Medicare Program; Changes to the Hospital Inpatient Prospective Payment Systems and Fiscal Year 1998 Rates; Corrections

DEPARTMENT OF HEALTH AND HUMAN SERVICES

Health Care Financing Administration

42 CFR Parts 400, 409, 410, 411, 412, 413, 424, 440, 485, 488, 489

and 498

[BPD-878-CN]

RIN 0938-AH55

Medicare Program; Changes to the Hospital Inpatient Prospective

Payment Systems and Fiscal Year 1998 Rates; Corrections

AGENCY: Health Care Financing Administration (HCFA), HHS.

ACTION: Final rule with comment period; correction notice.

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SUMMARY: In the August 29, 1997, issue of the Federal Register (62 FR

45966), we published a final rule with comment period revising the

Medicare hospital inpatient prospective payment systems for operating

costs and capital-related costs to implement necessary changes

resulting from the Balanced Budget Act of 1997, Pub. L. 105-33, and

changes arising from our continuing experience with the system. This

document corrects errors made in that document.

EFFECTIVE DATE: October 1, 1997.

FOR FURTHER INFORMATION CONTACT: Nancy Edwards, (410) 786-4531.

SUPPLEMENTARY INFORMATION: In the preamble of the August 29, 1997 final

rule with comment period, we indicated that if a hospital believed its

wage index value was incorrect as a result of an intermediary or HCFA

error that the hospital could not have known about before reviewing

data made available in mid-August, the hospital had to notify the

intermediary and HCFA in writing, no later than September 15, 1997 (see

62 FR 45989). As a result of this process, we have corrected the wage

data for 10 hospitals and included the wage data for 2 hospitals that

were erroneously omitted. In addition, the Balanced Budget Act of 1997,

Public Law 105-33, allowed hospitals meeting specific criteria to be

reclassified for fiscal year (FY) 1998 and subsequent years. Because

these reclassification decisions were made after publication of the

final rule with comment period, the impact on their area wage indexes

are reflected below. Accordingly, the wage index values for several

areas have changed and are corrected in this document.

The August 29, 1997 final rule with comment period also contained

technical and typographic errors. Therefore, we are making the

following corrections to the final rule with comment period:

[[Page 11148]]

1. On page 45967, third column, fourth full paragraph, fourth line,

the phrase ``are (MDH) for FY 1998 or 1999 will'' is corrected to read

``are not designated as Medicare-dependent small rural hospitals (MDHs)

for FY 1998 or 1999 will''.

2. On page 45968, second column, fifth full paragraph, first and

second lines, the phrase ``For cost reporting periods beginning on or

after'' is corrected to read ``For discharges on or after''.

3. On page 45997, third column, first paragraph, fourth through

sixth lines, the phrase ``uses the fixed loss outlier threshold of

$7,600 from the proposed rule'' is corrected to read ``uses a fixed

loss outlier threshold of $9,700''.

4. On page 46005, third column, first full paragraph, seventh line,

the phrase ``December 31, 1990'' is corrected to read ``December 31,

1998''.

5. On page 46019, first column, first paragraph, the table is

replaced with the following:

(1) Psychiatric hospital and units............................ $10,534

(2) Rehabilitation hospitals and units........................ 19,104

(3) Long-term care hospitals.................................. 37,688

6. On page 46020, second column, third full paragraph, the table is

replaced with the following:

(1) Psychiatric hospital and units............................ $8,482

(2) Rehabilitation hospitals and units........................ 16,677

(3) Long-term care hospitals.................................. 18,947

The changes in item numbers 6 and 7 reflect an update of 3.4

percent that was not included in the data published in the August 29,

1997 final rule with comment period. These changes were made through

Program Memorandum A-97-13 on September 29, 1997 and were effective

October 1, 1997.

7. On page 46042, second column, in the Table of Cost-of-Living

Adjustment Factors, Alaska and Hawaii Hospitals, the cost-of-living

adjustment for the County of Hawaii is corrected to read as follows:

County of Hawaii............................................. 1.15

8. On pages 46054 through 46069, in Table 3C--Hospital Case Mix

Indexes for Discharges Occurring in Federal Fiscal Year 1996; Hospital

Average Hourly Wages for Federal Fiscal Year 1998 Wage Index, the

average hourly wages for specified providers are corrected to read as

follows:

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Avg. hourly Corrected avg.

Provider Case mix index wage hourly wage

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09-0003......................................................... 01.3454 20.56 24.76

09-0007......................................................... 01.2828 20.38 21.23

14-0067......................................................... 01.7828 18.84 18.79

16-0029......................................................... 01.5134 18.14 18.32

22-0071......................................................... 01.9236 21.67 23.15

22-0077......................................................... 01.7917 22.92 23.28

33-0196......................................................... 01.3114 0.34 28.36

33-0385......................................................... 01.1776 -2.89 26.83

33-0396......................................................... 01.3520 24.91 31.58

39-0132......................................................... 01.3448 15.42 19.77

40-0029......................................................... 01.1383 .............. 9.92

40-0048......................................................... 01.2251 .............. 7.12

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9. On pages 46070 through 46076, in Table 4A--Wage Index and

Capital Geographic Adjustment Factor (GAF) for Urban Areas, the wage

index values and the GAFs for specified areas are corrected to read as

follows:

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Corrected Corrected

Urban area Wage index GAF wage index GAF

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0060...................... Aguadilla, PR................... 0.4224 0.5542 0.4188 0.5510

0470...................... Arecibo, PR..................... 0.4224 0.5542 0.4218 0.5537

1123...................... Boston-Worcester-Lawrence-Lowell- 1.1436 1.0962 1.1498 1.1003

Brockton, MA-NH \1\.

3500...................... Iowa City, IA................... 0.9401 0.9586 0.9413 0.9594

5600...................... New York, NY \1\................ 1.3982 1.2580 1.4449 1.2866

6120...................... Peoria-Pekin, IL................ 0.8586 0.9009 0.8571 0.8998

6160...................... Philadelphia, PA-NJ \1\......... 1.1379 1.0925 1.1398 1.0937

7440...................... San Juan-Bayamon, PR \1\........ 0.4618 0.5891 0.4625 0.5898

8840...................... Washington, DC-MD-VA-WV \1\..... 1.0780 1.0528 1.0911 1.0615

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\1\ Large Urban Area.

10. On pages 46076 through 46077, in Table 4B--Wage Index and

Capital Geographic Adjustment Factor (GAF) for Rural Areas, the wage

index value and the GAF for Puerto Rico are corrected to read as

follows:

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Corrected wage

Nonurban area Wage index GAF index Corrected GAF

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Puerto Rico................................. 0.4224 0.5542 0.3939 0.5283

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11. On pages 46077 through 46078, in Table 4C--Wage Index and

Capital Geographic Adjustment Factor (GAF) for Hospitals That Are

Reclassified, the wage index values and the GAFs for specified areas

are corrected to read as follows:

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Corrected wage

Area reclassified to Wage index GAF index Corrected GAF

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Boston-Worcester-Lawrence-Lowell-Brockton, MA-NH 1.1436 1.0962 1.1498 1.1003

Hartford, CT.................................... .............. .............. 1.2373 1.1570

Iowa City, IA................................... 0.9198 0.9444 0.9208 0.9451

[[Page 11149]]

New York, NY.................................... 1.3982 1.2580 1.4449 1.2866

Peoria-Pekin, IL................................ 0.8586 0.9009 0.8571 0.8998

Philadelphia, PA-NJ............................. 1.1379 1.0925 1.1398 1.0937

Washington, DC-MD-VA-WV......................... 1.0780 1.0528 1.0911 1.0615

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12. On pages 46078 through 46079, in Table 4D--Average Hourly Wage

for Urban Areas, the average hourly wages for specified areas are

corrected to read as follows:

------------------------------------------------------------------------

Corrected

Urban area Average hourly average hourly

wage wage

------------------------------------------------------------------------

Boston-Worcester-Lawrence-Lowell-

Brockton, MA-NH........................ 22.9992 23.1215

Iowa City, IA........................... 18.8914 18.9163

New York, NY............................ 28.1700 29.0344

Peoria-Pekin, IL........................ 17.2543 17.2229

Philadelphia, PA-NJ..................... 22.8669 22.9042

San Juan-Bayamon, PR.................... 9.2790 9.2933

Springfield, MA......................... 21.4074 21.5827

Washington, DC-MD-VA-WV................. 21.6632 21.9255

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13. On pages 46079 through 46080, in Table 4E--Average Hourly Wage

for Rural Areas, the average hourly wage for Puerto Rico is corrected

to read as follows:

------------------------------------------------------------------------

Corrected

Nonurban area Average hourly average hourly

wage wage

------------------------------------------------------------------------

Puerto Rico........................... 8.4891 7.9149

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14. On page 46080, in Table 4F--Puerto Rico Wage Index and Capital

Geographic Adjustment Factor (GAF), the wage index values and the GAFs

for specified areas are corrected to read as follows:

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Corrected wage

Area Wage index GAF index Corrected GAF

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Aquadilla, PR................................... 0.9291 0.9509 0.9212 0.9453

Arecibo, PR..................................... 0.9291 0.9509 0.9276 0.9498

San Juan-Bayamon, PR............................ 1.0156 1.0107 1.0172 1.0117

Rural Puerto Rico............................... 0.9291 0.9509 0.8663 0.9064

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15. On pages 46099 through 46105, Table 7A--Medicare Prospective

Payment System; Selected Percentile Lengths of Stay [FY 96 MEDPAR

Update 06/97 Grouper V14.0] is corrected by replacing it with the

following:

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BILLING CODE 4120-01-C

(Catalog of Federal Domestic Assistance Program No. 93.778, Medical

Assistance Program; No. 93.773 Medicare--Hospital Insurance; and No.

93.774, Medicare--Supplementary Medical Insurance)

Dated: February 23, 1998.

Neil J. Stillman,

Deputy Assistant, Secretary for Information Resource Management.

[FR Doc. 98-5384 Filed 3-5-98; 8:45 am]

BILLING CODE 4120-01-P