: $3,397.30.. Labor: $3,329.16. FY 2017 if Wage Index is less Nonlabor: Nonlabor: Nonlabor: Nonlabor: Than or Equal to 1.0000; Labor/ $2,096.13. $2,054.37. $2,082.21. $2,040.46. Non-Labor Share Percentage (62/ 38). ---------------------------------------------------------------------------------------------------------------- 6. On page 57291-- a. First column, second full paragraph, line 15, the figure ``0.999079'' is corrected to read ``0.999078''. b. Third column, first full paragraph line 6, the figure ``1.84'' is corrected to read ``1.83''. 7. On page 57293, third column-- a. First partial paragraph-- (1) Line 1, the figure ``0.9995'' is corrected to read ``0.9994''. (2) Line 4, ``0.9855'' is corrected to read ``0.9854''. b. First full paragraph, line 16, the figure ``0.9851'' is corrected to read ``0.9850''. c. Last paragraph-- (1) Line 2, the figure ``0.9991''is corrected to read ``0.9990''. (2) Line 4, ``0.9995'' is corrected to read ``0.9994''. 8. On page 57294-- a. Top of the page-- (1) Second column-- (a) First full paragraph, line 17, the figure ``$446.81'' is corrected to read ``$446.79''. (b) Second bulleted paragraph, line 6, the figure ``0.9991'' is corrected to read ``0.9990''. (2) Third column, second full paragraph-- (a) Line 13, the figure, ``0.09'' is corrected to read ``0.10''. (b) Line 26, the figure, ``1.84'' is corrected to read ``1.832''. b. Bottom of the page, the table titled ``COMPARISON OF FACTORS AND ADJUSTMENTS: FY 2016 CAPITAL FEDERAL RATE AND FY 2017 CAPITAL FEDERAL RATE'' is corrected to read as follows: Comparison of Factors and Adjustments: FY 2016 Capital Federal Rate and FY 2017 Capital Federal Rate ---------------------------------------------------------------------------------------------------------------- Percent change FY 2016 FY 2017 Change \3\ ---------------------------------------------------------------------------------------------------------------- Update Factor \1\............................... 1.0130 1.009 1.009 0.9 GAF/DRG Adjustment Factor \1\................... 0.9976 0.9990 0.9990 -0.10 Outlier Adjustment Factor \2\................... 0.9365 0.9386 1.0022 0.22 Permanent 2-midnight Policy Adjustment Factor... N/A 1.002 1.002 0.2 One-Time 2-midnight Policy Adjustment Factor.... N/A 1.006 1.006 0.6 Capital Federal Rate............................ $438.75 $446.79 1.0183 1.83 ---------------------------------------------------------------------------------------------------------------- \1\ The 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 2016 to FY 2017 resulting from the application of the 0.9990 GAF/DRG budget neutrality adjustment factor for FY 2017 is a net change of 0.9990 (or -0.10 percent). \2\ The 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 2017 outlier adjustment factor is 0.9386/0.9365, or 1.0022 (or 0.22 percent). \3\ Sum of individual changes may not match percent change in capital rate due to rounding. 9. On page 57295-- a. The top of the page, the table titled ``COMPARISON OF FACTORS AND ADJUSTMENTS: PROPOSED FY 2017 CAPITAL FEDERAL RATE AND FINAL FY 2017 CAPITAL FEDERAL RATE'' is corrected to read as follows: Comparison of Factors and Adjustments: Proposed FY 2017 Capital Federal Rate and Final FY 2017 Capital Federal Rate ---------------------------------------------------------------------------------------------------------------- Proposed FY 2017 Final FY 2017 Change Percent change ---------------------------------------------------------------------------------------------------------------- Update Factor \1\............................... 1.0090 1.0090 1.0000 0.00 GAF/DRG Adjustment Factor \1\................... 0.9993 0.9990 0.9997 -0.03 Outlier Adjustment Factor \2\................... 0.9374 0.9386 1.0013 0.13 Permanent 2-midnight Policy Adjustment Factor... 1.002 1.002 1.000 0.00 One-Time 2-midnight Policy Adjustment Factor.... 1.006 1.006 1.000 0.00 Capital Federal Rate............................ $446.35 $446.79 1.0010 0.10 ---------------------------------------------------------------------------------------------------------------- b. Lower three-fourths of the page, first column, second paragraph, line 21, the figure, ``$23,570.'' is corrected to read ``$23,573.'' 10. On page 57307, second column, first full paragraph-- a. Line 15, the figure ``$23,570'' is corrected to read ``$23,573''. b. Line 35, the figure ``$23,570'' is corrected to read ``$23,573''. 11. On page 57312-- a. Top of the page-- [[Page 68955]] (1) Table 1A titled ``NATIONAL ADJUSTED OPERATING STANDARDIZED AMOUNTS, LABOR/NONLABOR (69.6 PERCENT LABOR SHARE/30.4 PERCENT NONLABOR SHARE IF WAGE INDEX IS GREATER THAN 1)--FY 2017'' is corrected to read as follows: Table 1A--National Adjusted Operating Standardized Amounts, Labor/Nonlabor (69.6 Percent Labor Share/30.4 Percent Nonlabor Share if Wage Index Is Greater Than 1)--FY 2017 -------------------------------------------------------------------------------------------------------------------------------------------------------- Hospital submitted quality data and is Hospital submitted quality data and Hospital did NOT submit quality data Hospital did NOT submit quality data a meaningful EHR user (update = 1.65 is NOT a meaningful EHR user and is a meaningful EHR user and is NOT a meaningful EHR user percent) (update = -0.375 percent) (update = 0.975 percent) (update = -1.05 percent) -------------------------------------------------------------------------------------------------------------------------------------------------------- Labor Nonlabor Labor Nonlabor Labor Nonlabor Labor Nonlabor -------------------------------------------------------------------------------------------------------------------------------------------------------- $3,839.23 $1,677.91 $3,762.75 $1,643.50 $3,813.74 $1,665.77 $3,737.25 $1,632.37 -------------------------------------------------------------------------------------------------------------------------------------------------------- (2) Table 1B titled ``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 2017'' 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 2017 -------------------------------------------------------------------------------------------------------------------------------------------------------- Hospital submitted quality data and is Hospital submitted quality data and Hospital did NOT submit quality data Hospital did NOT submit quality data a meaningful EHR user (update = 1.65 is NOT a meaningful EHR user (update and is a meaningful EHR user (update and is NOT a meaningful EHR user percent) = -0.375 percent) = 0.975 percent) (update = -1.05 percent) -------------------------------------------------------------------------------------------------------------------------------------------------------- Labor Nonlabor Labor Nonlabor Labor Nonlabor Labor Nonlabor -------------------------------------------------------------------------------------------------------------------------------------------------------- $3,420.01 $2,096.13 $3,351.88 $2,054.37 $3,397.30 $2,082.21 $3,329.16 $2,040.46 -------------------------------------------------------------------------------------------------------------------------------------------------------- b. Middle of the page-- (1) Table 1C titled ``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 2017'' 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 2017 ---------------------------------------------------------------------------------------------------------------- Rates if wage index is greater than 1 Rates if wage index is less than -------------------------------------------- or equal to 1 Standardized amount --------------------------------- Labor Nonlabor Labor Nonlabor ---------------------------------------------------------------------------------------------------------------- National \1\...................... Not Applicable...... Not Applicable...... $3,420.01 $2,096.13 ---------------------------------------------------------------------------------------------------------------- \1\ For FY 2017, there are no CBSAs in Puerto Rico with a national wage index greater than 1. (2) Table 1D titled ``CAPITAL STANDARD FEDERAL PAYMENT RATE--FY 2017'' is corrected as follows: Table 1D--Capital Standard Federal Payment Rate--FY 2017 ------------------------------------------------------------------------ Rate ------------------------------------------------------------------------ National............................................... $446.79 ------------------------------------------------------------------------ C. Corrections of Errors in the Appendices 1. On page 57312, bottom of the page, third column, first partial paragraph, a. Line 8, the figure ``$987'' is corrected to read ``$990''. b. Line 10, the figure ``$66'' is corrected to read ``$72''. 2. On page 57315, upper three-fourths of the page-- a. Second column, third full paragraph, (1) Line 7, the figure ``1,380'' is corrected to read ``1,369''. (2) Line 9, the figure ``1,135'' is corrected to read ``1,146''. b. Third column, first full paragraph, line 13-- (1) The figure ``1,372'' is corrected to read ``1,369''. (2) The figure ``1,150'' is corrected to read ``1,153''. 3. On pages 57315 through 57317, the table titled ``TABLE I--IMPACT ANALYSIS OF CHANGES TO THE IPPS FOR OPERATING COSTS FOR FY 2017'' is corrected to read as follows: [[Page 68956]] Table I--Impact Analysis of Changes to the IPPS for Operating Costs for FY 2017 ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ FY 2017 FY 2017 Wage Rural and weights and data under new imputed floor Hospital rate DRG changes CBSA with Application of the Number of update and with designations FY 2017 MGCRB application of frontier wage All FY 2017 hospitals documentation application of with reclassifications national rural index and changes \1\ and coding recalibration application of and imputed out[dash]migration adjustment budget wage budget floor budget adjustment neutrality neutrality neutrality ........... (1) \2\ (2) \3\ (3) \4\ (4) \5\ (5) \6\ (6) \7\ (7) \8\ ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ All Hospitals.................................................. 3,330 1.0 0.0 0.0 0.0 0.0 0.1 0.9 By Geographic Location: Urban hospitals................................................ 2,515 0.9 0.0 0.0 -0.1 0.0 0.1 0.9 Large urban areas.......................................... 1,369 0.9 0.1 0.0 -0.3 -0.1 0.0 0.9 Other urban areas.......................................... 1,146 1.0 0.0 0.0 0.1 0.2 0.2 1.0 Rural hospitals................................................ 815 1.6 -0.4 0.1 1.3 -0.2 0.1 1.2 Bed Size (Urban): 0-99 beds.................................................. 659 0.9 -0.2 0.2 -0.5 0.1 0.2 0.9 100-199 beds............................................... 767 1.0 -0.1 0.0 0.0 0.3 0.2 0.7 200-299 beds............................................... 446 1.0 -0.1 -0.1 0.1 0.0 0.1 0.8 300-499 beds............................................... 431 1.0 0.1 0.0 -0.2 0.1 0.2 0.9 500 or more beds........................................... 212 0.9 0.2 0.0 -0.2 -0.2 0.0 1.1 Bed Size (Rural): 0-49 beds.................................................. 317 1.5 -0.5 0.1 0.2 -0.2 0.3 1.0 50-99 beds................................................. 292 1.8 -0.6 0.1 0.8 -0.2 0.1 1.2 100-149 beds............................................... 120 1.6 -0.4 0.0 1.5 -0.2 0.2 1.0 150-199 beds............................................... 46 1.7 -0.2 0.2 1.7 -0.3 0.0 1.3 200 or more beds........................................... 40 1.6 -0.1 0.2 2.5 -0.3 0.0 1.5 Urban by Region: New England................................................ 116 0.8 0.0 -0.5 1.1 0.9 0.1 -0.4 Middle Atlantic............................................ 315 0.9 0.1 -0.1 0.8 -0.2 0.1 0.9 South Atlantic............................................. 407 1.0 0.0 -0.2 -0.5 -0.3 0.1 0.9 East North Central......................................... 390 0.9 0.0 -0.1 -0.2 -0.4 0.0 1.0 East South Central......................................... 147 1.0 0.0 -0.1 -0.4 -0.3 0.0 1.2 West North Central......................................... 163 1.1 0.1 -0.1 -0.8 -0.4 0.7 1.0 West South Central......................................... 385 0.9 0.0 0.2 -0.5 -0.4 0.0 1.2 Mountain................................................... 163 1.1 0.0 0.1 -0.3 1.2 0.2 2.2 Pacific.................................................... 378 0.9 0.0 0.4 -0.4 1.0 0.1 0.5 Puerto Rico................................................ 51 0.9 0.1 -0.5 -1.0 0.1 0.1 0.3 Rural by Region: New England................................................ 21 1.3 -0.2 0.3 1.4 -0.3 0.2 1.6 Middle Atlantic............................................ 54 1.7 -0.4 0.1 0.8 -0.2 0.1 1.6 South Atlantic............................................. 128 1.7 -0.5 -0.1 2.3 -0.3 0.1 1.0 East North Central......................................... 115 1.7 -0.4 0.0 1.0 -0.2 0.1 1.2 East South Central......................................... 155 1.1 -0.3 0.4 2.2 -0.4 0.1 1.0 West North Central......................................... 98 2.2 -0.4 0.0 0.2 -0.1 0.3 1.5 West South Central......................................... 160 1.5 -0.4 0.4 1.3 -0.3 0.1 1.2 Mountain................................................... 60 1.7 -0.4 0.1 0.2 -0.1 0.2 1.3 Pacific.................................................... 24 1.9 -0.4 -0.3 1.3 -0.1 0.0 1.3 By Payment Classification: 0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 Urban hospitals............................................ 2,522 0.9 0.0 0.0 -0.1 0.0 0.1 0.9 Large urban areas.......................................... 1,369 0.9 0.1 0.0 -0.3 -0.1 0.0 0.9 Other urban areas.......................................... 1,153 1.0 0.0 0.0 0.1 0.2 0.2 1.0 Rural areas................................................ 808 1.6 -0.4 0.1 1.4 -0.2 0.1 1.2 Teaching Status: Nonteaching................................................ 2,266 1.1 -0.2 0.0 0.1 0.2 0.1 0.8 Fewer than 100 residents................................... 815 1.0 0.0 0.0 -0.1 0.0 0.2 0.9 100 or more residents...................................... 249 0.9 0.2 0.0 -0.1 -0.2 0.0 1.1 Urban DSH: Non-DSH.................................................... 589 0.9 -0.1 -0.2 0.2 0.0 0.2 0.8 100 or more beds........................................... 1,642 0.9 0.1 0.0 -0.1 0.0 0.1 0.9 Less than 100 beds......................................... 363 1.0 -0.3 0.0 -0.5 0.1 0.1 0.7 Rural DSH: SCH........................................................ 240 2.0 -0.6 0.1 0.1 -0.1 0.0 1.4 RRC........................................................ 325 1.7 -0.3 0.1 1.8 -0.2 0.0 1.3 100 or more beds........................................... 29 0.9 -0.4 0.1 2.9 -0.4 0.1 0.5 Less than 100 beds......................................... 142 0.8 -0.4 0.2 1.3 -0.4 0.7 0.2 Urban teaching and DSH: Both teaching and DSH...................................... 898 0.9 0.1 0.0 -0.2 -0.1 0.1 1.0 Teaching and no DSH........................................ 109 0.9 0.0 -0.1 1.1 0.0 0.0 0.7 No teaching and DSH........................................ 1,107 1.0 -0.1 0.1 -0.1 0.3 0.1 0.8 No teaching and no DSH..................................... 408 0.9 -0.1 -0.2 -0.4 0.0 0.2 0.9 Special Hospital Types: RRC........................................................ 189 0.8 -0.1 0.1 1.9 0.0 0.5 1.2 SCH........................................................ 324 2.1 -0.3 -0.1 0.0 0.0 0.0 1.7 MDH........................................................ 148 1.7 -0.6 0.0 0.6 -0.1 0.1 1.3 SCH and RRC................................................ 126 2.2 -0.3 0.1 0.4 -0.1 0.0 1.8 MDH and RRC................................................ 12 2.1 -0.6 -0.1 1.3 -0.2 0.0 2.2 Type of Ownership: Voluntary.................................................. 1,927 1.0 0.0 0.0 0.0 0.0 0.1 0.9 Proprietary................................................ 881 1.0 0.0 0.1 0.0 0.0 0.1 0.9 Government................................................. 522 1.0 0.0 -0.1 -0.2 0.0 0.1 0.9 [[Page 68957]] Medicare Utilization as a Percent of Inpatient Days: 0-25....................................................... 523 0.8 0.1 0.1 -0.3 0.2 0.0 1.1 25-50...................................................... 2,122 1.0 0.0 0.0 0.0 -0.1 0.1 0.9 50-65...................................................... 545 1.2 -0.2 -0.1 0.6 0.0 0.1 0.9 Over 65.................................................... 89 1.2 -0.3 0.3 -0.4 0.2 0.2 1.0 FY 2017 Reclassifications by the Medicare Geographic Classification Review Board: All Reclassified Hospitals................................. 791 1.1 -0.1 0.0 2.3 -0.2 0.0 0.9 Non-Reclassified Hospitals................................. 2,539 1.0 0.0 0.0 -0.8 0.1 0.1 0.9 Urban Hospitals Reclassified............................... 532 1.0 0.0 -0.1 2.3 -0.1 0.0 0.9 Urban Nonreclassified Hospitals............................ 1,936 0.9 0.1 0.0 -0.9 0.1 0.1 0.9 Rural Hospitals Reclassified Full Year..................... 277 1.7 -0.3 0.1 2.2 -0.2 0.0 1.3 Rural Nonreclassified Hospitals Full Year.................. 489 1.6 -0.4 0.2 -0.2 -0.2 0.3 1.1 All Section 401 Reclassified Hospitals:.................... 72 1.7 -0.2 0.0 0.3 -0.1 0.9 1.5 Other Reclassified Hospitals (Section 1886(d)(8)(B))....... 48 1.2 -0.4 0.1 3.1 -0.4 0.0 0.8 ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ \1\ 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. Discharge data are from FY 2015, and hospital cost report data are from reporting periods beginning in FY 2012 and FY 2013. \2\ This column displays the payment impact of the hospital rate update and other adjustments including the 1.65 percent adjustment to the national standardized amount and hospital-specific rate (the estimated 2.7 percent market basket update reduced by 0.3 percentage points for the multifactor productivity adjustment and the 0.75 percentage point reduction under the Affordable Care Act), the -1.5 percent documentation and coding adjustment to the national standardized amount and the adjustment of (1/0.998) to permanently remove the -0.2 percent reduction, and the 1.006 temporary adjustment 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 34 GROUPER, the changes to the relative weights and the recalibration of the MS DRG weights based on FY 2015 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 0.999078 in accordance with section 1886(d)(4)(C)(iii) of the Act. \4\ This column displays the payment impact of the update to wage index data using FY 2013 cost report data and the OMB labor market area delineations based on 2010 Decennial Census data. This column displays the payment impact of the application of the wage budget neutrality factor, which is calculated separately from the recalibration budget neutrality factor, and is calculated in accordance with section 1886(d)(3)(E)(i) of the Act. The wage budget neutrality factor is 1.000210. \5\ Shown here are the effects of geographic reclassifications by the Medicare Geographic Classification Review Board (MGCRB) along with the effects of the continued implementation of the new OMB labor market area delineations on these reclassifications. The effects demonstrate the FY 2017 payment impact of going from no reclassifications to the reclassifications scheduled to be in effect for FY 2017. Reclassification for prior years has no bearing on the payment impacts shown here. This column reflects the geographic budget neutrality factor of 0.988136. \6\ This column displays the effects of the rural and imputed floor based on the continued implementation of the new OMB labor market area delineations. The Affordable Care Act requires the rural floor budget neutrality adjustment to be 100 percent national level adjustment. The rural floor budget neutrality factor (which includes the imputed floor) applied to the wage index is 0.991987. This column also shows the effect of the 3-year transition for hospitals that were located in urban counties that became rural under the new OMB delineations or hospitals deemed urban where the urban area became rural under the new OMB delineations, with a budget neutrality factor of 0.999997. \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 wage index no less than 1.0 and of section 1886(d)(13) of the Act, as added by section 505 of Public Law 108-173, which provides for an increase in a hospital's wage index if a threshold percentage of residents of the county where the hospital is located commute to work at hospitals in counties with higher wage indexes. These are not budget neutral policies. \8\ This column shows the estimated change in payments from FY 2016 to FY 2017. 4. On page 57319, a. First column, second full paragraph, (1) Line 6, the figure ``0.988224'' is corrected to read ``0.988136''. (2) Line 13, the figure ``1.4'' is corrected to read ``1.3''. b. Second column-- (1) First full paragraph-- (a) Line 8, the figure ``0.9930'' is corrected to read ``0.991987''. (b) Line 9, the figure ``0.7'' is corrected to read ``0.8''. (2) Third full paragraph-- (a) Line 1, the figure ``397'' is corrected to read ``436''. (b) Line 5-- (1) The figure ``0.9930'' is corrected to read ``0.991987''. (2) The figure ``0.7'' is corrected to read ``0.8''. (c) Line 23, the figure ``1.0'' is corrected to read ``0.9''. (d) Line 31, the figure ``$24'' is corrected to read ``$22''. (e) Line 33, the figure ``0.7'' is corrected to read ``0.6''. c. Third column-- (1) First full paragraph, (a) Line 7, the figure ``$10'' is corrected to read ``$6.4''. (b) Line 18, the figure ``$17'' is corrected to read ``$18''. (2) Second full paragraph, line 28, the figure ``0.999994'' is corrected to read ``0.999997''. 5. On page 57320, the table titled ``FY 2017 IPPS Estimated Payments Due to Rural Floor and Imputed Floor with National Budget Neutrality'' is corrected to read as follows: [[Page 68958]] FY 2017 IPPS Estimated Payments Due to Rural and Imputed Floor With National Budget Neutrality ---------------------------------------------------------------------------------------------------------------- Percent change in Number of payments due to hospitals that application of State Number of will receive the rural floor and Difference (in $ hospitals rural floor or imputed floor millions) imputed floor with budget neutrality (1) (2) (3) (4) ---------------------------------------------------------------------------------------------------------------- Alabama............................. 83 6 -0.3 -6 Alaska.............................. 6 4 2.1 4 Arizona............................. 57 46 3.5 63 Arkansas............................ 44 0 -0.4 -4 California.......................... 301 186 1.3 131 Colorado............................ 48 3 0.2 3 Connecticut......................... 31 8 0.2 4 Delaware............................ 6 2 0 0 Washington, DC...................... 7 0 -0.4 -1 Florida............................. 171 16 -0.3 -2 Georgia............................. 105 0 -0.4 -18 Hawaii.............................. 12 0 -0.3 -10 Idaho............................... 14 0 -0.3 -1 Illinois............................ 126 3 -0.4 -1 Indiana............................. 89 0 -0.4 -19 Iowa................................ 35 0 -0.4 -11 Kansas.............................. 53 0 -0.3 -4 Kentucky............................ 65 0 -0.4 -3 Louisiana........................... 95 2 -0.4 -6 Maine............................... 18 0 -0.4 -5 Massachusetts....................... 58 15 0.6 -2 Michigan............................ 95 0 -0.4 22 Minnesota........................... 49 0 -0.3 -18 Mississippi......................... 62 0 -0.4 -6 Missouri............................ 74 2 -0.3 -4 Montana............................. 12 4 0.3 -8 Nebraska............................ 26 0 -0.3 1 Nevada.............................. 24 3 -0.2 -2 New Hampshire....................... 13 9 2.2 -2 New Jersey.......................... 64 18 0.2 11 New Mexico.......................... 25 0 -0.3 6 New York............................ 154 21 -0.3 -1 North Carolina...................... 84 1 -0.4 -20 North Dakota........................ 6 1 -0.3 -12 Ohio................................ 130 10 -0.4 -1 Oklahoma............................ 86 2 -0.3 -13 Oregon.............................. 34 2 -0.4 -4 Pennsylvania........................ 151 5 -0.4 -4 Puerto Rico......................... 51 12 0.1 -20 Rhode Island........................ 11 10 4.7 0 South Carolina...................... 57 5 -0.1 18 South Dakota........................ 18 0 -0.2 -2 Tennessee........................... 92 20 -0.3 -1 Texas............................... 320 3 -0.4 -7 Utah................................ 33 1 -0.3 -26 Vermont............................. 6 0 -0.2 -2 Virginia............................ 76 1 -0.3 -1 Washington.......................... 49 6 -0.1 -8 West Virginia....................... 29 3 -0.2 -1 Wisconsin........................... 65 6 -0.3 -5 Wyoming............................. 10 0 -0.1 0 ---------------------------------------------------------------------------------------------------------------- 6. On page 57321, second column, first partial paragraph -- a Line 1, the figure ``277'' is corrected to read ``278''. b Line 7, the figure ``1.0'' is corrected to read ``0.9''. 7. On pages 57321 through 57323, the table titled ``TABLE II-- IMPACT ANALYSIS OF CHANGES FOR FY 2017 ACUTE CARE HOSPITAL OPERATING PROSPECTIVE PAYMENT SYSTEM [PAYMENTS PER DISCHARGE]'' is corrected to read as follows: [[Page 68959]] Table II--Impact Analysis of Changes for FY 2017 Acute Care Hospital Operating Prospective Payment System [Payments per discharge] ---------------------------------------------------------------------------------------------------------------- Estimated Estimated Number of average FY average FY FY 2017 hospitals 2016 payment 2017 payment changes per discharge per discharge (1) (2) (3) (4) ---------------------------------------------------------------------------------------------------------------- All Hospitals................................... 3,330 $11,542 $11,649 0.9 By Geographic Location: Urban hospitals............................. 2,515 11,890 11,997 0.9 Large urban areas........................... 1,369 12,690 12,799 0.9 Other urban areas........................... 1,146 10,946 11,051 1.0 Rural hospitals............................. 815 8,602 8,707 1.2 Bed Size (Urban): 0-99 beds................................... 659 9,392 9,478 0.9 100-199 beds................................ 767 10,050 10,117 0.7 200-299 beds................................ 446 10,757 10,840 0.8 300-499 beds................................ 431 12,092 12,202 0.9 500 or more beds............................ 212 14,613 14,772 1.1 Bed Size (Rural): 0-49 beds................................... 317 7,208 7,279 1.0 50-99 beds.................................. 292 8,192 8,292 1.2 100-149 beds................................ 120 8,434 8,519 1.0 150-199 beds................................ 46 9,243 9,367 1.3 200 or more beds............................ 40 10,171 10,320 1.5 Urban by Region: New England................................. 116 12,957 12,901 -0.4 Middle Atlantic............................. 315 13,471 13,593 0.9 South Atlantic.............................. 407 10,498 10,595 0.9 East North Central.......................... 390 11,190 11,303 1.0 East South Central.......................... 147 10,042 10,160 1.2 West North Central.......................... 163 11,578 11,692 1.0 West South Central.......................... 385 10,693 10,820 1.2 Mountain.................................... 163 12,279 12,549 2.2 Pacific..................................... 378 15,372 15,452 0.5 Puerto Rico................................. 51 8,491 8,513 0.3 Rural by Region: New England................................. 21 11,818 12,009 1.6 Middle Atlantic............................. 54 8,655 8,791 1.6 South Atlantic.............................. 128 8,043 8,122 1.0 East North Central.......................... 115 8,918 9,023 1.2 East South Central.......................... 155 7,639 7,716 1.0 West North Central.......................... 98 9,420 9,560 1.5 West South Central.......................... 160 7,243 7,328 1.2 Mountain.................................... 60 10,100 10,228 1.3 Pacific..................................... 24 12,045 12,197 1.3 By Payment Classification: Urban hospitals............................. 2,522 11,886 11,993 0.9 Large urban areas........................... 1,369 12,690 12,799 0.9 Other urban areas........................... 1,153 10,940 11,046 1.0 Rural areas................................. 808 8,602 8,706 1.2 Teaching Status: Nonteaching................................. 2,266 9,600 9,680 0.8 Fewer than 100 residents.................... 815 11,133 11,231 0.9 100 or more residents....................... 249 16,764 16,949 1.1 Urban DSH: Non-DSH..................................... 589 10,055 10,140 0.8 100 or more beds............................ 1,642 12,247 12,359 0.9 Less than 100 beds.......................... 363 8,853 8,914 0.7 Rural DSH: SCH......................................... 240 8,584 8,702 1.4 RRC......................................... 325 9,006 9,123 1.3 100 or more beds............................ 29 7,018 7,054 0.5 Less than 100 beds.......................... 142 6,823 6,838 0.2 Urban teaching and DSH: Both teaching and DSH....................... 898 13,344 13,474 1.0 Teaching and no DSH......................... 109 11,361 11,442 0.7 No teaching and DSH......................... 1,107 10,047 10,124 0.8 No teaching and no DSH...................... 408 9,455 9,539 0.9 Special Hospital Types: RRC......................................... 189 9,709 9,824 1.2 [[Page 68960]] SCH......................................... 324 10,344 10,516 1.7 MDH......................................... 148 7,321 7,415 1.3 SCH and RRC................................. 126 10,767 10,957 1.8 MDH and RRC................................. 12 8,822 9,019 2.2 Type of Ownership: Voluntary................................... 1,927 11,719 11,830 0.9 Proprietary................................. 881 10,130 10,218 0.9 Government.................................. 522 12,485 12,596 0.9 Medicare Utilization as a Percent of Inpatient Days: 0-25........................................ 523 14,996 15,160 1.1 25-50....................................... 2,122 11,460 11,562 0.9 50-65....................................... 545 9,343 9,431 0.9 Over 65..................................... 89 6,948 7,019 1.0 FY 2017 Reclassifications by the Medicare Geographic Classification Review Board: All Reclassified Hospitals.................. 791 11,399 11,507 0.9 Non-Reclassified Hospitals.................. 2,539 11,595 11,701 0.9 Urban Hospitals Reclassified................ 532 12,008 12,115 0.9 Urban Nonreclassified Hospitals............. 1,936 11,849 11,955 0.9 Rural Hospitals Reclassified Full Year...... 277 8,984 9,101 1.3 Rural Nonreclassified Hospitals Full Year... 489 8,173 8,266 1.1 All Section 401 Reclassified Hospitals...... 72 11,307 11,474 1.5 Other Reclassified Hospitals (Section 48 7,889 7,954 0.8 1886(d)(8)(B))............................. ---------------------------------------------------------------------------------------------------------------- 7. On page 57324, top of the page, third column, last paragraph, line 1, the figure ``2,426'' is corrected to read ``2,419''. 8. On pages 57324 and 57325, the table titled ``Modeled Disproportionate Share Hospital Payments for Estimated FY 2017 DSHs by Hospital Type: Model DSH $ (In Millions) From FY 2016 to FY 2017'' is corrected to read as follows: Modeled Disproportionate Share Hospital Payments for Estimated FY 2017 DSHS by Hospital Type: Model DSH $ (in Millions) From FY 2016 to FY 2017 ---------------------------------------------------------------------------------------------------------------- FY 2016 final FY 2017 final Dollar Number of rule estimated rule estimated difference: FY Percent change DSHs (FY 2017) DSH $ * (in DSH $ * (in 2017- FY 2016 ** millions) millions) (in millions) (1) (2) (3) (4) (5) ---------------------------------------------------------------------------------------------------------------- Total........................... 2,419 $9,767 $9,551 -$216 -2.2 By Geographic Location: Urban Hospitals............. 1,921 9,294 9,106 -188 -2.0 Large Urban Areas....... 1,045 5,885 5,765 -120 -2.0 Other Urban Areas....... 876 3,408 3,341 -68 -2.0 Rural Hospitals............. 498 473 445 -28 -5.9 Bed Size (Urban): 0 to 99 Beds................ 336 189 185 -4 -2.2 100 to 249 Beds............. 837 2,211 2,154 -57 -2.6 250+ Beds................... 748 6,894 6,767 -127 -1.8 Bed Size (Rural): 0 to 99 Beds................ 368 206 190 -16 -7.8 100 to 249 Beds............. 116 211 199 -12 -5.5 250+ Beds................... 14 56 56 0 -0.2 Urban by Region: East North Central.......... 322 1,273 1,252 -22 -1.7 East South Central.......... 129 574 566 -8 -1.4 Middle Atlantic............. 232 1,614 1,570 -44 -2.7 Mountain.................... 125 448 448 0 -0.1 New England................. 90 394 385 -9 -2.4 Pacific..................... 312 1,459 1,448 -10 -0.7 Puerto Rico................. 41 104 116 12 11.3 [[Page 68961]] South Atlantic.............. 314 1,777 1,721 -56 -3.2 West North Central.......... 104 451 439 -11 -2.5 West South Central.......... 252 1,200 1,161 -39 -3.2 Rural by Region: East North Central.......... 64 49 44 -4 -8.3 East South Central.......... 141 149 141 -8 -5.3 Middle Atlantic............. 28 34 33 -1 -2.4 Mountain.................... 21 16 15 0 -0.2 New England................. 11 15 16 1 7.2 Pacific..................... 7 9 7 -3 -27.4 South Atlantic.............. 86 98 92 -6 -6.4 West North Central.......... 31 20 19 -1 -6.3 West South Central.......... 109 83 78 -6 -7.0 By Payment Classification: Urban Hospitals............. 1,886 9,243 9,055 -188 -2.0 Large Urban Areas....... 1,043 5,884 5,764 -120 -2.0 Other Urban Areas....... 843 3,359 3,292 -68 -2.0 Rural Hospitals............. 533 523 496 -28 -5.3 Teaching Status: Nonteaching................. 1,544 3,117 3,053 -64 -2.1 Fewer than 100 residents.... 637 3,213 3,132 -81 -2.5 100 or more residents....... 238 3,437 3,366 -71 -2.1 Type of Ownership: Voluntary................... 1,405 6,044 5,913 -131 -2.2 Proprietary................. 541 1,672 1,629 -43 -2.6 Government.................. 471 2,023 1,983 -40 -2.0 Unknown..................... 2 27 25 -2 -6.1 Medicare Utilization Percent: Missing or Unknown.......... 4 1 1 0 0.9 0 to 25..................... 428 3,013 2,974 -39 -1.3 25 to 50.................... 1,617 6,356 6,189 -166 -2.6 50 to 65.................... 319 385 375 -10 -2.5 Greater than 65............. 51 12 11 -1 -8.2 ---------------------------------------------------------------------------------------------------------------- Source: Dobson [bond] DaVanzo analysis of 2011-2013 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 $9,767 million in FY 2016 and $9,551 million in FY 2017. ** Percentage change is determined as the difference between Medicare DSH payments modeled for the FY 2017 IPPS/ LTCH PPS final rule (column 3) and Medicare DSH payments modeled for the FY 2016 IPPS/LTCH PPS final rule (column 2) divided by Medicare DSH payments modeled for the FY 2016 final rule (column 2) times 100 percent. 9. On page 57325, bottom of the page, third column, last paragraph, line 8, the figure ``6.4'' is corrected to read ``5.9''. 10. On page 57326, first column-- a. First partial paragraph-- (1) Line 7 the figure ``5.2'' is corrected to read ``5.5''. (2) Line 8, the figure ``5.9'' is corrected to read ``0.2''. b. First full paragraph, line 12, the figure ``11.4'' is corrected to read ``11.3''. c. Third full paragraph (last paragraph)-- (1) Line 12, the figure ``11.4'' is corrected to read ``11.3''. (2) Line 18, the figure ``$9.5 million'' is corrected to read ``$9.4 million''. 11. On page 57330, third column-- a. Fourth bulleted paragraph, line 4, the figure ``0.9991'' is corrected to read ``0.9990''. b. Last paragraph, line 6, the figure ``1.84'' is corrected to read ``1.83''. 12. On page 57331, top half of the page-- a. First column-- (1) First partial paragraph-- (a) Line 1, the phrase ``Less than half of the hospitals'' is corrected to read ``Most of the hospitals''. (b) Lines 4 through 6, the phrase ``the effects of changes to the GAFs, while the remainder of these urban area hospitals would experience no change or a decrease in'' is corrected to read ``the effects of changes to the GAFs, while hospitals in one urban area are expected to experience a decrease in''. (c) Line 11, the phrase ``except for two rural areas where changes in'' is corrected to read, ``except for one rural area where changes in''. (2) Third paragraph, lines 8 and line 9, the phrase ``0.7 percent, while hospitals in rural areas, on average, are expected to experience a 0.8'' is corrected to read ``0.7 percent, and hospitals in rural areas, on average, are also expected to experience a 0.7''. b. Second column-- (1) First partial paragraph, lines 2 through 6, the sentence ``The primary factor contributing to the small difference in the projected increase in capital IPPS payments per case for urban hospitals as compared to rural hospitals is the changes to the GAFs.'' is corrected by deleting the sentence. (2) First full paragraph-- (a) Lines 4 through 8, ``range from a 4.2 percent increase for the Puerto Rico urban hospitals, and a 1.4 percent [[Page 68962]] increase for the West South Central urban region to a 0.7 percent increase for the Mountain urban region.'' is corrected to read ``range from a 4.1 percent increase for the Puerto Rico urban hospitals, and a 2.1 percent increase for the Mountain urban region to a 0.7 percent increase for several other urban regions.''. (b) Line 13, the figure ``4.2'' is corrected to read ``4.1''. (c) Line 23, the figure ``1.6'' is corrected to read ``2.1''. (d) Line 26, the figure ``0.4'' should read ``0.1''. c. Third column-- (1) First full paragraph, line 9, the figure ``0.7'' is corrected to read ``0.6''. (2) Second full paragraph-- (a) Line 13, the figure ``1.0'' is corrected to read ``0.9''. (b) Line 17, the figure ``1.0'' is corrected to read ``0.9''. (c) Line 20, the figure ``0.2'' is corrected to read ``0.3''. 13. On pages 57331 and 57332, the table titled ``Table III.-- Comparison of Total Payments Per Case [FY 2016 Payments Compared To FY 2017 Payments]'' is corrected to read as follows: Table III--Comparison of Total Payments per Case [FY 2016 payments compared to FY 2017 payments] ---------------------------------------------------------------------------------------------------------------- Average FY Average FY Number of 2016 payments/ 2017 payments/ Change hospitals case case ---------------------------------------------------------------------------------------------------------------- By Geographic Location: All hospitals............................... 3,330 912 920 0.8 Large urban areas (populations over 1 1,369 1,011 1,019 0.7 million)............................... Other urban areas (populations of 1 1,146 871 879 0.9 million of fewer)...................... Rural areas............................. 815 618 623 0.7 Urban hospitals............................. 2,515 947 955 0.8 0-99 beds............................... 659 768 774 0.8 100-199 beds............................ 767 824 829 0.6 200-299 beds............................ 446 865 871 0.7 300-499 beds............................ 431 958 967 0.9 500 or more beds........................ 212 1,139 1,149 0.9 Rural hospitals............................. 815 618 623 0.7 0-49 beds............................... 317 520 524 0.7 50-99 beds.............................. 292 577 582 0.8 100-149 beds............................ 120 610 614 0.6 150-199 beds............................ 46 669 673 0.6 200 or more beds........................ 40 738 745 0.9 By Region: Urban by Region............................. 2,515 947 955 0.8 New England............................. 116 1,031 1,024 -0.6 Middle Atlantic......................... 315 1,056 1,064 0.7 South Atlantic.......................... 407 840 847 0.8 East North Central...................... 390 908 915 0.8 East South Central...................... 147 793 804 1.3 West North Central...................... 163 923 930 0.7 West South Central...................... 385 858 868 1.1 Mountain................................ 163 977 998 2.1 Pacific................................. 378 1,219 1,227 0.7 Puerto Rico............................. 51 435 453 4.1 Rural by Region............................. 815 618 623 0.7 New England............................. 21 868 878 1.1 Middle Atlantic......................... 54 591 603 2.1 South Atlantic.......................... 128 584 584 0.0 East North Central...................... 115 638 643 0.9 East South Central...................... 155 562 566 0.9 West North Central...................... 98 666 668 0.4 West South Central...................... 160 536 542 1.2 Mountain................................ 60 718 717 -0.1 Pacific................................. 24 804 812 1.0 By Payment Classification: All hospitals............................... 3,330 912 920 0.8 Large urban areas (populations over 1 1,369 1,011 1,019 0.7 million)............................... Other urban areas (populations of 1 1,153 870 878 0.9 million of fewer)...................... Rural areas................................. 808 619 623 0.7 Teaching Status: Non-teaching............................ 2,266 771 776 0.7 Fewer than 100 Residents................ 815 885 892 0.8 100 or more Residents................... 249 1,287 1,298 0.9 Urban DSH: 100 or more beds.................... 1,642 968 976 0.8 Less than 100 beds.................. 363 696 702 0.8 Rural DSH: Sole Community (SCH/EACH)........... 240 575 581 1.0 Referral Center (RRC/EACH).......... 325 649 654 0.7 Other Rural: 100 or more beds................ 29 538 540 0.4 [[Page 68963]] Less than 100 beds.............. 142 526 528 0.3 Urban teaching and DSH: Both teaching and DSH................... 898 1,043 1,052 0.9 Teaching and no DSH..................... 109 942 948 0.6 No teaching and DSH..................... 1,107 813 820 0.8 No teaching and no DSH.................. 408 815 820 0.6 Rural Hospital Types: Non special status hospitals............ 2,529 948 955 0.7 RRC/EACH................................ 189 772 782 1.4 SCH/EACH................................ 324 706 716 1.4 SCH, RRC and EACH....................... 126 748 756 1.1 Hospitals Reclassified by the Medicare Geographic Classification Review Board: FY2017 Reclassifications: All Urban Reclassified.................. 532 953 962 0.9 All Urban Non-Reclassified.............. 1,936 948 955 0.7 All Rural Reclassified.................. 277 650 655 0.9 All Rural Non-Reclassified.............. 489 578 580 0.3 Other Reclassified Hospitals (Section 42 599 602 0.5 1886(d)(8)(B))......................... Type of Ownership: Voluntary............................... 1,927 926 934 0.8 Proprietary............................. 881 820 827 0.8 Government.............................. 522 963 969 0.6 Medicare Utilization as a Percent of Inpatient Days: 0-25.................................... 523 1,103 1,114 1.0 25-50................................... 2,122 916 923 0.8 50-65................................... 545 745 750 0.7 Over 65................................. 89 529 531 0.4 ---------------------------------------------------------------------------------------------------------------- 14. On page 57342-- a. Top of the page-- (1) First column, first full paragraph-- (a) Line 11, the figure ``987'' is corrected to read ``990''. (b) Line 23, the figure ``809'' is corrected to read ``811''. (2) Second column, first partial paragraph-- (a) Line 12, the figure ``809'' is corrected to read ``811''. (b) Line 14, the figure''680'' is corrected to read ``683''. (c) Line 19, the figure ``66'' is corrected to read ``72''. (d) Line 23, the figure ``746'' is corrected to read ``755''. b. Middle of the page, the table titled ``TABLE V--ACCOUNTING STATEMENT: CLASSIFICATION OF ESTIMATED EXPENDITURES UNDER THE IPPS FROM FY 2016 TO FY 2017'' is corrected to read as follows: Table V--Accounting Statement: Classification of Estimated Expenditures Under the IPPS From FY 2016 to FY 2017 ------------------------------------------------------------------------ Category Transfers ------------------------------------------------------------------------ Annualized Monetized Transfers......... $755 million. From Whom to Whom...................... Federal Government to IPPS Medicare Providers. ------------------------------------------------------------------------ Dated: September 29, 2016. Madhura Valverde, Executive Secretary to the Department, Department of Health and Human Services. [FR Doc. 2016-24042 Filed 9-30-16; 11:15 am] BILLING CODE 4120-01-P
![Federal Register / Vol. 81, No. 193 / Wednesday, October 5, 2016 / Rules and Regulations 68947
DEPARTMENT OF HEALTH AND I. Background On page 56804, as a result of our
HUMAN SERVICES correction of the MS–DRG assignment
In FR Doc. 2016–18476 of August 22,
in Table 6B—New Procedure Codes for
Centers for Medicare & Medicaid 2016 (81 FR 56761) there were a number
13 ICD–10–PCS procedure codes that
Services of technical and typographical errors
describe endovascular thrombectomy
identified and corrected in the
procedures of the lower limb, as
42 CFR Parts 405, 412, 413, and 489 Correction of Errors section of this
described in section II.D. of this
correcting document. The provisions in
correction document, we are making
this correcting document are effective as
[CMS–1655–F; CMS–1664–F; CMS–1632–F2] additional conforming corrections to the
if they had been included in the
table describing ICD–10–PCS
document that appeared in the August
RIN 0938–AS77; 0938–AS88; 0938–AS41 Endovascular Thrombectomy Procedure
22, 2016 Federal Register. Accordingly,
Codes Reassigned to MS–DRGs 270,
the corrections are effective October 1,
Medicare Program; Hospital Inpatient 271, and 272 for FY 2017.
2016.
Prospective Payment Systems for On pages 56821 and 56823, we
Acute Care Hospitals and the Long- II. Summary of Errors erroneously stated there were 58
Term Care Hospital Prospective A. Summary of Errors in the Preamble additional combination codes for
Payment System and Policy Changes removal and replacement of knee joints.
and Fiscal Year 2017 Rates; Quality On page 56775, we made a There were 57 additional combination
Reporting Requirements for Specific typographical error in stating the cost codes.
Providers; Graduate Medical reduction. On pages 56822 and 56823, we
Education; Hospital Notification On page 56796, we are correcting erroneously listed the code number for
Procedures Applicable to Beneficiaries errors and inadvertent omissions in the (Replacement of Left Knee Joint,
Receiving Observation Services; summary and response to a comment on Femoral Surface with Synthetic
Technical Changes Relating to Costs the assignment of 18 additional Substitute, Cemented, Open Approach)
to Organizations and Medicare Cost diagnosis codes. as code 0SRU0JA three times within the
Reports; Finalization of Interim Final On page 56797, we erroneously table. The correct code number should
Rules With Comment Period on LTCH referred to the wrong table. be 0SRU0J9 (Replacement of Left Knee
PPS Payments for Severe Wounds, On page 56801, we are correcting Joint, Femoral Surface with Synthetic
Modifications of Limitations on errors and inadvertent omissions in our Substitute, Cemented, Open Approach).
Redesignation by the Medicare response to comments on our proposal As a result of the corrections to pages
Geographic Classification Review to redesignate four ICD–10–PCS 56803, 56804, 56821, 56822, and 56823,
Board, and Extensions of Payments to procedure codes. we have made conforming changes to
MDHs and Low-Volume Hospitals; On page 56803 and in the table on the ICD–10 MS–DRG Definitions
Correction page 56804 describing ICD–10–PCS Manual Version 34 and ICD–10 MS–
Endovascular Thrombectomy Procedure DRG Grouper Software Version 34 for
AGENCY: Centers for Medicare & FY 2017.
Codes Reassigned to MS–DRGs 270,
Medicaid Services (CMS), HHS.
271, and 272 for FY 2017, we are On page 56858, we erroneously
ACTION: Final rule; correction. correcting technical errors in our omitted MS–DRG 265 from the table of
discussion in response to comments to MS–DRGs subject to the policy for
SUMMARY: This document corrects
remove 34 ICD–10–PCS procedure replaced devices offered without cost or
technical and typographical errors in
codes describing endovascular with a credit.
the final rule that appeared in the
August 22, 2016 Federal Register titled thrombectomy of non-lower limbs from On pages 56895 and 56897, we
‘‘Medicare Program; Hospital Inpatient the proposed list of codes to be inadvertently made an error to the title
Prospective Payment Systems for Acute reassigned to MS–DRGs 270, 271 and of ICD–10–PCS procedure code
Care Hospitals and the Long-Term Care 272. In this response, we erroneously XW03331 and omitted an additional
Hospital Prospective Payment System referred to 34 procedure codes procedure code that describes
and Policy Changes and Fiscal Year describing non-lower limb procedures Idarucizumab. Cases involving
2017 Rates; Quality Reporting (as included in the list submitted by the Idarucizumab that are eligible for new
Requirements for Specific Providers; commenter) rather than 32 non-lower technology add-on payments will be
Graduate Medical Education; Hospital limb procedure codes. Two of the 34 identified by ICD–10–PCS procedure
Notification Procedures Applicable to procedure codes identified by the codes XW03331 (Introduction of
Beneficiaries Receiving Observation commenter, ICD–10–PCS procedure Idarucizumab, Dabigatran reversal agent
Services; Technical Changes Relating to codes 04CT3ZZ (Extirpation of matter into peripheral vein, percutaneous
Costs to Organizations and Medicare from right peroneal artery, percutaneous approach, New Technology Group 1)
Cost Reports; Finalization of Interim approach) and 04CU3ZZ (Extirpation of and XW04331 (Introduction of
Final Rules With Comment Period on matter from left peroneal artery, Idarucizumab, Dabigatran reversal agent
LTCH PPS Payments for Severe percutaneous approach), describe into central vein, percutaneous
Wounds, Modifications of Limitations endovascular thrombectomy of lower approach, New Technology Group 1).
on Redesignation by the Medicare limbs. These codes are assigned to MS– On page 56927, as a result of the
Geographic Classification Review Board, DRGs 270, 271 and 272, accurately correction of the technical errors
and Extensions of Payments to MDHs replicating the logic of ICD–9–CM MS– described in section II.B of this
and Low-Volume Hospitals.’’ DRGs Version 32 and supporting correction document, we have made
ehiers on DSK5VPTVN1PROD with RULES
clinical and resource use homogeneity conforming changes to the following:
DATES: This correction is effective
as originally proposed and in The number of hospitals approved for
October 1, 2016. accordance with the finalized policy to wage index reclassifications by the
FOR FURTHER INFORMATION CONTACT: add procedures describing endovascular Medicare Geographic Classification
Donald Thompson, (410) 786–4487. thrombectomy of lower limbs to ICD–10 Review Board (MGCRB) starting in FY
SUPPLEMENTARY INFORMATION: Version 34 MS–DRGS 270, 271 and 272. 2017 and the number of hospitals in a
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![68948 Federal Register / Vol. 81, No. 193 / Wednesday, October 5, 2016 / Rules and Regulations
MGCRB reclassification status for FY rule did not properly reflect the budget neutrality factors and the outlier
2017. following: threshold (as described previously).
On page 57002 in the table titled, • Withdrawal of a MGCRB
C. Summary of Errors in the Appendices
‘‘Previously Adopted and Newly reclassification for FY 2017 for one
Finalized Baseline and Performance provider. On pages 57312, 57315 through
Periods for the FY 2021 Program Year’’ • Application of urban to rural 57317, 57319 through 57323, 57330
we erroneously repeated the same reclassification under § 412.103 for through 57332 in our regulatory impact
information three times, and in the first three providers. analyses, we made conforming
instance provided incorrect Therefore, on page 57279, we corrections to the factors, values, and
performance period years for the recalculated the reclassification hospital tables and accompanying discussion of
Mortality (MORT–30–AMI, MORT–30– budget neutrality adjustment. the changes in operating and capital
HF, MORT–30–COPD) and THA/TKA The reclassification errors also IPPS payments for FY 2017 and the
measures. required the recalculation of additional effects of certain budget neutrality
On page 57033, we made a budget neutrality adjustment factors, the factors as a result of the technical errors
typographical error and omitted a dash fixed-loss cost threshold, the final wage that lead to conforming changes in our
within the web link address creating a indexes, and the national operating calculation of the operating and capital
non-functional link. standardized amounts. Therefore, we IPPS budget neutrality factors, outlier
made conforming changes to the threshold, final wage indexes, operating
On pages 57195, 57196, 57199, 57211,
following: standardized amounts, and capital
57213, 57218, and 57220 through 57223
• On page 57280, the rural floor Federal rate (as described in section II.B.
we inadvertently made technical and
budget neutrality adjustment and the of this correction document).
typographical errors to the Long-Term
wage index transition budget neutrality On pages 57324 through 57326, in the
Care Hospital Quality Reporting
adjustment. table titled ‘‘Modeled Disproportionate
Program section and have corrected • On page 57286, the calculation of Share Hospital Payments for Estimated
those errors for clarification. the outlier fixed-loss cost threshold and FY 2017 DSHs by Hospital Type: Model
B. Summary of Errors in the Addendum the national outlier adjustment factors. DSH $ (In Millions) From FY 2016 To
• On page 57288, the table titled FY 2017’’ and the accompanying
As discussed in section II.D. of this ‘‘Change of FY 2016 Standardized discussion, we made corrections to
correcting document, we made technical Amounts to the FY 2017 Standardized address technical and formatting errors
errors with regard to the calculation of Amounts’’. in the estimated impacts resulting from
Factor 3 of the uncompensated care On pages 57291 and 57293 through inadvertent errors in the calculation of
payment methodology. The revisions 57295, in our discussion of the Factor 3 for certain hospitals.
made to address some of these errors determination of the Federal hospital On pages 57331 through 57332, we
directly affected and required the inpatient capital related prospective made conforming corrections to Table
recalculation of all the budget neutrality payment rate update, we have made III—Comparison of Total Payments Per
factors and final outlier threshold. conforming corrections to the increase Case [FY 2016 Payments Compared to
Factor 3 is used to determine the in the capital Federal rate, the FY 2017 Payments].
amount of total uncompensated care incremental and cumulative budget On page 57342, we made conforming
payment a hospital is eligible to receive neutrality adjustment factors for corrections to the discussion of the
as well as the amount of the changes in the GAFs and the MS–DRG estimated changes in operating and
uncompensated care payment a hospital relative weights, the GAF/MS–DRG capital IPPS payments and the
receives per discharge. Per discharge budget neutrality adjustment factor (due accounting statement and table for acute
uncompensated care payments are then to the errors in our calculation of the care hospitals that arose from the
included when determining total GAFs, which are computed from the corrections of errors and conforming
payments for purposes of all of the wage index), the capital Federal rate, changes as described in sections II.B.
budget neutrality factors and the final and the outlier threshold (as discussed and II.D. of this correcting document.
outlier threshold. Therefore, we made previously).
conforming changes to pages 57278 Also, as a result of these errors, on D. Summary of Errors in and
through 57280, 57286, and 57291 to take pages 57294 and 57295, we have made Corrections to Files and Tables Posted
into account the updated per-discharge conforming corrections in the tables on the CMS Web Site
uncompensated care payments showing the comparison of factors and We are correcting the errors in the
determined using revised Factor 3 adjustments for the FY 2016 capital following IPPS tables that are listed on
amounts. We made further conforming Federal rate and FY 2017 capital Federal page 57311 of the FY 2017 IPPS/LTCH
corrections to the national outlier rate and the proposed FY 2017 capital PPS final rule and are available on the
adjustment factors on page 57286 and Federal rate and final FY 2017 capital Internet on the CMS Web site at https://
the table on page 57288 as a result of Federal rate. www.cms.gov/Medicare/Medicare-Fee-
these changes. Finally, we made On page 57307, we are making for-Service-Payment/
conforming corrections to the national conforming corrections the fixed-loss AcuteInpatientPPS/FY2017-IPPS-Final-
operating standardized amounts. amount for site neutral discharges due Rule-Home-Page.html. The tables that
We made inadvertent errors related to to corrections in the IPPS rates and are available on the Internet have been
the MGCRB reclassification status of one factors discussed previously. updated to reflect the revisions
provider as well as the status of three On page 57312, we have made discussed in this correcting document.
providers reclassified as urban to rural conforming corrections to the national Table 2—Case-Mix Index and Wage
ehiers on DSK5VPTVN1PROD with RULES
under section 1886(d)(8)(E) of the Act operating standardized amounts and Index Table—FY 2017. Because the
(codified in the regulations under capital standard Federal payment rate uncompensated care and reclassification
§ 412.103 and hereinafter referred to as (which also include the rates payable to errors discussed in section II.B. of this
§ 412.103). hospitals located in Puerto Rico) in correction document required that we
Specifically, the reclassification status Tables 1A, 1B, 1C, and 1D as a result of recalculate the rural and imputed floor
in the FY 2017 IPPS/LTCH PPS final the conforming corrections to certain budget neutrality factor, we are
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![68958 Federal Register / Vol. 81, No. 193 / Wednesday, October 5, 2016 / Rules and Regulations
FY 2017 IPPS ESTIMATED PAYMENTS DUE TO RURAL AND IMPUTED FLOOR WITH NATIONAL BUDGET NEUTRALITY
Percent change in
Number of payments due to
hospitals that will
Number of application of rural Difference
State receive the rural
hospitals floor and imputed (in $ millions)
floor or imputed floor with budget
floor neutrality
(1) (2) (3) (4)
Alabama ................................................................................... 83 6 ¥0.3 ¥6
Alaska ...................................................................................... 6 4 2.1 4
Arizona ..................................................................................... 57 46 3.5 63
Arkansas .................................................................................. 44 0 ¥0.4 ¥4
California .................................................................................. 301 186 1.3 131
Colorado .................................................................................. 48 3 0.2 3
Connecticut .............................................................................. 31 8 0.2 4
Delaware .................................................................................. 6 2 0 0
Washington, DC ....................................................................... 7 0 ¥0.4 ¥1
Florida ...................................................................................... 171 16 ¥0.3 ¥2
Georgia .................................................................................... 105 0 ¥0.4 ¥18
Hawaii ...................................................................................... 12 0 ¥0.3 ¥10
Idaho ........................................................................................ 14 0 ¥0.3 ¥1
Illinois ....................................................................................... 126 3 ¥0.4 ¥1
Indiana ..................................................................................... 89 0 ¥0.4 ¥19
Iowa ......................................................................................... 35 0 ¥0.4 ¥11
Kansas ..................................................................................... 53 0 ¥0.3 ¥4
Kentucky .................................................................................. 65 0 ¥0.4 ¥3
Louisiana .................................................................................. 95 2 ¥0.4 ¥6
Maine ....................................................................................... 18 0 ¥0.4 ¥5
Massachusetts ......................................................................... 58 15 0.6 ¥2
Michigan ................................................................................... 95 0 ¥0.4 22
Minnesota ................................................................................ 49 0 ¥0.3 ¥18
Mississippi ................................................................................ 62 0 ¥0.4 ¥6
Missouri .................................................................................... 74 2 ¥0.3 ¥4
Montana ................................................................................... 12 4 0.3 ¥8
Nebraska .................................................................................. 26 0 ¥0.3 1
Nevada ..................................................................................... 24 3 ¥0.2 ¥2
New Hampshire ....................................................................... 13 9 2.2 ¥2
New Jersey .............................................................................. 64 18 0.2 11
New Mexico ............................................................................. 25 0 ¥0.3 6
New York ................................................................................. 154 21 ¥0.3 ¥1
North Carolina .......................................................................... 84 1 ¥0.4 ¥20
North Dakota ............................................................................ 6 1 ¥0.3 ¥12
Ohio ......................................................................................... 130 10 ¥0.4 ¥1
Oklahoma ................................................................................. 86 2 ¥0.3 ¥13
Oregon ..................................................................................... 34 2 ¥0.4 ¥4
Pennsylvania ............................................................................ 151 5 ¥0.4 ¥4
Puerto Rico .............................................................................. 51 12 0.1 ¥20
Rhode Island ............................................................................ 11 10 4.7 0
South Carolina ......................................................................... 57 5 ¥0.1 18
South Dakota ........................................................................... 18 0 ¥0.2 ¥2
Tennessee ............................................................................... 92 20 ¥0.3 ¥1
Texas ....................................................................................... 320 3 ¥0.4 ¥7
Utah ......................................................................................... 33 1 ¥0.3 ¥26
Vermont ................................................................................... 6 0 ¥0.2 ¥2
Virginia ..................................................................................... 76 1 ¥0.3 ¥1
Washington .............................................................................. 49 6 ¥0.1 ¥8
West Virginia ............................................................................ 29 3 ¥0.2 ¥1
Wisconsin ................................................................................. 65 6 ¥0.3 ¥5
Wyoming .................................................................................. 10 0 ¥0.1 0
6. On page 57321, second column, b Line 7, the figure ‘‘1.0’’ is corrected ACUTE CARE HOSPITAL OPERATING
first partial paragraph — to read ‘‘0.9’’. PROSPECTIVE PAYMENT SYSTEM
a Line 1, the figure ‘‘277’’ is corrected 7. On pages 57321 through 57323, the [PAYMENTS PER DISCHARGE]’’ is
to read ‘‘278’’. table titled ‘‘TABLE II—IMPACT corrected to read as follows:
ANALYSIS OF CHANGES FOR FY 2017
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![Federal Register / Vol. 81, No. 193 / Wednesday, October 5, 2016 / Rules and Regulations 68959
TABLE II—IMPACT ANALYSIS OF CHANGES FOR FY 2017 ACUTE CARE HOSPITAL OPERATING PROSPECTIVE PAYMENT
SYSTEM
[Payments per discharge]
Estimated Estimated
average average FY
Number of FY 2017
FY 2016 2017
hospitals changes
payment per payment per
discharge discharge
(1) (2) (3) (4)
All Hospitals ..................................................................................................... 3,330 $11,542 $11,649 0.9
By Geographic Location:
Urban hospitals ......................................................................................... 2,515 11,890 11,997 0.9
Large urban areas .................................................................................... 1,369 12,690 12,799 0.9
Other urban areas .................................................................................... 1,146 10,946 11,051 1.0
Rural hospitals .......................................................................................... 815 8,602 8,707 1.2
Bed Size (Urban):
0–99 beds ................................................................................................. 659 9,392 9,478 0.9
100–199 beds ........................................................................................... 767 10,050 10,117 0.7
200–299 beds ........................................................................................... 446 10,757 10,840 0.8
300–499 beds ........................................................................................... 431 12,092 12,202 0.9
500 or more beds ..................................................................................... 212 14,613 14,772 1.1
Bed Size (Rural):
0–49 beds ................................................................................................. 317 7,208 7,279 1.0
50–99 beds ............................................................................................... 292 8,192 8,292 1.2
100–149 beds ........................................................................................... 120 8,434 8,519 1.0
150–199 beds ........................................................................................... 46 9,243 9,367 1.3
200 or more beds ..................................................................................... 40 10,171 10,320 1.5
Urban by Region:
New England ............................................................................................ 116 12,957 12,901 ¥0.4
Middle Atlantic .......................................................................................... 315 13,471 13,593 0.9
South Atlantic ........................................................................................... 407 10,498 10,595 0.9
East North Central .................................................................................... 390 11,190 11,303 1.0
East South Central ................................................................................... 147 10,042 10,160 1.2
West North Central ................................................................................... 163 11,578 11,692 1.0
West South Central .................................................................................. 385 10,693 10,820 1.2
Mountain ................................................................................................... 163 12,279 12,549 2.2
Pacific ....................................................................................................... 378 15,372 15,452 0.5
Puerto Rico ............................................................................................... 51 8,491 8,513 0.3
Rural by Region:
New England ............................................................................................ 21 11,818 12,009 1.6
Middle Atlantic .......................................................................................... 54 8,655 8,791 1.6
South Atlantic ........................................................................................... 128 8,043 8,122 1.0
East North Central .................................................................................... 115 8,918 9,023 1.2
East South Central ................................................................................... 155 7,639 7,716 1.0
West North Central ................................................................................... 98 9,420 9,560 1.5
West South Central .................................................................................. 160 7,243 7,328 1.2
Mountain ................................................................................................... 60 10,100 10,228 1.3
Pacific ....................................................................................................... 24 12,045 12,197 1.3
By Payment Classification:
Urban hospitals ......................................................................................... 2,522 11,886 11,993 0.9
Large urban areas .................................................................................... 1,369 12,690 12,799 0.9
Other urban areas .................................................................................... 1,153 10,940 11,046 1.0
Rural areas ............................................................................................... 808 8,602 8,706 1.2
Teaching Status:
Nonteaching .............................................................................................. 2,266 9,600 9,680 0.8
Fewer than 100 residents ......................................................................... 815 11,133 11,231 0.9
100 or more residents .............................................................................. 249 16,764 16,949 1.1
Urban DSH:
Non-DSH .................................................................................................. 589 10,055 10,140 0.8
100 or more beds ..................................................................................... 1,642 12,247 12,359 0.9
Less than 100 beds .................................................................................. 363 8,853 8,914 0.7
Rural DSH:
SCH .......................................................................................................... 240 8,584 8,702 1.4
RRC .......................................................................................................... 325 9,006 9,123 1.3
100 or more beds ..................................................................................... 29 7,018 7,054 0.5
Less than 100 beds .................................................................................. 142 6,823 6,838 0.2
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Urban teaching and DSH:
Both teaching and DSH ............................................................................ 898 13,344 13,474 1.0
Teaching and no DSH .............................................................................. 109 11,361 11,442 0.7
No teaching and DSH .............................................................................. 1,107 10,047 10,124 0.8
No teaching and no DSH ......................................................................... 408 9,455 9,539 0.9
Special Hospital Types:
RRC .......................................................................................................... 189 9,709 9,824 1.2
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![68960 Federal Register / Vol. 81, No. 193 / Wednesday, October 5, 2016 / Rules and Regulations
TABLE II—IMPACT ANALYSIS OF CHANGES FOR FY 2017 ACUTE CARE HOSPITAL OPERATING PROSPECTIVE PAYMENT
SYSTEM—Continued
[Payments per discharge]
Estimated Estimated
average average FY
Number of FY 2017
FY 2016 2017
hospitals changes
payment per payment per
discharge discharge
(1) (2) (3) (4)
SCH .......................................................................................................... 324 10,344 10,516 1.7
MDH .......................................................................................................... 148 7,321 7,415 1.3
SCH and RRC .......................................................................................... 126 10,767 10,957 1.8
MDH and RRC .......................................................................................... 12 8,822 9,019 2.2
Type of Ownership:
Voluntary ................................................................................................... 1,927 11,719 11,830 0.9
Proprietary ................................................................................................ 881 10,130 10,218 0.9
Government .............................................................................................. 522 12,485 12,596 0.9
Medicare Utilization as a Percent of Inpatient Days:
0–25 .......................................................................................................... 523 14,996 15,160 1.1
25–50 ........................................................................................................ 2,122 11,460 11,562 0.9
50–65 ........................................................................................................ 545 9,343 9,431 0.9
Over 65 ..................................................................................................... 89 6,948 7,019 1.0
FY 2017 Reclassifications by the Medicare Geographic Classification Re-
view Board:
All Reclassified Hospitals ......................................................................... 791 11,399 11,507 0.9
Non-Reclassified Hospitals ....................................................................... 2,539 11,595 11,701 0.9
Urban Hospitals Reclassified .................................................................... 532 12,008 12,115 0.9
Urban Nonreclassified Hospitals .............................................................. 1,936 11,849 11,955 0.9
Rural Hospitals Reclassified Full Year ..................................................... 277 8,984 9,101 1.3
Rural Nonreclassified Hospitals Full Year ................................................ 489 8,173 8,266 1.1
All Section 401 Reclassified Hospitals ..................................................... 72 11,307 11,474 1.5
Other Reclassified Hospitals (Section 1886(d)(8)(B)) .............................. 48 7,889 7,954 0.8
7. On page 57324, top of the page, 8. On pages 57324 and 57325, the DSH $ (In Millions) From FY 2016 to FY
third column, last paragraph, line 1, the table titled ‘‘Modeled Disproportionate 2017’’ is corrected to read as follows:
figure ‘‘2,426’’ is corrected to read Share Hospital Payments for Estimated
‘‘2,419’’. FY 2017 DSHs by Hospital Type: Model
MODELED DISPROPORTIONATE SHARE HOSPITAL PAYMENTS FOR ESTIMATED FY 2017 DSHS BY HOSPITAL TYPE: MODEL
DSH $ (IN MILLIONS) FROM FY 2016 TO FY 2017
FY 2016 FY 2017 Dollar
Number of final final difference: Percent
DSHs rule estimated rule estimated FY 2017– change **
(FY 2017) DSH $ * DSH $ * FY 2016
(in millions) (in millions) (in millions)
(1) (2) (3) (4) (5)
Total ..................................................................................... 2,419 $9,767 $9,551 ¥$216 ¥2.2
By Geographic Location:
Urban Hospitals ............................................................ 1,921 9,294 9,106 ¥188 ¥2.0
Large Urban Areas ................................................ 1,045 5,885 5,765 ¥120 ¥2.0
Other Urban Areas ................................................ 876 3,408 3,341 ¥68 ¥2.0
Rural Hospitals ............................................................. 498 473 445 ¥28 ¥5.9
Bed Size (Urban):
0 to 99 Beds ................................................................. 336 189 185 ¥4 ¥2.2
100 to 249 Beds ........................................................... 837 2,211 2,154 ¥57 ¥2.6
250+ Beds .................................................................... 748 6,894 6,767 ¥127 ¥1.8
Bed Size (Rural):
0 to 99 Beds ................................................................. 368 206 190 ¥16 ¥7.8
100 to 249 Beds ........................................................... 116 211 199 ¥12 ¥5.5
250+ Beds .................................................................... 14 56 56 0 ¥0.2
Urban by Region:
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East North Central ........................................................ 322 1,273 1,252 ¥22 ¥1.7
East South Central ....................................................... 129 574 566 ¥8 ¥1.4
Middle Atlantic .............................................................. 232 1,614 1,570 ¥44 ¥2.7
Mountain ....................................................................... 125 448 448 0 ¥0.1
New England ................................................................ 90 394 385 ¥9 ¥2.4
Pacific ........................................................................... 312 1,459 1,448 ¥10 ¥0.7
Puerto Rico ................................................................... 41 104 116 12 11.3
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![Federal Register / Vol. 81, No. 193 / Wednesday, October 5, 2016 / Rules and Regulations 68961
MODELED DISPROPORTIONATE SHARE HOSPITAL PAYMENTS FOR ESTIMATED FY 2017 DSHS BY HOSPITAL TYPE: MODEL
DSH $ (IN MILLIONS) FROM FY 2016 TO FY 2017—Continued
FY 2016 FY 2017 Dollar
Number of final final difference: Percent
DSHs rule estimated rule estimated FY 2017– change **
(FY 2017) DSH $ * DSH $ * FY 2016
(in millions) (in millions) (in millions)
(1) (2) (3) (4) (5)
South Atlantic ................................................................ 314 1,777 1,721 ¥56 ¥3.2
West North Central ....................................................... 104 451 439 ¥11 ¥2.5
West South Central ...................................................... 252 1,200 1,161 ¥39 ¥3.2
Rural by Region:
East North Central ........................................................ 64 49 44 ¥4 ¥8.3
East South Central ....................................................... 141 149 141 ¥8 ¥5.3
Middle Atlantic .............................................................. 28 34 33 ¥1 ¥2.4
Mountain ....................................................................... 21 16 15 0 ¥0.2
New England ................................................................ 11 15 16 1 7.2
Pacific ........................................................................... 7 9 7 ¥3 ¥27.4
South Atlantic ................................................................ 86 98 92 ¥6 ¥6.4
West North Central ....................................................... 31 20 19 ¥1 ¥6.3
West South Central ...................................................... 109 83 78 ¥6 ¥7.0
By Payment Classification:
Urban Hospitals ............................................................ 1,886 9,243 9,055 ¥188 ¥2.0
Large Urban Areas ................................................ 1,043 5,884 5,764 ¥120 ¥2.0
Other Urban Areas ................................................ 843 3,359 3,292 ¥68 ¥2.0
Rural Hospitals ............................................................. 533 523 496 ¥28 ¥5.3
Teaching Status:
Nonteaching .................................................................. 1,544 3,117 3,053 ¥64 ¥2.1
Fewer than 100 residents ............................................. 637 3,213 3,132 ¥81 ¥2.5
100 or more residents .................................................. 238 3,437 3,366 ¥71 ¥2.1
Type of Ownership:
Voluntary ....................................................................... 1,405 6,044 5,913 ¥131 ¥2.2
Proprietary .................................................................... 541 1,672 1,629 ¥43 ¥2.6
Government .................................................................. 471 2,023 1,983 ¥40 ¥2.0
Unknown ....................................................................... 2 27 25 ¥2 ¥6.1
Medicare Utilization Percent:
Missing or Unknown ..................................................... 4 1 1 0 0.9
0 to 25 ........................................................................... 428 3,013 2,974 ¥39 ¥1.3
25 to 50 ......................................................................... 1,617 6,356 6,189 ¥166 ¥2.6
50 to 65 ......................................................................... 319 385 375 ¥10 ¥2.5
Greater than 65 ............................................................ 51 12 11 ¥1 ¥8.2
Source: Dobson | DaVanzo analysis of 2011–2013 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 $9,767 million in FY 2016
and $9,551 million in FY 2017.
** Percentage change is determined as the difference between Medicare DSH payments modeled for the FY 2017 IPPS/LTCH PPS final rule
(column 3) and Medicare DSH payments modeled for the FY 2016 IPPS/LTCH PPS final rule (column 2) divided by Medicare DSH payments
modeled for the FY 2016 final rule (column 2) times 100 percent.
9. On page 57325, bottom of the page, b. Last paragraph, line 6, the figure (2) Third paragraph, lines 8 and line
third column, last paragraph, line 8, the ‘‘1.84’’ is corrected to read ‘‘1.83’’. 9, the phrase ‘‘0.7 percent, while
figure ‘‘6.4’’ is corrected to read ‘‘5.9’’. 12. On page 57331, top half of the hospitals in rural areas, on average, are
10. On page 57326, first column— page— expected to experience a 0.8’’ is
a. First partial paragraph— a. First column— corrected to read ‘‘0.7 percent, and
(1) Line 7 the figure ‘‘5.2’’ is corrected (1) First partial paragraph— hospitals in rural areas, on average, are
to read ‘‘5.5’’. (a) Line 1, the phrase ‘‘Less than half also expected to experience a 0.7’’.
(2) Line 8, the figure ‘‘5.9’’ is of the hospitals’’ is corrected to read
b. Second column—
corrected to read ‘‘0.2’’. ‘‘Most of the hospitals’’.
(b) Lines 4 through 6, the phrase ‘‘the (1) First partial paragraph, lines 2
b. First full paragraph, line 12, the
effects of changes to the GAFs, while the through 6, the sentence ‘‘The primary
figure ‘‘11.4’’ is corrected to read ‘‘11.3’’.
c. Third full paragraph (last remainder of these urban area hospitals factor contributing to the small
paragraph)— would experience no change or a difference in the projected increase in
(1) Line 12, the figure ‘‘11.4’’ is decrease in’’ is corrected to read ‘‘the capital IPPS payments per case for
corrected to read ‘‘11.3’’. effects of changes to the GAFs, while urban hospitals as compared to rural
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(2) Line 18, the figure ‘‘$9.5 million’’ hospitals in one urban area are expected hospitals is the changes to the GAFs.’’
is corrected to read ‘‘$9.4 million’’. to experience a decrease in’’. is corrected by deleting the sentence.
11. On page 57330, third column— (c) Line 11, the phrase ‘‘except for two (2) First full paragraph—
a. Fourth bulleted paragraph, line 4, rural areas where changes in’’ is (a) Lines 4 through 8, ‘‘range from a
the figure ‘‘0.9991’’ is corrected to read corrected to read, ‘‘except for one rural 4.2 percent increase for the Puerto Rico
‘‘0.9990’’. area where changes in’’. urban hospitals, and a 1.4 percent
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![68962 Federal Register / Vol. 81, No. 193 / Wednesday, October 5, 2016 / Rules and Regulations
increase for the West South Central (c) Line 23, the figure ‘‘1.6’’ is (b) Line 17, the figure ‘‘1.0’’ is
urban region to a 0.7 percent increase corrected to read ‘‘2.1’’. corrected to read ‘‘0.9’’.
for the Mountain urban region.’’ is (d) Line 26, the figure ‘‘0.4’’ should (c) Line 20, the figure ‘‘0.2’’ is
corrected to read ‘‘range from a 4.1 read ‘‘0.1’’. corrected to read ‘‘0.3’’.
percent increase for the Puerto Rico c. Third column—
urban hospitals, and a 2.1 percent 13. On pages 57331 and 57332, the
increase for the Mountain urban region (1) First full paragraph, line 9, the table titled ‘‘Table III.—Comparison of
to a 0.7 percent increase for several figure ‘‘0.7’’ is corrected to read ‘‘0.6’’. Total Payments Per Case [FY 2016
other urban regions.’’. (2) Second full paragraph— Payments Compared To FY 2017
(b) Line 13, the figure ‘‘4.2’’ is (a) Line 13, the figure ‘‘1.0’’ is Payments]’’ is corrected to read as
corrected to read ‘‘4.1’’. corrected to read ‘‘0.9’’. follows:
TABLE III—COMPARISON OF TOTAL PAYMENTS PER CASE
[FY 2016 payments compared to FY 2017 payments]
Average FY Average FY
Number of 2016 2017 Change
hospitals payments/case payments/case
By Geographic Location:
All hospitals .............................................................................................. 3,330 912 920 0.8
Large urban areas (populations over 1 million) ................................ 1,369 1,011 1,019 0.7
Other urban areas (populations of 1 million of fewer) ...................... 1,146 871 879 0.9
Rural areas ........................................................................................ 815 618 623 0.7
Urban hospitals ......................................................................................... 2,515 947 955 0.8
0–99 beds .......................................................................................... 659 768 774 0.8
100–199 beds .................................................................................... 767 824 829 0.6
200–299 beds .................................................................................... 446 865 871 0.7
300–499 beds .................................................................................... 431 958 967 0.9
500 or more beds .............................................................................. 212 1,139 1,149 0.9
Rural hospitals .......................................................................................... 815 618 623 0.7
0–49 beds .......................................................................................... 317 520 524 0.7
50–99 beds ........................................................................................ 292 577 582 0.8
100–149 beds .................................................................................... 120 610 614 0.6
150–199 beds .................................................................................... 46 669 673 0.6
200 or more beds .............................................................................. 40 738 745 0.9
By Region:
Urban by Region ...................................................................................... 2,515 947 955 0.8
New England ..................................................................................... 116 1,031 1,024 ¥0.6
Middle Atlantic ................................................................................... 315 1,056 1,064 0.7
South Atlantic .................................................................................... 407 840 847 0.8
East North Central ............................................................................. 390 908 915 0.8
East South Central ............................................................................ 147 793 804 1.3
West North Central ............................................................................ 163 923 930 0.7
West South Central ........................................................................... 385 858 868 1.1
Mountain ............................................................................................ 163 977 998 2.1
Pacific ................................................................................................ 378 1,219 1,227 0.7
Puerto Rico ........................................................................................ 51 435 453 4.1
Rural by Region ........................................................................................ 815 618 623 0.7
New England ..................................................................................... 21 868 878 1.1
Middle Atlantic ................................................................................... 54 591 603 2.1
South Atlantic .................................................................................... 128 584 584 0.0
East North Central ............................................................................. 115 638 643 0.9
East South Central ............................................................................ 155 562 566 0.9
West North Central ............................................................................ 98 666 668 0.4
West South Central ........................................................................... 160 536 542 1.2
Mountain ............................................................................................ 60 718 717 ¥0.1
Pacific ................................................................................................ 24 804 812 1.0
By Payment Classification:
All hospitals .............................................................................................. 3,330 912 920 0.8
Large urban areas (populations over 1 million) ................................ 1,369 1,011 1,019 0.7
Other urban areas (populations of 1 million of fewer) ...................... 1,153 870 878 0.9
Rural areas ............................................................................................... 808 619 623 0.7
Teaching Status:
Non-teaching ..................................................................................... 2,266 771 776 0.7
Fewer than 100 Residents ................................................................ 815 885 892 0.8
100 or more Residents ...................................................................... 249 1,287 1,298 0.9
Urban DSH:
ehiers on DSK5VPTVN1PROD with RULES
100 or more beds ....................................................................... 1,642 968 976 0.8
Less than 100 beds ................................................................... 363 696 702 0.8
Rural DSH:
Sole Community (SCH/EACH) ................................................... 240 575 581 1.0
Referral Center (RRC/EACH) .................................................... 325 649 654 0.7
Other Rural:
100 or more beds ................................................................ 29 538 540 0.4
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![Federal Register / Vol. 81, No. 193 / Wednesday, October 5, 2016 / Rules and Regulations 68963
TABLE III—COMPARISON OF TOTAL PAYMENTS PER CASE—Continued
[FY 2016 payments compared to FY 2017 payments]
Average FY Average FY
Number of 2016 2017 Change
hospitals payments/case payments/case
Less than 100 beds ............................................................ 142 526 528 0.3
Urban teaching and DSH:
Both teaching and DSH .................................................................... 898 1,043 1,052 0.9
Teaching and no DSH ....................................................................... 109 942 948 0.6
No teaching and DSH ....................................................................... 1,107 813 820 0.8
No teaching and no DSH .................................................................. 408 815 820 0.6
Rural Hospital Types:
Non special status hospitals .............................................................. 2,529 948 955 0.7
RRC/EACH ........................................................................................ 189 772 782 1.4
SCH/EACH ........................................................................................ 324 706 716 1.4
SCH, RRC and EACH ....................................................................... 126 748 756 1.1
Hospitals Reclassified by the Medicare Geographic Classification Review
Board:
FY2017 Reclassifications:
All Urban Reclassified ....................................................................... 532 953 962 0.9
All Urban Non-Reclassified ............................................................... 1,936 948 955 0.7
All Rural Reclassified ........................................................................ 277 650 655 0.9
All Rural Non-Reclassified ................................................................. 489 578 580 0.3
Other Reclassified Hospitals (Section 1886(d)(8)(B)) ....................... 42 599 602 0.5
Type of Ownership:
Voluntary ........................................................................................... 1,927 926 934 0.8
Proprietary ......................................................................................... 881 820 827 0.8
Government ....................................................................................... 522 963 969 0.6
Medicare Utilization as a Percent of Inpatient Days:
0–25 ................................................................................................... 523 1,103 1,114 1.0
25–50 ................................................................................................. 2,122 916 923 0.8
50–65 ................................................................................................. 545 745 750 0.7
Over 65 .............................................................................................. 89 529 531 0.4
14. On page 57342— (2) Second column, first partial (d) Line 23, the figure ‘‘746’’ is
a. Top of the page— paragraph— corrected to read ‘‘755’’.
(a) Line 12, the figure ‘‘809’’ is b. Middle of the page, the table titled
(1) First column, first full paragraph—
corrected to read ‘‘811’’. ‘‘TABLE V—ACCOUNTING
(a) Line 11, the figure ‘‘987’’ is (b) Line 14, the figure’’680’’ is STATEMENT: CLASSIFICATION OF
corrected to read ‘‘990’’. corrected to read ‘‘683’’. ESTIMATED EXPENDITURES UNDER
(b) Line 23, the figure ‘‘809’’ is (c) Line 19, the figure ‘‘66’’ is THE IPPS FROM FY 2016 TO FY 2017’’
corrected to read ‘‘811’’. corrected to read ‘‘72’’. is corrected to read as follows:
TABLE V—ACCOUNTING STATEMENT: CLASSIFICATION OF ESTIMATED EXPENDITURES UNDER THE IPPS FROM FY 2016
TO FY 2017
Category Transfers
Annualized Monetized Transfers .............................................................. $755 million.
From Whom to Whom .............................................................................. Federal Government to IPPS Medicare Providers.
Dated: September 29, 2016. DEPARTMENT OF THE INTERIOR ACTION: Final rule.
Madhura Valverde,
Executive Secretary to the Department, Fish and Wildlife Service SUMMARY: We, the U.S. Fish and
Department of Health and Human Services. Wildlife Service (Service), determine
[FR Doc. 2016–24042 Filed 9–30–16; 11:15 am]
50 CFR Part 17 threatened species status under the
BILLING CODE 4120–01–P [Docket No. FWS–R4–ES–2015–0132; Endangered Species Act of 1973 (Act),
4500030113] as amended, for Kentucky arrow darter
(Etheostoma spilotum), a fish species
RIN 1018–AZ09 from the upper Kentucky River basin in
Kentucky. The effect of this regulation
Endangered and Threatened Wildlife
ehiers on DSK5VPTVN1PROD with RULES
will be to add this species to the List of
and Plants; Threatened Species Status
Endangered and Threatened Wildlife.
for Kentucky Arrow Darter With 4(d)
Rule We are also adopting a rule under
section 4(d) of the Act (a ‘‘4(d) rule’’) to
AGENCY: Fish and Wildlife Service, further provide for the conservation of
Interior. the Kentucky arrow darter.
VerDate Sep<11>2014 15:06 Oct 04, 2016 Jkt 241001 PO 00000 Frm 00031 Fmt 4700 Sfmt 4700 E:\FR\FM\05OCR1.SGM 05OCR1](https://thefederalregister.org/doc/81_FR_69140/page/17.svg)
Document Created: 2016-10-05 03:29:28
Document Modified: 2016-10-05 03:29:28
| Category | Regulatory Information | |
| Collection | Federal Register | |
| sudoc Class | AE 2.7: GS 4.107: AE 2.106: | |
| Publisher | Office of the Federal Register, National Archives and Records Administration | |
| Section | Rules and Regulations | |
| Action | Final rule; correction. | |
| Dates | This correction is effective October 1, 2016. | |
| Contact | Donald Thompson, (410) 786-4487. | |
| FR Citation | 81 FR 68947 | |
| RIN Number | 0938-AS77, 0938-AS88 and 0938-AS41 | |
| CFR Citation | 42
CFR
405 42 CFR 412 42 CFR 413 42 CFR 489 |
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