03-24549. Medicare Program; Prospective Payment System and Consolidated Billing for Skilled Nursing Facilities; Correction
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Start Preamble
AGENCY:
Centers for Medicare & Medicaid Services (CMS), HHS.
ACTION:
Correction of final rule.
SUMMARY:
This document corrects technical errors that appeared in the final rule published in the Federal Register on August 4, 2003, entitled “Medicare Program; Prospective Payment System and Consolidated Billing for Skilled Nursing Facilities.”
EFFECTIVE DATE:
This correction is effective October 1, 2003.
Start Further InfoFOR FURTHER INFORMATION CONTACT:
Jeanette Kranacs, (410) 786-9385, or Sheila Lambowitz, (410) 786-7605.
End Further Info End Preamble Start Supplemental InformationSUPPLEMENTARY INFORMATION:
I. Background
In FR Doc. 03-19677 of August 4, 2003 (68 FR 46036), there were a number of technical errors that are identified and corrected in the “Correction of Errors” section below. The provisions in this correction document are effective as if they had been included in the document published August 4, 2003. Accordingly, the corrections are effective October 1, 2003.
In previous years, we have issued correction notices with respect to payment rates under the prospective payment system (PPS) for skilled nursing facilities (SNFs), reflecting minor adjustments to the hospital wage index relating to specific Metropolitan Statistical Areas (MSAs). For example, for fiscal year (FY) 2003, we issued a correction notice (December 27, 2002, 67 FR 79123) to update two MSA wage indexes. We did not recalculate the SNF budget neutrality factor as a result of these minor revisions.
However, it was recently determined that computational errors in the hospital wage index calculation process for FY 2004 were of sufficient magnitude to affect all of the published PPS payment rates for inpatient hospital services. A description of those computational errors will be included in a notice specific to the hospital inpatient PPS. As we explained in the August 4, 2003 final rule, the SNF wage index values reflect the wage data used in the FY 2004 inpatient hospital PPS rates, and therefore, we believe it would be appropriate to incorporate corrections to the inpatient hospital wage index. The scope of the resulting corrections to the hospital wage index will, in turn, necessitate revising the budget neutrality factor for the SNF PPS for FY 2004 as well. We note that correcting these computational errors is a purely Start Printed Page 55883administrative function that does not result in any change of policy or payment methodology.
Accordingly, in this correction document, we are republishing the SNF PPS payment rate tables (that is, Tables 1 through 9, inclusive) that appeared in the August 4, 2003 final rule, in order to show the corrected rates. (We note that we are not republishing Table 10 (FY 2004 Labor-Related Share (68 FR 46057)), as this table solely involves the relative importance of the various components of the labor-related share, and those figures have not changed from those that appeared in the final rule.) Further, we are republishing Table 11, which displays the projected impact of the FY 2004 SNF PPS payment update, including the variation in impact by region and by certain other facility characteristics. We note that the effect of the corrections being made in this notice is solely distributional in nature and, accordingly, that there is no change in the estimated aggregate expenditures for FY 2004 as set forth in the August 4, 2003 final rule. A further discussion of the projected impact of the FY 2004 SNF PPS payment update can be found in the August 4, 2003 final rule (68 FR 46067). In addition, the FY 2004 budget neutrality factor of 1.005 that appeared in the final rule (68 FR 46047) is hereby revised to 1.0016.
Finally, in the August 4, 2003 final rule (68 FR 46060), we added two radiopharmaceuticals, Zevalin and Bexxar, to the list of chemotherapy drugs that are excluded from consolidated billing (and, thus, are separately billable to Part B when furnished to a SNF resident during a covered Part A stay). We note that Healthcare Common Procedure Coding System (HCPCS) coding for Bexxar is currently in the process of being developed. Further, while the final rule identified HCPCS codes A9522 and A9523 for Zevalin, we note that the outpatient hospital PPS currently uses HCPCS codes G0273 and G0274 for Zevalin instead, and that further revision of these particular codes is possible in the near future. As we stated in the final rule, the consolidated billing exclusions will appear in a Consolidated Billing Annual Update Program Memorandum that we will issue at the end of CY 2003, and will be effective as of January 1, 2004 (68 FR 46059). Accordingly, we are clarifying as an interpretive matter that the HCPCS codes to be utilized in connection with Bexxar and Zevalin include any successor codes that may replace the codes currently listed in the regulation. Such successor codes would be disseminated through program instructions. Once HCPCS coding has been developed for Bexxar (and has been definitively established for Zevalin), we will make revisions, as appropriate, to the particular codes that appear in the regulations text at § 411.15(p)(2)(xii) and § 489.20(s)(12).
II. Correction of Errors
In FR Doc. 03-19677 of August 4, 2003 (68 FR 46036), make the following corrections:
Corrections to Preamble
1. On page 46040, Tables 1 and 2 are revised to read as follows:
Table 1.—FY 2004 Unadjusted Federal Rate Per Diem—Urban
Rate component Nursing— case-mix Therapy— case-mix Therapy— non-case- mix Non-case- mix Per Diem Amount $129.52 $97.56 $12.85 $66.10 Table 2.—FY 2004 Unadjusted Federal Rate Per Diem—Rural
Rate component Nursing— case-mix Therapy— case-mix Therapy— non-case- mix Non-case- mix Per Diem Amount $123.74 $112.50 $13.72 $67.33 2. On pages 46042 through 46043, Table 3 is revised to read as follows:
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3. On Pages 46044 through 46045, Table 4 is revised to read as follows:
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4. On page 46047, in the third column; in the first paragraph, the budget neutrality factor of “1.005” that appears in the penultimate sentence is revised to read “1.0016”.
5. On page 46048, Table 5 is revised to read as follows:
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6. On page 46049, Table 6 is revised to read as follows:
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7. On Pages 46050 through 46056, Table 7 is revised to read as follows:
Table 7.—Wage Index for Urban Areas
Urban area (constituent counties or county equivalents) Wage index 0040 Abilene, TX 0.7627 Taylor, TX 0060 Aguadilla, PR 0.4306 Aguada, PR Aguadilla, PR Moca, PR 0080 Akron, OH 0.9246 Portage, OH Summit, OH 0120 Albany, GA 1.0863 Dougherty, GA Lee, GA 0160 Albany-Schenectady-Troy, NY 0.8489 Albany, NY Montgomery, NY Rensselaer, NY Saratoga, NY Schenectady, NY Schoharie, NY 0200 Albuquerque, NM 0.9300 Bernalillo, NM Sandoval, NM Valencia, NM 0220 Alexandria, LA 0.8019 Rapides, LA 0240 Allentown-Bethlehem-Easton, PA 0.9721 Carbon, PA Lehigh, PA Northampton, PA 0280 Altoona, PA 0.8806 Blair, PA 0320 Amarillo, TX 0.8986 Potter, TX Randall, TX 0380 Anchorage, AK 1.2216 Anchorage, AK 0440 Ann Arbor, MI 1.1074 Lenawee, MI Livingston, MI Washtenaw, MI 0450 Anniston, AL 0.8090 Calhoun, AL 0460 Appleton-Oshkosh-Neenah, WI 0.9035 Calumet, WI Outagamie, WI Winnebago, WI 0470 Arecibo, PR 0.4155 Arecibo, PR Camuy, PR Hatillo, PR 0480 Asheville, NC 0.9720 Buncombe, NC Madison, NC 0500 Athens, GA 0.9818 Clarke, GA Madison, GA Oconee, GA 0520 Atlanta, GA 1.0130 Barrow, GA Bartow, GA Carroll, GA Cherokee, GA Clayton, GA Cobb, GA Coweta, GA De Kalb, GA Douglas, GA Fayette, GA Forsyth, GA Fulton, GA Gwinnett, GA Henry, GA Newton, GA Paulding, GA Pickens, GA Rockdale, GA Spalding, GA Walton, GA 0560 Atlantic City-Cape May, NJ 1.0795 Atlantic City, NJ Cape May, NJ 0580 Auburn-Opelika, AL 0.8494 Lee, AL 0600 Augusta-Aiken, GA-SC 0.9625 Columbia, GA McDuffie, GA Richmond, GA Aiken, SC Edgefield, SC 0640 Austin-San Marcos, TX 0.9609 Bastrop, TX Caldwell, TX Hays, TX Travis, TX Williamson, TX 0680 Bakersfield, CA 0.9810 Kern, CA 0720 Baltimore, MD 0.9919 Anne Arundel, MD Baltimore, MD Baltimore City, MD Carroll, MD Harford, MD Howard, MD Queen Annes, MD 0733 Bangor, ME 0.9904 Penobscot, ME 0743 Barnstable-Yarmouth, MA 1.2956 Barnstable, MA 0760 Baton Rouge, LA 0.8406 Ascension, LA East Baton Rouge, LA Livingston, LA West Baton Rouge, LA 0840 Beaumont-Port Arthur, TX 0.8424 Hardin, TX Jefferson, TX Orange, TX 0860 Bellingham, WA 1.1757 Whatcom, WA 0870 Benton Harbor, MI 0.8871 Berrien, MI 0875 Bergen-Passaic, NJ 1.1692 Bergen, NJ Passaic, NJ 0880 Billings, MT 0.8961 Yellowstone, MT 0920 Biloxi-Gulfport-Pascagoula, MS 0.9029 Hancock, MS Harrison, MS Jackson, MS 0960 Binghamton, NY 0.8428 Broome, NY Tioga, NY 1000 Birmingham, AL 0.9212 Blount, AL Jefferson, AL St. Clair, AL Shelby, AL 1010 Bismarck, ND 0.7965 Burleigh, ND Morton, ND 1020 Bloomington, IN 0.8662 Monroe, IN 1040 Bloomington-Normal, IL 0.8832 McLean, IL 1080 Boise City, ID 0.9209 Ada, ID Canyon, ID 1123 Boston-Worcester-Lawrence-Lowell-Brockton, MA-NH 1.1233 Bristol, MA Essex, MA Middlesex, MA Norfolk, MA Plymouth, MA Suffolk, MA Worcester, MA Hillsborough, NH Merrimack, NH Rockingham, NH Strafford, NH 1125 Boulder-Longmont, CO 1.0049 Boulder, CO 1145 Brazoria, TX 0.8137 Brazoria, TX 1150 Bremerton, WA Kitsap, WA 1240 Brownsville-Harlingen-San Benito, TX 1.0303 Cameron, TX 1260 Bryan-College Station, TX 0.9019 Brazos, TX 1280 Buffalo-Niagara Falls, NY 0.9604 Erie, NY Niagara, NY 1303 Burlington, VT 0.9704 Chittenden, VT Franklin, VT Grand Isle, VT 1310 Caguas, PR 0.4158 Caguas, PR Cayey, PR Cidra, PR Gurabo, PR San Lorenzo, PR 1320 Canton-Massillon, OH 0.9071 Carroll, OH Stark, OH 1350 Casper, WY 0.9095 Natrona, WY 1360 Cedar Rapids, IA 0.8874 Linn, IA 1400 Champaign-Urbana, IL 0.9907 Start Printed Page 55891 Champaign, IL 1440 Charleston-North Charleston, SC 0.9332 Berkeley, SC Charleston, SC Dorchester, SC 1480 Charleston, WV 0.8880 Kanawha, WV Putnam, WV 1520 Charlotte-Gastonia-Rock Hill, NC-SC 0.9760 Cabarrus, NC Gaston, NC Lincoln, NC Mecklenburg, NC Rowan, NC Stanly, NC Union, NC York, SC 1540 Charlottesville, VA 1.0025 Albemarle, VA Charlottesville City, VA Fluvanna, VA Greene, VA 1560 Chattanooga, TN-GA 0.9086 Catoosa, GA Dade, GA Walker, GA Hamilton, TN Marion, TN 1580 Cheyenne, WY 0.8796 Laramie, WY 1600 Chicago, IL 1.0892 Cook, IL De Kalb, IL Du Page, IL Grundy, IL Kane, IL Kendall, IL Lake, IL McHenry, IL Will, IL 1620 Chico-Paradise, CA 1.0193 Butte, CA 1640 Cincinnati, OH-KY-IN 0.9413 Dearborn, IN Ohio, IN Boone, KY Campbell, KY Gallatin, KY Grant, KY Kenton, KY Pendleton, KY Brown, OH Clermont, OH Hamilton, OH Warren, OH 1660 Clarksville-Hopkinsville, TN-KY 0.8244 Christian, KY Montgomery, TN 1680 Cleveland-Lorain-Elyria, OH 0.9671 Ashtabula, OH Geauga, OH Cuyahoga, OH Lake, OH Lorain, OH Medina, OH 1720 Colorado Springs, CO 0.9833 El Paso, CO 1740 Columbia, MO 0.8695 Boone, MO 1760 Columbia, SC 0.8902 Lexington, SC Richland, SC 1800 Columbus, GA-AL 0.8694 Russell, AL Chattanoochee, GA Harris, GA Muscogee, GA 1840 Columbus, OH 0.9648 Delaware, OH Fairfield, OH Franklin, OH Licking, OH Madison, OH Pickaway, OH 1880 Corpus Christi, TX 0.8521 Nueces, TX San Patricio, TX 1890 Corvallis, OR 1.1516 Benton, OR 1900 Cumberland, MD-WV 0.8200 Allegany, MD Mineral, WV 1920 Dallas, TX 0.9974 Collin, TX Dallas, TX Denton, TX Ellis, TX Henderson, TX Hunt, TX Kaufman, TX Rockwall, TX 1950 Danville, VA 0.9035 Danville City, VA Pittsylvania, VA 1960 Davenport-Moline-Rock Island, IA-IL 0.8985 Scott, IA Henry, IL Rock Island, IL 2000 Dayton-Springfield, OH 0.9518 Clark, OH Greene, OH Miami, OH Montgomery, OH 2020 Daytona Beach, FL 0.9078 Flagler, FL Volusia, FL 2030 Decatur, AL 0.8828 Lawrence, AL Morgan, AL 2040 Decatur, IL 0.8161 Macon, IL 2080 Denver, CO 1.0837 Adams, CO Arapahoe, CO Denver, CO Douglas, CO Jefferson, CO 2120 Des Moines, IA 0.9106 Dallas, IA Polk, IA Warren, IA 2160 Detroit, MI 1.0101 Lapeer, MI Macomb, MI Monroe, MI Oakland, MI St. Clair, MI Wayne, MI 2180 Dothan, AL 0.7741 Dale, AL Houston, AL 2190 Dover, DE 0.9805 Kent, DE 2200 Dubuque, IA 0.8886 Dubuque, IA 2240 Duluth-Superior, MN-WI 1.0171 St. Louis, MN Douglas, WI 2281 Dutchess County, NY 1.0934 Dutchess, NY 2290 Eau Claire, WI 0.9064 Chippewa, WI Eau Claire, WI 2320 El Paso, TX 0.9196 El Paso, TX 2330 Elkhart-Goshen, IN 0.9783 Elkhart, IN 2335 Elmira, NY 0.8377 Chemung, NY 2340 Enid, OK 0.8559 Garfield, OK 2360 Erie, PA 0.8601 Erie, PA 2400 Eugene-Springfield, OR 1.1456 Lane, OR 2440 Evansville-Henderson, IN-KY 0.8429 Posey, IN Vanderburgh, IN Warrick, IN Henderson, KY 2520 Fargo-Moorhead, ND-MN 0.9797 Clay, MN Cass, ND 2560 Fayetteville, NC 0.8986 Cumberland, NC 2580 Fayetteville-Springdale-Rogers, AR 0.8396 Benton, AR Washington, AR 2620 Flagstaff, AZ-UT 1.1333 Coconino, AZ Kane, UT 2640 Flint, MI 1.0858 Genesee, MI 2650 Florence, AL 0.7747 Colbert, AL Lauderdale, AL 2655 Florence, SC 0.8709 Florence, SC 2670 Fort Collins-Loveland, CO 1.0108 Larimer, CO 2680 Ft. Lauderdale, FL 1.0163 Broward, FL 2700 Fort Myers-Cape Coral, FL 0.9816 Lee, FL 2710 Fort Pierce-Port St. Lucie, FL 1.0008 Martin, FL St. Lucie, FL 2720 Fort Smith, AR-OK 0.8424 Start Printed Page 55892 Crawford, AR Sebastian, AR Sequoyah, OK 2750 Fort Walton Beach, FL 0.8966 Okaloosa, FL 2760 Fort Wayne, IN 0.9585 Adams, IN Allen, IN De Kalb, IN Huntington, IN Wells, IN Whitley, IN 2800 Forth Worth-Arlington, TX 0.9359 Hood, TX Johnson, TX Parker, TX Tarrant, TX 2840 Fresno, CA 1.0094 Fresno, CA Madera, CA 2880 Gadsden, AL 0.8206 Etowah, AL 2900 Gainesville, FL 0.9693 Alachua, FL 2920 Galveston-Texas City, TX 0.9279 Galveston, TX 2960 Gary, IN 0.9410 Lake, IN Porter, IN 2975 Glens Falls, NY 0.8475 Warren, NY Washington, NY 2980 Goldsboro, NC 0.8622 Wayne, NC 2985 Grand Forks, ND-MN 0.8636 Polk, MN Grand Forks, ND 2995 Grand Junction, CO 0.9633 Mesa, CO 3000 Grand Rapids-Muskegon-Holland, MI 0.9469 Allegan, MI Kent, MI Muskegon, MI Ottawa, MI 3040 Great Falls, MT 0.8809 Cascade, MT 3060 Greeley, CO 0.9372 Weld, CO 3080 Green Bay, WI 0.9461 Brown, WI 3120 Greensboro-Winston-Salem-High Point, NC 0.9166 Alamance, NC Davidson, NC Davie, NC Forsyth, NC Guilford, NC Randolph, NC Stokes, NC Yadkin, NC 3150 Greenville, NC 0.9098 Pitt, NC 3160 Greenville-Spartanburg-Anderson, SC 0.9335 Anderson, SC Cherokee, SC Greenville, SC Pickens, SC Spartanburg, SC 3180 Hagerstown, MD 0.9172 Washington, MD 3200 Hamilton-Middletown, OH 0.9214 Butler, OH 3240 Harrisburg-Lebanon-Carlisle, PA 0.9164 Cumberland, PA Dauphin, PA Lebanon, PA Perry, PA 3283 Hartford, CT 1.1555 Hartford, CT Litchfield, CT Middlesex, CT Tolland, CT 3285 Hattiesburg, MS 0.7307 Forrest, MS Lamar, MS 3290 Hickory-Morganton-Lenoir, NC 0.9242 Alexander, NC Burke, NC Caldwell, NC Catawba, NC 3320 Honolulu, HI 1.1098 Honolulu, HI 3350 Houma, LA 0.7748 Lafourche, LA Terrebonne, LA 3360 Houston, TX 0.9834 Chambers, TX Fort Bend, TX Harris, TX Liberty, TX Montgomery, TX Waller, TX 3400 Huntington-Ashland, WV-KY-OH 0.9595 Boyd, KY Carter, KY Greenup, KY Lawrence, OH Cabell, WV Wayne, WV 3440 Huntsville, AL 0.9245 Limestone, AL Madison, AL 3480 Indianapolis, IN 0.9916 Boone, IN Hamilton, IN Hancock, IN Hendricks, IN Johnson, IN Madison, IN Marion, IN Morgan, IN Shelby, IN 3500 Iowa City, IA 0.9548 Johnson, IA 3520 Jackson, MI 0.8986 Jackson, MI 3560 Jackson, MS 0.8357 Hinds, MS Madison, MS Rankin, MS 3580 Jackson, TN 0.8984 Chester, TN Madison, TN 3600 Jacksonville, FL 0.9529 Clay, FL Duval, FL Nassau, FL St. Johns, FL 3605 Jacksonville, NC 0.8544 Onslow, NC 3610 Jamestown, NY 0.7762 Chautaqua, NY 3620 Janesville-Beloit, WI 0.9282 Rock, WI 3640 Jersey City, NJ 1.1115 Hudson, NJ 3660 Johnson City-Kingsport-Bristol, TN-VA 0.8253 Carter, TN Hawkins, TN Sullivan, TN Unicoi, TN Washington, TN Bristol City, VA Scott, VA Washington, VA 3680 Johnstown, PA 0.8158 Cambria, PA Somerset, PA 3700 Jonesboro, AR 0.7794 Craighead, AR 3710 Joplin, MO 0.8681 Jasper, MO Newton, MO 3720 Kalamazoo-Battle Creek, MI 1.0500 Calhoun, MI Kalamazoo, MI Van Buren, MI 3740 Kankakee, IL 1.0419 Kankakee, IL 3760 Kansas City, KS-MO 0.9715 Johnson, KS Leavenworth, KS Miami, KS Wyandotte, KS Cass, MO Clay, MO Clinton, MO Jackson, MO Lafayette, MO Platte, MO Ray, MO 3800 Kenosha, WI 0.9761 Kenosha, WI 3810 Killeen-Temple, TX 0.9159 Bell, TX Coryell, TX 3840 Knoxville, TN 0.8820 Anderson, TN Blount, TN Knox, TN Loudon, TN Sevier, TN Union, TN 3850 Kokomo, IN 0.9045 Start Printed Page 55893 Howard, IN Tipton, IN 3870 La Crosse, WI-MN 0.9247 Houston, MN La Crosse, WI 3880 Lafayette, LA 0.8189 Acadia, LA Lafayette, LA St. Landry, LA St. Martin, LA 3920 Lafayette, IN 0.8584 Clinton, IN Tippecanoe, IN 3960 Lake Charles, LA 0.7841 Calcasieu, LA 3980 Lakeland-Winter Haven, FL 0.8811 Polk, FL 4000 Lancaster, PA 0.9282 Lancaster, PA 4040 Lansing-East Lansing, MI 0.9714 Clinton, MI Eaton, MI Ingham, MI 4080 Laredo, TX 0.8091 Webb, TX 4100 Las Cruces, NM 0.8688 Dona Ana, NM 4120 Las Vegas, NV-AZ 1.1528 Mohave, AZ Clark, NV Nye, NV 4150 Lawrence, KS 0.8677 Douglas, KS 4200 Lawton, OK 0.8267 Comanche, OK 4243 Lewiston-Auburn, ME 0.9383 Androscoggin, ME 4280 Lexington, KY 0.8685 Bourbon, KY Clark, KY Fayette, KY Jessamine, KY Madison, KY Scott, KY Woodford, KY 4320 Lima, OH 0.9522 Allen, OH Auglaize, OH 4360 Lincoln, NE 1.0033 Lancaster, NE 4400 Little Rock-North Little Rock, AR 0.8923 Faulkner, AR Lonoke, AR Pulaski, AR Saline, AR 4420 Longview-Marshall, TX 0.9113 Gregg, TX Harrison, TX Upshur, TX 4480 Los Angeles-Long Beach, CA 1.1795 Los Angeles, CA 4520 Louisville, KY-IN 0.9242 Clark, IN Floyd, IN Harrison, IN Scott, IN Bullitt, KY Jefferson, KY Oldham, KY 4600 Lubbock, TX 0.8272 Lubbock, TX 4640 Lynchburg, VA 0.9134 Amherst, VA Bedford City, VA Bedford, VA Campbell, VA Lynchburg City, VA 4680 Macon, GA 0.8953 Bibb, GA Houston, GA Jones, GA Peach, GA Twiggs, GA 4720 Madison, WI 1.0264 Dane, WI 4800 Mansfield, OH 0.9180 Crawford, OH Richland, OH 4840 Mayaguez, PR 0.4795 Anasco, PR Cabo Rojo, PR Hormigueros, PR Mayaguez, PR Sabana Grande, PR San German, PR 4880 McAllen-Edinburg-Mission, TX 0.8381 Hidalgo, TX 4890 Medford-Ashland, OR 1.0772 Jackson, OR 4900 Melbourne-Titusville-Palm Bay, FL 0.9776 Brevard, FL 4920 Memphis, TN-AR-MS 0.9009 Crittenden, AR De Soto, MS Fayette, TN Shelby, TN Tipton, TN 4940 Merced, CA 0.9690 Merced, CA 5000 Miami, FL 0.9894 Dade, FL 5015 Middlesex-Somerset-Hunterdon, NJ 1.1366 Hunterdon, NJ Middlesex, NJ Somerset, NJ 5080 Milwaukee-Waukesha, WI 0.9988 Milwaukee, WI Ozaukee, WI Washington, WI Waukesha, WI 5120 Minneapolis-St Paul, MN-WI 1.1001 Anoka, MN Carver, MN Chisago, MN Dakota, MN Hennepin, MN Isanti, MN Ramsey, MN Scott, MN Sherburne, MN Washington, MN Wright, MN Pierce, WI St. Croix, WI 5140 Missoula, MT 0.8718 Missoula, MT 5160 Mobile, AL 0.7994 Baldwin, AL Mobile, AL 5170 Modesto, CA 1.1275 Stanislaus, CA 5190 Monmouth-Ocean, NJ 1.0956 Monmouth, NJ Ocean, NJ 5200 Monroe, LA 0.7922 Ouachita, LA 5240 Montgomery, AL 0.7907 Autauga, AL Elmore, AL Montgomery, AL 5280 Muncie, IN 0.8775 Delaware, IN 5330 Myrtle Beach, SC 0.9112 Horry, SC 5345 Naples, FL 0.9790 Collier, FL 5360 Nashville, TN 0.9855 Cheatham, TN Davidson, TN Dickson, TN Robertson, TN Rutherford TN Sumner, TN Williamson, TN Wilson, TN 5380 Nassau-Suffolk, NY 1.3140 Nassau, NY Suffolk, NY 5483 New Haven-Bridgeport-Stamford-Waterbury-Danbury, CT 1.2385 Fairfield, CT New Haven, CT 5523 New London-Norwich, CT 1.1631 New London, CT 5560 New Orleans, LA 0.9174 Jefferson, LA Orleans, LA Plaquemines, LA St. Bernard, LA St. Charles, LA St. James, LA St. John The Baptist, LA St. Tammany, LA 5600 New York, NY 1.4018 Start Printed Page 55894 Bronx, NY Kings, NY New York, NY Putnam, NY Queens, NY Richmond, NY Rockland, NY Westchester, NY 5640 Newark, NJ 1.1518 Essex, NJ Morris, NJ Sussex, NJ Union, NJ Warren, NJ 5660 Newburgh, NY-PA 1.1509 Orange, NY Pike, PA 5720 Norfolk-Virginia Beach-Newport News, VA-NC 0.8619 Currituck, NC Chesapeake City, VA Gloucester, VA Hampton City, VA Isle of Wight, VA James City, VA Mathews, VA Newport News City, VA Norfolk City, VA Poquoson City, VA Portsmouth City, VA Suffolk City, VA Virginia Beach City VA Williamsburg City, VA York, VA 5775 Oakland, CA 1.4921 Alameda, CA Contra Costa, CA 5790 Ocala, FL 0.9728 Marion, FL 5800 Odessa-Midland, TX 0.9327 Ector, TX Midland, TX 5880 Oklahoma City, OK 0.8984 Canadian, OK Cleveland, OK Logan, OK McClain, OK Oklahoma, OK Pottawatomie, OK 5910 Olympia, WA 1.0963 Thurston, WA 5920 Omaha, NE-IA 0.9745 Pottawattamie, IA Cass, NE Douglas, NE Sarpy, NE Washington, NE 5945 Orange County, CA 1.1372 Orange, CA 5960 Orlando, FL 0.9654 Lake, FL Orange, FL Osceola, FL Seminole, FL 5990 Owensboro, KY 0.8374 Daviess, KY 6015 Panama City, FL 0.8202 Bay, FL 6020 Parkersburg-Marietta, WV-OH 0.8039 Washington, OH Wood, WV 6080 Pensacola, FL 0.8707 Escambia, FL Santa Rosa, FL 6120 Peoria-Pekin, IL 0.8734 Peoria, IL Tazewell, IL Woodford, IL 6160 Philadelphia, PA-NJ 1.0883 Burlington, NJ Camden, NJ Gloucester, NJ Salem, NJ Bucks, PA Chester, PA Delaware, PA Montgomery, PA Philadelphia, PA 6200 Phoenix-Mesa, AZ 1.0129 Maricopa, AZ Pinal, AZ 6240 Pine Bluff, AR 0.7865 Jefferson, AR 6280 Pittsburgh, PA 0.8901 Allegheny, PA Beaver, PA Butler, PA Fayette, PA Washington, PA Westmoreland, PA 6323 Pittsfield, MA 1.0276 Berkshire, MA 6340 Pocatello, ID 0.9042 Bannock, ID 6360 Ponce, PR 0.4708 Guayanilla, PR Juana Diaz, PR Penuelas, PR Ponce, PR Villalba, PR Yauco, PR 6403 Portland, ME 0.9949 Cumberland, ME Sagadahoc, ME York, ME 6440 Portland-Vancouver, OR-WA 1.1213 Clackamas, OR Columbia, OR Multnomah, OR Washington, OR Yamhill, OR Clark, WA 6483 Providence-Warwick-Pawtucket, RI 1.0977 Bristol, RI Kent, RI Newport, RI Providence, RI Washington, RI 6520 Provo-Orem, UT 0.9976 Utah, UT 6560 Pueblo, CO 0.8778 Pueblo, CO 6580 Punta Gorda, FL 0.9510 Charlotte, FL 6600 Racine, WI 0.8814 Racine, WI 6640 Raleigh-Durham-Chapel Hill, NC 0.9959 Chatham, NC Durham, NC Franklin, NC Johnston, NC Orange, NC Wake, NC 6660 Rapid City, SD 0.8806 Pennington, SD 6680 Reading, PA 0.9133 Berks, PA 6690 Redding, CA 1.1352 Shasta, CA 6720 Reno, NV 1.0682 Washoe, NV 6740 Richland-Kennewick-Pasco, WA 1.0609 Benton, WA Franklin, WA 6760 Richmond-Petersburg, VA 0.9349 Charles City County, VA Chesterfield, VA Colonial Heights City, VA Dinwiddie, VA Goochland, VA Hanover, VA Henrico, VA Hopewell City, VA New Kent, VA Petersburg City, VA Powhatan, VA Prince George, VA Richmond City, VA 6780 Riverside-San Bernardino, CA 1.1341 Riverside, CA San Bernardino, CA 6800 Roanoke, VA 0.8700 Botetourt, VA Roanoke, VA Roanoke City, VA Salem City, VA 6820 Rochester, MN 1.1739 Olmsted, MN 6840 Rochester, NY 0.9430 Genesee, NY Livingston, NY Monroe, NY Ontario, NY Orleans, NY Wayne, NY 6880 Rockford, IL 0.9666 Boone, IL Ogle, IL Winnebago, IL 6895 Rocky Mount, NC 0.9076 Edgecombe, NC Nash, NC 6920 Sacramento, CA 1.1845 El Dorado, CA Placer, CA Sacramento, CA 6960 Saginaw-Bay City-Midland, MI 1.0032 Bay, MI Midland, MI Saginaw, MI 6980 St. Cloud, MN 0.9506 Start Printed Page 55895 Benton, MN Stearns, MN 7000 St. Joseph, MO 0.9757 Andrews, MO Buchanan, MO 7040 St. Louis, MO-IL 0.9033 Clinton, IL Jersey, IL Madison, IL Monroe, IL St. Clair, IL Franklin, MO Jefferson, MO Lincoln, MO St. Charles, MO St. Louis, MO St. Louis City, MO Warren, MO Sullivan City, MO 7080 Salem, OR 1.0482 Marion, OR Polk, OR 7120 Salinas, CA 1.4339 Monterey, CA 7160 Salt Lake City-Ogden, UT 0.9913 Davis, UT Salt Lake, UT Weber, UT 7200 San Angelo, TX 0.8535 Tom Green, TX 7240 San Antonio, TX 0.8870 Bexar, TX Comal, TX Guadalupe, TX Wilson, TX 7320 San Diego, CA 1.1147 San Diego, CA 7360 San Francisco, CA 1.4514 Marin, CA San Francisco, CA San Mateo, CA 7400 San Jose, CA 1.4626 Santa Clara, CA 7440 San Juan-Bayamon, PR 0.4909 Aguas Buenas, PR Barceloneta, PR Bayamon, PR Canovanas, PR Carolina, PR Catano, PR Ceiba, PR Comerio, PR Corozal, PR Dorado, PR Fajardo, PR Florida, PR Guaynabo, PR Humacao, PR Juncos, PR Los Piedras, PR Loiza, PR Luguillo, PR Manati, PR Morovis, PR Naguabo, PR Naranjito, PR Rio Grande, PR San Juan, PR Toa Alta, PR Toa Baja, PR Trujillo Alto, PR Vega Alta, PR Vega Baja, PR Yabucoa, PR 7460 San Luis Obispo-Atascadero-Paso Robles, CA 1.1429 San Luis Obispo, CA 7480 Santa Barbara-Santa Maria-Lompoc, CA 1.0441 Santa Barbara, CA 7485 Santa Cruz-Watsonville, CA 1.2942 Santa Cruz, CA 7490 Santa Fe, NM 1.0653 Los Alamos, NM Santa Fe, NM 7500 Santa Rosa, CA 1.2877 Sonoma, CA 7510 Sarasota-Bradenton, FL 0.9964 Manatee, FL Sarasota, FL 7520 Savannah, GA 0.9472 Bryan, GA Chatham, GA Effingham, GA 7560 Scranton-Wilkes-Barre—Hazleton, PA 0.8412 Columbia, PA Lackawanna, PA Luzerne, PA Wyoming, PA 7600 Seattle-Bellevue-Everett, WA 1.1562 Island, WA King, WA Snohomish, WA 7610 Sharon, PA 0.7751 Mercer, PA 7620 Sheboygan, WI 0.8624 Sheboygan, WI 7640 Sherman-Denison, TX 0.9700 Grayson, TX 7680 Shreveport-Bossier City, LA 0.9083 Bossier, LA Caddo, LA Webster, LA 7720 Sioux City, IA-NE 0.8993 Woodbury, IA Dakota, NE 7760 Sioux Falls, SD 0.9309 Lincoln, SD Minnehaha, SD 7800 South Bend, IN 0.9821 St. Joseph, IN 7840 Spokane, WA 1.0901 Spokane, WA 7880 Springfield, IL 0.8944 Menard, IL Sangamon, IL 7920 Springfield, MO 0.8457 Christian, MO Greene, MO Webster, MO 8003 Springfield, MA 1.0543 Hampden, MA Hampshire, MA 8050 State College, PA 0.8740 Centre, PA 8080 Steubenville-Weirton, OH-WV 0.8398 Jefferson, OH Brooke, WV Hancock, WV 8120 Stockton-Lodi, CA 1.0404 San Joaquin, CA 8140 Sumter, SC 0.8243 Sumter, SC 8160 Syracuse, NY 0.9412 Cayuga, NY Madison, NY Onondaga, NY Oswego, NY 8200 Tacoma, WA 1.1116 Pierce, WA 8240 Tallahassee, FL 0.8520 Gadsden, FL Leon, FL 8280 Tampa-St. Petersburg-Clearwater, FL 0.9103 Hernando, FL Hillsborough, FL Pasco, FL Pinellas, FL 8320 Terre Haute, IN 0.8325 Clay, IN Vermillion, IN Vigo, IN 8360 Texarkana, AR-Texarkana, TX 0.8150 Miller, AR Bowie, TX 8400 Toledo, OH 0.9381 Fulton, OH Lucas, OH Wood, OH 8440 Topeka, KS 0.9108 Shawnee, KS 8480 Trenton, NJ 1.0517 Mercer, NJ 8520 Tucson, AZ 0.8981 Pima, AZ 8560 Tulsa, OK 0.9185 Creek, OK Osage, OK Rogers, OK Tulsa, OK Wagoner, OK 8600 Tuscaloosa, AL 0.8212 Tuscaloosa, AL 8640 Tyler, TX 0.9404 Smith, TX 8680 Utica-Rome, NY 0.8403 Herkimer, NY Oneida, NY 8720 Vallejo-Fairfield-Napa, CA 1.3377 Napa, CA Solano, CA 8735 Ventura, CA 1.1064 Ventura, CA 8750 Victoria, TX 0.8184 Victoria, TX 8760 Vineland-Millville-Bridgeton, NJ 1.0405 Cumberland, NJ 8780 Visalia-Tulare-Porterville, CA 0.9794 Tulare, CA 8800 Waco, TX 0.8394 Start Printed Page 55896 McLennan, TX 8840 Washington, DC-MD-VA-WV 1.0904 District of Columbia, DC Calvert, MD Charles, MD Frederick, MD Montgomery, MD Prince Georges, MD Alexandria City, VA Arlington, VA Clarke, VA Culpepper, VA Fairfax, VA Fairfax City, VA Falls Church City, VA Fauquier, VA Fredericksburg City, VA King George, VA Loudoun, VA Manassas City, VA Manassas Park City, VA Prince William, VA Spotsylvania, VA Stafford, VA Warren, VA Berkeley, WV Jefferson, WV 8920 Waterloo-Cedar Falls, IA 0.8366 Black Hawk, IA 8940 Wausau, WI 0.9692 Marathon, WI 8960 West Palm Beach-Boca Raton, FL 0.9798 Palm Beach, FL 9000 Wheeling, OH-WV 0.7494 Belmont, OH Marshall, WV Ohio, WV 9040 Wichita, KS 0.9238 Butler, KS Harvey, KS Sedgwick, KS 9080 Wichita Falls, TX 0.8341 Archer, TX Wichita, TX 9140 Williamsport, PA 0.8158 Lycoming, PA 9160 Wilmington-Newark, DE-MD 1.0882 New Castle, DE Cecil, MD 9200 Wilmington, NC 0.9563 New Hanover, NC Brunswick, NC 9260 Yakima, WA 1.0372 Yakima, WA 9270 Yolo, CA 0.9204 Yolo, CA 9280 York, PA 0.9119 York, PA 9320 Youngstown-Warren, OH 0.9214 Columbiana, OH Mahoning, OH Trumbull, OH 9340 Yuba City, CA 1.0196 Sutter, CA Yuba, CA 9360 Yuma, AZ 0.8895 Yuma, AZ 8. On Page 46056, Table 8 is revised as follows:
TABLE 8.—Wage Index for Rural Areas
Rural area Wage index Alabama 0.7492 Alaska 1.1886 Arizona 0.9270 Arkansas 0.7734 California 1.0027 Colorado 0.9328 Connecticut 1.2183 Delaware 0.9557 Florida 0.8870 Georgia 0.8595 Guam 0.9611 Hawaii 0.9958 Idaho 0.8974 Illinois 0.8254 Indiana 0.8824 Iowa 0.8416 Kansas 0.8034 Kentucky 0.7973 Louisiana 0.7458 Maine 0.8812 Maryland 0.9125 Massachusetts 1.0432 Michigan 0.8884 Minnesota 0.9330 Mississippi 0.7778 Missouri 0.7892 Montana 0.8800 Nebraska 0.8822 Nevada 0.9806 New Hampshire 1.0030 New Jersey1 New Mexico 0.8270 New York 0.8526 North Carolina 0.8458 North Dakota 0.7778 Ohio 0.8820 Oklahoma 0.7537 Oregon 0.9994 Pennsylvania 0.8378 Puerto Rico 0.4018 Rhode Island1 South Carolina 0.8498 South Dakota 0.8195 Tennessee 0.7886 Texas 0.7780 Utah 0.8974 Vermont 0.9307 Virginia 0.8498 Virgin Islands 0.7195 Washington 1.0388 West Virginia 0.8018 Wisconsin 0.9304 Wyoming 0.9110 1 All counties within the State are classified urban. 9. On Page 46057, in the second column, in the first line, “$20,379.” is revised to read “$20,371.”
10. On Page 46057, Table 9 is revised to read as follows:
Table 9.—SNF XYZ: Located in State College, PA
[Wage Index: 0.8740]
RUG group Labor Wage index Adj. labor Non-labor Adj. rate Percent adjustment Medi-care days Payment RVC $267.32 0.8740 $233.64 $82.70 $316.34 * $337.53 14 $4,725 RHA $206.58 0.8740 $180.55 $63.91 $244.46 * $260.84 16 $4,173 SSC $172.07 0.8740 $150.39 $53.24 $203.63 * * $244.36 30 $7,331 IA2 $116.68 0.8740 $101.98 $36.10 $138.03 $138.08 30 $4,142 Total 90 $20,371 * Reflects a 6.7 percent adjustment from section 314 of the BIPA. * * Reflects a 20 percent adjustment from section 101(a) of the BBRA. 11. On Page 46069, Table 11 is revised to read as follows:
Start Printed Page 55897
Start Printed Page 55898
III. Waiver of Proposed Rulemaking and Delayed Effective Date
We ordinarily publish a notice of proposed rulemaking in the Federal Register to provide a period for public comment before the provisions of a notice take effect. We can waive this procedure, however, if we find good cause that notice-and-comment procedure is impracticable, unnecessary, or contrary to the public interest and incorporate a statement of the finding and the reasons for it into the notice issued. We can also waive the 30-day delayed effective date of the Administrative Procedure Act (5 U.S.C. 553(d)) when there is good cause to do so and we publish in the rule an explanation of our good cause.
We find it unnecessary to undertake notice-and-comment rulemaking because this notice merely provides technical corrections to the regulations. We are not changing our payment methodology, but rather, are simply implementing correctly the payment methodology that we previously proposed, received comment on, and subsequently finalized. Thus, because the public has already had the opportunity to comment on the payment methodology being used to calculate wage indexes, additional comment would be unnecessary.
Further, it would be impracticable at this point in time either to solicit additional comments or to delay the effective date of these changes beyond October 1, 2003. The Social Security Act, in subparagraphs (G) and (H) of section 1888(e)(4), requires the updated SNF PPS rates to be in place at the beginning of each Federal fiscal year. Since the fiscal year begins on October 1, 2003, it is imperative that we ensure that the correct rates are in place and effective by October 1, 2003, and it would not have been possible to publish a notice and receive comments on it in the brief period of time between discovering our error and the October 1, 2003 effective date for the updated SNF PPS rates.
Finally, we believe that engaging in notice and comment prior to making these corrections or delaying the effective date beyond October 1, 2003 would be contrary to the public interest. As a matter of good public policy, the rates used in the SNF PPS should not be based on wage indexes that we now know were miscalculated. The public interest is served by ensuring that the rates used in the SNF PPS are correct and that such rates are in effect for the entire fiscal year. Thus, it would be contrary to the public interest to delay implementing such corrected rates in order either to engage in notice-and-comment rulemaking or to provide for a 30-day delay in the effective date. Therefore, we find good cause to waive notice-and-comment procedures, as well as the 30-day delay in effective date.
(Catalog of Federal Domestic Assistance Program No. 93.773, Medicare—Hospital Insurance; and Program No. 93.774, Medicare—Supplementary Medical Insurance Program)
Start SignatureEnd Signature End Supplemental InformationDated: September 24, 2003.
Ann Agnew,
Executive Secretary to the Department.
Document Information
- Effective Date:
- 10/1/2003
- Published:
- 09/29/2003
- Department:
- Centers for Medicare & Medicaid Services
- Entry Type:
- Rule
- Action:
- Correction of final rule.
- Document Number:
- 03-24549
- Dates:
- This correction is effective October 1, 2003.
- Pages:
- 55882-55898 (17 pages)
- Docket Numbers:
- CMS-1469-CN
- RINs:
- 0938-AL90: Prospective Payment System and Consolidated Billing for Skilled Nursing Facilities--Update for FY 2004 (CMS-1469-P)
- RIN Links:
- https://www.federalregister.gov/regulations/0938-AL90/prospective-payment-system-and-consolidated-billing-for-skilled-nursing-facilities-update-for-fy-200
- PDF File:
- 03-24549.pdf
- CFR: (7)
- 42 CFR 409
- 42 CFR 411
- 42 CFR 413
- 42 CFR 440
- 42 CFR 483
- More ...