06-9976. Medicare Program; Changes to the Hospital Inpatient Prospective Payment Systems and Fiscal Year 2007 Rates; Final Fiscal Year 2007 Wage Indices and Payment Rates After Application of Revised Occupational Mix Adjustment to the Wage Index; ...
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Start Preamble
AGENCY:
Centers for Medicare & Medicaid Services (CMS), HHS.
ACTION:
Correction of notice.
SUMMARY:
This document corrects wage index and technical errors that appeared in the notice published in the Federal Register on October 11, 2006 entitled “Medicare Program; Hospital Inpatient Prospective Payment Systems and Fiscal Year 2007 Rates.
DATES:
Effective Date: Corrections listed in items 10 through 12 of section III. of this notice are effective as of October 1, 2006. The corrections to the wage index listed in items 2a, 3 through 8a, and 9a of section III. of this notice are effective as of November 3, 2006. The corrections to the wage index listed in items 1, 2b, 8b, and 9b of section III. of this notice are effective as of November 21, 2006.
Start Further InfoFOR FURTHER INFORMATION CONTACT:
Marc Hartstein, (410) 786-4548.
End Further Info End Preamble Start Supplemental InformationSUPPLEMENTARY INFORMATION:
I. Background
In FR Doc. 06-8471 of October 11, 2006 (71 FR 59886), the notice entitled “Hospital Inpatient Prospective Payment Systems and Fiscal Year 2007 Rates: Final Fiscal Year 2007 Wage Indices and Payment Rates After Application of Revised Occupational Mix Adjustment to Wage Index” (hereinafter referred to as the “FY 2007 IPPS notice”), there were a number of technical errors that are identified and corrected in the Correction of Errors section (items 10 through 12 of section III. of this notice). These technical corrections are effective October 1, 2006.
In addition, in October 2006, we became aware of an error in the calculation of the FY 2007 wage index for a number of rural areas and several hospitals that are reclassified to those areas. The error also affected some hospitals in urban areas that are assigned the statewide rural wage index floor. Section 412.64(k)(1) of the regulations requires that wage index corrections made after October 1 are effective prospectively for the remainder of the fiscal year from the date the fiscal intermediaries are informed of the correction. We recalculated the wage indices for the affected hospitals, and on November 3, 2006, sent a Joint Signature Memorandum to the fiscal intermediaries informing them to pay hospitals using the corrected wage indices. Subsequent to the November 3, 2006 Joint Signature Memorandum, additional errors in the wage indices were brought to our attention and were corrected through a November 21, 2006 Joint Signature Memorandum. Therefore, the corrected FY 2007 wage indices are effective beginning November 3, 2006 or November 21, 2006. Accordingly, the wage index provisions of this correction notice are corrections to the tabulation of the rates paid to hospitals. We note that the Start Printed Page 570corrections to the impact analysis (item 1 of section III. of this notice) are effective as of November 3, 2006 since the additional corrections made based on the November 21, 2006 Joint Signature Memorandum had no significant effect on the impact analysis.
II. Summary of the Corrections to the FY 2007 IPPS Notice
We made corrections to wage index values and geographic adjustment factors (GAFs) that were published in Tables 2, 4A-1, 4A-2, 4B-1, 4B-2, 4C-1, and 4C-2. In addition, we are making technical corrections to— (1) the out-migration adjustments and qualifying counties that were published in Table 4J; and (2) the list of diagnosis-related groups (DRGs), relative weighting factors, and geometric and arithmetic mean length of stay (LOS) that were published in Table 5.
III. Correction of Errors
In FR Doc. 06-8471 of October 11, 2006 (71 FR 59886), make the following corrections:
1. On pages 59893 and 59894, in Table I.—Impact Analysis of Changes for FY 2007, the figures in the last column (All FY 2007 changes 8) are corrected to read as follows:
Impact Analysis of Final Changes for FY 2007 Operating Prospective Payment System
[Percent changes in payments per case]
All FY 2007 changes (4) All Hospitals 3.5 By Geographic Location: Urban hospitals 3.5 Large urban areas (populations over 1 million) 3.5 Other urban areas (populations of 1 million or fewer) 3.4 Rural hospitals 4 Bed Size (Urban): 0-99 beds 3.5 100-199 beds 3.8 200-299 beds 3.6 300-499 beds 3.4 500 or more beds 3.2 Bed Size (Rural): 0-49 beds 4.7 50-99 beds 4.9 100-149 beds 3.7 150-199 beds 3.3 200 or more beds 3.0 Urban by Region: New England 3.9 Middle Atlantic 3.9 South Atlantic 3.2 East North Central 3.4 East South Central 2.7 West North Central 2.8 West South Central 3.4 Mountain 3.7 Pacific 3.7 Puerto Rico 2.0 Rural by Region: New England 6.3 Middle Atlantic 5.2 South Atlantic 3.9 East North Central 3.8 East South Central 3.5 West North Central 4.3 West South Central 4.1 Mountain 2.7 Pacific 3.3 By Payment Classification: Urban hospitals 3.4 Large urban areas (populations over 1 million) 3.5 Other urban areas (populations of 1 million or fewer) 3.4 Rural areas 4.0 Teaching Status: Non-teaching 3.8 Fewer than 100 Residents 3.4 100 or more Residents 3.2 Urban DSH: Non-DSH 3.6 100 or more beds 3.4 Less than 100 beds 3.6 Rural DSH: SCH 4.6 RRC 3.5 Other Rural: 100 or more beds 3.5 Less than 100 beds 3.9 Urban teaching and DSH: Both teaching and DSH 3.3 Teaching and no DSH 3.3 No teaching and DSH 3.7 No teaching and no DSH 3.6 Rural Hospital Types: RRC 3.5 SCH 3.6 MDH 9.0 SCH and RRC 3.1 MDH and RRC 14.1 Unknown Type of Ownership: Voluntary 3.5 Proprietary 3.5 Government 3.4 Unknown 7.6 Medicare Utilization as a Percent of Inpatient Days: 0-25 3.6 25-50 3.3 50-65 3.7 Over 65 3.8 Unknown 4.4 Hospitals Reclassified by the Medicare Geographic Classification Review Board: FY 2005 Reclassifications Urban Hospitals Reclassified by the Medicare Geographic Classification Review Board: First Half FY 2007 Reclassifications 3.7 Urban Nonreclassified, First Half FY 2007 3.4 All Urban Hospitals Reclassified Second Half FY 2007 3.5 Urban Nonreclassified Hospitals Second Half FY 2007 3.4 All Rural Hospitals Reclassified Second Half FY 2007 3.6 Rural Nonreclassified Hospitals Second Half FY 2007 4.5 All Section 401 Reclassified Hospitals 5.4 Other Reclassified Hospitals (Section 1886(d)(8)(B)) 4.5 Section 508 Hospitals 2 Specialty Hospitals — Cardiac Specialty Hospitals 1.2 2. On pages 59903 through to 59968, in Table 2.—Hospital Case-Mix Indexes for Discharges Occurring in Federal Fiscal Year 2005; Hospital Wage Indexes for Federal Fiscal Year 2007; Hospital Average Hourly Wages for Federal Fiscal Years 2005 (2001 Wage Data), 2006 (2002 Wage Data), and 2007 (2003 Wage Data); Wage Indexes and 3-Year Average of Hospital Average Hourly Wages, for the listed providers, the wage indexes are corrected to read as follows:
a. Effective November 3, 2006
Provider No. FY 2007 wage index 040039 0.8341 040047 0.8431 070002 1.2452 070003 1.2461 070004 1.2452 070007 1.2452 070008 1.2452 070009 1.2452 070011 1.2452 070012 1.2452 070015 1.2452 070020 1.2525 070021 1.2461 070024 1.2452 070025 1.2452 070027 1.2452 070029 1.2452 070035 1.2452 Start Printed Page 571 070038 1.2452 100025 0.8847 100026 0.8847 100027 0.8847 100048 0.8847 100054 0.8847 100062 0.8907 100081 0.8847 100093 0.8847 100102 0.8972 100106 0.8847 100108 0.8847 100118 0.9245 100122 0.8847 100124 0.8847 100134 0.8847 100142 0.8847 100156 0.8972 100160 0.8847 100175 0.9078 100212 0.8907 100223 0.8847 100231 0.8847 100242 0.8847 100266 0.8847 100290 0.9429 100292 0.8847 230254 1.0381 230257 1.0381 230264 1.0381 230269 1.0381 230277 1.0381 260004 0.8341 260006 0.8341 260015 0.8345 260022 0.8615 260024 0.8341 260047 0.8348 260059 0.8341 260061 0.8341 260070 0.8341 260074 0.8499 260078 0.8341 260080 0.8341 260097 0.8766 260113 0.8341 260116 0.8341 260119 0.8345 260142 0.8341 260147 0.8341 260160 0.8341 260163 0.8341 260195 0.8341 280061 0.9048 340073 0.9828 380002 1.0282 380040 1.0152 380052 1.0152 380081 1.0152 390044 1.1196 390096 1.1196 430094 0.9048 470001 1.0770 470005 1.0383 470012 1.0383 470024 1.0383 500002 1.0390 500007 1.0598 500012 1.0390 500019 1.0603 500031 1.0390 500033 1.0390 500036 1.0390 500037 1.0390 500049 1.0390 500053 1.0390 500058 1.0390 500148 1.0390 530002 0.9128 530006 0.9128 530008 0.9128 530009 0.9128 530010 0.9128 530011 0.9128 530014 0.9128 530017 0.9128 530032 0.9128 530008 0.9057 530009 0.9057 530010 0.9057 530011 0.9057 530014 0.9057 530017 0.9057 530032 0.9057 b. Effective November 21, 2006.
Provider No. FY 2007 wage index 230013 1.0381 230019 1.0381 230029 1.0381 230047 1.0381 230071 1.0381 230130 1.0381 230151 1.0381 230195 1.0381 230204 1.0381 230207 1.0381 230223 1.0381 230227 1.0381 230254 1.0381 230257 1.0381 230264 1.0381 230269 1.0381 230277 1.0381 390065 1.0977 390138 1.0977 490005 1.0977 3. On page 59968 in Table 2.—Hospital Case-Mix Indexes for Discharges Occurring in Federal Fiscal Year 2005; Hospital Wage Indexes for Federal Fiscal Year 2007; Hospital Average Hourly Wages for Federal Fiscal Years 2005 (2001 Wage Data), 2006 (2002 Wage Data), and 2007 (2003 Wage Data); Wage Indexes and 3-Year Average of Hospital Average Hourly Wages, the table is corrected by adding a note to the end of the table to read as follows:
Note:
Due to the expiration of section 508 of the MMA, the wage index values for some hospitals will change in the second half of the fiscal year. The wage index values in this table reflect an average of the first half of FY 2007 (October 1, 2006-March 31, 2007) and second half of FY 2007 (April 1-September 30, 2007).
4. On pages 59975 through to 59998, in Table 4A-1.—Wage Index and Capital Geographic Adjustment Factor (GAF) for Urban Areas by CBSA, for the listed CBSAs, the wage indexes and GAFs are corrected to read as follows:
CBSA code Urban area (constituent counties) Wage index GAF 15540 Burlington-South Burlington, VT Chittenden County, VT 2 Franklin County, VT Grand Isle County, VT 1.0383 1.0261 23020 Fort Walton Beach-Crestview-Destin, FL2 Okaloosa County, FL 0.8847 0.9195 25540 Hartford-West Hartford-East Hartford, CT 1 2 Hartford County, CT Litchfield County, CT Middlesex County, CT Tolland County, CT 1.2452 1.1620 28420 Kennewick-Richland-Pasco, WA2 Benton County, WA Franklin County, WA 1.0390 1.0265 30300 Lewiston, ID-WA (WA Hospitals) 2 Nez Perce County, ID Asotin County, WA 1.0390 1.0265 Start Printed Page 572 31020 Longview, WA Cowlitz County, WA 1.0390 1.0265 34580 Mount Vernon-Anacortes, WA Skagit County, WA 1.0390 1.0265 35300 New Haven-Milford, CT 3 New Haven County, CT 1.2452 1.1620 35980 Norwich-New London, CT New London County, CT 1.2452 1.1620 36100 Ocala, FL2 Marion County, FL 0.8847 0.9195 37460 Panama City-Lynn Haven, FL Bay County, Fl 0.8847 0.9195 37860 Pensacola-Ferry Pass-Brent, FL Escambia County, FL Santa Rosa County, FL 0.8847 0.9195 48300 Wenatchee, WA Chelan County, WA Douglas County, WA 1.0390 1.0265 49420 Yakima, WA Yakima County, WA 1.0390 1.0265 1 Large urban area. 2 Hospitals geographically located in the area are assigned the statewide rural wage index for FY 2007. 3 For this area, the wage index and GAF on this table are only effective from October 1, 2006 through March 31, 2007. See Table 4A-2 for the values that are effective from April 1 through September 30, 2007. 5. On page 59998, in Table 4A-2.—Wage Index and Capital Geographic Adjustment Factor (GAF) for Certain Urban Areas by CBSA for the Period April 1 Through September 30, 2007, for the listed CBSAs, the wage indexes and GAFs are corrected to read as follows:
CBSA code Urban area (constituent counties) Wage index GAF 16940 Cheyenne, WY 0.9057 0.9344 35300 New Haven-Milford, CT 1.2452 1.1620 6. On pages 59998 and 59999, in Table 4B-1.—Wage Index and Capital Geographic Adjustment Factor (GAF) for Rural Areas by CBSA—FY 2007, for the listed CBSAs, the wage indexes and GAFs are corrected to read as follows:
CBSA code Nonurban area Wage index GAF 07 Connecticut 1.2452 1.1620 10 Florida 0.8847 0.9195 26 Missouri 0.8341 0.8832 38 Oregon 2 1.0152 1.0104 47 Vermont 1.0383 1.0261 50 Washington 1.0390 1.0265 7. On page 59999, in Table 4B-2.—Wage Index and Capital Geographic Adjustment Factor (GAF) for Certain Rural Areas by CBSA for the Period April 1 Through September 30, 2007, for the listed CBSA, the wage index and GAF is corrected to read as follows:
CBSA code Nonurban area Wage index GAF 53 Wyoming 0.9057 0.9344 8. On pages 59999 through to 60003, in Table 4C-1.—Wage Index and Capital Geographic Adjustment Factor (GAF) for Hospitals That Are Reclassified by CBSA, for the listed CBSAs, the wage indexes and GAFs are corrected to read as follows:
a. Effective November 3, 2006.
CBSA code Area Wage index GAF 23020 Fort Walton Beach-Crestview-Destin, FL 0.8847 0.9195 25540 Hartford-West Hartford-East Hartford, CT (CT Hospitals) 1.2452 1.1620 27860 Jonesboro, AR (MO Hospitals) 0.8345 0.8835 28420 Kennewick-Richland-Pasco, WA 1.0390 1.0265 38340 Pittsfield, MA 1.0383 1.0261 Start Printed Page 573 07 Connecticut 1.2452 1.1620 10 Florida (FL Hospitals) 0.8847 0.9195 14 Illinois (MO Hospitals) 0.8341 0.8832 16 Iowa 0.8615 0.9029 26 Missouri 0.8341 0.8832 30 New Hampshire 1.0770 1.0521 38 Oregon 1.0152 1.0104 50 Washington (WA Hospitals) 1.0390 1.0265 53 Wyoming 0.9048 0.9338 b. Effective November 21, 2006.
CBSA code Area Wage index GAF 47894 Washington-Arlington-Alexandria, DC-VA-MD-WV 1.0977 1.0659 9. On page 60003, in Table 4C-2.—Wage Index and Capital Geographic Adjustment Factor (GAF) for Certain Hospitals That Are Reclassified by CBSA for the Period April 1 Through September 30, 2007*, CBSAs 35300 and 19804 are corrected and CBSA 47894 is added. The wage indexes and GAFs are corrected to read as follows:
a. Effective November 3, 2006.
CBSA code Area Wage index GAF 19804 Detroit-Livonia-Dearborn, MI 1.0381 1.0192 35300 New Haven-Milford, CT 1.2452 1.1620 b. Effective November 21, 2006.
CBSA code Area Wage index GAF 47894 Washington-Arlington-Alexandria, DC-VA-MD-WV 1.0977 1.0659 10. On pages 60004 through to 60012, in Table 4J.—Out-Migration Adjustment—FY 2007, provider number 010009 is corrected and provider number 010010 is added to read as follows:
a. Effective October 1, 2006.
Provider No. Reclassified between 10/1/06 and 3/31/07 Reclassified between 4/1/07 and 9/30/07 Out-migration adjustment Qualifying county name 010009 * * 0.0092 MORGAN. 010010 * * 0.0259 MARSHALL. 11. On pages 60013 through to 60025, in Table 5.—List of Diagnosis-Related Groups (DRGS), Relative Weighting Factors, and Geometric and Arithmetic Mean Length of Stay (LOS), DRGs 525, 544, and 572 are corrected to read as follows:
a. Effective October 1, 2006.
DRG FY 07 final rule post-acute care DRG FY 07 final rule special pay DRG MDC Type DRG title Weights Geometric mean LOS Arithmetic mean LOS 525 No No 05 SURG Other Heart Assist System Implant 2.2268 7.7 14.3 544 Yes Yes 08 SURG Major Joint Replacement or Reattachment of Lower Extremity 1.9878 4.0 4.4 572 Yes No 06 MED Major Gastrointestinal Disorders and Peritoneal Infections 1.3378 5.6 7.1 12. On page 60025 in Table 5.—List of Diagnosis-Related Groups (DRGs), Relative Weighting Factors, and Geometric and Arithmetic Mean Length of Stay (LOS), the table is corrected by adding the following notes to the end of the table:
a. Effective October 1, 2006.
Note:
If there is an asterisk in the “Type” column this means that data is unavailable to calculate weights for these low volume DRGs. Therefore, last year's weights have been updated based on the percent change in Start Printed Page 574normalization factors between FY 2006 and FY 2007.
Note:
If there is no value or dashes (that is, “----”) in either the geometric mean LOS or the arithmetic mean LOS columns, the volume of cases is insufficient to determine a meaningful computation of these statistics.
IV. Discussion of Effective Date and Notice and Comment Rulemaking
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)). In addition, a final rule would ordinarily require a 30-day delay in effective date after the date of publication in the Federal Register. This correction of the rates published in the FY 2007 IPPS notice does not constitute a rule under the Administrative Procedure Act, because, in our FY 2007 IPPS final rule (71 FR 47870, August 18, 2006), we already published the methodologies and formulas we use for determining the wage index, geographic adjustment factors, and other rates. This notice does not change our methodology or formulas, but merely ensures that our rules are implemented correctly. As this notice is not a rule under the Administrative Procedure Act, no notice of proposed rulemaking or delay in effective date is necessary.
Start SignatureEnd Signature End Supplemental Information(Catalog of Federal Domestic Assistance Program No. 93.773, Medicare—Hospital Insurance; and Program No. 93.774, Medicare—Supplementary Medical Insurance Program.)
Dated: December 28, 2006.
Ashley Files Flory,
Deputy Executive Secretary to the Department.
[FR Doc. 06-9976 Filed 12-29-06; 1:29 pm]
BILLING CODE 4120-01-P
Document Information
- Published:
- 01/05/2007
- Department:
- Centers for Medicare & Medicaid Services
- Entry Type:
- Notice
- Action:
- Correction of notice.
- Document Number:
- 06-9976
- Pages:
- 569-574 (6 pages)
- Docket Numbers:
- CMS-1488-CN2
- RINs:
- 0938-A012
- PDF File:
- 06-9976.pdf