Medicare Program; Proposed Changes to the Hospital Inpatient Prospective Payment Systems and Fiscal Year 2008 Rates; Correction

Federal RegisterJun 7, 2007

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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare & Medicaid Services

42 CFR Parts 411, 412, 413, and 489

[CMS-1533-CN]

RIN 0938-A070

Medicare Program; Proposed Changes to the Hospital Inpatient Prospective Payment Systems and Fiscal Year 2008 Rates; Correction

AGENCY:

Centers for Medicare & Medicaid Services (CMS), HHS.

ACTION:

Correction of proposed rule.

SUMMARY:

This document corrects technical errors that appeared in the proposed rule entitled “Medicare Program; Proposed Changes to the Hospital Inpatient Prospective Payment Systems and Fiscal Year 2008 Rates” that appeared in the May 3, 2007

Federal Register

FOR FURTHER INFORMATION CONTACT:

Marc Hartstein, (410) 786-4548.

SUPPLEMENTARY INFORMATION:

I. Background

In FR Doc. 07-1920 of May 3, 2007 (72 FR 24680), there were a number of technical errors that are identified and corrected in the Correction of Errors section of this notice. We issued the fiscal year (FY) 2008 hospital inpatient prospective payment systems (IPPS) proposed rule on April 13, 2007. The FY 2008 IPPS proposed rule appeared in the May 3, 2007

Federal Register

II. Summary of Errors

We recently discovered that an error was made in the calculation of the DRG relative weights presented in the FY 2008 IPPS proposed rule. We have revised the relative weights to correct the error and have recalculated the standardized amounts. These changes increase the standardized amounts slightly and reduce the proposed FY 2008 outlier threshold by $85. Further, these revisions affect the DRG-specific costs thresholds for new technology add-on payments. Therefore, in this notice we are correcting the following:

• Preamble language regarding the methodology used to calculate charge-based and cost-based relative weights.

• Outlier threshold.

• Recalibration, wage and recalibration, geographic reclassification, and rural floor budget neutrality factors.

• Tables 1A through 1D, 2, 4A, 4C, 4J, 5, 10.

• Impact analysis tables (Tables I and II).

In addition, we have posted these corrected tables on our Web site at

http://www.cms.hhs.gov/AcuteInpatientPPS/WIFN/list.asp.

III. Correction of Errors

In FR Doc. 07-1920 of May 3, 2007 (72 FR 24680), make the following corrections:

A. Corrections to the Preamble

1. On page 24711, second column, last paragraph, sixth line from the bottom, the figure “$23,015” is corrected to read “$22,930.”

2. On page 24746, second column,

a. Third full paragraph, line 9, the phrase, “in the FY 2005 MedPAR” is corrected to read “in the FY 2006 MedPAR.”

b. Fifth full paragraph, last line, after the phrase “cost of living adjustment.”, the following sentence is added to read as follows:

“Beginning with FY 2008, because hospital charges include charges for both operating and capital costs, we are proposing to standardize total charges to remove the effects of differences in geographic adjustment factors, large urban add-on payments, cost-of-living adjustment, disproportionate share payments, and IME adjustments under the capital IPPS as well.”

3. On page 24747, first column, third full paragraph, last line, after the phrase “cost of living adjustment.” and before the phrase “Charges were then”, the following sentence is added to read as follows:

B. Corrections to the Addendum

1. On page 24836,

a. First column, second full paragraph,

(1) Line 14, the figure “0.999317” is corrected to read “0.999367.”

(2) Lines 19 and 29, the figure “0.998557” is corrected to read “0.998573.”

b. Second column, first partial paragraph, line 17, the figure “0.991938” is corrected to read “0.991925.”

2. On page 24837, second column, second full paragraph, line 6, the figure “$23,015” is corrected to read “$22,930”.

3. On page 24839, top half of the page, in the table Comparison of FY 2007 Standardized Amounts to Proposed FY 2008 Single Standardized Amount with Full Update and Reduced Update, the figures in the listed entries are corrected to read as follows:

Full update

(3.3 percent)

Reduced

update

(1.3 percent)

FY 2008 DRG Recalibrations and Wage Index Budget Neutrality Factor

0.999367

FY 2008 Reclassification Budget Neutrality Factor

0.991925

4. On page 24846, third column, first full paragraph,

a. Line 38, the figure “$417.26” is corrected to read “$417.12.”

b. Line 40, the figure “$413.87” is corrected to read “$413.73.”

5. On page 24847,

a. Middle of the page, in the table Comparison of Factors and Adjustments: FY 2007 Capital Federal Rate and Proposed FY 2008 Capital Federal Rate for Urban Hospitals, third column, last row, the figure, “$413.87” is corrected to read “$413.73.”

b. Lower third of the page, in the table Comparison of Factors and Adjustments: FY 2007 Capital Federal Rate and Proposed FY 2008 Capital Federal Rate for Rural Hospitals, third column, last row, the figure “$417.26” is corrected to read “$417.12.”

6. On page 24848,

a. First column, fourth full paragraph,

(1) Line 10, the phrase “is $197.21” is corrected to read “is $197.11.”.

(2) Line 12, the figure “$195.60” is corrected to read “$195.51.”

b. Second column, third paragraph, last line, the figure “$23,015” is corrected to read “$22,930”.

7. On page 24850, in Table 1A.—National Adjusted Operating Standardized Amounts, Labor/Nonlabor (69.7 Percent Labor Share/30.3 Percent Nonlabor Share If Wage Index Greater Than 1), the table is corrected to read as follows:

Table 1A.—National Adjusted Operating Standardized Amounts, Labor/Nonlabor (69.7 Percent Labor Share/30.3 Percent Nonlabor Share If Wage Index Greater Than 1)

Full update

(3.3 percent)

Labor-related

Nonlabor-related

Reduced update

(1.3 Percent)

Labor-related

Nonlabor-related

$3,430.41

$1,491.27

$3,363.99

$1,462.40

8. On page 24850, in Table 1B.—National Adjusted Operating Standardized Amounts, Labor/Nonlabor (62 Percent Labor Share/38 Percent Nonlabor Share If Wage Index Less Than Or Equal To 1), the table 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 Less Than or Equal to 1)

Full update

(3.3 percent)

Labor-related

Nonlabor-related

Reduced update

(1.3 Percent)

Labor-related

Nonlabor-related

$3,051.44

$1,870.24

$2,992.36

$1,834.03

9. On page 24850, in Table 1C.—Adjusted Operating Standardized Amounts For Puerto Rico Labor, Labor/Nonlabor, the table is corrected to read as follows:

Table 1C.—Adjusted Operating Standardized Amounts for Puerto Rico, Labor/Nonlabor

Rates if wage index greater than 1

Labor

Nonlabor

Rates if wage index less than or equal to 1

Labor

Nonlabor

National

$3,430.41

$1,491.27

$3,363.99

$1,462.40

Puerto Rico

1,442.16

883.90

1,365.40

960.66

10. On page 24850, in Table 1D.—Capital Standard Federal Payment Rate, the table is corrected to read as follows:

Table 1D.—Capital Standard Federal Payment Rate

Urban rate

Rural rate

National

$413.73

$417.12

Puerto Rico

195.51

197.11

11. On pages 24851 through 24917, in Table 2.—Hospital Case-Mix Indexes For Discharges Occurring in Federal Fiscal Year 2006; Hospital Wage Indexes For Federal Fiscal Year 2008; Hospital Average Hourly Wages For Federal Fiscal Years 2006 (2002 Wage Data), 2007 (2003 Wage Data), And 2008 (2004 Wage Data); And 3-Year Average Of Hospital Average Hourly Wages, the wage index for the listed provider numbers are corrected to read as follows:

Provider No.

FY 2008

wage index

010012

0.9390

010047

0.7776

010052

0.7701

010109

0.8049

010110

0.7900

010164

0.8042

040014

0.8720

040017

0.8718

040041

0.8720

040071

0.8720

040076

0.8720

040078

0.8720

040100

0.8720

040119

0.8720

050007

1.4907

050008

1.4792

050009

1.4200

050013

1.4200

050016

1.2015

050047

1.4792

050055

1.4792

050070

1.4907

050113

1.4907

050152

1.4792

050228

1.4792

050232

1.2015

050280

1.2826

050289

1.4907

050407

1.4792

050454

1.4792

050457

1.4792

050506

1.2015

050633

1.2015

050667

1.4200

050668

1.4792

050697

1.2826

050707

1.4907

050733

1.2826

050754

1.4907

060010

0.9730

060030

0.9730

080001

1.0777

080003

1.0777

100102

0.8874

100290

0.9331

110107

0.9752

110164

0.9752

110201

0.9752

130066

0.9680

130068

0.9680

150015

0.8904

160030

1.0022

180013

0.9407

180064

0.8131

180066

0.9407

180079

0.8075

180080

0.8042

180124

0.9407

190044

0.7849

190190

0.7752

190246

0.7752

200032

0.8878

210028

0.9429

230036

0.9398

230041

0.9398

230047

1.0091

230080

0.9398

230105

0.9398

230195

1.0091

230204

1.0091

230222

0.9398

230227

1.0091

230257

1.0091

230264

1.0091

230297

1.0091

230299

1.0091

230300

1.0091

240006

1.0760

240010

1.0760

240018

1.0084

240061

1.0760

240069

1.0760

240071

1.0760

270081

0.8574

280065

0.9746

310010

1.0812

310011

1.0864

310014

1.0777

310044

1.0812

310081

1.0777

310092

1.0812

310110

1.0812

320001

0.9739

320005

0.9739

320006

0.9739

320009

0.9739

320011

0.9407

320017

0.9739

320019

0.9739

320021

0.9739

320037

0.9739

320074

0.9739

320079

0.9739

320083

0.9739

330135

1.1528

330205

1.1528

330264

1.1528

340133

0.8916

360044

0.8825

370113

0.8718

380029

1.0479

380051

1.0479

380056

1.0479

390044

1.0777

390096

1.0777

390133

1.0777

410013

1.1793

430012

0.9394

430013

0.9394

430048

0.8398

440011

0.8042

440015

0.8042

440019

0.8042

440030

0.7972

440034

0.8042

440035

0.9407

440056

0.8042

440073

0.9407

440084

0.7949

440110

0.8042

440120

0.8042

440125

0.8042

440144

0.9407

440148

0.9407

440151

0.9407

440153

0.7923

440173

0.8042

440175

0.9407

440192

0.9407

440225

0.8042

440226

0.8042

450370

0.8444

450565

0.8690

450755

0.8498

12. On pages 24924, 29426, and 24941, in Table 4A.—Wage Index and Capital Geographic Adjustment Factor (GAF) for Urban Areas by CBSA—FY 2008, the wage index and GAF for the listed CBSAs are corrected to read as follows:

CBSA code

Urban area

Wage index

GAF

10740

Albuquerque, NM

0.9739

0.9821

Bernalillo County, NM

Sandoval County, NM

Torrance County, NM

Valencia County, NM

13020

Bay City MI

0.9398

0.9584

Bay County, MI

40340

Rochester, MN

1.0760

1.0514

Dodge County, MN

Olmsted County, MN

Wabasha County, MN

13. On pages 24948 through 24951, in Table 4C.—Wage Index And Capital Geographic Adjustment Factor (GAF) For Hospitals That Are Reclassified By CBSA FY 2008, the wage indices and GAFs for the listed areas are corrected to read as follows:

CBSA code

Area

Wage index

GAF

10740

Albuquerque, NM

0.9739

0.9821

13020

Bay City, MI

0.9398

0.9584

22220

Fayetteville-Springdale-Rogers, AR-MO

0.8718

0.9103

35980

Norwich-New London, CT

1.1793

1.1196

40340

Rochester, MN

1.0760

1.0514

40660

Rome, GA

0.9390

0.9578

43620

Sioux Falls, SD

0.9394

0.9581

14. On pages 24952 through 24960, in Table 4J.—Out-Migration Adjustment—FY 2008, the entries for the listed providers are corrected to read as follows:

Provider No.

Reclassified for FY 2008

Out-migration

adjustment

Qualifying county name

County code

010009

0.0092

MORGAN

01510

010025

0.0235

CHAMBERS

01080

010038

0.0039

CALHOUN

01070

010047

0.0178

BUTLER

01060

010052

0.0103

TALLAPOOSA

01610

010054

0.0092

MORGAN

01510

010065

0.0103

TALLAPOOSA

01610

010078

0.0039

CALHOUN

01070

010085

0.0092

MORGAN

01510

010109

0.0451

PICKENS

01530

010110

0.0302

BULLOCK

01050

010146

0.0039

CALHOUN

01070

010150

0.0178

BUTLER

01060

050007

0.0141

SAN MATEO

05510

050008

0.0026

SAN FRANCISCO

05480

050016

0.0103

SAN LUIS OBISPO

05500

050047

0.0026

SAN FRANCISCO

05480

050055

0.0026

SAN FRANCISCO

05480

050070

0.0141

SAN MATEO

05510

050076

0.0026

SAN FRANCISCO

05480

050113

0.0141

SAN MATEO

05510

050152

0.0026

SAN FRANCISCO

05480

050194

0.0052

SANTA CRUZ

05540

050197

0.0141

SAN MATEO

05510

050228

0.0026

SAN FRANCISCO

05480

050232

0.0103

SAN LUIS OBISPO

05500

050242

0.0052

SANTA CRUZ

05540

050289

0.0141

SAN MATEO

05510

050407

0.0026

SAN FRANCISCO

05480

050454

0.0026

SAN FRANCISCO

05480

050457

0.0026

SAN FRANCISCO

05480

050506

0.0103

SAN LUIS OBISPO

05500

050541

0.0141

SAN MATEO

05510

050633

0.0103

SAN LUIS OBISPO

05500

050668

0.0026

SAN FRANCISCO

05480

050707

0.0141

SAN MATEO

05510

050714

0.0052

SANTA CRUZ

05540

050754

0.0141

SAN MATEO

05510

060010

0.0153

LARIMER

06340

060030

0.0153

LARIMER

06340

080001

0.0063

NEW CASTLE

08010

080003

0.0063

NEW CASTLE

08010

100102

0.0125

COLUMBIA

10110

100156

0.0125

COLUMBIA

10110

100290

0.0582

SUMTER

10590

110146

0.0805

CAMDEN

11170

130049

0.032

KOOTENAI

13270

130066

0.032

KOOTENAI

13270

130067

0.0696

BINGHAM

13050

130068

0.032

KOOTENAI

13270

140167

0.1055

IROQUOIS

14460

150006

0.0113

LA PORTE

15450

150015

0.0113

LA PORTE

15450

150146

0.0319

NOBLE

15560

160030

0.004

STORY

16840

170137

0.0336

DOUGLAS

17220

180064

0.0319

MONTGOMERY

18860

180066

0.0449

LOGAN

18700

180079

0.0263

HARRISON

18480

190044

0.0258

ACADIA

19000

190099

0.0188

AVOYELLES

19040

190184

0.0161

CALDWELL

19100

190190

0.0161

CALDWELL

19100

190246

0.0161

CALDWELL

19100

200032

0.0466

OXFORD

20080

210028

0.0512

ST. MARY'S

21180

230069

0.0209

LIVINGSTON

23460

230279

0.0209

LIVINGSTON

23460

240018

0.0872

GOODHUE

24240

270081

0.0237

MUSSELSHELL

27320

300011

0.0069

HILLSBOROUGH

30050

300012

0.0069

HILLSBOROUGH

30050

300020

0.0069

HILLSBOROUGH

30050

300034

0.0069

HILLSBOROUGH

30050

310010

0.0092

MERCER

31260

310011

0.0115

CAPE MAY

31180

310021

0.0092

MERCER

31260

310044

0.0092

MERCER

31260

310092

0.0092

MERCER

31260

310110

0.0092

MERCER

31260

320003

0.0629

SAN MIGUEL

32230

320011

0.0442

RIO ARRIBA

32190

330027

0.0149

NASSAU

33400

330106

0.0149

NASSAU

33400

330167

0.0149

NASSAU

33400

330181

0.0149

NASSAU

33400

330182

0.0149

NASSAU

33400

330198

0.0149

NASSAU

33400

330225

0.0149

NASSAU

33400

330259

0.0149

NASSAU

33400

330331

0.0149

NASSAU

33400

330332

0.0149

NASSAU

33400

330372

0.0149

NASSAU

33400

340133

0.0308

MARTIN

34580

360010

0.0076

TUSCARAWAS

36800

360013

0.0136

SHELBY

36760

360025

0.0072

ERIE

36220

360044

0.0124

DARKE

36190

360096

0.0072

COLUMBIANA

36140

360175

0.0176

CLINTON

36130

360185

0.0072

COLUMBIANA

36140

380022

0.0068

LINN

38210

380029

0.0075

MARION

38230

380051

0.0075

MARION

38230

380056

0.0075

MARION

38230

390030

0.0284

SCHUYLKILL

39650

390031

0.0284

SCHUYLKILL

39650

390065

0.049

ADAMS

39000

390138

0.0213

FRANKLIN

39350

390151

0.0213

FRANKLIN

39350

390162

0.02

NORTHAMPTON

39590

390181

0.0284

SCHUYLKILL

39650

390183

0.0284

SCHUYLKILL

39650

390313

0.0284

SCHUYLKILL

39650

420009

0.0113

OCONEE

42360

420039

0.0153

UNION

42430

420062

0.0109

CHESTERFIELD

42120

440030

0.0056

HAMBLEN

44310

440067

0.0056

HAMBLEN

44310

440084

0.0033

MONROE

44610

440153

0.0007

COCKE

44140

450324

0.0132

GRAYSON

45564

450370

0.024

COLORADO

45312

450393

0.0132

GRAYSON

45564

450395

0.0451

POLK

45850

450438

0.024

COLORADO

45312

450469

0.0132

GRAYSON

45564

450565

0.0486

PALO PINTO

45841

450755

0.0294

HOCKLEY

45652

510077

0.0021

MINGO

51290

15. On pages 24960 through 24977, in Table 5.—List of Proposed Medicare Severity-Diagnosis Related Groups (MS-DRGs), Relative Weighting Factors, and Geometric and Arithmetic Mean Length of Stay, the table is corrected to read as follows:

BILLING CODE 4120-01-P

EP07JN07.000

EP07JN07.001

EP07JN07.002

EP07JN07.003

EP07JN07.004

EP07JN07.005

EP07JN07.006

EP07JN07.007

EP07JN07.008

EP07JN07.009

EP07JN07.010

EP07JN07.011

EP07JN07.012

EP07JN07.013

EP07JN07.014

EP07JN07.015

EP07JN07.016

EP07JN07.017

EP07JN07.018

BILLING CODE 4120-01-C

16. On pages 25095 through 25099, in Table 10.—Geometric Mean Plus The Lesser of .75 Of The National Adjusted Operating Standardized Payment

Amount (Increased To Reflect The Difference Between Costs And Charges) Or .75 Of One Standard Deviation Of Mean Charges By Proposed Medicare Severity Diagnosis Related Group (MS-DRG) April 2007,

the table is corrected to read as follows:

Cases taken from the FY 2006 MedPAR file; proposed MS-DRGs are from GROUPER Version 25.0.

Proposed MS-DRG

Number of cases

Threshold

629

$337,776

328

177,459

23,999

266,199

21,742

162,448

842

159,506

495

90,877

413

130,276

560

92,482

1,358

96,148

177

72,498

1,289

71,569

1,923

51,377

1,484

36,890

901

138,451

558

107,625

251

74,547

3,112

81,762

2,576

60,740

8,417

79,522

11,626

52,970

14,454

41,141

1,609

73,994

2,862

45,280

3,751

30,578

1,057

59,862

2,987

35,341

4,263

30,562

813

58,045

2,506

42,020

7,710

36,365

4,777

51,688

14,602

33,107

55,357

25,687

4,549

58,682

7,720

39,547

5,430

34,186

1,156

29,433

593

22,836

4,664

30,610

16,896

24,934

7,716

29,072

48,432

19,657

789

28,525

2,639

22,939

4,201

17,679

1,340

53,318

2,288

41,979

1,185

36,186

55,552

34,358

112,189

27,004

94,547

21,586

1,383

30,616

12,393

23,506

103,747

18,936

7,092

34,031

10,001

26,444

6,056

20,628

8,655

26,844

32,523

21,427

1,197

33,931

874

24,318

1,101

32,854

1,307

24,933

957

20,523

2,077

24,135

8,190

17,502

1,646

33,910

1,940

28,383

2,591

22,654

5,328

35,679

10,382

26,404

12,152

20,144

717

30,107

2,641

23,706

3,319

17,874

6,676

29,690

14,890

22,313

15,484

17,172

1,521

56,938

1,088

42,964

755

36,338

1,252

51,314

1,048

35,977

642

30,167

100

15,837

28,714

101

56,905

19,341

102

1,352

24,321

103

15,023

17,133

113

568

31,544

114

601

21,640

115

1,098

25,563

116

665

23,828

117

1,400

16,827

121

587

22,514

122

674

13,518

123

2,843

19,108

124

679

24,153

125

4,705

16,568

129

1,374

37,663

130

1,072

28,539

131

655

35,824

132

728

27,050

133

1,352

31,142

134

2,661

20,306

135

781

35,301

136

1,113

24,451

137

1,108

28,410

138

1,370

20,587

139

2,145

22,300

146

687

35,060

147

1,422

25,142

148

935

18,944

149

39,248

15,883

150

939

25,105

151

6,801

13,607

152

2,352

22,958

153

16,028

15,145

154

1,843

27,851

155

4,207

22,020

156

5,140

16,103

157

1,145

28,232

158

3,039

21,662

159

2,418

15,345

163

13,431

79,829

164

18,047

47,971

165

14,553

37,942

166

20,290

58,779

167

20,772

40,117

168

5,758

30,294

175

11,954

33,475

176

40,173

26,670

177

57,179

36,617

178

71,192

30,381

179

27,454

24,673

180

22,474

32,948

181

32,156

26,822

182

6,163

22,468

183

1,654

29,694

184

4,141

22,561

185

2,593

15,740

186

8,533

31,857

187

9,968

25,761

188

5,148

20,974

189

104,531

28,757

190

57,041

27,770

191

121,659

24,280

192

196,903

18,419

193

88,053

29,668

194

266,599

24,679

195

147,744

18,274

196

5,143

30,999

197

6,894

25,721

198

4,943

21,129

199

3,257

33,231

200

8,185

23,984

201

3,523

17,676

202

31,587

20,635

203

41,587

15,003

204

26,039

17,394

205

5,775

26,368

206

22,415

18,854

207

46,165

83,212

208

79,432

41,398

215

150

151,502

216

8,411

165,422

217

7,609

118,088

218

3,256

98,470

219

10,062

132,460

220

13,481

94,478

221

8,383

81,144

222

2,865

149,784

223

5,770

116,219

224

1,919

138,213

225

5,871

109,030

226

7,048

112,464

227

50,536

88,444

228

3,084

126,976

229

4,128

89,139

230

1,989

73,311

231

1,478

138,287

232

1,795

107,403

233

16,911

119,988

234

39,167

86,734

235

9,628

97,022

236

32,871

68,172

237

21,789

85,211

238

44,929

53,794

239

13,814

64,168

240

13,349

43,051

241

3,350

31,297

242

17,179

64,273

243

37,856

50,218

244

68,201

42,102

245

6,241

54,054

246

32,661

64,613

247

279,972

46,787

248

5,013

58,218

249

29,657

41,876

250

5,739

53,408

251

39,905

38,200

252

44,602

48,168

253

46,864

43,475

254

59,029

34,550

255

2,609

39,961

256

3,833

30,250

257

774

23,818

258

598

49,682

259

7,328

35,034

260

867

47,446

261

2,804

28,303

262

3,378

23,301

263

788

29,053

264

30,137

39,708

280

60,735

36,717

281

57,734

28,584

282

60,951

23,031

283

15,852

30,928

284

4,911

23,409

285

3,254

17,351

286

23,282

40,266

287

172,488

28,923

288

3,245

50,617

289

1,423

36,464

290

484

28,249

291

183,774

29,157

292

217,052

24,421

293

226,688

17,810

294

1,704

21,989

295

1,658

13,805

296

1,730

26,654

297

943

20,306

298

554

12,889

299

17,443

28,063

300

46,820

21,997

301

39,910

15,712

302

7,873

23,741

303

81,458

15,192

304

2,084

24,110

305

35,646

15,139

306

1,379

27,644

307

6,447

18,857

308

33,528

27,255

309

79,751

20,827

310

160,738

14,816

311

24,867

13,364

312

169,247

18,273

313

220,769

14,894

314

60,053

30,750

315

30,730

23,629

316

20,101

16,823

326

11,567

88,786

327

10,901

49,818

328

9,333

32,074

329

48,135

80,371

330

66,303

47,127

331

31,391

35,021

332

1,890

74,102

333

6,196

46,130

334

4,023

34,266

335

7,161

68,407

336

12,516

43,200

337

8,835

32,563

338

1,499

58,047

339

3,192

39,795

340

3,607

30,753

341

874

42,806

342

2,536

31,921

343

6,875

24,258

344

898

51,426

345

2,915

33,636

346

2,909

27,779

347

1,568

36,443

348

3,985

27,800

349

5,787

19,265

350

1,669

41,035

351

3,997

28,329

352

8,419

19,894

353

3,182

44,303

354

9,118

30,612

355

17,451

23,281

356

8,366

58,953

357

8,046

40,130

358

2,714

31,167

368

3,052

31,502

369

4,005

25,728

370

3,914

20,084

371

16,843

32,446

372

22,903

26,907

373

14,897

20,598

374

9,414

34,760

375

19,730

26,563

376

4,816

22,403

377

50,503

30,943

378

84,806

24,936

379

128,748

19,140

380

2,917

32,583

381

4,894

26,915

382

5,445

20,581

383

1,303

28,065

384

8,664

21,556

385

2,107

33,476

386

7,221

25,067

387

5,230

20,543

388

18,267

29,699

389

46,328

23,347

390

48,052

16,336

391

47,511

24,761

392

306,515

17,829

393

23,917

28,925

394

45,952

23,434

395

26,460

17,594

405

3,903

83,940

406

5,241

49,125

407

2,310

36,497

408

1,644

67,203

409

1,713

46,400

410

722

35,648

411

978

65,359

412

1,063

47,834

413

881

37,325

414

5,596

59,660

415

6,847

40,610

416

6,222

30,251

417

16,671

46,291

418

27,563

36,466

419

38,264

28,533

420

714

61,258

421

1,091

36,437

422

364

28,520

423

1,500

63,840

424

912

44,260

425

157

35,667

432

16,259

30,416

433

9,022

22,852

434

945

17,210

435

11,908

32,613

436

13,987

26,367

437

4,357

23,539

438

14,426

31,691

439

24,816

25,250

440

27,346

18,913

441

13,912

29,122

442

12,756

23,365

443

6,698

18,374

444

12,447

31,276

445

16,757

25,851

446

16,849

20,274

453

846

162,178

454

1,496

110,006

455

1,875

85,089

456

764

132,358

457

1,763

93,955

458

1,534

78,607

459

3,180

93,067

460

50,317

61,555

461

1,062

78,144

462

14,234

58,820

463

5,283

64,018

464

6,322

42,171

465

2,942

31,102

466

4,152

70,822

467

10,818

52,840

468

28,701

44,445

469

29,730

57,143

470

410,173

41,440

471

2,227

71,285

472

6,218

48,040

473

22,546

39,667

474

2,829

51,053

475

3,530

35,636

476

1,698

26,070

477

2,257

57,109

478

7,144

41,570

479

10,267

33,395

480

25,866

50,686

481

59,136

38,146

482

64,739

33,332

483

5,729

44,536

484

17,949

37,665

485

967

55,459

486

1,535

40,900

487

1,214

33,214

488

1,551

33,205

489

3,866

26,495

490

19,803

34,057

491

58,396

24,028

492

4,700

48,148

493

15,248

36,196

494

30,563

28,910

495

1,867

51,435

496

5,049

34,292

497

7,519

27,156

498

1,177

36,767

499

1,245

22,858

500

1,349

47,836

501

3,679

30,766

502

6,825

23,032

503

736

38,112

504

2,155

30,857

505

3,214

24,352

506

909

25,023

507

779

33,035

508

2,722

26,249

509

465

25,608

510

957

38,420

511

4,008

30,072

512

11,961

23,087

513

1,287

29,502

514

1,339

20,718

515

3,577

51,402

516

10,963

37,292

517

18,263

30,388

533

828

27,486

534

3,634

15,819

535

6,844

27,022

536

34,321

15,408

537

654

20,405

538

1,164

12,954

539

3,379

34,667

540

4,187

27,375

541

1,858

22,002

542

6,158

33,306

543

18,413

25,124

544

12,644

18,008

545

4,016

34,451

546

5,881

24,102

547

4,880

18,469

548

591

33,006

549

1,077

25,270

550

904

18,381

551

9,502

29,646

552

87,859

18,492

553

2,790

24,265

554

20,253

14,944

555

1,995

22,555

556

19,168

14,428

557

3,184

29,321

558

14,178

19,372

559

1,635

28,972

560

3,979

20,901

561

7,617

13,636

562

4,996

26,929

563

36,056

15,451

564

1,606

27,237

565

3,237

21,478

566

2,779

15,695

573

5,687

46,949

574

12,100

33,325

575

6,468

25,393

576

558

44,896

577

2,179

31,142

578

3,299

23,686

579

3,088

44,811

580

6,766

31,460

581

5,288

23,941

582

8,972

24,930

583

15,549

19,001

584

1,431

27,897

585

2,818

20,786

592

3,982

30,226

593

12,832

23,538

594

2,955

16,562

595

1,082

29,610

596

5,755

19,571

597

548

29,514

598

1,483

23,497

599

350

15,943

600

572

21,988

601

865

15,125

602

21,307

26,948

603

130,923

18,145

604

2,627

25,150

605

22,672

16,152

606

1,363

22,966

607

7,169

14,791

614

1,376

44,346

615

1,626

32,541

616

1,132

61,354

617

6,822

37,382

618

343

28,522

619

663

60,076

620

1,877

41,119

621

6,556

35,242

622

1,234

45,937

623

3,268

33,291

624

487

24,889

625

1,098

40,232

626

2,522

27,537

627

14,305

19,134

628

3,267

51,514

629

3,958

40,808

630

684

31,392

637

16,283

26,892

638

40,811

20,070

639

41,135

14,010

640

55,690

23,971

641

188,104

16,575

642

1,542

23,138

643

5,014

31,125

644

11,845

24,210

645

8,402

18,520

652

10,437

57,281

653

1,585

86,150

654

3,231

54,167

655

1,650

40,670

656

3,721

56,568

657

7,359

38,736

658

8,479

32,186

659

4,442

51,032

660

7,444

36,348

661

4,745

29,748

662

988

41,594

663

2,131

29,231

664

4,676

23,754

665

690

46,858

666

2,213

30,439

667

3,948

19,910

668

3,757

39,537

669

12,491

27,870

670

13,411

19,410

671

884

28,518

672

965

19,128

673

12,577

43,111

674

10,503

40,270

675

11,704

31,229

682

75,827

30,254

683

112,129

25,615

684

43,451

19,020

685

2,493

19,996

686

1,581

31,234

687

3,322

24,255

688

1,198

18,441

689

55,398

25,904

690

200,059

18,352

691

898

31,887

692

654

25,534

693

2,235

27,712

694

19,213

17,667

695

974

24,032

696

10,565

14,808

697

575

17,475

698

21,061

27,909

699

22,820

23,309

700

15,089

17,723

707

4,874

35,532

708

17,015

29,281

709

755

34,020

710

2,037

27,689

711

921

34,145

712

819

20,449

713

11,755

25,154

714

32,745

15,644

715

638

34,191

716

1,382

26,921

717

634

31,538

718

633

19,455

722

871

28,980

723

2,037

23,777

724

666

15,999

725

802

23,413

726

3,940

16,420

727

1,098

26,180

728

6,176

16,848

729

578

22,426

730

552

14,387

734

1,470

39,650

735

1,328

26,263

736

840

68,822

737

3,429

39,321

738

954

28,973

739

975

48,200

740

4,366

31,584

741

6,554

24,119

742

10,705

29,966

743

35,310

21,122

744

1,498

28,762

745

2,189

20,066

746

2,486

27,713

747

11,218

20,664

748

21,171

19,841

749

1,037

42,792

750

484

24,671

754

1,083

31,715

755

3,152

24,245

756

831

16,790

757

1,322

31,004

758

1,597

24,623

759

1,186

19,161

760

1,703

19,848

761

1,918

13,557

765

2,497

22,146

766

2,634

14,889

767

119

15,750

768

28,201

769

29,901

770

181

18,191

774

1,442

12,637

775

5,224

9,066

776

491

15,413

777

177

19,480

778

489

8,798

779

107

14,082

780

5,638

781

3,004

13,343

782

125

8,369

794

2,880

799

623

76,151

800

699

45,583

801

602

35,355

802

691

51,739

803

1,003

33,630

804

996

25,527

808

8,315

34,115

809

15,527

24,895

810

3,818

21,504

811

18,344

24,532

812

83,082

18,156

813

15,031

25,132

814

1,631

29,730

815

3,337

23,820

816

2,355

18,234

820

1,481

83,993

821

2,529

40,735

822

2,139

28,780

823

2,436

64,907

824

3,039

40,522

825

2,009

29,739

826

562

77,350

827

1,318

40,156

828

872

29,232

829

1,374

44,261

830

531

25,785

834

5,257

51,445

835

1,469

30,879

836

1,526

23,524

837

1,623

85,432

838

900

41,508

839

1,385

26,968

840

15,152

38,374

841

11,012

29,060

842

7,678

22,849

843

1,477

32,639

844

2,854

25,034

845

1,008

21,623

846

2,480

37,292

847

23,667

25,136

848

1,699

20,748

849

1,498

26,843

853

31,444

77,914

854

6,881

50,010

855

467

36,089

856

6,187

69,506

857

10,059

36,989

858

3,500

28,786

862

7,425

33,012

863

21,807

21,882

864

19,826

20,564

865

2,019

27,840

866

9,406

16,786

867

5,306

38,488

868

2,369

24,746

869

1,100

20,520

870

13,710

90,935

871

203,702

33,685

872

92,118

25,456

876

968

40,268

880

10,494

15,328

881

4,576

11,727

882

1,656

12,481

883

786

17,701

884

21,619

19,048

885

77,763

16,598

886

376

14,393

887

423

18,850

894

4,480

8,389

895

6,474

16,201

896

5,369

25,303

897

35,835

13,689

901

917

48,598

902

2,135

31,632

903

1,739

24,530

904

941

39,574

905

798

25,597

906

745

23,573

907

8,098

53,982

908

7,884

35,453

909

5,971

26,248

913

813

26,149

914

6,958

16,346

915

24,023

916

5,369

10,725

917

14,155

28,466

918

34,847

14,539

919

10,569

27,881

920

12,135

22,284

921

11,659

15,316

922

1,005

26,606

923

4,211

16,053

927

182

181,306

928

794

60,107

929

459

32,721

933

155

31,143

934

694

23,842

935

2,179

21,397

939

423

43,099

940

690

32,755

941

1,077

26,227

945

5,053

21,694

946

3,199

17,198

947

6,544

23,445

948

34,325

15,485

949

742

18,955

950

476

12,079

951

990

14,489

955

446

82,175

956

3,718

55,062

957

1,157

102,443

958

737

70,330

959

816

53,566

963

1,395

46,322

964

1,578

32,525

965

2,016

27,560

969

598

75,122

970

231

47,821

974

7,276

34,615

975

3,463

29,344

976

2,728

23,762

977

4,871

23,005

981

26,280

77,452

982

18,594

53,442

983

6,766

38,481

984

669

55,818

985

1,048

38,813

986

890

27,837

987

8,036

54,475

988

11,880

36,064

989

6,537

26,243

999

16,006

17. On pages 25118 through 25123, in Table I.—Impact Analysis of Proposed Changes For FY 2008, the listed entries and footnotes are corrected to read as follows:

BILLING CODE 4120-01-P

EP07JN07.019

EP07JN07.020

EP07JN07.021

BILLING CODE 4120-01-C

18. On page

25124,

Shown here are the tentative effects of geographic reclassifications by the Medicare Geographic Classification Review Board (MGCRB). The effects demonstrate the FY 2008 payment impact of going from no reclassifications to the reclassifications scheduled to be in effect for FY 2008. Reclassification for prior years has no bearing on the payment impacts shown here. This column reflect the geographic budget neutrality factor of 0.991925.

This column displays the effects of the proposed changes in the rural floor budget neutrality adjustment applied on the wage index instead of on the standardized amount. The column reflects a proposed rural floor budget neutrality factor of 0.997080.

This column shows tentative changes in payments from FY 2007 to FY 2008 including a 0.976 case mix index adjustment for coding and documentation improvements that are anticipated with the adoption of the MS-DRGs prior to the assumed growth occurring. In incorporates all of the changes displayed in Columns 4, 5, 6, 7, 8, 9, 10 and (the changes displayed in Columns 2 and 3 are included in Column 4).

This column shows tentative changes in payments from FY 2007 to FY 2008 with a case mix index adjustment and the assumed growth for improvements in documentation and coding. It incorporates all of the changes displayed in

Columns 4, 5, 6, 7, 8, 9, 10 and (the changes displayed in Columns 2 and 3 are included in Column 4). It also reflects the impact of the proposed FY 2008 update, and changes in hospitals' reclassification status in FY 2008 compared to FY 2007. The sum of these impacts may be different from the percentage changes shown here due to rounding and interactive effects.

a. First column, second full paragraph, line 25, the figure “0.999317” is corrected to read “0.999367.”

b. Second column, last paragraph, line 3, the figure “0.999317” is corrected to read “0.999367.”

19. On page 25125,

a. First column, last paragraph, line 5, the figure “0.991938” is corrected to read “0.991925.”

b. Second column, first full paragraph, line 17, the figure “0.997084” is corrected to read “0.997080.”

20. On pages 25126 through 25128, in Table II.—Impact Analysis of Proposed Changes For FY 2008 Operating Prospective Payment System, the listed entries are corrected to read as follows:

Table II.—Impact Analysis of Proposed Changes for FY 2008 Operating Prospective Payment System (Payments per Case)

[Percent changes in payments per case]

Number of hospitals

Published average proposed FY 2008 payment per case

Corrected average proposed FY 2008 payment per case

Published all proposed FY 2008 changes

Corrected all proposed FY 2008 changes

(1)

(3)

(4)

All hospitals

3535

9299

3.3

By Geographic Location:

Urban hospitals

2540

9678

9680

3.6

Large urban areas (populations over 1 million)

1409

10156

10157

4.2

Other urban areas (populations of 1 million or fewer)

1131

9103

9107

2.8

2.9

Rural hospitals

995

7123

7110

0.9

0.7

Bed Size (Urban):

0-99 beds

632

7263

7261

0.4

0.3

100-199 beds

849

8170

8159

3.4

3.2

200-299 beds

480

9120

9117

3.5

3.4

300-499 beds

412

10136

10143

4.0

500 or more beds

167

12234

12254

4.0

4.2

Bed Size (Rural):

0-49 beds

342

6065

6045

−1.6

−1.9

50-99 beds

369

6588

6572

0.5

0.2

100-149 beds

172

6960

6945

1.3

1.1

150-199 beds

7735

7727

1.4

1.3

200 or more beds

8938

8937

2.0

Urban by Region:

New England

126

10001

10004

2.6

Middle Atlantic

350

10529

10532

2.8

South Atlantic

388

9175

9176

4.2

4.3

East North Central

395

9197

9199

3.4

3.5

East South Central

166

8784

8786

3.2

West North Central

156

9321

9334

2.8

3.0

West South Central

358

9174

9175

4.0

Mountain

153

9826

9836

3.3

3.5

Pacific

395

11657

11656

4.7

Puerto Rico

4525

4511

3.6

3.3

Rural by Region:

New England

9714

9716

0.4

Middle Atlantic

7525

7514

0.8

0.6

South Atlantic

173

6700

6683

1.8

1.6

East North Central

124

7574

7567

0.7

0.6

East South Central

177

6479

6462

1.2

1.0

West North Central

115

7792

7786

0.6

West South Central

194

6339

6322

−0.7

−0.9

Mountain

7834

7822

0.9

0.7

Pacific

8896

8881

2.0

1.8

By Payment Classification:

Urban hospitals

2619

9629

9631

3.6

Large urban areas (populations over 1 million)

1436

10127

10128

4.1

Other urban areas (populations of 1 million or fewer)

1183

9034

9038

2.8

Rural areas

916

7242

7230

0.9

0.8

Teaching Status:

Non-teaching

2479

7851

7844

2.7

2.6

Fewer than 100 Residents

816

9384

9385

3.5

100 or more Residents

240

13533

13555

4.1

4.2

Urban DSH:

Non-DSH

879

8307

8314

2.0

2.1

100 or more beds

1527

10182

10183

4.0

Less than 100 beds

359

6697

6682

1.9

1.6

Rural DSH:

SCH

391

7013

6994

0.3

0.0

RRC

189

7818

7809

1.7

1.6

100 or more beds

6028

6010

2.1

1.8

Less than 100 beds

154

5353

5335

0.4

0.0

Urban teaching and DSH:

Both teaching and DSH

805

11185

11192

4.0

4.1

Teaching and no DSH

192

9078

9089

2.5

2.6

No teaching and DSH

1081

8283

8273

3.7

3.5

No teaching and no DSH

541

7812

7817

1.9

2.0

Rural Hospital Types:

RRC

8358

8359

2.5

SCH

9301

9296

0.8

MDH

6339

6319

0.3

0.0

SCH and RRC

10239

10236

2.7

MDH and RRC

9674

9677

−0.8

Type of Ownership:

Voluntary

2069

9424

9427

3.2

Proprietary

823

8478

8471

3.7

3.6

Government

598

9593

9589

3.5

3.4

Medicare Utilization as a Percent of Inpatient Days:

0-25

230

13443

13434

5.6

5.5

25-50

1292

10570

10576

4.0

4.1

50-65

1453

8116

8113

2.6

2.5

Over 65

441

7331

7325

1.2

Hospitals Reclassified by the Medicare Geographic Classification Review Board: FY 2008 Reclassifications:

All Reclassified Hospitals FY 2008

801

8938

8937

2.8

All Non-Reclassified Hospitals FY 2008

2734

9417

9416

3.4

Urban Reclassified Hospitals FY 2008

434

9581

9595

3.3

3.4

Urban Non-reclassified Hospitals FY 2008

2105

9701

9705

3.6

3.7

Rural Reclassified Hospitals FY 2008

367

7669

7663

1.5

1.4

Rural Nonreclassified Hospitals FY 2008

568

6392

6374

−0.3

−0.6

All Section 401 Reclassified Hospitals

8799

8787

1.8

1.6

Other Reclassified Hospitals (Section 1886(d)(8)(B))

6729

6710

1.4

1.1

Former Section 508 Hospitals

107

9814

9823

0.5

0.6

Specialty Hospitals

Cardiac Specialty Hospitals

10676

10727

−0.6

−0.1

These payment amounts per case do not reflect any estimates of annual case-mix increase.

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

Dated: June 1, 2007.

Ann C. Agnew,

Executive Secretary to the Department.

[FR Doc. 07-2806 Filed 6-1-07; 2:04 pm]

BILLING CODE 4120-01-P

This is a copy of a public record, reproduced as it was published. It is not legal advice, and it may not be the version a court would rely on. Check the official source before you cite it.